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What happens when I stop taking a drug like Ozempic or Mounjaro?

<a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Drugs like Ozempic are very <a href="https://dom-pubs.pericles-prod.literatumonline.com/doi/10.1111/dom.12932">effective</a> at helping most people who take them lose weight. Semaglutide (sold as Wegovy and Ozempic) and tirzepatide (sold as Zepbound and Mounjaro) are the most well known in the class of drugs that mimic hormones to reduce feelings of hunger. But does weight come back when you stop using it? The short answer is yes. Stopping <a href="https://jamanetwork.com/journals/jama/fullarticle/2812936">tirzepatide</a> and <a href="https://doi.org/10.1111/dom.14725">semaglutide</a> will result in weight regain in most people. So are these medications simply another (expensive) form of yo-yo dieting? Let’s look at what the evidence shows so far. <h2>It’s a long-term treatment, not a short course</h2> If you have a bacterial infection, antibiotics will help your body fight off the germs causing your illness. You take the full course of medication, and the infection is gone. For obesity, taking tirzepatide or semaglutide can help your body get rid of fat. However it doesn’t fix the reasons you gained weight in the first place because obesity is a chronic, complex condition. When you stop the medications, the weight returns. Perhaps a more useful comparison is with high blood pressure, also known as hypertension. Treatment for hypertension is lifelong. It’s the same with obesity. Medications work, but only while you are taking them. (Though obesity is more complicated than hypertension, as many different factors both cause and perpetuate it.) Therefore, several concurrent approaches are needed; taking medication can be an important part of effective management but on its own, it’s often insufficient. And in an unwanted knock-on effect, stopping medication can undermine other strategies to lose weight, like eating less. <h2>Why do people stop?</h2> Research trials show anywhere from <a href="https://asean-endocrinejournal.org/index.php/JAFES/article/view/1771">6%</a> to <a href="https://pubmed.ncbi.nlm.nih.gov/35015037/">13.5%</a> of participants stop taking these drugs, primarily because of <a href="https://www.health.harvard.edu/staying-healthy/glp-1-diabetes-and-weight-loss-drug-side-effects-ozempic-face-and-more">side effects</a>. But these studies don’t account for those forced to stop because of cost or <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023">widespread supply issues</a>. We don’t know how many people have needed to stop this medication over the past few years for these reasons. Understanding what stopping does to the body is therefore important. <h2>So what happens when you stop?</h2> When you stop using tirzepatide or semaglutide, it takes several days (or even a couple of weeks) to <a href="https://pubmed.ncbi.nlm.nih.gov/30565096/">move out of your system</a>. As it does, a number of things happen: <ul> <li>you start feeling hungry again, because both <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4119845/">your brain and your gut</a> no longer have the medication working to make you feel full</li> </ul> <ul> <li> blood sugars increase, because the medication is no longer acting on the pancreas to help control this. If you have diabetes as well as obesity you may need to take other medications to keep these in an acceptable range. Whether you have diabetes or not, you may need to eat foods with a <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/carbohydrates-and-the-glycaemic-index">low glycemic index</a> to stabilise your blood sugars </li> <li> over the longer term, most people experience a return to their <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10092593/">previous blood pressure and cholesterol levels</a>, as the weight comes back </li> <li> weight regain will mostly be in the form of fat, because it will be gained faster than skeletal muscle. </li> </ul> While you were on the medication, you will have lost <a href="https://academic.oup.com/jes/article/5/Supplement_1/A16/6240360">proportionally less skeletal muscle than fat</a>, muscle loss is inevitable when you lose weight, no matter whether you use medications or not. The problem is, when you stop the medication, your body preferentially puts on fat. <h2>Is stopping and starting the medications a problem?</h2> People whose weight fluctuates with tirzepatide or semaglutide may experience some of the downsides of <a href="https://pubmed.ncbi.nlm.nih.gov/21829159/">yo-yo dieting</a>. When you keep going on and off diets, it’s like a rollercoaster ride for your body. Each time you regain weight, your body has to <a href="https://www.jomes.org/journal/view.html?doi=10.7570/jomes.2017.26.4.237">deal with</a> spikes in blood pressure, heart rate, and how your body handles sugars and fats. This can <a href="https://cardiab.biomedcentral.com/articles/10.1186/s12933-022-01735-x">stress</a> your heart and overall cardiovascular system, as it has to respond to greater fluctuations than usual. Interestingly, the risk to the body from weight fluctuations is greater for people who are <a href="https://jech.bmj.com/content/74/8/662">not obese</a>. This should be a caution to those who are not obese but still using tirzepatide or semaglutide to try to lose unwanted weight. <h2>How can you avoid gaining weight when you stop?</h2> Fear of regaining weight when stopping these medications is valid, and needs to be addressed directly. As obesity has many causes and perpetuating factors, many evidence-based approaches are needed to reduce weight regain. This might include: <ul> <li> getting quality <a href="https://www.hindawi.com/journals/ije/2010/270832/">sleep</a> </li> <li> exercising in a way that builds and maintains muscle. While on the medication, you will <a href="https://pubmed.ncbi.nlm.nih.gov/32628589/">likely have lost muscle</a> as well as fat, although this is not inevitable, especially if you <a href="https://www.europeanreview.org/article/34169">exercise regularly</a> while taking it </li> </ul> <ul> <li> addressing emotional and cultural aspects of life that contribute to over-eating and/or eating unhealthy foods, and how you view your body. Stigma and shame around body shape and size is not cured by taking this medication. Even if you have a healthy relationship with food, we live in a culture that is <a href="https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2009.159491">fat-phobic and discriminates</a> against people in larger bodies </li> <li> eating in a healthy way, hopefully continuing with habits that were formed while on the medication. Eating meals that have high nutrition and fibre, for example, and lower overall portion sizes. </li> </ul> Many people will stop taking tirzepatide or semaglutide at some point, given it is expensive and in short supply. When you do, it is important to understand what will happen and what you can do to help avoid the consequences. Regular reviews with your GP are also important. <hr /> Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/224972/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, General Practitioner, PhD Candidate, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-happens-when-i-stop-taking-a-drug-like-ozempic-or-mounjaro-224972">original article</a>.

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No, taking drugs like Ozempic isn’t ‘cheating’ at weight loss or the ‘easy way out’

<a href="https://theconversation.com/profiles/clare-collins-7316">Clare Collins</a>, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Obesity medication that is effective has been a long time coming. Enter semaglutide (sold as Ozempic and Wegovy), which is helping people improve weight-related health, including <a href="https://pubmed.ncbi.nlm.nih.gov/37952131/">lowering the risk</a> of a having a heart attack or stroke, while also silencing “<a href="https://theconversation.com/some-ozempic-users-say-it-silences-food-noise-but-there-are-drug-free-ways-to-stop-thinking-about-food-so-much-208467">food noise</a>”. As demand for semaglutide increases, so are <a href="https://www.smh.com.au/lifestyle/health-and-wellness/in-a-fat-phobic-world-ozempic-is-hardly-the-easy-way-out-20240401-p5fgjd.html">claims</a> that taking it is “cheating” at weight loss or the “easy way out”. We don’t tell people who need statin medication to treat high cholesterol or drugs to manage high blood pressure they’re cheating or taking the easy way out. Nor should we shame people taking semaglutide. It’s a drug used to treat diabetes and obesity which needs to be taken long term and comes with risks and side effects, as well as benefits. When prescribed for obesity, it’s given alongside advice about diet and exercise. <h2>How does it work?</h2> Semaglutide is a <a href="https://en.wikipedia.org/wiki/GLP-1_receptor_agonist">glucagon-like peptide-1</a> receptor agonist (GLP-1RA). This means it makes your body’s own glucagon-like peptide-1 hormone, called <a href="https://en.wikipedia.org/wiki/Glucagon-like_peptide-1">GLP-1</a> for short, work better. GLP-1 gets secreted by cells in your gut when it <a href="https://pubmed.ncbi.nlm.nih.gov/38218319/">detects increased nutrient levels</a> after eating. This stimulates insulin production, which lowers blood sugars. GLP-1 also slows gastric emptying, which makes you feel full, and reduces hunger and feelings of reward after eating. <iframe id="tc-infographic-1031" class="tc-infographic" style="border: none;" src="https://cdn.theconversation.com/infographics/1031/c11b606581d4bc58a71f066492d7f740b52c04e1/site/index.html" width="100%" height="400px" frameborder="0"></iframe> GLP-1 receptor agonist (GLP-1RA) medications like Ozempic help the body’s own GLP-1 work better by mimicking and extending its action. Some studies have found less GLP-1 gets released after meals in <a href="https://pubmed.ncbi.nlm.nih.gov/38218319/">adults with obesity or type 2 diabetes mellitus</a> compared to adults with normal glucose tolerance. So having less GLP-1 circulating in your blood means you don’t feel as full after eating and get hungry again sooner compared to people who produce more. GLP-1 has a very short half-life of about <a href="https://pubmed.ncbi.nlm.nih.gov/28443255/">two minutes</a>. So GLP-1RA medications were designed to have a very long half-life of about <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">seven days</a>. That’s why semaglutide is given as a weekly injection. <h2>What can users expect? What does the research say?</h2> Higher doses of semaglutide are prescribed to treat obesity compared to type 2 diabetes management (up to 2.4mg versus 2.0mg weekly). A large group of <a href="https://pubmed.ncbi.nlm.nih.gov/36691309/">randomised controlled trials</a>, called STEP trials, all tested weekly 2.4mg semaglutide injections versus different interventions or placebo drugs. Trials lasting 1.3–2 years consistently found weekly 2.4 mg semaglutide injections <a href="https://pubmed.ncbi.nlm.nih.gov/36691309/">led to 6–12% greater weight loss</a> compared to placebo or alternative interventions. The average weight change depended on how long medication treatment lasted and length of follow-up. Weight reduction due to semaglutide also leads to a <a href="https://pubmed.ncbi.nlm.nih.gov/36769420/">reduction in systolic and diastolic blood pressure</a> of about 4.8 mmHg and 2.5 mmHg respectively, a reduction in <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/triglycerides">triglyceride levels</a> (a type of blood fat) and <a href="https://pubmed.ncbi.nlm.nih.gov/38041774/">improved physical function</a>. Another recent trial in adults with pre-existing heart disease and obesity, but without type 2 diabetes, found adults receiving weekly 2.4mg semaglutide injections had a <a href="https://pubmed.ncbi.nlm.nih.gov/37952131/">20% lower risk</a> of specific cardiovascular events, including having a non-fatal heart attack, a stroke or dying from cardiovascular disease, after three years follow-up. <h2>Who is eligible for semaglutide?</h2> Australia’s regulator, the Therapeutic Goods Administration (TGA), has <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023">approved</a> semaglutide, sold as Ozempic, for treating type 2 diabetes. However, due to shortages, the TGA had advised doctors not to start new Ozempic prescriptions for “off-label use” such as obesity treatment and the Pharmaceutical Benefits Scheme doesn’t currently subsidise off-label use. The TGA has <a href="https://www.tga.gov.au/resources/prescription-medicines-registrations/wegovy-novo-nordisk-pharmaceuticals-pty-ltd">approved Wegovy to treat obesity</a> but it’s not currently available in Australia. When it’s available, doctors will be able to prescribe <a href="https://pubmed.ncbi.nlm.nih.gov/36934408/">semaglutide to treat obesity</a> in conjunction with lifestyle interventions (including diet, physical activity and psychological support) in adults with obesity (a BMI of 30 or above) or those with a BMI of 27 or above who also have weight-related medical complications. <h2>What else do you need to do during Ozempic treatment?</h2> Checking details of the <a href="https://pubmed.ncbi.nlm.nih.gov/36691309/">STEP trial intervention components</a>, it’s clear participants invested a lot of time and effort. In addition to taking medication, people had brief lifestyle counselling sessions with dietitians or other health professionals every four weeks as a minimum in most trials. Support sessions were designed to help people stick with consuming 2,000 kilojoules (500 calories) less daily compared to their energy needs, and performing 150 minutes of <a href="https://www.healthdirect.gov.au/tips-for-getting-active">moderate-to-vigorous physical activity</a>, like brisk walking, dancing and gardening each week. STEP trials varied in other components, with follow-up time periods varying from 68 to 104 weeks. The aim of these trials was to show the effect of adding the medication on top of other lifestyle counselling. A <a href="https://pubmed.ncbi.nlm.nih.gov/38041774/">review of obesity medication trials</a> found people reported they needed less <a href="https://pubmed.ncbi.nlm.nih.gov/28652832/">cognitive behaviour training</a> to help them stick with the reduced energy intake. This is one aspect where drug treatment may make adherence a little easier. Not feeling as hungry and having environmental food cues “switched off” may mean less support is required for goal-setting, self-monitoring food intake and <a href="https://theconversation.com/9-ways-wont-power-is-better-than-willpower-for-resisting-temptation-and-helping-you-eat-better-71267">avoiding things that trigger eating</a>. <h2>But what are the side effects?</h2> Semaglutide’s side-effects <a href="https://pubmed.ncbi.nlm.nih.gov/38041774/">include</a> nausea, diarrhoea, vomiting, constipation, indigestion and abdominal pain. In one study these <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">led to</a> discontinuation of medication in 6% of people, but interestingly also in 3% of people taking placebos. More severe side-effects included gallbladder disease, acute pancreatitis, hypoglycaemia, acute kidney disease and injection site reactions. To reduce risk or severity of side-effects, <a href="https://pubmed.ncbi.nlm.nih.gov/36934408/">medication doses are increased very slowly</a> over months. Once the full dose and response are achieved, research indicates you need to take it long term. Given this long-term commitment, and associated <a href="https://www.health.gov.au/topics/private-health-insurance/what-private-health-insurance-covers/out-of-pocket-costs#:%7E:text=An%20out%20of%20pocket%20cost,called%20gap%20or%20patient%20payments">high out-of-pocket cost of medication</a>, when it comes to taking semaglutide to treat obesity, there is no way it can be considered “cheating”. <hr /> Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/219116/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/clare-collins-7316">Clare Collins</a>, Laureate Professor in Nutrition and Dietetics, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/no-taking-drugs-like-ozempic-isnt-cheating-at-weight-loss-or-the-easy-way-out-219116">original article</a>.

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Drugs like Ozempic won’t ‘cure’ obesity but they might make us more fat-phobic

