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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>.

Body

Surgery won’t fix my chronic back pain, so what will?

<a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/christopher-maher-826241">Christopher Maher</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/fiona-blyth-448021">Fiona Blyth</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/james-mcauley-1526139">James Mcauley</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>, and <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> This week’s ABC Four Corners episode <a href="https://www.abc.net.au/news/2024-04-08/pain-factory/103683180">Pain Factory</a> highlighted that our health system is failing Australians with chronic pain. Patients are receiving costly, ineffective and risky care instead of effective, low-risk treatments for chronic pain. The challenge is considering how we might reimagine health-care delivery so the effective and safe treatments for chronic pain are available to millions of Australians who suffer from chronic pain. <a href="https://www.aihw.gov.au/getmedia/10434b6f-2147-46ab-b654-a90f05592d35/aihw-phe-267.pdf.aspx">One in five</a> Australians aged 45 and over have chronic pain (pain lasting three or more months). This costs an estimated <a href="https://www.aihw.gov.au/getmedia/10434b6f-2147-46ab-b654-a90f05592d35/aihw-phe-267.pdf.aspx">A$139 billion a year</a>, including $12 billion in direct health-care costs. The most common complaint among people with chronic pain is low back pain. So what treatments do – and don’t – work? <h2>Opioids and invasive procedures</h2> Treatments offered to people with chronic pain include strong pain medicines such as <a href="https://pubmed.ncbi.nlm.nih.gov/30561481/">opioids</a> and invasive procedures such as <a href="https://pubmed.ncbi.nlm.nih.gov/36878313/">spinal cord stimulators</a> or <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/imj.14120">spinal fusion surgery</a>. Unfortunately, these treatments have little if any benefit and are associated with a risk of significant harm. <a href="https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-06900-8">Spinal fusion surgery</a> and <a href="https://privatehealthcareaustralia.org.au/consumers-urged-to-be-cautious-about-spinal-cord-stimulators-for-pain/#:%7E:text=Australian%20health%20insurance%20data%20shows,of%20the%20procedure%20is%20%2458%2C377.">spinal cord stimulators</a> are also extremely costly procedures, costing tens of thousands of dollars each to the health system as well as incurring costs to the individual. <h2>Addressing the contributors to pain</h2> Recommendations from the latest <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/low-back-pain-clinical-care-standard">Australian</a> and <a href="https://www.who.int/publications/i/item/9789240081789">World Health Organization</a> clinical guidelines for low back pain focus on alternatives to drug and surgical treatments such as: <ul> <li>education</li> <li>advice</li> <li>structured exercise programs</li> <li>physical, psychological or multidisciplinary interventions that address the physical or psychological contributors to ongoing pain.</li> </ul> Two recent Australian trials support these recommendations and have found that interventions that address each person’s physical and psychological contributors to pain produce large and sustained improvements in pain and function in people with chronic low back pain. The interventions have minimal side effects and are cost-effective. In the <a href="https://jamanetwork.com/journals/jama/fullarticle/2794765">RESOLVE</a> trial, the intervention consists of pain education and graded sensory and movement “retraining” aimed to help people understand that it’s safe to move. In the <a href="https://pubmed.ncbi.nlm.nih.gov/37146623/">RESTORE</a> trial, the intervention (cognitive functional therapy) involves assisting the person to understand the range of physical and psychological contributing factors related to their condition. It guides patients to relearn how to move and to build confidence in their back, without over-protecting it. <h2>Why isn’t everyone with chronic pain getting this care?</h2> While these trials provide new hope for people with chronic low back pain, and effective alternatives to spinal surgery and opioids, a barrier for implementation is the out-of-pocket costs. The interventions take up to 12 sessions, lasting up to 26 weeks. One physiotherapy session <a href="https://www.sira.nsw.gov.au/__data/assets/pdf_file/0005/1122674/Physiotherapy-chiropractic-and-osteopathy-fees-practice-requirements-effective-1-February-2023.pdf">can cost</a> $90–$150. In contrast, <a href="https://www.servicesaustralia.gov.au/chronic-disease-individual-allied-health-services-medicare-items">Medicare</a> provides rebates for just five allied health visits (such as physiotherapists or exercise physiologists) for eligible patients per year, to be used for all chronic conditions. Private health insurers also limit access to reimbursement for these services by typically only covering a proportion of the cost and providing a cap on annual benefits. So even those with private health insurance would usually have substantial out-of-pocket costs. Access to trained clinicians is another barrier. This problem is particularly evident in <a href="https://www.ruralhealth.org.au/15nrhc/sites/default/files/B2-1_Bennett.pdf">regional and rural Australia</a>, where access to allied health services, pain specialists and multidisciplinary pain clinics is limited. Higher costs and lack of access are associated with the increased use of available and subsidised treatments, such as pain medicines, even if they are ineffective and harmful. The <a href="https://www.safetyandquality.gov.au/publications-and-resources/resource-library/data-file-57-opioid-medicines-dispensing-2016-17-third-atlas-healthcare-variation-2018">rate of opioid use</a>, for example, is higher in regional Australia and in areas of socioeconomic disadvantage than metropolitan centres and affluent areas. <h2>So what can we do about it?</h2> We need to reform Australia’s health system, private and <a href="https://www.health.gov.au/sites/default/files/documents/2020/12/taskforce-final-report-pain-management-mbs-items-final-report-on-the-review-of-pain-management-mbs-items.docx">public</a>, to improve access to effective treatments for chronic pain, while removing access to ineffective, costly and high-risk treatments. Better training of the clinical workforce, and using technology such as telehealth and artificial intelligence to train clinicians or deliver treatment may also improve access to effective treatments. A recent Australian <a href="https://pubmed.ncbi.nlm.nih.gov/38461844/">trial</a>, for example, found telehealth delivered via video conferencing was as effective as in-person physiotherapy consultations for improving pain and function in people with chronic knee pain. Advocacy and <a href="https://pubmed.ncbi.nlm.nih.gov/37918470/">improving the public’s understanding</a> of effective treatments for chronic pain may also be helpful. Our hope is that coordinated efforts will promote the uptake of effective treatments and improve the care of patients with chronic pain.<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/227450/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, Professor, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/christopher-maher-826241">Christopher Maher</a>, Professor, Sydney School of Public Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/fiona-blyth-448021">Fiona Blyth</a>, Professor, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/james-mcauley-1526139">James Mcauley</a>, Professor of Psychology, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>, and <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, Professor of Physiotherapy, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie 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/surgery-wont-fix-my-chronic-back-pain-so-what-will-227450">original article</a>.

Body

Do optimists really live longer? Here’s what the research says

<a href="https://theconversation.com/profiles/fuschia-sirois-331254">Fuschia Sirois</a>, <a href="https://theconversation.com/institutions/durham-university-867">Durham University</a> Do you tend to see the glass as half full, rather than half empty? Are you always looking on the bright side of life? If so, you may be surprised to learn that this tendency could actually be good for your health. A <a href="https://content.apa.org/record/2020-71981-001">number of studies</a> have shown that optimists enjoy higher levels of wellbeing, better sleep, lower stress and even better cardiovascular health and immune function. And now, <a href="https://pubmed.ncbi.nlm.nih.gov/35674052/">a recent study</a> has shown that being an optimist is linked to longer life. To conduct their study, researchers tracked the lifespan of nearly 160,000 women aged between 50 to 79 for a period of 26 years. At the beginning of the study, the women completed a <a href="https://local.psy.miami.edu/people/faculty/ccarver/availbale-self-report-instruments/lot-r/">self-report measure of optimism</a>. Women with the highest scores on the measure were categorised as optimists. Those with the lowest scores were considered pessimists. Then, in 2019, the researchers followed up with the participants who were still living. They also looked at the lifespan of participants who had died. What they found was that those who had the highest levels of optimism were more likely to live longer. More importantly, the optimists were also more likely than those who were pessimists to live into their nineties. Researchers refer to this as “exceptional longevity”, considering the average lifespan for women is about 83 years in developed countries. What makes these findings especially impressive is that the results remained even after accounting for other factors known to predict a long life – including education level and economic status, ethnicity, and whether a person suffered from depression or other chronic health conditions. But given this study only looked at women, it’s uncertain whether the same would be true for men. However, <a href="https://www.pnas.org/doi/abs/10.1073/pnas.1900712116">another study</a> which looked at both men and women also found that people with the highest levels of optimism enjoyed a lifespan that was between 11% and 15% longer than those who were the least optimistic. <h2>The fountain of youth?</h2> So why is it that optimists live longer? At first glance it would seem that it may have to do with their healthier lifestyle. For example, <a href="https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.117.310828">research from several studies</a> has found that optimism is linked to eating a healthy diet, staying physically active, and being less likely to smoke cigarettes. These healthy behaviours are well known to improve heart health and <a href="https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases">reduce the risk</a> for cardiovascular disease, which is a <a href="https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)">leading cause of death</a> globally. Adopting a healthy lifestyle is also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3857242/">important for reducing the risk</a> of other potentially deadly diseases, such as diabetes and cancer. But having a healthy lifestyle may only be part of the reason optimists live a longer than average life. This latest study found that lifestyle only accounted for 24% of the link between optimism and longevity. This suggests a number of other factors affect longevity for optimists. Another possible reason could be due to the way optimists manage stress. When faced with a stressful situation, optimists tend to deal with it head-on. They <a href="https://pubmed.ncbi.nlm.nih.gov/16859439/">use adaptive coping strategies</a> that help them resolve the source of the stress, or view the situation in a less stressful way. For example, optimists will problem-solve and plan ways to deal with the stressor, call on others for support, or try to find a “silver lining” in the stressful situation. All of these approaches are well-known to reduce feelings of stress, as well as the biological reactions that occur when we feel stressed. It’s these <a href="https://www.apa.org/topics/stress/body">biological reactions to stress</a> –- such as elevated cortisol (sometimes called the “stress hormone”), increased heart rate and blood pressure, and impaired immune system functioning –- that can take a toll on health over time and increase the risk for developing <a href="https://www.sciencedirect.com/science/article/pii/S0889159115004316?via%3Dihub">life-threatening diseases</a>, such as cardiovascular disease. In short, the way optimists cope with stress may help protect them somewhat against its harmful effects. <h2>Looking on the bright side</h2> Optimism is typically viewed by researchers as a relatively stable personality trait that is determined by both <a href="https://www.cambridge.org/core/journals/twin-research-and-human-genetics/article/sex-differences-in-the-genetic-architecture-of-optimism-and-health-and-their-interrelation-a-study-of-australian-and-swedish-twins/58F21AA11943D44B4BA4C63A966E6AC7">genetic</a> and early childhood influences (such as having a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6541423/">secure and warm relationship</a> with your parents or caregivers). But if you’re not naturally prone to seeing the glass as half full, there are some ways you can increase your <a href="https://www.tandfonline.com/doi/abs/10.1080/17439760.2016.1221122?journalCode=rpos20">capacity to be optimistic</a>. Research shows optimism can change over time, and can be cultivated by engaging in simple exercises. For example, visualising and then writing about your “<a href="https://www.psychologytoday.com/us/blog/what-matters-most/201303/what-is-your-best-possible-self">best possible self</a>” (a future version of yourself who has accomplished your goals) is a technique that studies have found can <a href="https://www.tandfonline.com/doi/full/10.1080/17439760.2016.1221122">significantly increase optimism</a>, at least temporarily. But for best results, the goals need to be both positive and reasonable, rather than just wishful thinking. Similarly, simply <a href="https://www.tandfonline.com/doi/abs/10.3200/SOCP.149.3.349-364">thinking about positive future events</a> can also be effective for boosting optimism. It’s also crucial to temper any expectations for success with an accurate view of what you can and can’t control. Optimism is reinforced when we experience the positive outcomes that we expect, and <a href="https://psycnet.apa.org/record/1970-20680-001">can decrease</a> when these outcomes aren’t as we want them to be. Although more research is needed, it’s possible that regularly envisioning yourself as having the best possible outcomes, and taking realistic steps towards achieving them, can help develop an optimistic mindset. Of course, this might be easier said than done for some. If you’re someone who isn’t naturally optimistic, the best chances to improve your longevity is by <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003332">living a healthy lifestyle</a> by staying physically active, eating a healthy diet, managing stress, and getting a good night’s sleep. Add to this cultivating a more optimistic mindset and you might further increase your chances for a long life.<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/184785/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/fuschia-sirois-331254">Fuschia Sirois</a>, Professor in Social & Health Psychology, <a href="https://theconversation.com/institutions/durham-university-867">Durham 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/do-optimists-really-live-longer-heres-what-the-research-says-184785">original article</a>.