<a href="https://theconversation.com/profiles/emma-beckett-22673">Emma Beckett</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Many have <a href="https://www.economist.com/leaders/2023/03/02/new-drugs-could-spell-an-end-to-the-worlds-obesity-epidemic">declared</a> drugs like Ozempic could “end obesity” by reducing the appetite and waistlines of millions of people around the world. When we look past the hype, this isn’t just untrue – it can also be harmful. The focus on weight, as opposed to health, is a feature of <a href="https://www.sciencedirect.com/science/article/abs/pii/S0277539521001217">diet culture</a>. This frames the pursuit of thinness as more important than other aspects of physical and cultural wellbeing. The Ozempic buzz isn’t just rooted in health and medicine but plays into ideas of <a href="https://butterfly.org.au/weight-bias-fatphobia-diet-culture/#:%7E:text=Weight%20bias%2C%20sometimes%20also%20called,or%20being%20around%20fat%20people.">fat stigma and fat phobia</a>. This can perpetuate fears of fatness and fat people, and the behaviours that <a href="https://link.springer.com/article/10.1186/S12916-018-1116-5">harm people who live in larger bodies</a>. <h2>Not the first ‘miracle’ weight-loss drug</h2> This isn’t the first time we have heard that weight-loss drugs will change the world. Ozempic and <a href="https://www.ncbi.nlm.nih.gov/books/NBK551568/">its family</a> of GLP-1-mimicking drugs are the <a href="https://theconversation.com/ozempic-is-in-the-spotlight-but-its-just-the-latest-in-a-long-and-strange-history-of-weight-loss-drugs-209324">latest in a long line of weight loss drugs</a>. Each looked promising at the time. But none have lived up to the hype in the long term. Some have even been withdrawn from sale due to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5126837/">severe side effects</a>. Science does improve <a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(20)30028-8/fulltext">incrementally</a>, but diet culture also keeps us on a cycle of hope for the next <a href="https://sahrc.org/2022/04/diet-culture-a-brief-history/">miracle cure</a>. So drugs like Ozempic might not deliver the results individuals expect, continuing the cycle of hope and shame. <h2>Ozempic doesn’t work the same for everyone</h2> When we talk about the results of studies using Ozempic, we often <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719041/">focus on the average</a> (also known as the mean) results or the maximum (or peak) results. So, studies might <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">show</a> those using the drug lost an average of 10.9% of their body weight, but some lost more than 20% and others less than 5% What we don’t talk about as much is that responses are variable. Some people are “<a href="https://www.sciencedirect.com/science/article/pii/S2212877820301769">non-responders</a>”. This means not everyone loses as much weight as the average, and some don’t lose weight at all. For some people, the side-effects will outweigh the benefits. When people are on drugs like Ozempic, their blood sugar is better controlled by enhancing the release of insulin and reducing the levels of another hormone called glucagon. But there is greater variability in the amount of <a href="https://www.sciencedirect.com/science/article/pii/S2212877820301769#bib88">weight lost</a> than the variability in blood sugar control. It isn’t clear why, but is likely due to differences in genetics and lifestyles, and weight being more complex to regulate. <h2>Treatment needs to be ongoing. What will this mean?</h2> When weight-loss drugs do work, they are only effective while they’re being taken. This means that to keep the weight off people need to keep taking them long term. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9542252/">One study found</a> an average weight loss of more than 17% after a year on Ozempic became an average net weight loss of 5.6% more than two years after stopping treatment. Short-term side effects of drugs like Ozempic include dizziness, nausea, vomiting and other gastrointestinal upsets. But because these are new drugs, we simply don’t have data to tell us if side effects will increase as people take them for longer periods. Nor do we know if <a href="https://www.medicalnewstoday.com/articles/why-weight-loss-drugs-stop-working-how-to-break-past-ozempic-plateau#:%7E:text=A%20lifetime%20commitment%20to%20Ozempic&text=By%20these%20standards%2C%20such%20drugs,long%2Dterm%20risk%20is%20unknown.">effectiveness will be reduced</a> in the long term. This is called <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/drug-tolerance#:%7E:text=A%20condition%20that%20occurs%20when,or%20different%20medicine%20is%20needed.">drug tolerance</a> and is documented for other long-term treatments such as antidepressants and chemotherapies. <h2>Biology is only part of the story</h2> For some people, using GLP-1-mimicking drugs like Ozempic will be validating and empowering. They will feel like their biology has been “normalised” in the same way that blood pressure or cholesterol medication can return people to the “normal” range of measures. But biologically, obesity <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202176/#:%7E:text=Obesity%20behaves%20as%20complex%20polygenic,about%2080%25%20(3).">isn’t solely about GLP-1 activity</a> with <a href="https://www.worldobesity.org/what-we-do/our-policy-priorities/the-roots-of-obesity">many other</a> hormones, physical activity, and even our gut microbes involved. Overall, <a href="https://www.ncbi.nlm.nih.gov/books/NBK278977/">obesity is complex and multifaceted</a>. Obesity isn’t just driven by personal biology and choice; it has social, cultural, political, environmental and economic determinants. <h2>A weight-centred approach misses the rest of the story</h2> The weight-centred approach <a href="https://butterfly.org.au/body-image/health-not-weight/#:%7E:text=Health%20and%20wellbeing%20are%20multi,on%20their%20size%20or%20appearance.">suggests that leading with thinness means health will follow</a>. But changing appetite is only part of the story when it comes to health. Obesity often <a href="https://www.sciencedirect.com/science/article/pii/S2667368123000335#:%7E:text=Obesity%20related%20malnutrition%20can%20also,%5D%2C%20%5B7%5D%5D.">co-exists with malnutrition</a>. We try to separate the effects in research using statistics, but focusing on the benefits of weight-loss drugs without addressing the underlying malnutrition means we aren’t likely to see the <a href="https://www.wsj.com/articles/ozempic-diet-exercise-healthy-43eee86c">improved health outcomes in everyone who loses weight</a>. <h2>Obesity isn’t an issue detached from people</h2> Even when it is well-intentioned, the rhetoric around the joy of “ending the obesity epidemic” can <a href="https://theconversation.com/ozempic-the-miracle-drug-and-the-harmful-idea-of-a-future-without-fat-211661">harm people</a>. Obesity doesn’t occur in isolation. It is people who are obese. And the celebration and hype of these weight-loss drugs can reinforce harmful fat stigma. The framing of these drugs as a “cure” exacerbates the binary view of thin versus fat, and healthy versus unhealthy. These are not binary outcomes that are good or bad. Weight and health exist on a spectrum. Ironically, while fat people are told they need to lose weight for their health, they are also <a href="https://www.dailytelegraph.com.au/news/nsw/ozempic-shame-why-users-are-embarrassed-to-admit-using-weight-loss-wonder-drug/news-story/ee52a819c69459afe6576d25988f9bd6">shamed for “cheating” or taking shortcuts</a> by using medication. <h2>Drugs are tools, not silver bullets</h2> The creation of these drugs is a start, but they remain expensive, and the hype has been followed by <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023#:%7E:text=Consumer%20Medicine%20Information%20.-,Why%20the%20Ozempic%20shortage%20happened,label%20prescribing%20for%20weight%20loss.">shortages</a>. Ultimately, complex challenges aren’t addressed with simple solutions. This is particularly true when people are involved, and even more so when there isn’t even an agreement on what the challenge is. Many organisations and individuals see obesity is a disease and believe this framing helps people to seek treatment. Others think it’s unnecessary to attach medical labels to body types and <a href="https://www.forbes.com/sites/geoffreykabat/2013/07/09/why-labeling-obesity-as-a-disease-is-a-big-mistake/?sh=5ca95cc2103b">argue</a> it confuses risk factors (things that are linked to increased risk of illness) with illness itself. Regardless, two things will always remain true. Drugs can only ever be tools, and those tools need to be applied in a context. To use these tools ethically, we need to remain mindful of who this application harms along the way. <hr /> Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/219309/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/emma-beckett-22673">Emma Beckett</a>, Adjunct Senior Lecturer, Nutrition, Dietetics & Food Innovation - School of Health Sciences, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/drugs-like-ozempic-wont-cure-obesity-but-they-might-make-us-more-fat-phobic-219309">original article</a>.

Body

Considering taking a weight-loss drug like Ozempic? Here are some potential risks and benefits

<a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> and <a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> After weight-loss drugs like Ozempic exploded onto the market, celebrities and social media influencers were quick to spruik their benefits, leading to their rapid rise in use. In the last three months of 2022, clinicians in the United States alone wrote <a href="https://www.washingtonpost.com/business/2023/09/27/ozempic-prescriptions-data-analysis/">more than nine million prescriptions</a> for these drugs. As they’ve grown in popularity, we’ve also heard more about the potential side effects – from common gastrointestinal discomforts, to more serious mental health concerns. But what does the science say about how well Ozempic and Wegovy (which are both brand names of the drug semaglutide) work for weight loss? And what are the potential side effects? Here’s what to consider if you or a loved one are thinking of taking the drug. <h2>Potential benefits</h2> 1) It’s likely to help you lose weight The largest, well-conducted <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">research study</a> of semaglutide was from United Kingdom in 2021. Some 1,961 people who were classified as “overweight” or “obese” were randomly assigned to have either semaglutide or a placebo and followed for 68 weeks (about 1.3 years). All participants also had free access to advice about healthy eating and physical activity. The study found those taking semaglutide lost weight – significantly more than people who had the placebo (-14.9% of their body weight compared with -2.4% of body weight). In another <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">study</a> in the United States, one health-care clinic gave 408 people weekly injections of semaglutide. Over the first three months, those included in the final analysis (175 people) lost an average of 6.7kg. Over the first six months, they lost an average of 12.3kg. Large weight losses have been found in a more <a href="https://www.nature.com/articles/s41591-022-02026-4">recent trial</a> of semaglutide, suggesting weight loss is a very likely outcome of ongoing use of the medication. 2) It may reduce your chronic disease risk factors When people in the overweight or obese weight categories lose <a href="https://www.sciencedirect.com/science/article/pii/S1550413116300535">at least 5%</a> of their body weight, physiological changes often occur beyond a change in weight or shape. This <a href="https://www.nih.gov/news-events/nih-research-matters/research-context-obesity-metabolic-health">might include</a> lowered cholesterol levels, lowered blood pressure and lowered blood glucose levels, which all reduce the risk of chronic diseases. In one of the semaglutide <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">trials</a>, most people (87.3%) lost at least 5% of their body weight. Although most of the large studies of semaglutide excluded people with metabolic health conditions such as type 2 diabetes, metabolic health gains were <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">observed</a>, including lowered blood pressure, blood glucose levels and fasting blood lipid (fat) levels. In the UK <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">study</a> from 2021, people taking semaglutide had greater improvements in physical capabilities and risk factors for heart disease and diabetes, including reductions in waist circumference, markers of inflammation, blood pressure and blood glucose levels. 3) It might improve your quality of life, emotional wellbeing or sense of achievement The original trial of semaglutide did not focus on this bundle of benefits, but further follow-ups show additional benefits associated with the medication. Compared to the placebo, people taking semaglutide saw significant <a href="https://www.tandfonline.com/doi/full/10.1080/00325481.2022.2150006">improvements</a> in their physical functioning and perceptions of their general health, social functioning and mental health. Anecdotally (not based on scientific research), people using semaglutide, such as <a href="https://people.com/oprah-winfrey-reveals-weight-loss-medication-exclusive-8414552">Oprah Winfrey</a>, report a reclaiming or turning point of their life, social situation and body image. <h2>What about the risks?</h2> 1) You may experience gastrointestinal symptoms In the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">US clinical trial</a>, nearly half (48.6%) of people taking semaglutide reported experiencing adverse effects. Nausea and vomiting were the most frequently experienced (36.6%) followed by diarrhea (8.6%), fatigue (6.3%) and constipation (5.7%). In the UK study, nausea and diarrhoea were also commonly reported. In <a href="https://www.nejm.org/doi/10.1056/NEJMoa2032183?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">another trial</a>, many participants (74.2%) using semaglutide reported gastrointestinal symptoms. However, nearly half (47.9%) using the placebo also reported gastrointestinal symptoms, indicating that symptoms may be similar to those experienced during normal daily living. Most gastrointestinal symptoms were mild to moderate in severity, and resolved for most people without the need to stop participating in the study. 2) You might feel fatigued Fatigue was the second most common side effect for participants in the US <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">clinical trial</a>, affecting 6.3% of participants. 3) You might be among the minority who don’t tolerate the drug Australia’s Therapeutic Goods Administration (TGA) has <a href="https://www.tga.gov.au/news/safety-alerts/compounding-safety-information-semaglutide-products">approved</a> Ozempic as safe to use, for the treatment of type 2 diabetes but it has not yet been approved for weight loss. The TGA has also <a href="https://www.tga.gov.au/resources/prescription-medicines-registrations/wegovy-novo-nordisk-pharmaceuticals-pty-ltd">approved Wegovy</a> (a higher dose of semagtlutide) for weight loss, however it’s not yet available in Australia. In the US <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">clinical trial</a>, no unexpected safety issues were reported. However, five patients (2.9%) had to stop taking the medication because they could not tolerate the adverse effects. Fifteen (8.6%) had to either reduce the dose or remain on the same dose to avoid the adverse effects. In <a href="https://www.nejm.org/doi/10.1056/NEJMoa2032183?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">other studies</a>, some patients stopped the trial due to gastrointestinal symptoms being so severe they could not tolerate continuing. More severe safety concerns reported in <a href="https://www.nejm.org/doi/10.1056/NEJMoa2032183?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">studies</a> include gallbladder-related disorders (mostly cholelithiasis, also known as gallstones) in 34 patients (2.6%) and mild acute pancreatitis in three patients (0.2%). All people recovered during the trial period. A 2024 European <a href="https://link.springer.com/article/10.1007/s11096-023-01694-7">study</a> analysed psychiatric adverse events associated with semaglutide, liraglutide and tirzepatide (which work in a similar way to semaglutide). Between January 2021 and May 2023, the drug database recorded 481 psychiatric events (about 1.2% of the total reported) associated with these drugs. About half of these events were reported as depression, followed by anxiety (39%) and suicidal ideation (19.6%). Nine deaths and 11 life-threatening outcomes were reported during the study period. Due to the severity and fatal outcomes of some of these reports, <a href="https://www.fda.gov/drugs/drug-safety-and-availability/update-fdas-ongoing-evaluation-reports-suicidal-thoughts-or-actions-patients-taking-certain-type">the US Food and Drug Administration</a> investigated further but did not find evidence that use of these medicines caused suicidal thoughts or actions. 4) It might be difficult to access Despite being considered safe, the TGA has <a href="https://www.tga.gov.au/safety/shortages/medicine-shortage-alerts/update-prescribers-advised-not-start-new-patients-ozempic#:%7E:text=Ozempic%27s%20TGA%2Dapproved%20indication%20is,consult%20the%20appropriate%20prescribing%20guidelines.">warned</a> significant Ozempic access barriers are likely to continue throughout 2024. To manage the shortage, pharmacists are instructed to give preference to people with type 2 diabetes who are seeking the medication. 5) You might not always get clear information from vested interests Given the popularity of Ozempic and Wegovy, health organisations such as the World Obesity Federation have expressed <a href="https://www.theguardian.com/society/2023/mar/12/orchestrated-pr-campaign-how-skinny-jab-drug-firm-sought-to-shape-obesity-debate">concern</a> about the medication’s marketing, PR and strong <a href="https://www.theguardian.com/australia-news/2023/jan/06/tga-investigates-influencers-after-diabetes-drug-ozempic-promoted-as-weight-loss-treatment">social media presence</a>. Some journalists have <a href="https://www.theguardian.com/society/2023/mar/12/orchestrated-pr-campaign-how-skinny-jab-drug-firm-sought-to-shape-obesity-debate">raised conflict of interest concerns</a> about the relationship between some obesity researchers and Novo Nordrisk, Ozempic and Wegovy’s manufacturer. The worry is that researchers might be influenced by their relationship with Novo Nordrisk to produce study results that are more favourable to the medications. <h2>Bottom line</h2> Ozempic is a medication that should be used in conjunction with your health care provider. But remember, weight is only one aspect of your health and wellbeing. It’s important to take a holistic view of your health and prioritise eating well, moving more and getting enough sleep. <hr /> Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-132745">Ozempic series</a> here.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/219312/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, Professor of Community Health and Wellbeing, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> and <a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, Lecturer, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/considering-taking-a-weight-loss-drug-like-ozempic-here-are-some-potential-risks-and-benefits-219312">original article</a>.

Body

Legendary Star Wars and James Bond actor passes away

The galaxy far, far away has dimmed a little with the passing of Michael Culver, a distinguished British actor whose name became etched in the annals of cinematic history, particularly for his role in the iconic 1980 film Star Wars: Episode V - The Empire Strikes Back. Culver, who portrayed Captain Needa, the unfortunate Imperial officer, met his demise in one of the franchise's most memorable scenes at the hands of Darth Vader. However, his legacy extends far beyond the realms of science fiction, encompassing a career spanning over five decades of stage, screen and political activism. Born in 1938 in Hempstead, North London, to esteemed parents within the theatre industry, Culver was destined for a life under the spotlight. His father, Roland Culver, was a notable West End stage actor, while his mother, Daphne Rye, served as a casting director in London-based theatre. Following in their footsteps, Culver honed his craft at the London Academy of Music and Dramatic Art, laying the foundation for a prolific acting career. Culver's journey in the performing arts began in the late 1950s, with appearances on Broadway in Shakespearean classics such as King Henry V, Hamlet, and Twelfth Night. His talent soon graced the West End stage in 1962, marking the start of a distinguished theatrical career. Transitioning to the small screen, Culver made his onscreen debut in 1961, captivating audiences with his versatile performances in British television series and movies. However, it was Culver's portrayal of Captain Needa in The Empire Strikes Back that solidified his status as a cultural icon. Despite his character's brief appearance, Culver left an indelible mark on audiences worldwide, immortalised in one of cinema's most unforgettable moments. His confrontation with Vader, culminating in a chilling demise, remains etched in the memories of countless fans, a testament to Culver's ability to captivate audiences with his presence. Beyond his intergalactic exploits, Culver's talents graced a multitude of productions, including notable roles in Sherlock Holmes, A Passage to India, Secret Army, and even appearing in two James Bond movies – From Russia With Love and Thunderball – in uncredited roles. His versatility and dedication to his craft earned him admiration and respect from peers and audiences alike. Yet, Culver's contributions extended beyond the realms of entertainment; in the early 2000s, he shifted his focus to political activism, leveraging his platform to advocate for causes close to his heart. Despite bidding farewell to the limelight, Culver's legacy endures through the countless lives he touched and the memories he forged on stage and screen. An extended message on the Alliance Agents Facebook page, who represented Culver, read as follows: "We are very sad to confirm the passing of our friend and client Michael Culver. A career spanning over 50 years with notable roles in Sherlock Holmes, A Passage to India, Secret Army and of course one of the most memorable death scenes in the Star Wars franchise. Michael largely gave up acting in the early 2000's to concentrate his efforts into his political activism. It's been an honor to have represented Michael for for the last decade and to have taken him to some of the best Star Wars events in the UK and Europe. A real highlight was taking Michael to Celebration in Chicago in 2019. He was lost for words when he saw his queue line with nearly 200 people waiting to see him. We worked with Michael just 3 weeks ago at his last home signing with our friends at Elite Signatures. Michel died on Tuesday 27th February at the age of 85." "We miss him." His passing leaves a void in the hearts of fans and colleagues, a reminder of the fleeting nature of life's curtain call. As we reflect on his remarkable journey, let us celebrate the life and legacy of Michael Culver, an actor whose talents transcended galaxies and whose spirit will continue to inspire generations to come. In his memory, let us heed the timeless words of Captain Needa himself: "We shall double our efforts." Rest in peace, Michael Culver. The force will always be with you. Images: IMDB / Wookiepedia

Caring

War in Ukraine affected wellbeing worldwide, but people’s speed of recovery depended on their personality