Caring

Silent cancers: here’s what you need to know when there are no obvious symptoms

<a href="https://theconversation.com/profiles/justin-stebbing-1405462">Justin Stebbing</a>, <a href="https://theconversation.com/institutions/anglia-ruskin-university-1887">Anglia Ruskin University</a> The recent revelations about the Princess of Wales’s <a href="https://www.bbc.com/news/uk-68640917">cancer diagnosis</a> highlight a crucial aspect of cancer detection – the disease’s sometimes silent nature. Silent cancers are those without noticeable symptoms. They pose a unique challenge in early detection and treatment. Contrary to common perception, cancer does not always announce its presence through overt symptoms or obvious signs. Many people receive a <a href="https://academic.oup.com/clinchem/article-abstract/70/1/179/7283928">cancer diagnosis incidentally</a>, when it’s found during routine medical examinations or investigations for unrelated health concerns – as seems to be the case for both <a href="https://www.wsj.com/health/kate-middleton-catherine-cancer-what-is-preventative-chemotherapy-9625370d">the princess</a> and <a href="https://www.bbc.co.uk/news/health-68171163">King Charles III</a>. While even silent cancers can sometimes be <a href="https://pubmed.ncbi.nlm.nih.gov/22584215/">aggressive and advance rapidly</a>, they can also remain <a href="https://pubmed.ncbi.nlm.nih.gov/20363069/">dormant</a> for years or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8819710/">even decades</a>. Some <a href="https://ascopubs.org/doi/10.14694/EdBook_AM.2012.32.98">prostate</a>, <a href="https://ascopubs.org/doi/10.14694/EdBook_AM.2012.32.301">breast</a> and <a href="https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2020.571421/full">thyroid</a> cancers, for example, <a href="https://www.tmlep.com/clinical-learning/2023-01-23-when-did-this-tumour-start-the-need-for-a-gompertzian-understanding-of-tumour-growth-kinetics">often evolve slowly</a> without obvious symptoms or spreading beyond the original area. Research suggests that some of these cancers are <a href="https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2020.571421/full">overtreated</a>. Sometimes patients are best left alone or treated much more gently, perhaps even without medical intervention, using a <a href="https://www.nejm.org/doi/full/10.1056/nejmoa1311593">“watch and wait”</a> strategy. This approach may be taken with prostate cancer in the elderly, for example. <h2>The importance of early diagnosis</h2> Whatever the cancer, it’s always important to get an early diagnosis though – and for silent cancers, this is obviously a challenge. Some cancer symptoms <a href="https://pubmed.ncbi.nlm.nih.gov/36702593/">can be vague</a> and easily mistaken for benign ailments. Fatigue, unexplained weight loss and persistent pain are among the nonspecific symptoms that may signal an underlying malignancy. But such symptoms can be misinterpreted or easily dismissed, which contributes to delayed diagnosis and treatment. <figure><iframe src="https://www.youtube.com/embed/MGMy6BzBvp0?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> Fortunately, in many countries including the UK, we have <a href="https://www.england.nhs.uk/cancer/early-diagnosis/screening-and-earlier-diagnosis/">screening</a> tests for diseases like breast or colon cancer, to increase early diagnoses. Early diagnosis is a <a href="https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.32887">key factor</a> for successful cancer treatment. Detecting cancer in its silent phase offers a window of opportunity for early intervention and improved outcomes. The discovery of asymptomatic cancers through diagnostic imaging or screening tests underscores the importance of these proactive healthcare measures. Identifying cancer at an early stage means the disease is confined to its site of origin, smaller and potentially easier to cure. Diagnosing a smaller cancer often means that if an operation is needed, it may be a less invasive surgery. There may also be a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6825992/">lower chance</a> of needing post-operative preventative chemotherapy, to mop up any residual cells. Colorectal cancer (CRC) is a good example to show the critical importance of screening. Studies show that patients who participate in CRC <a href="https://www.nice.org.uk/guidance/dg56/chapter/1-Recommendations">screening</a>, such as colonoscopies or tests that look for blood in the stool, are more likely to be diagnosed while asymptomatic and have more positive prognoses after treatment. Those diagnosed with CRC after showing symptoms, such as rectal bleeding or changes in bowel habits, tend to have more <a href="https://bmjopengastro.bmj.com/content/4/1/e000146%20">advanced tumors and poorer outcomes</a>. <figure><iframe src="https://www.youtube.com/embed/nA9_Io3LDpA?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> Public health initiatives aimed at raising awareness about the importance of both cancer screening and symptom recognition play a pivotal role in reducing diagnostic delays. Empowering people to engage in <a href="https://healthcaredelivery.cancer.gov/prevention/#:%7E:text=Cancer%20can%20be%20prevented%20through,they%20are%20more%20easily%20treated.">preventive healthcare measures</a> such as HPV vaccinations and lifestyle changes that decrease risk can facilitate early detection and intervention, potentially altering the trajectory of the disease. <h2>Biomarker discovery</h2> The latest advances in diagnostic technologies, often known as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012218/#:%7E:text=During%20biomarker%20discovery%2C%20evaluation%20of,design%20of%20future%20validation%20studies.">“biomarker discovery”</a>, hold promise for improving early detection rates and refining treatment strategies for silent cancers. From <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/molecular-profiling">molecular profiling</a> to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9922467/">liquid biopsy techniques</a> (blood tests to diagnose cancer), innovative approaches are reshaping the landscape of cancer diagnosis, offering new avenues for personalised and precision medicine. For example, I worked with a team using blood tests to identify cancers in more than <a href="https://www.nature.com/articles/s41388-023-02591-z">1,000 women recalled after screening for mammography</a>. We looked at the DNA that tumour cells release – so-called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10496721/">cell-free DNA</a> – and also metabolomics (rare markers related to metabolism in the blood). From this information, we found healthy patients, benign disease, pre-cancer and breast cancer. Although there’s increasing awareness and use of this <a href="https://www.sciencedirect.com/science/article/abs/pii/S1769721218307110">approach in Europe</a>, it isn’t standard in the UK. Asymptomatic cancers represent a formidable challenge for patient care. But, by encouraging patients to adopt preventive lifestyles and engage with screenings and tests, asymptomatic cancers don’t have to be a hidden threat to health.<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/226536/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/justin-stebbing-1405462">Justin Stebbing</a>, Professor of Biomedical Sciences, <a href="https://theconversation.com/institutions/anglia-ruskin-university-1887">Anglia Ruskin 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/silent-cancers-heres-what-you-need-to-know-when-there-are-no-obvious-symptoms-226536">original article</a>.

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There are new flu vaccines on offer for 2024. Should I get one? What do I need to know?

<a href="https://theconversation.com/profiles/allen-cheng-94997">Allen Cheng</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Influenza is a common respiratory infection. Although most cases are relatively mild, flu can cause more severe illness in young children and older people. Influenza virtually <a href="https://pubmed.ncbi.nlm.nih.gov/33243355/">disappeared</a> from Australia during the first years of the COVID-19 pandemic when public health restrictions reduced contact between people. Since 2022, it has returned to a seasonal pattern, although the flu season has started and peaked a few months earlier than before 2020. It’s difficult to predict the intensity of the flu season at this point in the year, but we can sometimes get clues from the northern hemisphere. There, the season <a href="https://www.who.int/tools/flunet">started</a> <a href="https://gis.cdc.gov/grasp/fluview/flu_by_age_virus.html">earlier</a> than usual for the third year running (peaking in early January rather than late February/March), with a similar number of reported cases and hospitalisations to the previous year. Influenza vaccines are recommended annually, but there are now an increasing number of different vaccine types. Here’s what to know about this year’s shots, available from <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">this month</a>. <h2>What goes into a flu vaccine?</h2> Like other vaccines, influenza vaccines work by “training” the immune system on a harmless component of the influenza virus (known as an antigen), so it can respond appropriately when the body encounters the real virus. Influenza strains are constantly changing due to genetic mutation, with the pace of genetic change <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10421855">much higher</a> than for SARS-CoV-2 (the virus that causes COVID). The strains that go into the vaccine are <a href="https://www.who.int/teams/global-influenza-programme/vaccines/who-recommendations">reviewed</a> twice each year by the World Health Organization (WHO), which selects vaccine strains to match the next season’s predicted circulating strains. All current influenza vaccines in <a href="https://www.tga.gov.au/resources/publication/meeting-statements/aivc-recommendations-composition-influenza-vaccines-australia-2024">Australia</a> contain four different strains (known as quadrivalent vaccines). One of the strains appeared to <a href="https://www.nejm.org/doi/full/10.1056/NEJMp2314801">disappear</a> during the COVID pandemic, and the WHO has recently <a href="https://cdn.who.int/media/docs/default-source/influenza/who-influenza-recommendations/vcm-southern-hemisphere-recommendation-2024/202309_qanda_recommendation.pdf?sfvrsn=7a6906d1_5">recommended</a> dropping this strain from the vaccine. It’s expected trivalent (three strain) vaccines will become available in the near future. <h2>What’s different about new flu vaccines?</h2> There are eight brands of flu vaccines <a href="https://www.health.gov.au/resources/publications/atagi-statement-on-the-administration-of-seasonal-influenza-vaccines-in-2024?language=en">available</a> in Australia in 2024. These include egg-based vaccines (Vaxigrip Tetra, Fluarix Tetra, Afluria Quad, FluQuadri and Influvac Tetra), cell-based vaccines (Flucelvax Quad), adjuvanted vaccines (Fluad Quad) and high-dose vaccines (Fluzone High-Dose Quad). Until recently, the process of manufacturing flu vaccines has remained similar. Since the development of the influenza vaccine in the <a href="https://www.who.int/news-room/spotlight/history-of-vaccination/history-of-influenza-vaccination">1940s</a>, influenza viruses were grown in chicken eggs, then extracted, inactivated, purified and processed to make up the egg-based vaccines that are still used widely. However, there have been several enhancements to influenza vaccines in recent years. Older people’s immune systems tend not to respond as strongly to vaccines. In some flu vaccines, adjuvants (components that stimulate the immune system) are included with the influenza antigens. For example, an adjuvant is used in the Fluad Quad vaccine, recommended for over 65s. Studies <a href="https://ncirs.org.au/sites/default/files/2021-02/Adjuvanted%20influenza%20vaccine%20vs%20standard%20dose%20influenza%20vaccine%20SoF%20EP%20E2D%20tables_26%20Feb%202021_Final.pdf">suggest</a> adjuvanted influenza vaccines are slightly better than standard egg-based vaccines without adjuvant in older people. An alternative approach to improving the immune response is to use higher doses of the vaccine strains. An example is Fluzone High-Dose Quad – another option for older adults – which contains the equivalent of four doses of a standard influenza vaccine. Studies <a href="https://ncirs.org.au/sites/default/files/2022-05/HD%20vs%20sIV%20SoF%20EP%20E2D_March%202022_Final.pdf">suggest</a> the high dose vaccine is better than the standard dose vaccine (without an adjuvant) in preventing hospitalisation and complications in older people. Other manufacturers have updated the manufacturing process. Cell-based vaccines, such as Flucelvax Quad, use cells instead of eggs in the manufacturing process. Other vaccines that are <a href="https://www.cdc.gov/flu/prevent/advances.htm">not yet available</a> also use different technologies. In the past, <a href="https://pubmed.ncbi.nlm.nih.gov/31151913/">manufacturing issues</a> with egg-based vaccines have reduced their effectiveness. Using an alternative method of production provides some degree of insurance against this in the future. <h2>What should I do this year?</h2> Given indications this year’s flu season may be earlier than usual, it’s probably safest to get your vaccine early. This is particularly <a href="https://www.health.gov.au/resources/publications/atagi-statement-on-the-administration-of-seasonal-influenza-vaccines-in-2024?language=en">important</a> for those at highest risk of severe illness, including older adults (65 years and over), those with chronic medical conditions, young children (six months to five years) and Aboriginal and Torres Strait Islander people. Influenza vaccines are also recommended in pregnancy to protect both the mother and the baby for the first months of life. Influenza vaccines are widely available, including at GP clinics and pharmacies, while many workplaces have occupational programs. For high-risk groups, <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">four of the vaccines</a> are subsidised by the Australian government through the <a href="https://www.health.gov.au/our-work/national-immunisation-program">National Immunisation Program</a>. In older people, a number of vaccines are now recommended: <a href="https://www.health.gov.au/sites/default/files/2024-03/atagi-statement-on-the-administration-of-covid-19-vaccines-in-2024.pdf">COVID</a> and influenza, as well as one-off courses of <a href="https://www.health.gov.au/sites/default/files/documents/2020/06/national-immunisation-program-pneumococcal-vaccination-schedule-from-1-july-2020-clinical-advice-for-vaccination-providers.pdf">pneumococcal</a> and <a href="https://www.health.gov.au/topics/immunisation/vaccines/shingles-herpes-zoster-immunisation-service">shingles</a> vaccines. In general, most vaccines can be given in the same visit, but talk to your doctor about which ones you need. <h2>Are there side effects?</h2> All influenza vaccines can <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">cause</a> a sore arm and sometimes more generalised symptoms such as fever and tiredness. These are expected and reflect the immune system reacting appropriately to the vaccine, and are mostly mild and short-term. These side effects are slightly more common in <a href="https://ncirs.org.au/sites/default/files/2021-02/Adjuvanted%20influenza%20vaccine%20vs%20standard%20dose%20influenza%20vaccine%20SoF%20EP%20E2D%20tables_26%20Feb%202021_Final.pdf">adjuvanted</a> and <a href="https://ncirs.org.au/sites/default/files/2022-05/HD%20vs%20sIV%20SoF%20EP%20E2D_March%202022_Final.pdf">high dose</a> vaccines. As with all medications and vaccines, allergic reactions such as anaphylaxis can occur after the flu vaccine. All vaccine providers are trained to recognise and respond to anaphylaxis. People with egg allergies should discuss this with their doctor, but in general, <a href="https://www.allergy.org.au/patients/food-allergy/egg-allergy-flu-vaccine">studies suggest</a> they can safely receive any (including egg-based) influenza vaccines. Serious side effects from the influenza vaccine, such as Guillain-Barré syndrome, a neurological complication, are very rare (one case per million people vaccinated). They are <a href="https://pubmed.ncbi.nlm.nih.gov/23810252/">thought</a> to be less common after influenza vaccination than after infection with influenza.<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/226623/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/allen-cheng-94997">Allen Cheng</a>, Professor of Infectious Diseases, <a href="https://theconversation.com/institutions/monash-university-1065">Monash 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/there-are-new-flu-vaccines-on-offer-for-2024-should-i-get-one-what-do-i-need-to-know-226623">original article</a>.

Body

Eating some chocolate really might be good for you – here’s what the research says