<a href="https://theconversation.com/profiles/luke-smillie-7502">Luke Smillie</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> The war in Ukraine has had impacts around the world. <a href="https://mitsloan.mit.edu/ideas-made-to-matter/ripple-effects-russia-ukraine-war-test-global-economies">Supply chains</a> have been disrupted, the <a href="https://news.un.org/pages/wp-content/uploads/2022/06/GCRG_2nd-Brief_Jun8_2022_FINAL.pdf?utm_source=United+Nations&utm_medium=Brief&utm_campaign=Global+Crisis+Response">cost of living</a> has soared and we’ve seen the <a href="https://www.unhcr.org/hk/en/73141-ukraine-fastest-growing-refugee-crisis-in-europe-since-wwii.html">fastest-growing refugee crisis since World War II</a>. All of these are in addition to the devastating humanitarian and economic impacts within Ukraine. Our international team was conducting a global study on wellbeing in the lead up to and after the Russian invasion. This provided a unique opportunity to examine the psychological impact of the outbreak of war. As we explain in a new study published in <a href="https://www.nature.com/articles/s41467-024-44693-6">Nature Communications</a>, we learned the toll on people’s wellbeing was evident across nations, not just <a href="https://ijmhs.biomedcentral.com/articles/10.1186/s13033-023-00598-3">in Ukraine</a>. These effects appear to have been temporary – at least for the average person. But people with certain psychological vulnerabilities struggled to recover from the shock of the war. <h2>Tracking wellbeing during the outbreak of war</h2> People who took part in our study completed a rigorous “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2773515/">experience-sampling</a>” protocol. Specifically, we asked them to report their momentary wellbeing four times per day for a whole month. Data collection began in October 2021 and continued throughout 2022. So we had been tracking wellbeing around the world during the weeks surrounding the outbreak of war in February 2022. We also collected measures of personality, along with various sociodemographic variables (including age, gender, political views). This enabled us to assess whether different people responded differently to the crisis. We could also compare these effects across countries. Our analyses focused primarily on 1,341 participants living in 17 European countries, excluding Ukraine itself (44,894 experience-sampling reports in total). We also expanded these analyses to capture the experiences of 1,735 people living in 43 countries around the world (54,851 experience-sampling reports) – including in Australia. <h2>A global dip in wellbeing</h2> On February 24 2022, the day Russia invaded Ukraine, there was a sharp decline in wellbeing around the world. There was no decline in the month leading up to the outbreak of war, suggesting the change in wellbeing was not already occurring for some other reason. However, there was a gradual increase in wellbeing during the month after the Russian invasion, suggestive of a “return to baseline” effect. Such effects are commonly reported in psychological research: situations and events that impact our wellbeing often (<a href="https://www.researchgate.net/publication/237535630_Adaptation_and_the_Set-Point_Model_of_Subjective_Well-BeingDoes_Happiness_Change_After_Major_Life_Events">though not always</a>) do so <a href="https://www.researchgate.net/publication/7062343_Beyond_the_Hedonic_Treadmill_Revising_the_Adaptation_Theory_of_Well-Being">temporarily</a>. Unsurprisingly, people in Europe experienced a sharper dip in wellbeing compared to people living elsewhere around the world. Presumably the war was much more salient for those closest to the conflict, compared to those living on an entirely different continent. Interestingly, day-to-day fluctuations in wellbeing mirrored the salience of the war on social media as events unfolded. Specifically, wellbeing was lower on days when there were more tweets mentioning Ukraine on Twitter/X. Our results indicate that, on average, it took around two months for people to return to their baseline levels of wellbeing after the invasion. <h2>Different people, different recoveries</h2> There are <a href="https://pubmed.ncbi.nlm.nih.gov/31944795/">strong links</a> between our wellbeing and our individual personalities. However, the dip in wellbeing following the Russian invasion was fairly uniform across individuals. None of the individual factors assessed in our study, including personality and sociodemographic factors, predicted people’s response to the outbreak of war. On the other hand, personality did play a role in how quickly people recovered. Individual differences in people’s recovery were linked to a personality trait called “stability”. Stability is a broad dimension of personality that combines low neuroticism with high agreeableness and conscientiousness (three traits from the <a href="https://www.sciencedirect.com/topics/social-sciences/big-five">Big Five</a> personality framework). Stability is so named because it reflects the stability of one’s overall psychological functioning. This can be illustrated by breaking stability down into its three components: <ol> <li> low neuroticism describes <a href="https://www.pnas.org/doi/full/10.1073/pnas.2212154120">emotional stability</a>. People low in this trait experience less intense negative emotions such as anxiety, fear or anger, in response to negative events </li> <li> high agreeableness describes <a href="https://psycnet.apa.org/record/2018-63285-010">social stability</a>. People high in this trait are generally more cooperative, kind, and motivated to maintain social harmony </li> <li> high conscientiousness describes <a href="https://doi.org/10.1016/j.paid.2023.112331">motivational stability</a>. People high in this trait show more effective patterns of goal-directed self-regulation. </li> </ol> So, our data show that people with less stable personalities fared worse in terms of recovering from the impact the war in Ukraine had on wellbeing. In a supplementary analysis, we found the effect of stability was driven specifically by neuroticism and agreeableness. The fact that people higher in neuroticism recovered more slowly accords with a wealth of research linking this trait with <a href="https://pubmed.ncbi.nlm.nih.gov/10573882/">coping difficulties</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5428182/">poor mental health</a>. These effects of personality on recovery were stronger than those of sociodemographic factors, such as age, gender or political views, which were not statistically significant. Overall, our findings suggest that people with certain psychological vulnerabilities will often struggle to recover from the shock of global events such as the outbreak of war in Ukraine.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/224147/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/luke-smillie-7502">Luke Smillie</a>, Professor in Personality Psychology, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/war-in-ukraine-affected-wellbeing-worldwide-but-peoples-speed-of-recovery-depended-on-their-personality-224147">original article</a>.

Mind

How dieting, weight suppression and even misuse of drugs like Ozempic can contribute to eating disorders

<a href="https://theconversation.com/profiles/samantha-withnell-1504436">Samantha Withnell</a>, <a href="https://theconversation.com/institutions/western-university-882">Western University</a> and <a href="https://theconversation.com/profiles/lindsay-bodell-1504260">Lindsay Bodell</a>, <a href="https://theconversation.com/institutions/western-university-882">Western University</a> Up to 72 per cent of women and 61 per cent of men are dissatisfied with their weight or <a href="https://doi.org/10.1016/j.eatbeh.2014.04.010">body image</a>, according to a U.S. study. Globally, millions of people <a href="https://doi.org/10.1111%2Fobr.12466">attempt to lose weight</a> every year with the hope that weight loss will have positive effects on their body image, health and quality of life. However, these motivated individuals often struggle to maintain new diets or exercise regimens. The rise of medications such as semaglutides, like <a href="https://dhpp.hpfb-dgpsa.ca/dhpp/resource/101298">Ozempic</a> or <a href="https://dhpp.hpfb-dgpsa.ca/dhpp/resource/101765">Wegovy</a>, <a href="https://www.cbc.ca/news/health/ozempic-weight-loss-1.6772021">might be viewed as an appealing “quick fix”</a> alternative to meet weight loss goals. Research led by our team and others suggests that such attempts to lose weight often do more harm than good, and even increase the risk of <a href="https://osf.io/9stq2">developing an eating disorder</a>. <h2>Weight loss and eating disorders</h2> Eating disorders are <a href="https://doi.org/10.1002/eat.20589">serious mental health conditions</a> primarily characterized by extreme patterns of under- or over-eating, concerns about one’s shape or body weight or other behaviours intended to influence body shape or weight such as exercising excessively or self-inducing vomiting. Although once thought to only affect young, white adolescent girls, eating disorders do not discriminate; eating disorders can develop in people of <a href="https://doi.org/10.1002/erv.2553">any age, sex, gender or racial/ethnic background</a>, with an estimated <a href="https://nedic.ca/general-information/">one million Canadians</a> suffering from an eating disorder at any given time. Feb. 1 to 7 is <a href="https://nedic.ca/edaw/">National Eating Disorders Awareness Week</a>. As a clinical psychologist and clinical psychology graduate student, our research has focused on how eating disorders develop and what keeps them going. Pertinent to society’s focus on weight-related goals, our research has examined associations between weight loss and eating disorder symptoms. <h2>Eating disorders and ‘weight suppression’</h2> In eating disorders research, the state of maintaining weight loss is referred to as “weight suppression.” Weight suppression is typically defined as the difference between a person’s current weight and their highest lifetime weight (excluding pregnancy). Despite the belief that weight loss will improve body satisfaction, we found that in a sample of over 600 men and women, weight loss had no impact on women’s negative body image and was associated with increased body dissatisfaction in <a href="https://doi.org/10.1016/j.bodyim.2023.01.011">men</a>. Importantly, being more weight suppressed has been associated with the <a href="https://doi.org/10.1093/ajcn/nqaa146">onset of eating disorders</a>, including anorexia nervosa and bulimia nervosa. <a href="https://doi.org/10.1007/s11920-018-0955-2">One proposed explanation</a> for the relationship between weight suppression and eating disorders is that maintaining weight loss becomes increasingly difficult as body systems that <a href="https://doi.org/10.3945/ajcn.110.010025">reduce metabolic rate and energy expenditure, and increase appetite</a>, are activated to promote weight gain. There is growing awareness that <a href="https://doi.org/10.1136/bmj.g2646">weight regain is highly likely following conventional diet programs</a>. This might lead people to engage in more and more extreme behaviours to control their weight, or they might shift between extreme restriction of food intake and episodes of overeating or binge eating, the characteristic symptoms of bulimia nervosa. <h2>Ozempic and other semaglutide drugs</h2> Semaglutide drugs like Ozempic and Wegovy are part of a class of drug called <a href="https://pdf.hres.ca/dpd_pm/00067924.PDF">glucagon-like peptide-1 agonists (GLP-1As)</a>. These drugs work by mimicking the hormone GLP-1 to interact with neural pathways that signal satiety (fullness) and slow stomach emptying, leading to reduced food intake. Although GLP-1As are indicated to treat Type 2 diabetes, <a href="https://www.cbc.ca/news/canada/london/ozempic-off-label-1.6884141">they are increasingly prescribed off-label</a> or being <a href="https://www.bbc.com/news/health-67414203">illegally purchased</a> without a prescription because of their observed effectiveness at inducing weight loss. Although medications like Ozempic do often lead to weight loss, the rate of weight loss may <a href="https://doi.org/10.1001/jama.2021.3224">slow down or stop over time</a>. Research by Lindsay Bodell, one of the authors of this story, and her colleagues on weight suppression may help explain why effects of semaglutides diminish over time, as <a href="https://doi.org/10.1016/j.physbeh.2019.112565">weight suppression is associated with reduced GLP-1 response</a>. This means those suppressing their weight could become less responsive to the satiety signals activated by GLP-1As. Additionally, weight loss effects are only seen for as long as the medication is taken, meaning those who take these drugs to achieve some weight loss goal are <a href="https://doi.org/10.1111/dom.14725">likely to regain most, if not all, weight lost</a> when they stop taking the medication. <h2>Risks of dieting and weight-loss drugs</h2> The growing market for off-label weight loss drugs is concerning, because of the exacerbation of <a href="https://theconversation.com/ozempic-the-miracle-drug-and-the-harmful-idea-of-a-future-without-fat-211661">weight stigma</a> and the serious <a href="https://doi.org/10.1016/j.jand.2022.01.004">health risks</a> associated with unsupervised weight loss, including developing eating disorders. Researchers and health professionals are already raising the alarm about the use of GLP-1As in children and adolescents, due to concerns about their possible <a href="https://doi.org/10.1017/cts.2023.612">impact on growth and development</a>. Moreover, popular weight-loss methods, whether they involve pills or “crash diets,” often mimic symptoms of eating disorders. For example, intermittent fasting diets that involve long periods of fasting followed by short periods of food consumption may mimic and <a href="https://doi.org/10.1016/j.eatbeh.2022.101681">increase the risk of developing binge eating problems</a>. The use of diet pills or laxatives to lose weight has been found to increase the risk of <a href="https://doi.org/10.2105/AJPH.2019.305390">being diagnosed with an eating disorder in the next one to three years</a>. Drugs like Ozempic may also be <a href="https://doi.org/10.1002/eat.24109">misused by individuals already struggling with an eating disorder</a> to suppress their appetite, compensate for binge eating episodes or manage fear of weight gain. Individuals who are already showing signs of an eating disorder, such as limiting their food intake and intense concerns about their weight, may be most at risk of spiralling from a weight loss diet or medication into an eating disorder, <a href="https://doi.org/10.1002/eat.24116">even if they only lose a moderate amount of weight</a>. People who are dissatisfied with their weight or have made multiple attempts to lose weight often feel pressured to try increasingly drastic methods. However, any diet, exercise program or weight-loss medication promising a quick fix for weight loss should be treated with extreme caution. At best, you may gain the weight back; at worst, you put yourself at risk for much more serious eating disorders and other health problems.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/221514/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/samantha-withnell-1504436">Samantha Withnell</a>, PhD Candidate, Clinical Psychology, <a href="https://theconversation.com/institutions/western-university-882">Western University</a> and <a href="https://theconversation.com/profiles/lindsay-bodell-1504260">Lindsay Bodell</a>, Assistant Professor of Psychology, <a href="https://theconversation.com/institutions/western-university-882">Western University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-dieting-weight-suppression-and-even-misuse-of-drugs-like-ozempic-can-contribute-to-eating-disorders-221514">original article</a>.

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After 3 months of devastation in the Israel-Hamas war, is anyone ‘winning’?