<a href="https://theconversation.com/profiles/dan-baumgardt-1451396">Dan Baumgardt</a>, <a href="https://theconversation.com/institutions/university-of-bristol-1211">University of Bristol</a> Although it always makes me scoff slightly to see Easter eggs making their first appearance in supermarkets at the end of December, there are few people who aren’t delighted to receive a bit of chocolate every year. It makes sense that too much chocolate would be bad for you because of the high fat and sugar content in most products. But what should we make of common claims that eating some chocolate is actually good for you? Happily, there is a fair amount of evidence that shows, in the right circumstances, chocolate may be both beneficial for your heart and good for your mental state. In fact, chocolate – or more specifically cacao, the raw, unrefined bean – is a medicinal wonder. It contains many different active compounds which can evoke pharmacological effects within the body, like medicines or drugs. Compounds that lead to neurological effects in the brain have to be able to cross the <a href="https://link.springer.com/chapter/10.1007/978-3-642-13443-2_7">blood-brain barrier</a>, the protective shield which prevents harmful substances – like toxins and bacteria – entering the delicate nervous tissue. One of these is the compound <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3672386/">theobromine</a>, which is also found in tea and contributes towards its bitter taste. Tea and chocolate also contain caffeine, which theobromine is related to as part of the purine family of chemicals. These chemicals, among others, contribute to chocolate’s addictive nature. They have the ability to cross the blood-brain barrier, where they can influence the nervous system. They are therefore known as <a href="https://pubmed.ncbi.nlm.nih.gov/15549276/">psychoactive</a> chemicals. <figure><iframe src="https://www.youtube.com/embed/HloqayQdR6M?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> What effects can chocolate have on mood? Well, <a href="https://academic.oup.com/nutritionreviews/article/71/10/665/1931144?login=false">a systematic review</a> looked at a group of studies which examined the feelings and emotions associated with consuming chocolate. Most demonstrated improvements in mood, anxiety, energy and states of arousal. Some noted the feeling of guilt, which is perhaps something we’ve all felt after one too many Dairy Milks. <h2>Health benefits of cocoa</h2> There are other organs, aside from the brain, that might benefit from the medicinal effects of cocoa. For centuries, chocolate has been used as a medicine to treat a <a href="https://pubmed.ncbi.nlm.nih.gov/10917925/">long list of diseases</a> including anaemia, tuberculosis, gout and even low libido. These might be spurious claims but there is evidence to suggest that eating cacao has a positive effect on the cardiovascular system. First, it can prevent <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8068178/">endothelial dysfunction</a>. This is the process through which arteries harden and get laden down with fatty plaques, which can in turn lead to heart attacks and strokes. Eating dark chocolate may also reduce <a href="https://www.sciencedirect.com/science/article/pii/S1537189115001135?via%3Dihub">blood pressure</a>, which is another risk factor for developing arterial disease, and prevent formation of clots which block up blood vessels. <figure><iframe src="https://www.youtube.com/embed/8VUcPCbSSCY?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> Some studies have suggested that dark chocolate might be useful in adjusting ratios of <a href="https://pubmed.ncbi.nlm.nih.gov/20968113/">high-density lipoprotein cholesterol</a>, which can help protect the heart. Others have examined insulin resistance, the phenomenon associated with Type 2 diabetes and weight gain. They suggest that the <a href="https://www.sciencedirect.com/science/article/pii/S0963996900000697#:%7E:text=Cocoa%20is%20rich%20in%20polyphenols%20particularly%20in%20catechins,and%20cocoa%20powder%20have%20been%20published%20only%20recently.">polyphenols</a> – chemical compounds present in plants – found in foodstuffs like chocolate may also lead to <a href="https://pubmed.ncbi.nlm.nih.gov/29993262/">improved control of blood sugars</a>. <h2>Chocolate toxicity</h2> As much as chocolate might be considered a medicine for some, it can be a poison for others. It’s well documented that the ingestion of caffeine and theobromine is highly toxic for domestic animals. Dogs are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4801869/">particularly affected</a> because of their often voracious appetites and generally unfussy natures. The culprit is often dark chocolate, which can provoke symptoms of agitation, rigid muscles and even seizures. In certain cases, if ingested in high enough quantities, it can lead to comas and abnormal, even fatal heart rhythms. Some of the compounds found in chocolate have also been found to have potentially negative effects in humans. Chocolate is a source of oxalate which, along with calcium, is one of the main components of <a href="https://pubmed.ncbi.nlm.nih.gov/20301742/">kidney stones</a>. Some clinical groups have advised against consuming oxalate rich foods, such as spinach and rhubarb – and chocolate, for those who suffer from recurrent kidney stones. So, what should all this mean for our chocolate consumption habits? Science points in the direction of chocolate that has as high a cocoa solid content as possible, and the minimum of extras. The potentially harmful effects of chocolate are more related to fat and sugar, and may counteract any possible benefits. A daily dose of 20g-30g of plain or dark chocolate with cocoa solids above 70% – rather than milk chocolate, which contains fewer solids and white chocolate, which contains none – could lead to a greater health benefit, as well as a greater high. But whatever chocolate you go for, please don’t share it with the dog.<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/226759/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/dan-baumgardt-1451396">Dan Baumgardt</a>, Senior Lecturer, School of Physiology, Pharmacology and Neuroscience, <a href="https://theconversation.com/institutions/university-of-bristol-1211">University of Bristol</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/eating-some-chocolate-really-might-be-good-for-you-heres-what-the-research-says-226759">original article</a>.

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What are the most common symptoms of menopause? And which can hormone therapy treat?

<a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Despite decades of research, navigating menopause seems to have become harder – with conflicting information on the internet, in the media, and from health care providers and researchers. Adding to the uncertainty, a recent <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00462-8/fulltext">series in the Lancet</a> medical journal challenged some beliefs about the symptoms of menopause and which ones menopausal hormone therapy (also known as hormone replacement therapy) can realistically alleviate. So what symptoms reliably indicate the start of perimenopause or menopause? And which symptoms can menopause hormone therapy help with? Here’s what the evidence says. <h2>Remind me, what exactly is menopause?</h2> Menopause, simply put, is complete loss of female fertility. Menopause is traditionally defined as the final menstrual period of a woman (or person female at birth) who previously menstruated. Menopause is diagnosed after 12 months of no further bleeding (unless you’ve had your ovaries removed, which is surgically induced menopause). Perimenopause starts when menstrual cycles first vary in length by seven or more days, and ends when there has been no bleeding for 12 months. Both perimenopause and menopause are hard to identify if a person has had a hysterectomy but their ovaries remain, or if natural menstruation is suppressed by a treatment (such as hormonal contraception) or a health condition (such as an eating disorder). <h2>What are the most common symptoms of menopause?</h2> <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">Our study</a> of the highest quality menopause-care guidelines found the internationally recognised symptoms of the perimenopause and menopause are: <ul> <li>hot flushes and night sweats (known as vasomotor symptoms)</li> <li>disturbed sleep</li> <li>musculoskeletal pain</li> <li>decreased sexual function or desire</li> <li>vaginal dryness and irritation</li> <li>mood disturbance (low mood, mood changes or depressive symptoms) but not clinical depression.</li> </ul> However, none of these symptoms are menopause-specific, meaning they could have other causes. In <a href="https://journals.lww.com/menopausejournal/abstract/2015/07000/moderate_to_severe_vasomotor_and_sexual_symptoms.6.aspx">our study of Australian women</a>, 38% of pre-menopausal women, 67% of perimenopausal women and 74% of post-menopausal women aged under 55 experienced hot flushes and/or night sweats. But the severity of these symptoms <a href="https://journals.lww.com/menopausejournal/abstract/2015/07000/moderate_to_severe_vasomotor_and_sexual_symptoms.6.aspx">varies greatly</a>. Only 2.8% of pre-menopausal women reported moderate to severely bothersome hot flushes and night sweats symptoms, compared with 17.1% of perimenopausal women and 28.5% of post-menopausal women aged under 55. So bothersome hot flushes and night sweats appear a reliable indicator of perimenopause and menopause – but they’re not the only symptoms. Nor are hot flushes and night sweats a western society phenomenon, as has been suggested. Women in Asian countries are <a href="https://journals.lww.com/menopausejournal/fulltext/2022/05000/prevalence,_severity,_and_associated_factors_in.9.aspx">similarly affected</a>. Depressive symptoms and anxiety are also often linked to menopause but they’re less menopause-specific than hot flushes and night sweats, as they’re common across the entire adult life span. The <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">most robust guidelines</a> do not stipulate women must have hot flushes or night sweats to be considered as having perimenopausal or post-menopausal symptoms. They acknowledge that new mood disturbances may be a primary manifestation of <a href="https://www.cell.com/cell/abstract/S0092-8674(23)00905-4?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867423009054%3Fshowall%3Dtrue">menopausal hormonal changes</a>. The extent to which menopausal hormone changes impact memory, concentration and problem solving (frequently talked about as “brain fog”) is uncertain. <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2022.2122792">Some studies</a> suggest perimenopause may impair verbal memory and resolve as women transition through menopause. But strategic thinking and planning (executive brain function) <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2022.2122792">have not been shown to change</a>. <h2>Who might benefit from hormone therapy?</h2> The Lancet papers <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00462-8/fulltext">suggest</a> menopause hormone therapy <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02799-X/fulltext">alleviates</a> hot flushes and night sweats, but the likelihood of it improving sleep, mood or “brain fog” is limited to those bothered by vasomotor symptoms (hot flushes and night sweats). In contrast, the highest quality <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">clinical guidelines</a> consistently identify both vasomotor symptoms and mood disturbances associated with menopause as reasons for menopause hormone therapy. In other words, you don’t need to have hot flushes or night sweats to be prescribed menopause hormone therapy. Often, menopause hormone therapy is prescribed alongside a topical vaginal oestrogen to treat vaginal symptoms (dryness, irritation or urinary frequency). However, none of these guidelines recommend menopause hormone therapy for cognitive symptoms often talked about as “brain fog”. Despite musculoskeletal pain being the most common menopausal symptom in <a href="https://journals.lww.com/menopausejournal/abstract/2016/07000/prevalence_and_severity_of_vasomotor_symptoms_and.6.aspx">some populations</a>, the effectiveness of menopause hormone therapy for this specific symptoms still needs to be studied. Some guidelines, such as an <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783">Australian endorsed guideline</a>, support menopause hormone therapy for the prevention of osteoporosis and fracture, but not for the prevention of any other disease. <h2>What are the risks?</h2> The greatest concerns about menopause hormone therapy have been about breast cancer and an increased risk of a deep vein clot which might cause a lung clot. Oestrogen-only menopause hormone therapy is <a href="https://www.nice.org.uk/guidance/ng23">consistently considered</a> to cause little or no change in breast cancer risk. Oestrogen taken with a progestogen, which is required for women who have not had a hysterectomy, <a href="https://www.moh.gov.my/moh/resources/Penerbitan/CPG/Women%20Health/CPG_Management_of_Menopause_2022_e-version-1.pdf">has been associated with a small increase</a> in the risk of breast cancer, although any <a href="https://www.bmj.com/content/bmj/371/bmj.m3873.full.pdf">risk appears to vary</a> according to the type of therapy used, the dose and duration of use. Oestrogen taken orally has also been associated with an increased risk of a deep vein clot, although the risk varies according to the formulation used. This risk is avoided by using estrogen patches or gels <a href="https://www.bmj.com/content/bmj/364/bmj.k4810.full.pdf">prescribed at standard doses</a> <h2>What if I don’t want hormone therapy?</h2> If you can’t or don’t want to take menopause hormone therapy, there are also effective non-hormonal prescription therapies available for troublesome hot flushes and night sweats. In Australia, most of these options are “off-label”, although the new medication <a href="https://australianprescriber.tg.org.au/articles/management-of-menopause.html">fezolinetant</a> has just been <a href="https://www.tga.gov.au/resources/artg/401401">approved</a> in Australia for postmenopausal hot flushes and night sweats, and is expected to be available by mid-year. Fezolinetant, taken as a tablet, acts in the brain to stop the chemical neurokinin 3 triggering an inappropriate body heat response (flush and/or sweat). Unfortunately, most over-the-counter treatments promoted for menopause are either <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">ineffective or unproven</a>. However, cognitive behaviour therapy and hypnosis <a href="https://journals.lww.com/menopausejournal/abstract/2023/06000/the_2023_nonhormone_therapy_position_statement_of.4.aspx">may provide symptom relief</a>. The Australasian Menopause Society has useful <a href="https://www.menopause.org.au/health-info/fact-sheets">menopause fact sheets</a> and a <a href="https://www.menopause.org.au/health-info/find-an-ams-doctor">find-a-doctor</a> page. The <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783">Practitioner Toolkit for Managing Menopause</a> is also freely available.<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/225174/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, Chair of Women's Health, <a href="https://theconversation.com/institutions/monash-university-1065">Monash 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-are-the-most-common-symptoms-of-menopause-and-which-can-hormone-therapy-treat-225174">original article</a>.

Body

What if there was a hearing aid that understood your listening intentions?

<div class="page" title="Page 1"> <div class="section"> <div class="layoutArea"> <div class="column">Hearing conversations in noisy environments can be especially hard for people with impaired hearing. Unfortunately, traditional hearing aids adopt a ‘one-size-fits-all’ approach to processing sounds, regardless of the listening needs of individual users. This may make listening and engaging with others more difficult. Users may also experience a lack of sound clarity and be reluctant to engage in conversations with others.</div> <div class="column"> </div> <div class="column">Hearing aid manufacturer <a href="https://www.oticon.co.nz/hearing-aid-users" target="_blank" rel="noopener">Oticon</a> is taking the next important step on the journey to solve the No.1 challenge for people with hearing loss – hearing speech in noise2. With new groundbreaking 4D Sensor technology, <a href="https://www.oticon.co.nz/hearing-aid-users/hearing-aids/products/intent" target="_blank" rel="noopener">Oticon Intent</a> is capable of understanding the user’s listening intentions by recognising what they want and need to listen to, in order to deliver truly personalised support.</div> <div class="column"> </div> <div class="column">The Brain And Sound</div> <div class="column"> </div> <div class="column">Our ears gather the sounds around us, but the true hero in sound processing is the brain, as it is constantly working to make sense of sound. Oticon uses their BrainHearingTM philosophy to develop technology that provides the brain with access to the full sound environment.</div> <div class="column"> </div> <div class="column">The latest <a style="font-family: -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, Oxygen, Ubuntu, Cantarell, 'Open Sans', 'Helvetica Neue', sans-serif;" href="https://www.oticon.co.nz/hearing-aid-users/hearing-loss/understand-hearing-loss/how-hearing-works" target="_blank" rel="noopener">BrainHearingTM</a> insights reveal that people’s communication behaviour reflects their listening needs and intentions at a given moment via head and body movements. In conversation, users tend to keep their heads still to engage with a single person or move their heads in a group conversation to engage with different people. When struggling to hear what someone is saying, users are likely to lean in to listen.</div> <div class="column"> </div> <div class="column">The technology in Oticon Intent understands and adapts to the user through sensors that monitor head and body movements, conversation activity and the acoustic environment. Oticon Intent helps users move beyond just hearing and listening, helping them to communicate and fully engage in life.</div> <div class="column"> </div> <div class="column">Ease Of Communication</div> <div class="column"> </div> <div class="column">In challenging, noisy environments, Oticon Intent makes it possible to: <div class="page" title="Page 1"> <div class="section"> <div class="layoutArea"> <div class="column"> <ul> <li>Move through a crowd with seamless awareness, while orienting to the surrounding sounds.</li> <li>Begin chatting with a group of people, thanks to heightened access to voices and balanced background sounds so they are not intrusive, while still accessible.</li> <li>Start an intimate conversation with one person, easily hearing the speaker’s voice amid the noise all around.</li> </ul> </div> </div> </div> </div> </div> </div> </div> </div> <img class="alignnone size-full wp-image-50989" src="https://oversixtydev.blob.core.windows.net/media/2024/03/Oticon_Intent_HA_In_Hand_Hero3_KC_1321_Expires_On_2_8_2029_1280.jpg" alt="" width="1280" height="720" /> Engage More In Life “If you have a hearing loss, you can actually protect your brain from cognitive decline by using active hearing aids which enable you to connect with others and let you engage in life to the fullest,” says Thomas Behrens, Vice President of Audiology at Oticon. “You can also enjoy future-proof, next- generation connectivity technology, crafted into the smallest form factor we have designed to date within this category.” Open Up The Digital World Offering easy connection to compatible smart devices through Bluetooth® Low Energy technology, Oticon Intent also enables users to engage in the digital world like never before. It allows a detailed, high-quality sound experience for hands-free calls and delivers direct streaming of music, audio book and much more3. With up to 20 hours of battery life, users will never have to worry about running out of battery. When they need a recharge, they’d simply drop the hearing aids into the charger for just 30 minutes for up to 8 hours of battery life4. Your hearing matters. Take a step towards better hearing by contacting your nearest <a href="https://www.oticon.co.nz/hearing-aid-users/find-audiologist" target="_blank" rel="noopener">hearing care professional</a>. To explore this revolutionary hearing aid that helps users to engage in life like never before, visit <a href="https://www.oticon.co.nz/oticon-intent" target="_blank" rel="noopener">www.oticon.co.nz/oticon-intent</a> For more information and to find your nearest hearing clinic, visit <a href="https://www.oticon.co.nz" target="_blank" rel="noopener">oticon.co.nz</a> *4D Sensor technology only available in Oticon Intent 1 & 2. [2.] Jorgensen, L., & Novak, M. (2020). Factors Influencing Hearing Aid Adoption. Seminars in hearing, 41(1), 6–20. [3.] Hands-free communication is available on select devices. See which hearing aids and devices are compatible here: oticon.co.nz/compatibility. [4.] Expected use time for rechargeable battery depends on use pattern, active feature set, hearing loss, sound environment, battery age and use of wireless accessories. Images: Supplied. This is a sponsored article produced in partnership with Oticon.