<a href="https://theconversation.com/profiles/ian-parmeter-932739">Ian Parmeter</a>, <a href="https://theconversation.com/institutions/australian-national-university-877">Australian National University</a> The 19th century German war strategist and field marshal Helmuth von Moltke famously <a href="https://global.oup.com/academic/product/strategy-9780199325153?cc=us&lang=en&">coined</a> the aphorism “No battle plan survives first contact with the enemy”. His observation might well be applied to the tragedy we are witnessing in Gaza. Three months after the current conflict began, civilians have borne the brunt of the violence on both sides, with the deaths of more than 22,000 Palestinians in Gaza and 1,200 Israelis. Some 85% of Gazans <a href="https://apnews.com/article/israel-hamas-war-news-01-03-2024-3b77b0c36bf2cd9922b7a484234bef5f">have also been displaced</a> and a quarter of the population is facing a famine, according to the United Nations. The conflict still has a long way to run and may be headed towards stalemate. From a geopolitical perspective, here’s where the main players stand at the start of the new year. <h2>Israel: limited success …</h2> Israel has so far failed to achieve either of its primary war aims: the destruction of Hamas and freedom for the remainder of the 240 Israelis taken hostage on October 7. Hamas fighters continue to use their tunnel network to ambush Israeli soldiers and are firing rockets at Israel, albeit in much lower volumes: 27 were <a href="https://www.timesofisrael.com/at-stroke-of-midnight-hamas-attacks-israel-with-heavy-new-year-rocket-barrage/">fired</a> at the start of the new year, <a href="https://www.timesofisrael.com/liveblog_entry/idf-9500-rockets-fired-at-israel-since-oct-7-including-3000-in-1st-hours-of-onslaught/">compared</a> with 3,000 in the first hours of the conflict on October 7. There are still around <a href="https://www.economist.com/middle-east-and-africa/2023/12/20/israel-isnt-sure-what-to-do-about-the-hostages-in-gaza">130 Israelis</a> being held hostage, and only <a href="https://www.rand.org/pubs/commentary/2023/12/five-potential-next-steps-for-the-hostage-situation.html">one hostage</a> has been freed by the Israeli Defence Forces (IDF), as opposed to releases arranged through Qatari and Egyptian mediators. Israeli society is divided between those who want to prioritise negotiations to release the hostages and those who want to prioritise the elimination of Hamas. Israel achieved an important symbolic success with the apparent targeted killing of Hamas deputy leader <a href="https://www.cbsnews.com/news/israel-lebanon-hamas-saleh-al-arouri-fears-widening-regional-conflict/">Saleh al-Arouri</a> in Beirut on January 2. Though Israel has not formally claimed responsibility, there is little doubt it was <a href="https://www.axios.com/2024/01/02/hamas-saleh-arouri-killed-beirut-hezbollah-israel-gaza">behind</a> the killing. But the two Gaza–based Hamas leaders Israel most wants to eliminate, political leader Yahya Sinwar and military leader Mohammed Deif, are still at large. Israel still has US support in the UN Security Council, which has <a href="https://www.cnn.com/2023/12/22/politics/un-security-council-resolution-israel-gaza-resolution/index.html">managed to pass</a> only one toothless resolution since the war began. But the Biden administration is <a href="https://apnews.com/article/biden-israel-hamas-oct-7-44c4229d4c1270d9cfa484b664a22071">publicly pressuring</a> Israel to change its tactics to minimise Palestinian casualties. <h2>…and facing a ‘day after’ conundrum</h2> The Israeli government is also divided on how Gaza should be run when the fighting stops. Prime Minister Benjamin Netanyahu has <a href="https://www.jpost.com/breaking-news/article-777731">said</a> he won’t accept Gaza remaining “Hamastan” (Hamas-controlled) or becoming “Fatahstan” (ruled by the Palestinian Authority, which is dominated by the secular Fatah party). US President Joe Biden <a href="https://www.reuters.com/world/middle-east/biden-says-palestinian-authority-should-ultimately-govern-gaza-west-bank-2023-11-18/">prefers</a> a Gaza government led by a reformed Palestinian Authority, but Netanyahu has rejected this and has not articulated an alternative plan. Defence Minister Yoav Gallant this week <a href="https://www.timesofisrael.com/gallants-post-war-gaza-plan-palestinians-to-run-civil-affairs-with-global-task-force/">outlined</a> what seems to be his own plan for Gaza, involving governance by unspecified Palestinian authorities. His plan did not immediately have Israeli cabinet approval and has been <a href="https://thehill.com/opinion/international/4391112-dangerous-ideas-about-the-day-after-in-gaza/">slammed</a> by hard-right ministers. Two of these, Finance Minister Bezalel Smotrich and National Security Minister Itamar Ben–Gvir, have <a href="https://www.timesofisrael.com/likud-minister-slams-smotrich-ben-gvirs-unrealistic-call-for-gazan-emigration/#:%7E:text=Ben%20Gvir%20hit%20back%20at,will%20protect%20the%20IDF%20soldiers.%E2%80%9D">called</a> for a solution that encourages the Palestinian population to emigrate and for Israeli settlers to return to the strip. That would be <a href="https://www.france24.com/en/middle-east/20240103-us-condemns-far-right-israeli-ministers-call-for-palestinians-to-emigrate-from-gaza">unacceptable</a> to the Biden administration. Israel’s massive bombing campaign has also slowly turned international opinion against it, as expressed in the UN General Assembly <a href="https://apnews.com/article/un-assembly-israel-palestinians-hamas-vote-resolution-bffc37b2ecc444d906492008cde0aaf6">vote</a> last month in which 153 of the 193 member states called for a ceasefire. Are Netanyahu’s days now numbered? The current issue of The Economist <a href="https://www.economist.com/leaders/2024/01/03/binyamin-netanyahu-is-botching-the-war-time-to-sack-him">features a headline</a> that reads “Binyamin Netanyahu is botching the war. Time to sack him”. Whether or not that’s a fair judgement, it’s clear that internal divisions and indecision within his government are hindering Israel’s prosecution of the war. <h2>Hamas – still standing</h2> The militant group has obviously been hurt. Israel claims to have <a href="https://news.sky.com/story/israel-gaza-latest-hamas-war-sky-news-blog-12978800?postid=6736630">killed or captured</a> between 8,000 and 9,000 of Hamas’ approximately 30,000–strong fighting force – though it has not explained how it calculates militant deaths. Hamas’ main achievement is that it is still standing. To win, the militant group does not have to defeat Israel – it needs merely to survive the IDF onslaught. Hamas can claim some positives. Its attack on October 7 has put the Palestinian issue at the top of the Middle East agenda. Citizens in the Arab states that have signed peace agreements with Israel are clearly angry. And an Israeli-Saudi agreement to normalise relations between the countries, which had been imminent before the conflict, is off the table for now. Opinion polling also <a href="https://apnews.com/article/israel-hamas-palestinians-opinion-poll-wartime-views-a0baade915619cd070b5393844bc4514">shows support</a> for Hamas has risen from 12% to 44% in the West Bank and from 38% to 42% in Gaza in the past three months. If it were possible to hold fair Palestinian elections now, they could produce results Israel and the US would not like. <h2>United States – weakness in dealing with Israel</h2> Biden embraced Netanyahu immediately after the Hamas attack, but US efforts since then to influence Israel’s war plans have not yielded any results. Secretary of State Antony Blinken failed in his effort to persuade Israel to end the war by the start of the new year. His <a href="https://apnews.com/article/us-turkey-israel-greece-gaza-hamas-jordan-36e5e1be205d5200916fd447c8c8e455">current visit</a> to the region is unlikely to yield any major changes. Moreover, divisions in the US may hurt Biden in the lead–up to the presidential election in November. Young, college–educated progressives, who tend to vote Democratic, have taken part in demonstrations against Biden’s public support for Israel’s right to defend itself, if not its way of doing so. These progressives won’t vote for the almost–certain Republican candidate, Donald Trump. But they could stay home on election day, handing the election to Trump. US support for Ukraine has also become a casualty of the war. Republicans, taking their cue from Trump, are prioritising support for Israel and stopping the flow of migrants across the US-Mexico border. They are losing interest in Ukraine – which clearly benefits Russian President Vladimir Putin. Those benefits will be reinforced if Trump wins the presidency again. <h2>United Nations – irrelevant</h2> The UN has also failed in its mission of maintaining world peace. The only Security Council resolution on the war meant nothing, as Russia was pleased to <a href="https://www.politico.com/news/2023/12/22/un-security-council-gaza-aid-00133112">point out</a>. The recent UN General Assembly resolution illustrated Israel’s growing isolation, but has done nothing to change the course of the war. UN Secretary–General Antonio Guterres has been powerless to influence either Israel or Hamas. <h2>Iran – watching for opportunities</h2> The Hezbollah militant group will do a lot of huffing and puffing over the killing of al-Arouri in a Hezbollah-controlled part of Beirut. But it takes its orders from Tehran, which still shows no sign of wanting to become directly involved in the war. That said, Iran appears to have no problem with its proxies – Hezbollah in Lebanon and the <a href="https://theconversation.com/why-yemens-houthis-are-getting-involved-in-the-israel-hamas-war-and-how-it-could-disrupt-global-shipping-219220">Houthis in Yemen</a> – providing token support for Hamas through limited rocket, drone and artillery attacks. Iran is likely to be reinforced in this approach by the bombings at the tomb of former Quds Force commander <a href="https://theconversation.com/iran-vows-revenge-for-soleimanis-killing-but-heres-why-it-wont-seek-direct-confrontation-with-the-us-129440">Qassem Soleimani</a> last week, which killed almost 100 Iranians. The bombings have been claimed by the Islamic State, which will likely make Iran more focused on its internal security than on assisting Hamas.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/220644/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/ian-parmeter-932739">Ian Parmeter</a>, Research Scholar, Centre for Arab and Islamic Studies, <a href="https://theconversation.com/institutions/australian-national-university-877">Australian National University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/after-3-months-of-devastation-in-the-israel-hamas-war-is-anyone-winning-220644">original article</a>.

Travel Trouble

Do you really need antibiotics? Curbing our use helps fight drug-resistant bacteria

<a href="https://theconversation.com/profiles/minyon-avent-1486987">Minyon Avent</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>; <a href="https://theconversation.com/profiles/fiona-doukas-1157050">Fiona Doukas</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/kristin-xenos-1491653">Kristin Xenos</a>, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Antibiotic resistance occurs when a microorganism changes and no longer responds to an antibiotic that was previously effective. It’s <a href="https://thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00502-2/fulltext">associated with</a> poorer outcomes, a greater chance of death and higher health-care costs. In Australia, antibiotic resistance means some patients are admitted to hospital because oral antibiotics are <a href="https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance">no longer effective</a> and they need to receive intravenous therapy via a drip. Antibiotic resistance is rising to high levels in certain parts of the world. Some hospitals <a href="https://www.reactgroup.org/news-and-views/news-and-opinions/year-2022/the-impact-of-antibiotic-resistance-on-cancer-treatment-especially-in-low-and-middle-income-countries-and-the-way-forward/">have to consider</a> whether it’s even viable to treat cancers or perform surgery due to the risk of antibiotic-resistant infections. Australia is <a href="https://www.safetyandquality.gov.au/our-work/antimicrobial-resistance/antimicrobial-use-and-resistance-australia-aura/aura-2023-fifth-australian-report-antimicrobial-use-and-resistance-human-health">one of the highest users</a> of antibiotics in the developed world. We need to use this precious resource wisely, or we risk a future where a simple infection could kill you because there isn’t an effective antibiotic. <h2>When should antibiotics not be used?</h2> Antibiotics only work for some infections. They work against bacteria but <a href="https://www.safetyandquality.gov.au/publications-and-resources/resource-library/do-i-really-need-antibiotics">don’t treat</a> infections caused by viruses. Most community acquired infections, even those caused by bacteria, are likely to get better without antibiotics. Taking an antibiotic when you don’t need it won’t make you feel better or recover sooner. But it can increase your chance of side effects like nausea and diarrhoea. Some people think green mucus (or snot) is a sign of bacterial infection, requiring antibiotics. But it’s actually <a href="https://www.safetyandquality.gov.au/sites/default/files/2023-11/aura_2023_do_i_really_need_antibiotics.pdf">a sign</a> your immune system is working to fight your infection. <h2>If you wait, you’ll often get better</h2> <a href="https://www.tg.org.au/">Clinical practice guidelines</a> for antibiotic use aim to ensure patients receive antibiotics when appropriate. Yet 40% of GPs say they prescribe antibiotics <a href="https://doi.org/10.1071/HI13019">to meet patient expectations</a>. And <a href="https://pubmed.ncbi.nlm.nih.gov/35973750/">one in five</a> patients expect antibiotics for respiratory infections. It can be difficult for doctors to decide if a patient has a viral respiratory infection or are at an early stage of serious bacterial infection, particularly in children. One option is to “watch and wait” and ask patients to return if there is clinical deterioration. An alternative is to prescribe an antibiotic but advise the patient to not have it dispensed unless specific symptoms occur. This can <a href="https://doi.org/10.1002/14651858.CD004417.pub5">reduce antibiotic use by 50%</a> with no decrease in patient satisfaction, and no increase in complication rates. <h2>Sometimes antibiotics are life-savers</h2> For some people – particularly those with a weakened immune system – a simple infection can become more serious. Patients with life-threatening suspected infections should receive an appropriate antibiotic <a href="https://www.safetyandquality.gov.au/our-work/clinical-care-standards/antimicrobial-stewardship-clinical-care-standard">immediately</a>. This includes serious infections such as <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/bacterial-meningitis#:%7E:text=What%20is%20bacterial%20meningitis%3F,can%20cause%20life%2Dthreatening%20problems.">bacterial meningitis</a> (infection of the membranes surrounding the brain) and <a href="https://clinicalexcellence.qld.gov.au/priority-areas/safety-and-quality/sepsis/adult-sepsis#:%7E:text=Adult%20patients%20with%20sepsis%20also,adult%20emergency%20department%20sepsis%20pathway.">sepsis</a> (which can lead to organ failure and even death). <h2>When else might antibiotics be used?</h2> Antibiotics are sometimes used to prevent infections in patients who are undergoing surgery and are at significant risk of infection, such as those undergoing bowel resection. These patients will <a href="https://www.tg.org.au">generally receive</a> a single dose before the procedure. Antibiotics may also <a href="https://www.tg.org.au">be given</a> to patients undergoing chemotherapy for solid organ cancers (of the breast or prostate, for example), if they are at high risk of infection. While most sore throats are caused by a virus and usually resolve on their own, some high risk patients with a bacterial strep A infection which can cause “scarlet fever” are given antibiotics to prevent a more serious infection like <a href="https://www.rhdaustralia.org.au/">acute rheumatic fever</a>. <h2>How long is a course of antibiotics?</h2> The recommended duration of a course of antibiotics depends on the type of infection, the likely cause, where it is in your body and how effective the antibiotics are at killing the bacteria. In the past, courses were largely arbitrary and based on assumptions that antibiotics should be taken for long enough to eliminate the infecting bacteria. More recent research does not support this and shorter courses are <a href="https://www.acpjournals.org/doi/full/10.7326/M19-1509">nearly always as effective as longer ones</a>, particularly for community acquired respiratory infections. For <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736742/">community acquired pneumonia</a>, for example, research shows a three- to five-day course of antibiotics is at least as effective as a seven- to 14-day course. The “take until all finished” approach is no longer recommended, as the longer the antibiotic exposure, the greater the chance the bacteria will develop resistance. However, for infections where it is more difficult to eradicate the bacteria, such as tuberculosis and bone infections, a combination of antibiotics for many months is usually required. <h2>What if your infection is drug-resistant?</h2> You may have an antibiotic-resistant infection if you don’t get better after treatment with standard antibiotics. Your clinician will collect samples for lab testing if they suspect you have antibiotic-resistant infection, based on your travel history (especially if you’ve been hospitalised in a country with high rates of antibiotic resistance) and if you’ve had a recent course of antibiotics that hasn’t cleared your infection. Antibiotic-resistant infections are managed by prescribing broad-spectrum antibiotics. These are like a sledgehammer, wiping out many different species of bacteria. (Narrow-spectrum antibiotics conversely can be thought of as a scalpel, more targeted and only affecting one or two kinds of bacteria.) Broad-spectrum antibiotics are usually more expensive and come with more severe side effects. <h2>What can patients do?</h2> Decisions about antibiotic prescriptions should be made using <a href="https://www.safetyandquality.gov.au/our-work/partnering-consumers/shared-decision-making/decision-support-tools-specific-conditions">shared decision aids</a>, where patients and prescribers discuss the risks and benefits of antibiotics for conditions like a sore throat, middle ear infection or acute bronchitis. Consider asking your doctor questions such as: <ul> <li>do we need to test the cause of my infection?</li> <li>how long should my recovery take?</li> <li>what are the risks and benefits of me taking antibiotics?</li> <li>will the antibiotic affect my regular medicines?</li> <li>how should I take the antibiotic (how often, for how long)?</li> </ul> Other ways to fight antibiotic resistance include: <ul> <li>returning leftover antibiotics to a pharmacy for safe disposal</li> <li>never consuming leftover antibiotics or giving them to anyone else</li> <li>not keeping prescription repeats for antibiotics “in case” you become sick again</li> <li>asking your doctor or pharmacist what you can do to feel better and ease your symptoms rather than asking for antibiotics.</li> </ul> <a href="https://theconversation.com/profiles/minyon-avent-1486987">Minyon Avent</a>, Antimicrobial Stewardship Pharmacist, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>; <a href="https://theconversation.com/profiles/fiona-doukas-1157050">Fiona Doukas</a>, PhD candidate, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/kristin-xenos-1491653">Kristin Xenos</a>, Research Assistant, College of Health, Medicine and Wellbeing, School of Biomedical Science and Pharmacy, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/do-you-really-need-antibiotics-curbing-our-use-helps-fight-drug-resistant-bacteria-217920">original article</a>.

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Drug resistance may make common infections like thrush untreatable

<a href="https://theconversation.com/profiles/christine-carson-109004">Christine Carson</a>, <a href="https://theconversation.com/institutions/the-university-of-western-australia-1067">The University of Western Australia</a> We’ve all heard about antibiotic resistance. This happens when bacteria develop strategies to avoid being destroyed by an antibiotic. The consequences of antibiotic resistance mean an antibiotic previously used to cure bacterial infections no longer works effectively because the bacteria have become resistant to the drug. This means it’s getting harder to cure the infections some bacteria cause. But unfortunately, it’s only one part of the problem. The same phenomenon is also happening with other causes of infections in humans: fungi, viruses and parasites. “Antimicrobial resistance” means the drugs used to treat diseases caused by microbes (bugs that cause infection) no longer work. This occurs with antibacterial agents used against bacteria, antifungal agents used against fungi, anti-parasitic agents used against parasites and antiviral agents used against viruses. This means a wide range of previously controllable infections are becoming difficult to treat – and may become untreatable. <h2>Fighting fungi</h2> Fungi are responsible for a range of infections in humans. Tinea, ringworm and vulvovaginal candidiasis (thrush) are some of the more familiar and common superficial fungal infections. There are also life-threatening fungal infections such as aspergillosis, cryptococcosis and invasive fungal bloodstream infections including those caused by Candida albicans and Candida auris. Fungal resistance to antifungal agents is a problem for several reasons. First, the range of antifungal agents available to treat fungal infections is limited, especially compared to the range of antibiotics available to treat bacterial infections. There are only four broad families of antifungal agents, with a small number of drugs in each category. Antifungal resistance further restricts already limited options. Life-threatening fungal infections happen less frequently than life-threatening bacterial infections. But they’re rising in frequency, especially among people whose immune systems are compromised, including by <a href="https://7news.com.au/news/qld/first-heart-transplant-patient-to-die-from-fungal-infection-at-brisbanes-prince-charles-hospital-identified-as-mango-hill-gp-muhammad-hussain-c-12551559">organ transplants</a> and chemotherapy or immunotherapy for cancer. The threat of getting a drug-resistant fungal infection makes all of these health interventions riskier. The greatest <a href="https://www.frontiersin.org/articles/10.3389/fimmu.2017.00735/full">burden of serious fungal disease</a> occurs in places with limited health-care resources available for diagnosing and treating the infections. Even if infections are diagnosed and antifungal treatment is available, antifungal resistance reduces the treatment options that will work. But even in Australia, common fungal infections are impacted by resistance to antifungal agents. Vulvovaginal candidiasis, known as thrush and caused by Candida species and some closely related fungi, is usually reliably treated by a topical antifungal cream, sometimes supplemented with an oral tablet. However, instances of <a href="https://www.theage.com.au/national/victoria/they-can-t-sit-properly-doctors-treat-growing-number-of-women-with-chronic-thrush-20230913-p5e499.html">drug-resistant thrush</a> are increasing, and new treatments are needed. <h2>Targeting viruses</h2> Even <a href="https://theconversation.com/why-are-there-so-many-drugs-to-kill-bacteria-but-so-few-to-tackle-viruses-137480">fewer antivirals</a> are available than antibacterial and antifungal agents. Most antimicrobial treatments work by exploiting differences between the microbe causing the infection and the host (us) experiencing the infection. Since viruses use our cells to replicate and cause their infection, it’s difficult to find antiviral treatments that selectively target the virus without damaging us. With so few antiviral drugs available, any resistance that develops to one of them significantly reduces the treatment options available. Take COVID, for example. Two antiviral medicines are in widespread use to treat this viral infection: Paxlovid (containing nirmatrelvir and ritonavir) and Lagevrio (molnupiravir). So far, SARS-CoV-2, the virus that causes COVID, has not developed significant resistance to either of these <a href="https://www.cidrap.umn.edu/covid-19/low-levels-resistance-paxlovid-seen-sars-cov-2-isolates">treatments</a>. But if SARS-CoV-2 develops resistance to either one of them, it halves the treatment options. Subsequently relying on one would likely lead to its increased use, which may heighten the risk that resistance to the second agent will develop, leaving us with no antiviral agents to treat COVID. The threat of antimicrobial resistance makes our ability to treat serious COVID infections rather precarious. <h2>Stopping parasites</h2> Another group of microbes that cause infections in humans are single-celled microbes such as Plasmodium, Giardia, Leishmania, and Trypanosoma. These microbes are sometimes referred to as parasites, and they are becoming increasingly resistant to the very limited range of anti-parasitic agents used to treat the infections they cause. Several Plasmodium species cause malaria and anti-parasitic drugs have been the cornerstone of malaria treatment for decades. But their usefulness has been significantly reduced by the <a href="https://www.mmv.org/our-work/mmvs-pipeline-antimalarial-drugs/antimalarial-drug-resistance">development of resistance</a>. Giardia parasites cause an infection called giardiasis. This can resolve on its own, but it can also cause severe gastrointestinal symptoms such as diarrhea, nausea, and bloating. These microbes have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6207226/">developed resistance</a> to the main treatments and patients infected with drug-resistant parasites can have protracted, unpleasant infections. <h2>Resistance is a natural consequence</h2> Treating infections influences microbes’ evolutionary processes. Exposure to drugs that stop or kill them pushes microbes to either evolve or die. The exposure to antimicrobial agents provokes the evolutionary process, selecting for microbes that are resistant and can survive the exposure. The pressure to evolve, provoked by the antimicrobial treatment, is called “selection pressure”. While most microbes will die, a few will evolve in time to overcome the antimicrobial drugs used against them. The evolutionary process that leads to the emergence of resistance is inevitable. But some things can be done to minimise this and the problems it brings. Limiting the use of antimicrobial agents is one approach. This means reserving antimicrobial agents for when their use is known to be necessary, rather than using them “just in case”. Antimicrobial agents are precious resources, holding at bay many infectious diseases that would otherwise sicken and kill millions. It is imperative we do all we can to preserve the effectiveness of those that remain, and give ourselves more options by working to discover and develop new ones.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/213460/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/christine-carson-109004">Christine Carson</a>, Senior Research Fellow, School of Medicine, <a href="https://theconversation.com/institutions/the-university-of-western-australia-1067">The University of Western Australia</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/drug-resistance-may-make-common-infections-like-thrush-untreatable-213460">original article</a>.