Hearing

What’s the difference between autism and Asperger’s disorder?

<a href="https://theconversation.com/profiles/andrew-cashin-458270">Andrew Cashin</a>, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> Swedish climate activist Greta Thunberg describes herself as having <a href="https://www.theguardian.com/environment/2019/sep/02/greta-thunberg-responds-to-aspergers-critics-its-a-superpower">Asperger’s</a> while others on the autism spectrum, such as Australian comedian Hannah Gatsby, <a href="https://www.theguardian.com/stage/2022/mar/19/hannah-gadsby-autism-diagnosis-little-out-of-whack">describe</a> themselves as “autistic”. But what’s the difference? Today, the previous diagnoses of “Asperger’s disorder” and “autistic disorder” both fall within the diagnosis of autism spectrum disorder, or ASD. Autism describes a “neurotype” – a person’s thinking and information-processing style. Autism is one of the forms of diversity in human thinking, which comes with strengths and challenges. When these challenges become overwhelming and impact how a person learns, plays, works or socialises, a diagnosis of <a href="https://www.psychiatry.org/patients-families/autism/what-is-autism-spectrum-disorder">autism spectrum disorder</a> is made. <h2>Where do the definitions come from?</h2> The Diagnostic and Statistical Manual of Mental Disorders (DSM) outlines the criteria clinicians use to diagnose mental illnesses and behavioural disorders. Between 1994 and 2013, autistic disorder and Asperger’s disorder were the two primary diagnoses related to autism in the fourth edition of the manual, the DSM-4. In 2013, the DSM-5 collapsed both diagnoses into one <a href="https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596">autism spectrum disorder</a>. <h2>How did we used to think about autism?</h2> The two thinkers behind the DSM-4 diagnostic categories were Baltimore psychiatrist Leo Kanner and Viennese paediatrician Hans Asperger. They described the challenges faced by people who were later diagnosed with autistic disorder and Asperger’s disorder. Kanner and Asperger observed patterns of behaviour that differed to typical thinkers in the domains of communication, social interaction and flexibility of behaviour and thinking. The variance was associated with challenges in adaptation and distress. Between the 1940s and 1994, the majority of those diagnosed with autism also had an intellectual disability. Clinicians became focused on the accompanying intellectual disability as a necessary part of autism. The introduction of Asperger’s disorder shifted this focus and acknowledged the diversity in autism. In the DSM-4 it superficially looked like autistic disorder and Asperger’s disorder were different things, with the Asperger’s criteria stating there could be no intellectual disability or delay in the development of speech. Today, as a legacy of the recognition of the autism itself, the <a href="https://www.aihw.gov.au/reports/disability/autism-in-australia/contents/autism">majority of people</a> diagnosed with autism spectrum disorder – the new term from the DSM-5 – don’t a have an accompanying intellectual disability. <h2>What changed with ‘autism spectrum disorder’?</h2> The move to autism spectrum disorder brought the previously diagnosed autistic disorder and Asperger’s disorder under the one new diagnostic umbrella term. It made clear that other diagnostic groups – such as intellectual disability – can co-exist with autism, but are separate things. The other major change was acknowledging communication and social skills are intimately linked and not separable. Rather than separating “impaired communication” and “impaired social skills”, the diagnostic criteria changed to “impaired social communication”. The introduction of the spectrum in the diagnostic term further clarified that people have varied capabilities in the flexibility of their thinking, behaviour and social communication – and this can change in response to the context the person is in. <h2>Why do some people prefer the old terminology?</h2> Some people feel the clinical label of Asperger’s allowed a much more refined understanding of autism. This included recognising the achievements and great societal contributions of people with known or presumed autism. The contraction “Aspie” played an enormous part in the shift to positive identity formation. In the time up to the release of the DSM-5, <a href="https://xminds.org/resources/Documents/Web%20files/Aspie%20Criteria%20by%20Attwood.pdf">Tony Attwood and Carol Gray</a>, two well known thinkers in the area of autism, highlighted the strengths associated with “being Aspie” as something to be proud of. But they also raised awareness of the challenges. <h2>What about identity-based language?</h2> A more recent shift in language has been the reclamation of what was once viewed as a slur – “autistic”. This was a shift from person-first language to identity-based language, from “person with autism spectrum disorder” to “autistic”. The neurodiversity rights movement describes its aim to <a href="https://researchonline.jcu.edu.au/71531/1/JCU_71531_AAM.pdf">push back</a> against a breach of human rights resulting from the wish to cure, or fundamentally change, people with autism. The movement uses a “social model of disability”. This views disability as arising from societies’ response to individuals and the failure to adjust to enable full participation. The inherent challenges in autism are seen as only a problem if not accommodated through reasonable adjustments. However the social model contrasts itself against a very outdated medical or clinical model. Current clinical thinking and practice focuses on <a href="https://www.collegianjournal.com/article/S1322-7696(22)00122-6/fulltext">targeted</a> supports to reduce distress, promote thriving and enable optimum individual participation in school, work, community and social activities. It doesn’t aim to cure or fundamentally change people with autism. A diagnosis of autism spectrum disorder signals there are challenges beyond what will be solved by adjustments alone; individual supports are also needed. So it’s important to combine the best of the social model and contemporary clinical model.<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/223643/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/andrew-cashin-458270">Andrew Cashin</a>, Professor of Nursing, School of Health and Human Sciences, <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/whats-the-difference-between-autism-and-aspergers-disorder-223643">original article</a>.

Mind

Kate Middleton is having ‘preventive chemotherapy’ for cancer. What does this mean?