Body

5 reasons why climate change may see more of us turn to alcohol and other drugs

<a href="https://theconversation.com/profiles/helen-louise-berry-8608">Helen Louise Berry</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> and <a href="https://theconversation.com/profiles/francis-vergunst-230743">Francis Vergunst</a>, <a href="https://theconversation.com/institutions/university-of-oslo-934">University of Oslo</a> Climate change will affect every aspect of our <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01859-7/fulltext">health and wellbeing</a>. But its potential harms go beyond the body’s ability to handle extreme heat, important as this is. Extreme weather events, such as floods, droughts, storms and wildfires, are becoming more frequent and severe. These affect our <a href="https://pubmed.ncbi.nlm.nih.gov/36165756/">mental health</a> in a multitude of <a href="https://www.nature.com/articles/s41558-018-0102-4">ways</a>. Coping with climate change can be overwhelming. Sometimes, the best someone can do is to seek refuge in alcohol, tobacco, over-the-counter and prescription drugs, or other psychoactive substances. This is understandable, but dangerous, and can have serious consequences. We outline <a href="https://journals.sagepub.com/doi/full/10.1177/17456916221132739">five ways</a> climate change could increase the risk of harmful substance use. <h2>1. Mental health is harmed</h2> Perhaps the most obvious way climate change can be linked to harmful substance use is by damaging mental health. This <a href="https://onlinelibrary.wiley.com/doi/10.1111/dar.12448">increases the risk</a> of new or worsened substance use. People with a mental disorder are <a href="https://www.hindawi.com/journals/psychiatry/2018/5697103/">at high risk</a> of also having a <a href="https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-11-25#:%7E:text=Prevalence%20of%20comorbidity%20in%20epidemiological%20studies&text=Among%20subjects%20with%20an%20alcohol,a%20comorbid%20SUD%20%5B39%5D.">substance-use disorder</a>. This often precedes their mental health problems. Climate change-related increases in the number and nature of extreme events, in turn, are escalating risks to mental health. For example, extreme heat is linked to increased <a href="https://pubmed.ncbi.nlm.nih.gov/27727320/">distress</a> across the whole population. In extreme heat, more people go to the <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2789481">emergency department</a> for psychiatric problems, including for <a href="https://www.sciencedirect.com/science/article/abs/pii/S0048969720338249">alcohol</a> and <a href="https://www.nature.com/articles/s43856-023-00346-1">substance use</a> generally. This is even true for <a href="https://www.sciencedirect.com/science/article/pii/S0048969720325572">a single very hot day</a>. Post-traumatic stress disorder, depression, anxiety and <a href="https://onlinelibrary.wiley.com/doi/abs/10.5694/mja13.10307">other mental health</a> problems are <a href="https://www.frontiersin.org/articles/10.3389/fpubh.2019.00367/full">common</a> at the time of extreme weather events and can persist for months, even years afterwards, especially if people are exposed to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9116266/">multiple events</a>. This can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6101235/">increase</a> the likelihood of using substances as a way to cope. <h2>2. Worry increases</h2> With <a href="https://climatecommunication.yale.edu/publications/climate-change-in-the-american-mind-beliefs-attitudes-december-2022/">increasing public awareness</a> of how climate change is endangering wellbeing, people are <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/articles/worriesaboutclimatechangegreatbritain/septembertooctober2022#:%7E:text=The%20level%20of%20worry%20about,lives%20right%20now%20(29%25).">increasingly worried</a> about what will happen if it remains unchecked. Worrying isn’t the same as meeting the criteria for a mental disorder. But <a href="https://www.undp.org/publications/peoples-climate-vote">surveys</a> show climate change generates complex emotional responses, <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(21)00278-3/fulltext">especially in children</a>. As well as feelings of worry, there is anxiety, fear, guilt, anger, grief and helplessness. Some <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904966/">emotional states</a>, such as <a href="https://www.pnas.org/doi/full/10.1073/pnas.1909888116">sadness</a>, are linked with long-term tobacco use and also make substance use <a href="https://pubmed.ncbi.nlm.nih.gov/16011392/">relapse</a> more likely. <h2>3. Physical injuries hurt us in many ways</h2> Physical injuries caused by extreme weather events – such as smoke inhalation, burns and flood-related cuts and infections – increase the risk of harmful substance use. That’s partly because they <a href="https://pubmed.ncbi.nlm.nih.gov/20033251/">increase</a> the risk of psychological distress. If injuries cause long-term illness or disability, consequent feelings of hopelessness and depression can dispose some people to self-medicate with alcohol or other drugs. Substance use itself can also generate long-term physiological harm, disabilities or other chronic health problems. These are <a href="https://www.tandfonline.com/doi/abs/10.3109/00952999609001655">linked with</a> higher rates of harmful substance use. <h2>4. Our day-to-day lives change</h2> A single catastrophic event, such as a storm or flood, can devastate lives overnight and change the way we live. So, too, can the more subtle changes in climate and day-to-day weather. Both can disrupt behaviour and routines in ways that risk new or worsened substance use, for example, using stimulants to cope with fatigue. Take, for example, hotter temperatures, which disrupt <a href="https://www.cell.com/one-earth/fulltext/S2590-3322(22)00209-3?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS2590332222002093%3Fshowall%3Dtrue">sleep</a>, undermine <a href="https://jhr.uwpress.org/content/57/2/400">academic performance</a>, <a href="https://www.nature.com/articles/s41562-017-0097">reduce physical activity</a>, and promote <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(22)00173-5/fulltext">hostile language</a> and <a href="https://www.cambridge.org/core/elements/abs/climate-change-and-human-behavior/F64471FA47B8A6F5524E7DDDDE571D57">violent behaviour</a>. <h2>5. It destabilises communities</h2> Finally, climate change is destabilising the socioeconomic, natural, built and geopolitical <a href="https://www.nature.com/articles/s41558-018-0102-4">systems</a> on which human wellbeing – <a href="https://theconversation.com/climate-change-and-health-ipcc-reports-emerging-risks-emerging-consensus-24213">indeed survival</a> – depends. Damaged infrastructure, agricultural losses, school closures, homelessness and displacement are significant <a href="https://www.nature.com/articles/s41558-018-0102-4">sources of psychosocial distress</a> that prompt acute (short-term) and chronic (long-term) stress responses. <a href="https://doi.org/10.1196/annals.1441.030">Stress</a>, in turn, can <a href="https://doi.org/10.1007/s002130100917">increase</a> the risk of <a href="https://link.springer.com/article/10.1007/s002130100917">harmful substance use</a> and make people more likely to relapse. <h2>Why are we so concerned?</h2> Substance-use disorders are economically and socially <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30337-7/fulltext">very costly</a>. Risky substance use that doesn’t meet the criteria for a formal diagnosis <a href="https://digitalcommons.fiu.edu/srhreports/health/health/32/">can also harm</a>. Aside from its direct physical harm, harmful substance use disrupts <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3843305/">education</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3234116/">employment</a>. It increases the risk of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676144/">accidents</a> and <a href="https://www.tandfonline.com/doi/abs/10.1080/09595230600944479">crime</a>, and it undermines social relationships, intimate <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795906/#:%7E:text=Results%20indicated%20that%20alcohol%20use,drinkers%20with%20low%20relationship%20satisfaction.">partnerships</a> and <a href="https://www.cambridge.org/core/journals/development-and-psychopathology/article/abs/longitudinal-relations-between-parental-drinking-problems-family-functioning-and-child-adjustment/CE508589A9E799FD6DC9E23DF364FB8F">family functioning</a>. <h2>Politicians take note</h2> As we head towards the <a href="https://www.cop28.com">COP28 global climate talks</a> in Dubai, climate change is set to hit the headlines once more. Politicians know climate change is undermining human health and wellbeing. It’s well past time to insist they act. As we have seen for populations as a whole, there are multiple possible ways for climate change to cause a rise in harmful substance use. This means multidimensional <a href="https://www.nature.com/articles/s41558-018-0102-4">prevention strategies</a> are needed. As well as addressing climate change more broadly, we need strategies including: <ul> <li> supporting vulnerable individuals, especially <a href="https://journals.sagepub.com/doi/full/10.1177/21677026211040787">young people</a>, and marginalised commmunities, who are <a href="https://www.nature.com/articles/s41558-018-0102-4">hit hardest</a> by extreme weather-related events </li> <li> focusing health-related policies more on broadscale health promotion, for example, healthier eating, active transport and community-led mental health support </li> <li> investing in climate-resilient infrastructure, such as heat-proofing buildings and greening cities, to prevent more of the destabilising effects and stress we know contributes to mental health problems and harmful substance use. </li> </ul> There is now <a href="https://news.un.org/en/story/2022/10/1129912">no credible pathway</a> to avoiding dangerous climate change. However, if <a href="https://carnegieendowment.org/2023/01/12/climate-protests-tracking-growing-unrest-pub-88778#:%7E:text=These%20are%20just%20a%20few,even%20more%20numerous%20and%20influential.">increasing rates</a> of climate protests are anything to go by, the world may finally be ready for radical change – and perhaps for reduced harmful substance use.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/217894/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/helen-louise-berry-8608">Helen Louise Berry</a>, Honorary Professor, Centre for Health Systems and Safety Research, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> and <a href="https://theconversation.com/profiles/francis-vergunst-230743">Francis Vergunst</a>, Associate Professor, Psychosocial Difficulties, <a href="https://theconversation.com/institutions/university-of-oslo-934">University of Oslo</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/5-reasons-why-climate-change-may-see-more-of-us-turn-to-alcohol-and-other-drugs-217894">original article</a>.

Mind

What exactly is a ceasefire, and why is it so difficult to agree on one in Gaza?

<a href="https://theconversation.com/profiles/marika-sosnowski-1415833">Marika Sosnowski</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Barely a week after Hamas’ attack on Israeli soldiers and civilians on October 7 and the subsequent airstrikes by the Israeli Defence Force on the Gaza Strip, talk of a ceasefire had already begun. More than five weeks into the war, calls for a ceasefire have only grown louder. Visiting the White House this week, Indonesian President Joko Widodo <a href="https://www.aljazeera.com/news/2023/11/14/indonesian-president-joko-widodo-urges-biden-to-help-end-gaza-atrocities">said</a>, a “ceasefire is a must for the sake of humanity.” Israel has thus far <a href="https://apnews.com/article/israel-hamas-war-news-11-11-2023-d4d272416107c02e63dabd9548395026">refused</a> to discuss a ceasefire without the release of the 240 hostages being held by Hamas. But what exactly is a ceasefire, and how do they work? And what sort of arrangement would be most effective in Gaza? <h2>Different terms, different meanings</h2> Virtually as old as conflict itself, a ceasefire is an ancient way of formalising a halt to armed violence between warring parties for a certain period of time. Historically, the terms truce and armistice were used as synonyms. Perhaps surprisingly, international humanitarian law has <a href="https://www.chathamhouse.org/2023/11/humanitarian-pauses-and-ceasefires-what-are-differences">no provisions</a> relating specifically to when ceasefires should be negotiated, what they need to contain or how they need to be applied. It is only in the last 50 years or so that a range of new terminology has become commonplace to describe the phenomenon of a “<a href="https://beyondintractability.org/essay/cease-fire">ceasefire</a>”. These include: <ul> <li> <a href="https://ru.usembassy.gov/joint-statement-russian-federation-united-states-syria/">cessation of hostilities</a> </li> <li> <a href="https://www.thenewhumanitarian.org/news/2017/12/04/un-calls-humanitarian-pause-yemen-conditions-capital-deteriorate">humanitarian pauses</a> </li> <li> <a href="https://www.peaceagreements.org/viewmasterdocument/2093">de-escalation areas</a> </li> <li> <a href="https://reliefweb.int/report/sudan/un-call-days-tranquility-bears-fruit-more-five-million-children-have-been-vaccinated">days of tranquility</a> (pauses in fighting to allow for immunisation of children) </li> <li> <a href="https://kaldorcentre.unsw.edu.au/sites/kaldorcentre.unsw.edu.au/files/Policy_brief_Creating_safe_zones_and_safe_corridors.pdf">safe zones</a> and safe corridors </li> <li> <a href="https://osce.org/stories/osce-mirror-patrols-windows-of-hope-eastern-ukraine">windows of silence</a> (one name given to the 2014 ceasefire in Ukraine). </li> </ul> Many of these terms have been used in the Gaza conflict. For instance, in late October, the UN General Assembly <a href="https://press.un.org/en/2023/ga12548.doc.htm">adopted</a> a resolution calling for an “immediate, durable and sustained humanitarian truce leading to cessation of hostilities”. In the Security Council, the US has <a href="https://www.bbc.com/news/world-middle-east-67320520">called</a> for “humanitarian pauses”, but not a “ceasefire”. Russia, meanwhile, has <a href="https://news.un.org/en/story/2023/10/1142427">demanded</a> a “humanitarian ceasefire”, but is unhappy with a “truce” or “pauses”. This week, Hamas said it is willing to <a href="https://www.france24.com/en/middle-east/20231113-%F0%9F%94%B4-live-more-gaza-hospitals-halt-operations-as-israeli-assault-continues">release</a> 70 hostages in exchange for a five-day “truce”. Israeli Prime Minister Benjamin Netanyahu has previously <a href="https://www.theguardian.com/world/2023/nov/04/gaza-ceasefire-talks-ongoing-despite-israeli-pm-rejecting-pause-says-us">rejected</a> a “temporary truce”, but under pressure from the US, has agreed this week to <a href="https://www.aljazeera.com/features/2023/11/10/will-israels-humanitarian-pauses-mean-much-for-gaza-no-say-experts">implement</a> daily four-hour “humanitarian pauses”. While there have been <a href="https://ukraine.un.org/en/174777-glossary-humanitarian-terms-pauses-during-conflict">attempts</a> to differentiate between these terms, states continue to place different emphasis or apply different meanings to them in ad hoc ways. This makes finding common ground difficult. <h2>What could be achieved in Gaza instead</h2> So, if we have no common definitions as a starting point, how do parties come to any useful or enforceable agreement on a ceasefire? Thus far in Gaza, the answer has mostly been they don’t. It may be simplistic to say that words are what we use as humans to make sense of and order the world, but in this context, specifics matter. Arguably, in focusing so squarely on getting to a halt in fighting (whatever we want to call that), we lose sight of many other important factors and actions that may or may not fall under the broad and open-to-interpretation umbrella term of “ceasefire”. For example, Israel and Hamas might find agreement if negotiators focused on more specific details or issues, such as: <ul> <li> the amount of ordnance being used by both sides on a daily basis, and what kind of ordnance </li> <li> where or what is targeted by both sides </li> <li> the number of aid convoys allowed into Gaza, where they would come from, where they would go and what they would be carrying </li> <li> the number and/or nationality of hostages to be released and at what regularity. </li> </ul> I am not a negotiator and this is not an exhaustive list. What it hopes to illustrate is that efforts for a grand-bargain-type ceasefire should not be prioritised over more nuanced, and perhaps tangible, efforts for other types of lulls in fighting. <h2>How ceasefires can be problematic</h2> At the same time, it should not be forgotten that ceasefires can have unintended consequences. Often these consequences are far from beneficial, positive or humanitarian – the kinds of things we expect from a ceasefire. For example, in Syria, local <a href="https://www.washingtonpost.com/politics/2021/06/18/do-ceasefires-syria-work-we-checked-data/">ceasefires</a> and reconciliation agreements have been used during the civil war to allow for the evacuation of citizens from their homes in places like <a href="https://paxforpeace.nl/publications/no-return-to-homs/#:%7E:text=The%2520report%2520'No%2520Return%2520to,cities%2520and%2520neighbourhoods%2520in%2520Syria.">Old Homs</a> and <a href="https://www.middleeasteye.net/opinion/besiege-bombard-retake-reconciliation-agreements-syria">Daraya</a>. Subsequently, a raft of presidential decrees were enacted that enabled the Syrian regime to permanently reappropriate their properties. State-backed <a href="https://www.brookings.edu/articles/beyond-fragility-syria-and-the-challenges-of-reconstruction-in-fierce-states/">reconstruction</a> and development projects such as Basila City (which ironically means “Peace City” in old Aramaic), Marouta and Homs Dream were then built on the land acquired via the ceasefire agreements. Likewise, during the Russian invasion of Ukraine, <a href="https://www.newsweek.com/evacuation-route-offered-fleeing-ukrainians-mined-1685418">humanitarian corridors</a> were implemented that allowed people from the besieged city of Mariupol to evacuate. Shortly afterwards, however, Ukrainian President Volodymyr Zelensky <a href="https://www.novinite.com/articles/214156/Zelensky+accused+Russia+of+Mining+Humanitarian+Corridors">accused</a> Russia of laying landmines within the corridors to thwart civilians’ ability to flee. In another example, humanitarian corridors that Russia <a href="https://www.reuters.com/markets/asia/top-wrap-1-ukrainians-trapped-besieged-city-fighting-blocks-evacuation-efforts-2022-03-07/">proposed</a> setting up would not lead civilians to safety, but rather into Russia or its close ally Belarus. Israel has similarly announced “<a href="https://www.bloomberg.com/news/articles/2023-10-16/israel-announces-another-safe-passage-for-gazans-to-move-south">safe corridors</a>” enabling <a href="https://www.aljazeera.com/features/2023/11/10/will-israels-humanitarian-pauses-mean-much-for-gaza-no-say-experts">mass displacement</a> of civilians from the north to the south of the country. The relocation is <a href="https://www.theguardian.com/world/2023/oct/13/israel-hamas-war-latest-gaza-residents-told-move-ground-assault">supposedly</a> for civilians’ own safety, despite the fact airstrikes are killing civilians there, too. Many also <a href="https://www.newarab.com/news/egypt-israeli-safe-zones-gaza-prelude-displacement">fear</a> the supposed “safe corridors” could lead to a permanent displacement of Gazans. Israel has reportedly also canvassed support for a <a href="https://www.nytimes.com/2023/11/05/world/middleeast/israel-egypt-gaza.html#:%7E:text=Israeli%2520leaders%2520and%2520diplomats%2520have,the%2520border%2520in%2520neighboring%2520Egypt.">humanitarian corridor</a> that would direct Palestinians towards the Sinai peninsula in Egypt, in effect making them an Egyptian problem with little possibility of return. The idea has unsurprisingly been rejected by both the Palestinians and Egypt. <h2>A ceasefire is only the beginning</h2> Despite all this, ceasefires are perhaps the best-formalised tools humans have so far devised to halt the violence of armed conflict for a time. Therefore, given the suffering of civilians on both sides in the Israel-Hamas conflict, it is imperative some form of ceasefire happens. However, we should not be blinded by calls for a ceasefire (whatever terms are used), but stay alert to the hazards that ceasefires can themselves create. In any case, a ceasefire that stops violence for four hours, four days or four months will only be the beginning of the more challenging work that needs to be done to bring meaningful and long-term security and stablity to both Palestinians and Israelis.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/217683/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/marika-sosnowski-1415833">Marika Sosnowski</a>, Postdoctoral research fellow, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-exactly-is-a-ceasefire-and-why-is-it-so-difficult-to-agree-on-one-in-gaza-217683">original article</a>.

Legal

Foul play suspected in tragic death of TV star's 15-year-old niece

Police are investigating the death of TV star Audrina Patridge’s 15-year-old niece, after her cause of death was revealed to be a drug overdose. Young Sadie passed away in February just nine days after her 15th birthday. Police are still looking into the exact manner of how the teenager died, as they are investigating different avenues of how the drugs entered her system. Sources have been trying to figure out how the teenager got her hands on narcotics, adding that police have learned that she allegedly used Snapchat to procure Percocet that was laced with fentanyl. Fentanyl is a synthetic opioid drug, which can be up to 100x stronger than typical opioid drugs like morphine. Fentanyl, a very fast acting medication, is a prescription drug used during surgeries and prescribed for very severe pain, often in late-stage cancers. Despite being an effective pain reliever, Fentanyl is also manufactured illegally and may be sold as powder, fake pills or mixed in with other illicit drugs, like heroin, with this combination being especially deadly. Audrina, known for her role on The Hills, shared the heartbreaking news in February that her niece had passed away in a 10-slide Instagram tribute. “My heart hurts to even write this. My beautiful niece is now in heaven,” she captioned the slide show that looked back on cherished memories. “I know it’s not goodbye forever, but it is the hardest to say goodbye for now. We will miss you and cherish every single moment we had with you. Rest in peace Say Say!! We love you forever & ever!” Image credits: Instagram

Legal

Can Israel and Hamas be held to account for alleged crimes against civilians?

<a href="https://theconversation.com/profiles/amy-maguire-129609">Amy Maguire</a>, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> <a href="https://www.redcross.org.au/ihl/">International humanitarian law</a> – the law of armed conflict – aims to constrain how wars are fought. It is designed to protect noncombatants and limit the means of warfare. As each hour brings news of further horror in the Israel-Hamas conflict, what role should international law be playing? And does it actually have any capacity to constrain the behaviour of the combatants? <h2>A humanitarian nightmare is unfolding</h2> On <a href="https://edition.cnn.com/2023/10/16/middleeast/israel-hamas-gaza-war-explained-week-2-mime-intl/index.html">October 7</a>, the Hamas militant group launched thousands of rockets against Israel in advance of a ground attack. Militants <a href="https://abcnews.go.com/International/live-updates/israel-gaza-hamas/?id=103804516#:%7E:text=ABC%20News%20Chief%20Global%20Affairs,war%20in%20Israel%20and%20Gaza.&text=At%20least%201%2C400%20people%20have,7%2C%20Israeli%20authorities%20said.">killed</a> more than 1,400 people and wounded 3,400 others in towns and kibbutzim across southern Israel. It was the <a href="https://theconversation.com/deadliest-day-for-jews-since-the-holocaust-spurs-a-crisis-of-confidence-in-the-idea-of-israel-and-its-possible-renewal-215507">deadliest day</a> for Jewish people since the Holocaust. Most of those killed were civilians, including many <a href="https://abcnews.go.com/International/horror-israeli-authorities-show-footage-hamas-atrocities-reporters-notebook/story?id=104015431#:%7E:text=It%20was%20part%20of%20the,injured%20in%20Israel%2C%20authorities%20said.">children</a> who were shot, blown up or burned to death. Hundreds of young people were also <a href="https://www.washingtonpost.com/world/2023/10/08/israel-festival-attack-gaza-militants/">massacred</a> at a music festival, and Hamas took around 200 <a href="https://www.reuters.com/world/middle-east/former-hamas-chief-meshaal-says-israeli-captives-include-high-ranking-officers-2023-10-16/">hostages</a> back to Gaza. Israel is responding to this attack with <a href="https://abcnews.go.com/International/live-updates/israel-gaza-hamas/?id=103804516#:%7E:text=ABC%20News%20Chief%20Global%20Affairs,war%20in%20Israel%20and%20Gaza.&text=At%20least%201%2C400%20people%20have,7%2C%20Israeli%20authorities%20said.">airstrikes</a>, which have to date <a href="https://www.wsj.com/livecoverage/israel-hamas-war-gaza-palestinians/card/latest-death-tolls-in-gaza-and-israel-xJRhBt04VQMocRuYUtsA">killed</a> at least 4,000 people in Gaza and injured thousands more. The vast majority of these casualties are Palestinian civilians. Israel has also rapidly mobilised around <a href="https://www.washingtonpost.com/world/2023/10/10/israel-military-draft-reservists/">360,000 reservists</a> in preparation for an anticipated ground offensive on Gaza. In recent days, a blast at a <a href="https://www.nytimes.com/2023/10/17/world/middleeast/gaza-hospital-explosion-israel.html">Gaza hospital</a> killed hundreds, including patients and displaced people seeking sanctuary. Hamas and several Arab states have <a href="https://www.theguardian.com/world/2023/oct/18/israel-faces-blame-from-regional-allies-over-gaza-hospital-deaths">blamed</a> Israel for the explosion, while Israel has <a href="https://www.nytimes.com/2023/10/17/world/middleeast/islamic-jihad-gaza-hospital-israel.html">blamed</a> Palestinian Islamic Jihad. The situation in Gaza is dire for people with urgent needs, including <a href="https://www.abc.net.au/news/2023-10-18/israel-gaza-war-live-updates-october-18/102989182?utm_campaign=abc_news_web&utm_content=link&utm_medium=content_shared&utm_source=abc_news_web#live-blog-post-55243">5,000 women</a> due to give birth this month and <a href="https://www.nytimes.com/2023/10/16/world/middleeast/gaza-evacuation-twin-babies-hospital.html#:%7E:text=The%20babies%2C%20Nuha%20and%20Fatin,of%20an%20Israeli%20ground%20invasion.">newborn babies</a> whose families cannot find drinking water to prepare formula. Meanwhile, Israel has <a href="https://www.theguardian.com/world/2023/oct/12/no-power-water-or-fuel-to-gaza-until-hostages-freed-says-israeli-minister">cut off</a> water, electricity and fuel supplies to Gaza and ordered a <a href="https://theconversation.com/gaza-is-being-strangled-why-israels-evacuation-order-violates-international-law-215787">total siege</a> of the territory. Israel has also ordered residents of northern Gaza to <a href="https://www.hrw.org/news/2023/10/16/why-israels-gaza-evacuation-order-so-alarming">evacuate</a> to the south. Aid agencies have been unable to provide desperately needed <a href="https://time.com/6324539/israel-gaza-humanitarian-aid-egypt-border/">humanitarian assistance</a> to civilians through the border crossing with Egypt. Prior to this latest horrific escalation, Gaza was already entrenched in a <a href="https://theconversation.com/gaza-has-been-blockaded-for-16-years-heres-what-a-complete-siege-and-invasion-could-mean-for-vital-supplies-215359">humanitarian crisis</a>. The situation now is beyond comprehension. <a href="https://www.abc.net.au/listen/programs/radionational-breakfast/gaza-610/102983118">Léo Cans</a>, the head of mission for Doctors Without Borders in Palestine, said hospitals are being overwhelmed and hundreds will die without electricity being restored: "This is something that is known and could be prevented just by letting fuel and supplies inside Gaza. What is ahead of us is beyond words […] at the end of the road it’s a big wall, and this big wall is full of dead people." <h2>Principles governing the conduct of war</h2> International humanitarian law is a pragmatic body of law. Its existence acknowledges the inevitability of armed conflict and it aims to mitigate war’s impact on people. International humanitarian law is not, in itself, concerned with the justifications for why combatants engage in war. It applies even in situations where a state is entitled to act in self-defence under broader international law. We are witnessing gross violations of fundamental humanitarian law principles in the conflict. Here are some examples: Distinction between civilians and combatants Attacks are considered <a href="https://ihl-databases.icrc.org/en/ihl-treaties/api-1977/article-51">unlawful</a> if they are: <ul> <li> directed specifically against civilians </li> <li> launched indiscriminately without distinction between civilians and combatants </li> <li> or directed at military targets but anticipated to cause harm to civilians disproportionate to the military advantage being sought. </li> </ul> Methods of warfare It is <a href="https://casebook.icrc.org/law/conduct-hostilities#iii_1">unlawful</a> to conduct war in a manner that causes unnecessary suffering. Attacks targeting civilians are fundamentally unnecessary and, therefore, illegal. Collective punishment The fourth Geneva Convention prohibits <a href="https://ihl-databases.icrc.org/en/ihl-treaties/gciv-1949/article-33">collective punishment</a>: "No protected person may be punished for an offence he or she has not personally committed. Collective penalties and likewise all measures of intimidation or of terrorism are prohibited." This prohibition reflects the idea of <a href="https://guide-humanitarian-law.org/content/article/3/collective-punishment/">individual criminal responsibility</a> under international criminal law. Prosecutions for breaches of humanitarian law are directed towards individuals who can be proven responsible, rather than against states or populations. Humanitarian protection Common Article 3 of the Geneva Conventions requires <a href="https://www.icrc.org/en/doc/war-and-law/treaties-customary-law/geneva-conventions/overview-geneva-conventions.htm">humane protection</a> for all people in enemy hands. It prohibits murder and hostage-taking. It also requires the provision of humanitarian assistance to all people without distinction. Obligations of occupying powers It is arguable Israel is a de facto occupying power of the Gaza Strip because it has such a <a href="https://theconversation.com/gaza-is-being-strangled-why-israels-evacuation-order-violates-international-law-215787">high level of control</a> over people’s lives. For example, it has the ability to shut off supplies of essential life services. The argument Israel is occupying Gaza will be strengthened should Israel launch a ground invasion. As such, the rules of international humanitarian law on occupiers are also relevant. These include an obligation to <a href="https://ihl-databases.icrc.org/en/ihl-treaties/hague-conv-iv-1907/regulations-art-43#:%7E:text=Regulations%3A%20Art.-,43,in%20force%20in%20the%20country.">protect</a> civilians from attacks and <a href="https://humanrights.gov.au/our-work/commission-general/international-covenant-civil-and-political-rights-human-rights-your#:%7E:text=opinions%20without%20interference.-,2.,other%20media%20of%20his%20choice.">respect their human rights</a>. <h2>Hamas and humanitarian law</h2> International humanitarian law applies to all combatants, whether they are state or non-state actors. UN independent experts say Hamas has clearly committed <a href="https://www.ohchr.org/en/press-releases/2023/10/israeloccupied-palestinian-territory-un-experts-deplore-attacks-civilians">war crimes</a>, including the murders and hostage-taking of Israeli civilians. Hamas also put Palestinian civilians in harm’s way by <a href="https://www.reuters.com/world/middle-east/hamas-tells-gaza-residents-stay-home-israel-ground-offensive-looms-2023-10-13/#:%7E:text=Eyad%20Al%2DBozom%2C%20spokesman%20for,your%20homes%2C%20and%20your%20places.">telling them</a> not to evacuate to southern Gaza, as ordered by Israel. The group has a history of using civilians as <a href="https://theconversation.com/how-the-laws-of-war-apply-to-the-conflict-between-israel-and-hamas-215493">human shields</a> as a <a href="https://stratcomcoe.org/cuploads/pfiles/hamas_human_shields.pdf">strategic tool</a> in conflicts with Israel. However, holding Hamas accountable for violating international humanitarian law is very challenging. As a non-state actor, Hamas is not a member of forums like the United Nations, where pressure may be brought to bear on member states. If individual Hamas militants are apprehended, they could be charged with <a href="https://www.thenewhumanitarian.org/interview/2023/10/17/how-have-israel-and-hamas-broken-laws-war">war crimes</a> and tried in Israeli courts or the International Criminal Court. Even though Hamas is a non-state actor, <a href="https://www.icc-cpi.int/victims/state-palestine">Palestine</a> has accepted the court’s jurisdiction. In fact, the International Criminal Court opened an <a href="https://www.lawfaremedia.org/article/where-does-the-icc-palestine-investigation-stand">investigation</a> into alleged war crimes in Palestine in 2021. The current Gaza conflict would fall within the court’s mandate and could lead it to direct greater energy to that ongoing investigation. The court’s chief prosecutor, Karim Khan, said on October 13: "We have jurisdiction for any Rome Statute crimes […] committed by Palestinians in Israel and also we have clear jurisdiction for any crimes committed by the forces of Israel in Palestine." <h2>Israel and humanitarian law</h2> Israel and its allies also have a complex relationship with international humanitarian law. One key issue is Israel’s right to self-defence in response to the October 7 attack by Hamas. International law confirms a state may use force to <a href="https://casebook.icrc.org/a_to_z/glossary/self-defence#:%7E:text=Self%2Ddefense%20in%20international%20law,Charter%20and%20customary%20international%20law.">defend</a> itself in response to an armed attack. Israel, the United States and other allies <a href="https://www.whitehouse.gov/briefing-room/speeches-remarks/2023/10/10/remarks-by-president-biden-on-the-terrorist-attacks-in-israel-2/">contend</a> the Hamas attack triggered Israel’s <a href="https://www.foreignminister.gov.au/minister/penny-wong/speech/speech-senate-hamas-attacks-israel-senate-motion-parliament-house">right to self-defence</a>. But there is a distinction to be drawn between a state’s right to self-defence and what that right permits, in the sense of how war is conducted. For example, UN independent experts have <a href="https://www.ohchr.org/en/press-releases/2023/10/israeloccupied-palestinian-territory-un-experts-deplore-attacks-civilians">condemned</a> Israel’s “indiscriminate military attacks” against Palestinian civilians: "This amounts to collective punishment. There is no justification for violence that indiscriminately targets innocent civilians, whether by Hamas or Israeli forces. This is absolutely prohibited under international law and amounts to a war crime." Neither <a href="https://arabcenterdc.org/resource/the-international-criminal-courts-failure-to-hold-israel-accountable/">Israel</a> nor the <a href="https://www.hrw.org/news/2020/09/02/qa-international-criminal-court-and-united-states">United States</a> is a party to the International Criminal Court. Neither state would accept the court’s jurisdiction over its nationals. Indeed, the United States has <a href="https://www.state.gov/the-united-states-opposes-the-icc-investigation-into-the-palestinian-situation/">condemned</a> the court’s decision to open its investigation into alleged war crimes in Palestine. In time, the court may seek to hold Israeli nationals accountable for war crimes, but its capacity to do so seems very limited. <h2>What about the United Nations?</h2> UN Secretary-General Antonio Guterres has <a href="https://www.voanews.com/a/un-s-guterres-denounces-collective-punishment-of-palestinians/7315616.html">called</a> for an immediate ceasefire. He said the grievances of the Palestinian people after more than 50 years of occupation do not “justify the acts of terror committed by Hamas”. And he said the Hamas attack on October 7 does not “justify the collective punishment of the Palestinian people”. UN human rights chief Volker Türk has also <a href="https://www.ctvnews.ca/world/un-human-rights-lead-warns-of-consequences-for-breaching-humanitarian-law-amid-israel-hamas-war-1.6605453">warned</a> all parties that violations of humanitarian law will have consequences, and those who commit war crimes will be held accountable. But the <a href="https://www.un.org/securitycouncil/#:%7E:text=The%20Security%20Council%20has%20primary,to%20comply%20with%20Council%20decisions.">UN Security Council</a>, which is charged with maintaining international peace and security, has yet to agree on a <a href="https://news.un.org/en/story/2023/10/1142467">statement</a> on the conflict. The <a href="https://reliefweb.int/report/occupied-palestinian-territory/4-members-favour-5-against-security-council-rejects-russian-federations-resolution-calling-immediate-humanitarian-ceasefire-israel-palestine-crisis">debate</a> in the council since the latest escalation in this perpetual conflict demonstrates the deep diplomatic fault lines between the key global players and the warring parties. At this point, a sad reality is that international law and global institutions can do little to constrain the actions of the combatants on both sides or provide assistance to the millions at grave risk of harm.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/215705/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/amy-maguire-129609">Amy Maguire</a>, Associate Professor in Human Rights and International Law, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/can-israel-and-hamas-be-held-to-account-for-alleged-crimes-against-civilians-215705">original article</a>.

Legal

Little House on the Prairie star passes away

Hersha Parady, renowned for her role in Little House on the Prairie, has passed away at the age of 78. According to a statement provided to The Hollywood Reporter by her son, Jonathan Peverall, Parady passed away at her residence in Norfolk, Virginia on Wednesday August 23. Her son had been actively seeking financial assistance before her demise, as Parady had been diagnosed with meningioma, a prevalent type of brain tumour. Peverall initiated a <a href="https://www.gofundme.com/f/helping-hersha" target="_blank" rel="noopener">GoFundMe campaign</a> with the intention of aiding his mother's escalating medical expenses. In a heartfelt plea on the fundraising page, he recounted how the illness had depleted her vitality, memory and vibrant demeanour, rendering her predominantly bedridden and struggling with day-to-day tasks. Relocating his mother to his own home, Peverall worked diligently to ensure she received the necessary medical attention. He emphasised that the associated costs extended beyond medical procedures, encompassing aspects such as moving expenditures, at-home nursing care and medical equipment. "While we contemplate a surgery to potentially ameliorate her condition, the path to recovery is an arduous one," he stated, acknowledging the substantial financial burden posed by these circumstances. Balancing a full-time job and caring for his three children added to the challenge, yet he reassured that they were providing the best care they could, regardless of external contributions. "Rest assured, we are taking care of her to the best of our ability, and we will continue to do so, regardless of any contributions made here," Peverall wrote. "This GoFundMe is about improving my Mom’s quality of life and giving her the support she needs during this difficult time. It's also about showing her that she is not alone in her fight. "Her family and friends have been here supporting her through everything, but there is only so much help she is willing to accept from the people she loves. My Mom has always been a fiercely independent woman, and asking for help isn't in her nature. That's why I'm stepping in to do it on her behalf." Peverall expressed his gratitude and urged supporters to rally around Parady, demonstrating that her on-screen "Little House" family was united in this battle, just as she had been a presence in their lives through the show. In an update dated August 1, Peverall shared that his mother had undergone a "successful" surgery. However, complications arose as Parady developed pneumonia during her recovery, leading to her admission to the intensive care unit. Unfortunately, her condition deteriorated to a point where she couldn't regain full consciousness. The medical team at the hospital launched an investigation into her condition. Peverall maintained ongoing communication with the medical professionals, seeking insights to guide the best decisions for her care. Despite the trying circumstances, he expressed hope and called upon others to remain optimistic. Parady embarked on her career in theater after graduating from Berea High School in 1963. Her journey took her to Los Angeles, where she secured a role opposite Jon Voight in a production of A Streetcar Named Desire. Subsequently, she transitioned to the silver screen, featuring in an episode of Bearcats!. However, it was in 1977 that Parady achieved widespread recognition for her portrayal of school teacher Alice Garvey in the fourth season of Little House on the Prairie. Appearing in 35 more episodes, her character, Alice, met a tragic end in season six, perishing in a fire. The actress also appeared in other shows including Kenan & Kel, The Phoenix, and The Quest, and movies like The Break and The Babysitter's Seduction. Parady is survived by her son Jonathan Peverall and her three grandchildren. Images: GoFundMe / Instagram

News

Ozempic is in the spotlight but it’s just the latest in a long and strange history of weight-loss drugs

<a href="https://theconversation.com/profiles/laura-dawes-1445353">Laura Dawes</a>, <a href="https://theconversation.com/institutions/australian-national-university-877">Australian National University</a> Losing weight conveniently, cheaply, safely. That’s been the holy grail of weight-loss ever since 19th century English undertaker and weight-loss celebrity William Banting’s 1863 <a href="https://www.gutenberg.org/files/57545/57545-h/57545-h.htm">Letter on Corpulence</a> spruiked his “miraculous” method of slimming down. Since then, humans have tried many things – diet, exercise, psychotherapy, surgery – to lose weight. But time and again we return to the promise of a weight-loss drug, whether it’s a pill, injection, or tonic. A “diet drug”. The <a href="https://www.hup.harvard.edu/catalog.php?isbn=9780674281448#:%7E:text=Childhood%2520Obesity%2520in%2520America%2520traces,problem%2520facing%2520American%2520children%2520today.">history of diet drugs</a> is not a glowing one, however. There have been so many popular drug treatments for excess weight over the years. All, however, have eventually lost their shine and some have even been banned. <h2>Ozempic is a recent arrival</h2> <a href="https://www.novonordisk.com/our-products/our-medicines.html">Ozempic and its sister drug Wegovy</a>, both manufactured by Novo Nordisk, are the latest offerings in a long history of drug treatments for people who are overweight. They contain the same active ingredient – semaglutide, which mimics a hormone, <a href="https://www.sciencedirect.com/science/article/abs/pii/S1544319118303273">GLP-1</a> (glucagon-like peptide-1) that acts on the hypothalamus (the brain’s “hunger centre”) to regulate appetite. As an obesity treatment, semaglutide appears to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573908/">work</a> in part by reducing appetite. These are injections. And there can be <a href="https://www.novonordisk.com.au/content/dam/nncorp/au/en/pdfs/Ozempic-1mg-cmi-v3.0.pdf%22%22">side effects</a>, most commonly nausea and diarrhoea. Although marketed as treatments for chronic obesity and diabetes, they have <a href="https://www.forbes.com/health/body/ozempic-for-weight-loss/#footnote_1">exploded in popularity</a> as diet drugs, largely thanks to social media. This has helped drive a <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023#:%7E:text=Why%2520the%2520Ozempic%2520shortage%2520happened,label%2520prescribing%2520for%2520weight%2520loss.">shortage of Ozempic</a> for diabetes treatment. <h2>From ‘gland treatment’ to amphetamines</h2> But Ozempic is not the first weight-loss drug. For example, organotherapy (gland treatment) was <a href="https://www.hup.harvard.edu/catalog.php?isbn=9780674281448#:%7E:text=Childhood%20Obesity%20in%20America%20traces,problem%20facing%20American%20children%20today.">hugely popular</a> in the 1920s to 1940s. It rode on a wave of enthusiasm for endocrinology and specifically the discovery that “ductless glands” – such as the thyroid, pituitary and renal glands – secreted chemical messengers (or “hormones”, as they came to be known). These hormones coordinate the activities and growth of different parts of the body. Doctors prescribed overweight people extracts of animal glands – either eaten raw or dried in pill form or injected – to treat their <a href="https://www.hup.harvard.edu/catalog.php?isbn=9780674281448#:%7E:text=Childhood%20Obesity%20in%20America%20traces,problem%20facing%20American%20children%20today.">supposedly “sluggish glands”</a>. For slaughterhouse companies, this was a lucrative new market for offal. But organotherapy soon fell from favour. There was no evidence excess weight was usually caused by underperforming glands or that gland extracts (thyroid in particular) were doing anything other than <a href="https://my.clevelandclinic.org/health/diseases/21741-thyrotoxicosis">poisoning you</a>. <a href="https://nyupress.org/9780814776391/on-speed/">Amphetamines</a> were first used as a nasal decongestant in the 1930s, but quickly found a market for weight-loss. Why they worked was complex. The drug operated on the hypothalamus but also had an effect on mental state. Amphetamine is, of course, an “upper”. The theory was it helped people feel up to dieting and gave pleasure not found on a plate. Amphetamines too, <a href="https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2007.110593">fell from treatment use</a> in the 1970s with Nixon’s “war on drugs” and recognition they were addictive. <h2>Another decade, another drug</h2> Each decade seems to produce its own briefly popular weight-loss drug. For example, the popular <a href="https://www.nytimes.com/1997/09/23/science/how-fen-phen-a-diet-miracle-rose-and-fell.html">diet drug</a> of the 1980s and 90s was fen-phen, which contained appetite suppressants fenfluramine and phentermine. During the height of its craze, vast numbers of users testified to dramatic weight loss. But after users experienced heart valve and lung disease, fen-phen was <a href="https://pubmed.ncbi.nlm.nih.gov/9688104/">withdrawn</a> from the market in 1997. Its producer allocated a <a href="https://www.bloomberg.com/news/articles/2012-08-23/pfizer-asks-end-to-fen-phen-suits-linked-to-lung-ailment">reported US$21 billion</a> to settle the associated lawsuits. The hormone <a href="https://www.webmd.com/obesity/features/the-facts-on-leptin-faq">leptin</a> aroused excitement in the mid-1990s. Leptin seemed, for a brief moment, to hold the key to how the hypothalamus regulated fat storage. Pharmaceutical company Amgen <a href="https://www.science.org/doi/10.1126/science.7732366">wagered millions</a> buying the <a href="https://pubmed.ncbi.nlm.nih.gov/30532682/">rights</a> to the research in the hope this discovery could be turned into a treatment, only to discover it didn’t translate from mice into people. Far from not having enough leptin, people with obesity tend to be <a href="https://www.healthline.com/nutrition/leptin-101">leptin-resistant</a>. So taking more leptin doesn’t help with weight-loss. Amgen <a href="https://news.harvard.edu/gazette/story/2009/01/obesity-reviving-the-promise-of-leptin/">sold</a> the rights it had paid so much for. <a href="https://www.healthline.com/nutrition/ephedra-sinica">Ephedra</a> was popular as a weight-loss treatment and as a stimulant in the 1990s and 2000s, finding buyers among athletes, body builders and in the military. But the US Food and Drug Administration <a href="https://ods.od.nih.gov/HealthInformation/Ephedra.aspx">banned</a> the sale of dietary supplements containing ephedra in 2004 after it was linked to <a href="https://www.nejm.org/doi/full/10.1056/nejmc1502505">health problems</a> ranging from heart attacks and seizures to strokes and even death, and in Australia ephedra is <a href="https://www.legislation.gov.au/Details/F2023L00864">prescription-only</a>. Now we have Ozempic. Just because the history of diet drugs has <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3362858/">been so dire</a>, we shouldn’t jump to conclusions about new ones – Ozempic is not a drug of the 1920s or 1960s or 1990s. And as <a href="https://www.hup.harvard.edu/catalog.php?isbn=9780674281448#:%7E:text=Childhood%2520Obesity%2520in%2520America%2520traces,problem%2520facing%2520American%2520children%2520today.">history recognises</a>, multiple complexities can combine to push a drug into popularity or damn it to history’s rubbish bin. These include patients’, physicians’ and industry interests; social attitudes about drug treatment; evidence about safety and efficacy; beliefs and knowledge about the cause of excess weight. One noticeable contrast with past diet drug experiences is that now, many people are <a href="https://www.nytimes.com/2022/11/22/well/ozempic-diabetes-weight-loss.html">happy to talk</a> about using Ozempic. It seems to be increasingly socially acceptable to use a drug to achieve weight-loss for primarily aesthetic reasons. (Due to Ozempic shortages in Australia, though, doctors have been <a href="https://www.tga.gov.au/safety/shortages/medicine-shortage-alerts/ozempic-semaglutide-supply-update">asked</a> to direct current supplies to people with type 2 diabetes who satisfy certain criteria. In other words, it’s not really meant to be used just to treat obesity). <h2>Our enduring search for weight-loss drugs</h2> Ozempic is predicted to earn Novo Nordisk <a href="https://www.pharmaceutical-technology.com/comment/novo-nordisk-ozempic/">US$12.5 billion this year alone</a>, but it’s not just industry interests stoking this enduring desire for weight-loss drugs. Patients on an endless cycle of dieting and exercise want something more convenient, with a more certain outcome. And doctors, too, want to offer patients effective treatment, and a drug prescription is a workable option given the constraints of appointment times. The body positivity movement has not yet ousted anti-fat bias or stigma. And despite <a href="https://www.who.int/teams/health-promotion/enhanced-wellbeing/first-global-conference">decades of recognition</a> of the major role our physical and social environment plays in human health, there’s little political, public or industry appetite for change. Individuals are left to personally defend against an obesogenic environment, where economic, cultural, social, health and urban design policies can conspire to make it easy to gain weight but hard to lose it. It is no wonder demand for weight-loss drugs continues to soar.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/209324/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/laura-dawes-1445353">Laura Dawes</a>, Research Fellow in Medico-Legal History, <a href="https://theconversation.com/institutions/australian-national-university-877">Australian National University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/ozempic-is-in-the-spotlight-but-its-just-the-latest-in-a-long-and-strange-history-of-weight-loss-drugs-209324">original article</a>.

Body

Promising Alzheimer’s drug offers hope for a bright future in treatment

A remarkable and significant breakthrough in the fight against Alzheimer’s disease is ushering in a new era of hope and possibilities for patients grappling with early onset dementia. Scientists and researchers are celebrating this groundbreaking development, viewing it as a tremendous opportunity to transform the landscape of Alzheimer's treatment. The drug in question, donanemab, developed by Eli Lilly, has shown remarkable success in clinical trials and is anticipated to receive approval from the Food and Drug Administration later this year, according to a report in the <a href="https://nypost.com/2023/07/17/alzheimers-drug-donanemab-lowers-risk-of-dementia/" target="_blank" rel="noopener">New York Post</a>. Individuals who participated in the donanemab trials experienced a remarkable 40% reduction in the risk of transitioning from mild cognitive impairment to mild or moderate dementia. This is an extraordinary advancement that brings renewed optimism to those affected by this devastating condition. Donanemab would be the third Alzheimer’s drug to emerge in recent months, following the introduction of Leqembi and Aduhelm. This is just the beginning of an exciting new chapter in the realm of molecular therapies for Alzheimer's, as expressed by Dr. Gil Rabinovici, director of the University of California San Francisco’s Memory and Ageing Centre, in an editorial for JAMA. Dr. Daniel Skovronsky, the chief scientific and medical officer at Lilly, has emphasised the significance of this breakthrough. He states, "This will be a very important and meaningful drug," as quoted in Fierce Biotech. Skovronsky further adds, "[T]here’s a huge opportunity here for patients." Such resolute optimism is inspiring, reflecting the tremendous potential this drug holds for transforming lives. Similar to Leqembi and Aduhelm, donanemab is a monoclonal antibody designed to target plaque in the brain, specifically the amyloid protein. These amyloid plaques are responsible for the propagation of another protein called tau, which contributes to the development of Alzheimer's disease. Notably, the donanemab trial also revealed that the drug slowed cognitive decline by an impressive 35% compared to a placebo in individuals with low to intermediate levels of tau protein in the brain. In fact, donanemab demonstrated superior efficacy in clearing amyloid plaques when compared to Aduhelm and Leqembi. Moreover, unlike Leqembi, which necessitates long-term usage, patients taking donanemab may follow a fixed-duration dosing schedule, potentially allowing some individuals to discontinue the treatment after a certain period. "I expect that many patients will be able to stop dosing even as soon as 12 months," Skovronsky affirmed. This stands as a significant departure from being prescribed a lifelong medication, providing an exciting and meaningful prospect for patients. While it is important to note that these new Alzheimer’s drugs do carry limitations and risks, medical experts remain cautiously optimistic. Donanemab, along with the other emerging drugs, has been associated with brain swelling and bleeding. Tragically, three individuals in the donanemab clinical trial lost their lives due to these side effects. The risk of brain swelling and bleeding is heightened among those carrying the APOE4 gene, which is associated with an increased susceptibility to Alzheimer’s. Furthermore, individuals with more advanced stages of the disease showed minimal to no benefit compared to those who received a placebo. As a result, it is possible that donanemab will be recommended primarily for individuals with low to intermediate levels of tau proteins, indicating milder forms of the disease. Nevertheless, Skovronsky and other medical experts maintain their optimism regarding the FDA's approval, expressing the urgent need for it to come to fruition. Skovronsky highlights, "Every day that goes by, there are some patients who pass through this early stage of Alzheimer’s disease and become more advanced, and they won’t benefit from treatment. That’s a very pressing sense of urgency." While challenges and risks remain, the emergence of donanemab and its potential approval by the FDA represents a beacon of hope for the millions of individuals and families affected by Alzheimer's disease. It symbolises the start of a new chapter in the fight against this debilitating condition, offering renewed prospects for a brighter future filled with effective treatments and improved quality of life. Image: Shutterstock

Mind

Thor and Star Wars actor dies suddenly just days before birthday

Actor Ray Stevenson, best known for his work in the Marvel and Star Wars universes, has passed away at 58, just four days shy of his 59th birthday. No cause of death has been made public, but the news was confirmed to Variety through one of the late actor’s representatives, and Italian publication La Repubblica reported that he had been hospitalised shortly before he passed away. Stevenson was in Italy working on his upcoming action movie, Cassino in Ischia, at the time of his death. The Irish-born actor will be remembered by loved ones - those who knew him in real life and those who knew him through his wide range of film, TV, and theatre projects - and by the entertainment industry at large. Born in Northern Ireland in 1864, Steven moved to England with his family at the age of eight, and discovered his calling as an actor after witnessing John Malkovich in a West End theatre production. Stevenson went on to study acting, landing one of his first roles in television in The Dwelling Place, before establishing his place on the screen in a number of other British series, from the likes of Waking the Dead to Dalziel and Pascoe, and At Home with the Braithwaites. His career in Hollywood found its feet with his role in the 2004 King Arthur movie, where he took on the role of one of the Knights of the Round Table. And just four years later, Stevenson made a name for himself in the fan-favourite Marvel universe, playing the titular character Frank Castle in Punisher: War Zone. He was the third actor to ever portray Punisher on screen. Stevenson went on to appear in the likes of The Book of Eli, The Three Musketeers, and the Divergent series, before making his return to Marvel with Thor, where he played one of the god’s Warriors Three up until Thor: Ragnarok. He wasn’t to stop at Marvel, however, with the actor taking on the challenge - and opportunity - of voicing a character in the hit animated Star Wars TV series Clone Wars and Rebels as Mandalorian Gar Saxon. He was set to make his return to that same expanded universe, but this time with his own face at the forefront as a Jedi known as Baylan Skoll, in the upcoming live action Ahsoka series. His co-stars in that series were devastated to hear of his loss, with the show’s lead and Ahsoka’s actress - Rosario Dawson - posting a touching tribute to social media, alongside a series of pics with the late star. “A giant of a man… stunned and reeling from this tragic, devastating news. Gone too soon from this world,” she wrote. “At a loss for words… just wanted to mark this moment and share your ever ready and present smile. Love you forever. Holding your family in my heart.” <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/p/Csjo9svpyue/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/Csjo9svpyue/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by rosariodawson (@rosariodawson)</a> </div> </blockquote> “Cherishing this time we got to spend together this past year,” fellow Ahsoka actress Natasha Liu Bordizzo wrote, sharing Dawson’s post, “your giant heart, belly laughs and spirited zest for life will be sorely missed.” “RIP Ray Stevenson, whose turn as Titus Pullo on ROME is one of the greatest effortlessly charming performances of TV's golden age,” one fan shared. “A warm guy, by all accounts, and a serious craftsman. He'll be sorely missed.” “I’m shocked and saddened by the tragic news that a great actor and my good friend Ray Stevenson has passed away. I will miss you Big Ray!” wrote Scott Atkins, who starred in Accident Man with Stevenson. “Life is short so make the most of it people.” As Stevenson’s former Rome co-star James Purefoy said, “so sad to hear the news that Ray Stevenson, our Pullo in Rome, has passed away. A brilliant, gutsy, larger-than-life actor who filled every part he played right up to the brim. “My thoughts are with his family, his lovely wife Betta and their beautiful kids. What a loss.” “Ray… My heart is shattered and I can’t fathom you not being here. My dear friend. My Master. A giant with an even bigger heart,” a heartbroken Ivanna Sakhno, another Ahsoka star, said in her tribute. “You understood the infinite. Your love for life, your partner Elisabetta and your 3 boys was unyielding. Knowing you in this lifetime had been one of the greatest gifts. “I carry your light within me. Fly freely, Blackbird.” Images: Getty

News

Put your Star Wars knowledge to the test

While May 4 is not a public holiday, for passionate Star Wars fans around the world, it may as well be. Whether you prefer to dress-up with friends and celebrate with a mega movie marathon - after hours spent deciding which trilogy to begin with, of course - or scroll your favourite forums to find that next snippet of news about any upcoming projects, it’s fun to have the odd fun fact to drop into conversation, whether or not your present company particularly wants to hear it. And now’s the time to put your knowledge to the test, with some Star Wars trivia to challenge and to impress - especially if you get that perfect 15/15. So, “may the Force be with you”, and don’t forget to scroll to the bottom for the answers! 1. What was the false working title used to mask production for Star Wars Episode VI: Return of the Jedi in 1982? A: Blue Moon B: Blue Harvest C: Force Squadron D: Galaxy’s Edge 2. The term ‘Ewok’ was never said aloud in the original trilogy. A: True B: False 3. Who delivered the line “congratulations, you are being rescued” in Rogue One: A Star Wars Story? A: Cassian Andor B: C-3PO C: K-2SO D: Orson Krennic 4. How many actresses have portrayed (in the live action films) the leader of the Rebel Alliance, Mon Mothma? A: 4 B: 3 C: 2 D: 1 5. Which movie features the most stop-motion animation? A: The Phantom Menace B: Empire Strikes Back C: Return of the Jedi D: A New Hope 6. Why are porgs so prominent in The Last Jedi? A: Director Rian Johnson was asked by a crew member’s child to include the feathered friends B: The marketing team had requested something small and fuzzy for the younger audience C: Porgs were inspired by early concept art for BB-8 that they didn’t want to toss aside completely D: The island on which they filmed was home to puffins and it was easier just to tie them in 7. Yoda shares a voice actor with which iconic Muppet? A: Miss Piggy B: Kermit C: Gonzo D: Swedish Chef 8. How many films does the Rebel Alliance’s Blue Squadron appear in? A: 1 B: 2 C: 3 D: 4 9. Which phrase can be heard in every Star Wars movie? A: “There’s no such thing as luck.” B: “Rebellions are built on hope.” C: “I have a bad feeling about this.” D: “Never underestimate a droid.” 10. In The Phantom Menace, Qui-Gon Jinn used which common household item as his communicator? A: A lint brush B: A torch C: A tin of shoe polish D: A razor 11. How many Sith can there be at any one time? A: 8 B: 6 C: 4 D: 2 12. What was Luke Skywalker originally going to be called? A: Luke Stardestroyer B: Luke Starkiller C: Luke Skykiller D: Luke Lars 13. The noise from passing which object served as the inspiration for lightsaber sounds? A: A radio B: A microwave C: A television D: A racecar 14. Which quote is correct? A: “No, I am your father.” B: “Luke, I am your father.” 15. Who built C-3PO? A: Luke Skywalker B: Jar Jar Binks C: Shmi Skywalker D: Anakin Skywalker Images: Getty ANSWERS: <blockquote> 1: A, 2: A, 3: C, 4: C, 5: B, 6: D, 7: A, 8: A, 9: C, 10: D, 11: D, 12: B, 13: C, 14: A, 15: D </blockquote>

Movies

New lessons about old wars: keeping the complex story of Anzac Day relevant in the 21st century

What happened on the Gallipoli peninsula in Turkey 108 years ago has shocked and shaped Aotearoa New Zealand ever since. The challenge in the 21st century, then, is how best to give contemporary relevance to such an epochal event. The essence of the Anzac story is well known. As part of the first world war British Imperial Forces, the Australian and New Zealand Army Corps (Anzacs) landed at Gallipoli on April 25 1915. For eight months they endured the constant threat of death or maiming in terrible living conditions. Ultimately, their occupation of that narrow and rugged piece of Turkish coast failed. The 30,000 Anzacs were evacuated after eight months. More than 2,700 New Zealand and 8,700 Australian soldiers died, with many more wounded. The <a href="https://nzhistory.govt.nz/war/anzac-day-resources">first anniversary</a> of the landing was a day of mourning, with Anzac Day becoming a public holiday in 1922. A remembrance day of sorrow mixed with pride, it has grown over the years to include all those who served and died in later international conflicts. Over time, various narratives and themes have emerged from that Gallipoli “origin story”: of Aotearoa New Zealand’s emergence as a nation, proving itself to Britain and Empire; of the brave, fit, loyal soldier-mates who emblemised the Kiwi spirit of egalitarianism, fairness and duty. All this mingled with the lasting shock and underlying anger at class hierarchy and the British leadership’s incompetence. But historians know well that the “Anzac spirit” is a complex and ever-evolving idea. In 2023, what do we teach school-aged children about its meaning and significance? One way forward is to rethink those Anzac narratives and tropes in a more complex way. <h2>Colonialism and class</h2> The Anzac story is tied up in the nation’s history as part of the British Empire. The Anzac toll was just part of a staggering 46,000 “Britons” – including many from India and Ireland – who died at Gallipoli. Some 86,000 Turks also died defending their peninsula. We need to teach about the Anzac sacrifice in the context of a global conflict where the magnitude of loss was horrific. Importantly, Anzac themes are bound up in early forms of colonial nationalism: New Zealand proving itself to Britain and developing its own fighting mentality on battlefields far from home. Part of this involves the notion of incompetent British commanders who let down the Anzac troops – but this is part of a bigger story. Focusing on imperial and class hierarchies of the time can place what happened in that broader context. The legendary story of <a href="https://nzhistory.govt.nz/wellington-battalion-captures-chunuk-bair">Chunuck Bair</a>, taken on August 8 by Colonel William Malone’s Wellington Regiment, but where most of the soldiers were killed when they weren’t relieved in time, is particularly evocative. <h2>Māori and the imperial project</h2> From our vantage point in the present, of course, we cannot ignore the Māori experience of war and colonialism. As the historian Vincent O’Malley has suggested, New Zealand’s “great war” of nation-making was actually <a href="https://teara.govt.nz/en/new-zealand-wars">Ngā pakanga o Aotearoa</a> – the New Zealand Wars. It’s time to teach the complexity of this past and the multiple perspectives on it. For example, Waikato leader <a href="https://nzhistory.govt.nz/people/te-kirihaehae-te-puea-herangi">Te Puea Hērangi</a>led opposition to WWI conscription and spoke against Māori participation on the side of a power that had only recently invaded her people’s land. Conversely, Māori seeking inclusion in the settler nation did participate. On July 3 1915, the 1st Māori Contingent landed at Anzac Cove. <a href="https://teara.govt.nz/en/biographies/3b54/buck-peter-henry">Te Rangi Hiroa</a> (Sir Peter Buck) (Ngāti Mutunga) was to say, "Our feet were set on a distant land where our blood was to be shed in the cause of the Empire to which we belonged." These words echo the familiar Anzac trope of the New Zealand nation being born at Gallipoli. Such sentiments led to postwar pilgrimages to retrace the steps of ancestors and claim the site as part of an Anzac heritage – a corner of New Zealand even. For many young New Zealanders it has become a rite of passage, part of the big OE. That a visit to Anzac Cove is still more popular than visiting the sites of Ngā pakanga o Aotearoa is something our teaching can investigate. <h2>Mateship and conformity</h2> The notion of the Anzac soldier as courageous and beyond reproach, willing to make the ultimate sacrifice for nation and empire, is also overdue for revision. The “glue” of mateship – a potent combination of masculine bravery and strength with extreme loyalty to fellow soldiers – is again a contested narrative. By the 1970s, as historian Rowan Light’s work shows, there was a significant challenge to such perceptions from the counterculture, peace protesters and feminists. And by the 1980s, veterans were sharing their stories more candidly with writer Maurice Shadbolt and war historian Chris Pugsley. Teaching about the meaning of mateship might examine the history of those peer-pressured into participating in war, those who were conscripted and had no choice, and more on the fate of conscientious objectors like Archibald Baxter. At its worst, the idea of mateship was window dressing for uniformity and parochialism. New Zealanders today have complex multicultural and global roots. We have ancestors who were co-opted to fight on different sides in 20th-century wars, including those who fought anti-colonial wars in India, Ireland and Samoa. Some came here as refugees escaping conflict. Jingoism and what it really represents deserves critical analysis. <h2>Poppies and peace</h2> The ubiquitous poppy, an icon much reproduced in classrooms, is also ripe for contextualisation and debate over its meaning. In the age of global environmental crisis, it can be seen as more than a symbol of sacrifice immortalised in verse and iconography. The poppy also reminds us of the landscapes devastated by the machinery of war that killed and maimed people, plants and animals. It contains within it myriad lessons about the threats science and technology can pose to a vulnerable planet. Anzac Day rose from the shock, loss and grief felt by those on the home front. And beyond the familiar tropes of nationalism, mateship and egalitarianism, this remains its overriding mood. Remembering and learning about the terrible physical and mental cost of war is the real point of those familiar phrases “lest we forget” and “never again”. That spirit of humanitarianism chimes with Aotearoa New Zealand’s modern role and evolving self-image as a peacekeeping, nuclear-free nation. Anzac Day also speaks to the need for global peace and arbitration, and how war is no viable solution to conflict. Those are surely lessons worth teaching. Image credits: Getty Images This article originally appeared on <a href="https://theconversation.com/new-lessons-about-old-wars-keeping-the-complex-story-of-anzac-day-relevant-in-the-21st-century-204013" target="_blank" rel="noopener">The Conversation</a>.

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What happens when I stop taking a drug like Ozempic or Mounjaro?

No, taking drugs like Ozempic isn’t ‘cheating’ at weight loss or the ‘easy way out’

Drugs like Ozempic won’t ‘cure’ obesity but they might make us more fat-phobic

Considering taking a weight-loss drug like Ozempic? Here are some potential risks and benefits

Legendary Star Wars and James Bond actor passes away

War in Ukraine affected wellbeing worldwide, but people’s speed of recovery depended on their personality

How dieting, weight suppression and even misuse of drugs like Ozempic can contribute to eating disorders

After 3 months of devastation in the Israel-Hamas war, is anyone ‘winning’?

Do you really need antibiotics? Curbing our use helps fight drug-resistant bacteria

Drug resistance may make common infections like thrush untreatable

5 reasons why climate change may see more of us turn to alcohol and other drugs

What exactly is a ceasefire, and why is it so difficult to agree on one in Gaza?

Foul play suspected in tragic death of TV star's 15-year-old niece

Can Israel and Hamas be held to account for alleged crimes against civilians?

Little House on the Prairie star passes away

Ozempic is in the spotlight but it’s just the latest in a long and strange history of weight-loss drugs

Promising Alzheimer’s drug offers hope for a bright future in treatment

Thor and Star Wars actor dies suddenly just days before birthday

Put your Star Wars knowledge to the test

New lessons about old wars: keeping the complex story of Anzac Day relevant in the 21st century

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Shop

Catalogues

Travel

Health

Lifestyle

Finance

Entertainment

Property

Information

Keep up to date

Search

What happens when I stop taking a drug like Ozempic or Mounjaro?

No, taking drugs like Ozempic isn’t ‘cheating’ at weight loss or the ‘easy way out’

Drugs like Ozempic won’t ‘cure’ obesity but they might make us more fat-phobic

Considering taking a weight-loss drug like Ozempic? Here are some potential risks and benefits

Legendary Star Wars and James Bond actor passes away

War in Ukraine affected wellbeing worldwide, but people’s speed of recovery depended on their personality

How dieting, weight suppression and even misuse of drugs like Ozempic can contribute to eating disorders

After 3 months of devastation in the Israel-Hamas war, is anyone ‘winning’?

Do you really need antibiotics? Curbing our use helps fight drug-resistant bacteria

Drug resistance may make common infections like thrush untreatable

5 reasons why climate change may see more of us turn to alcohol and other drugs

What exactly is a ceasefire, and why is it so difficult to agree on one in Gaza?

Foul play suspected in tragic death of TV star's 15-year-old niece

Can Israel and Hamas be held to account for alleged crimes against civilians?

Little House on the Prairie star passes away

Ozempic is in the spotlight but it’s just the latest in a long and strange history of weight-loss drugs

Promising Alzheimer’s drug offers hope for a bright future in treatment

Thor and Star Wars actor dies suddenly just days before birthday

Put your Star Wars knowledge to the test

New lessons about old wars: keeping the complex story of Anzac Day relevant in the 21st century

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