<a href="https://theconversation.com/profiles/ian-olver-1047">Ian Olver</a>, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a> Catherine, Princess of Wales, is undergoing treatment for cancer. In a video thanking followers for their messages of support after her major abdominal surgery, the Princess of Wales explained, “tests after the operation found cancer had been present.” “My medical team therefore advised that I should undergo a course of preventative chemotherapy and I am now in the early stages of that treatment,” she said in the two-minute video. No further details have been released about the Princess of Wales’ treatment. But many have been asking what preventive chemotherapy is and how effective it can be. Here’s what we know about this type of treatment. <h2>It’s not the same as preventing cancer</h2> To <a href="https://www.cancer.org.au/about-us/how-we-help/prevention">prevent cancer developing</a>, lifestyle changes such as diet, exercise and sun protection are <a href="https://www.cancer.org.au/about-us/how-we-help/prevention">recommended</a>. Tamoxifen, a hormone therapy drug can be used to reduce the risk of cancer for some patients at <a href="https://www.mayoclinic.org/diseases-conditions/breast-cancer/in-depth/breast-cancer/art-20045353">high risk of breast cancer</a>. Aspirin <a href="https://www.cancer.gov/about-cancer/causes-prevention/research/aspirin-cancer-risk">can also be used</a> for those at high risk of bowel and other cancers. <h2>How can chemotherapy be used as preventive therapy?</h2> In terms of treating cancer, prevention refers to giving chemotherapy after the cancer has been removed, to prevent the cancer from returning. If a cancer is localised (limited to a certain part of the body) with no evidence on scans of it spreading to distant sites, local treatments such as surgery or radiotherapy can remove all of the cancer. If, however, cancer is first detected after it has spread to distant parts of the body at diagnosis, clinicians use treatments such as chemotherapy (anti-cancer drugs), hormones or immunotherapy, which circulate <a href="https://www.healthline.com/health/cancer/metastatic-cancer">around the body</a> . The other use for chemotherapy is to add it before or after surgery or radiotherapy, to prevent the primary cancer <a href="https://www.verywellhealth.com/adjuvant-therapy-5198903">coming back</a>. The surgery may have cured the cancer. However, in some cases, undetectable microscopic cells may have spread into the bloodstream to distant sites. This will result in the cancer returning, months or years later. With some cancers, treatment with chemotherapy, given before or after the local surgery or radiotherapy, can kill those cells and prevent the cancer coming back. If we can’t see these cells, how do we know that giving additional chemotherapy to prevent recurrence is effective? We’ve learnt this from clinical trials. Researchers have compared patients who had surgery only with those whose surgery was followed by additional (or often called adjuvant) chemotherapy. The additional therapy resulted in patients not relapsing and surviving longer. <h2>How effective is preventive therapy?</h2> The effectiveness of preventive therapy depends on the type of cancer and the type of chemotherapy. Let’s consider the common example of bowel cancer, which is at high risk of returning after surgery because of its size or spread to local lymph glands. The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564362/">first chemotherapy tested</a> improved survival by 15%. With more intense chemotherapy, the chance of surviving six years is approaching 80%. Preventive chemotherapy is usually given for three to six months. <h2>How does chemotherapy work?</h2> Many of the chemotherapy drugs stop cancer cells dividing by disrupting the DNA (genetic material) in the centre of the cells. To improve efficacy, drugs which work at different sites in the cell are given in combinations. Chemotherapy is not selective for cancer cells. It kills any dividing cells. But cancers consist of a higher proportion of dividing cells than the normal body cells. A <a href="https://www.canceraustralia.gov.au/cancer-types/breast-cancer/treatment/chemotherapy/how-does-chemotherapy-work#:%7E:text=Chemotherapy%20works%20by%20killing%20cells%20that%20are%20rapidly,cells%20can%20repair%20the%20damage%20and%20can%20recover.">greater proportion of the cancer is killed</a> with each course of chemotherapy. Normal cells can recover between courses, which are usually given three to four weeks apart. <h2>What are the side effects?</h2> The side effects of chemotherapy are usually reversible and are seen in parts of the body where there is normally a high turnover of cells. The production of blood cells, for example, is temporarily disrupted. When your white blood cell count is low, there is an increased risk of infection. Cell death in the lining of the gut leads to mouth ulcers, nausea and vomiting and bowel disturbance. Certain drugs sometimes given during chemotherapy can attack other organs, such as causing numbness in the hands and feet. There are also generalised symptoms such as <a href="https://www.cancervic.org.au/cancer-information/treatments/treatments-types/chemotherapy/side_effects_of_chemotherapy.html">fatigue</a>. Given that preventive chemotherapy given after surgery starts when there is no evidence of any cancer remaining after local surgery, patients can usually resume normal activities within weeks of completing the courses of chemotherapy.<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/226461/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/ian-olver-1047">Ian Olver</a>, Adjunct Professsor, School of Psychology, Faculty of Health and Medical Sciences, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</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/kate-middleton-is-having-preventive-chemotherapy-for-cancer-what-does-this-mean-226461">original article</a>.

Body

What are the four waves of feminism? And what comes next?

<a href="https://theconversation.com/profiles/sharon-crozier-de-rosa-122804">Sharon Crozier-De Rosa</a>, <a href="https://theconversation.com/institutions/university-of-wollongong-711">University of Wollongong</a> In Western countries, feminist history is generally packaged as a story of “waves”. The so-called first wave lasted from the mid-19th century to 1920. The second wave spanned the 1960s to the early 1980s. The third wave began in the mid-1990s and lasted until the 2010s. Finally, some say we are experiencing a fourth wave, which began in the mid-2010s and continues now. The first person to use “waves” was journalist Martha Weinman Lear, in her 1968 New York Times article, <a href="https://www.nytimes.com/1968/03/10/archives/the-second-feminist-wave.html">The Second Feminist Wave</a>, demonstrating that the women’s liberation movement was another <a href="https://www.vox.com/2018/3/20/16955588/feminism-waves-explained-first-second-third-fourth">“new chapter</a> in a grand history of women fighting together for their rights”. She was responding to anti-feminists’ framing of the movement as a “<a href="https://www.vox.com/2018/3/20/16955588/feminism-waves-explained-first-second-third-fourth">bizarre historical aberration</a>”. <a href="https://www.journals.uchicago.edu/doi/abs/10.1086/718868">Some feminists</a> criticise the usefulness of the metaphor. Where do feminists who preceded the first wave sit? For instance, Middle Ages feminist writer <a href="https://blogs.loc.gov/bibliomania/2023/08/30/christine-de-pizan/">Christine de Pizan</a>, or philosopher <a href="https://plato.stanford.edu/entries/wollstonecraft/">Mary Wollstonecraft</a>, author of <a href="https://www.penguin.com.au/books/a-vindication-of-the-rights-of-woman-9780141441252">A Vindication of the Rights of Woman</a> (1792). Does the metaphor of a single wave <a href="https://www.vox.com/2018/3/20/16955588/feminism-waves-explained-first-second-third-fourth">overshadow</a> the complex variety of feminist concerns and demands? And does this language exclude the <a href="https://www.journals.uchicago.edu/doi/abs/10.1086/718868">non-West</a>, for whom the “waves” story is meaningless? Despite these concerns, countless feminists <a href="https://www.researchgate.net/publication/317322421_Finding_a_Place_in_History_The_Discursive_Legacy_of_the_Wave_Metaphor_and_Contemporary_Feminism">continue to use</a> “waves” to explain their position in relation to previous generations. <h2>The first wave: from 1848</h2> The first wave of feminism refers to the campaign for the vote. It began in the United States in 1848 with the <a href="https://www.loc.gov/exhibitions/women-fight-for-the-vote/about-this-exhibition/seneca-falls-and-building-a-movement-1776-1890/">Seneca Falls Convention</a>, where 300 gathered to debate Elizabeth Cady Stanton’s Declaration of Sentiments, outlining women’s inferior status and demanding suffrage – or, the right to vote. It continued over a decade later, in 1866, in Britain, with the presentation of a <a href="https://www.parliament.uk/about/living-heritage/transformingsociety/electionsvoting/womenvote/parliamentary-collections/1866-suffrage-petition/presenting-the-petition/">suffrage petition</a> to parliament. This wave ended in 1920, when women were granted the right to vote in the US. (Limited women’s suffrage had been introduced in Britain two years earlier, in 1918.) First-wave activists believed once the vote had been won, women could use its power to enact other much-needed reforms, related to property ownership, education, employment and more. White leaders dominated the movement. They included longtime president of the the International Woman Suffrage Alliance <a href="https://cattcenter.iastate.edu/home/about-us/carrie-chapman-catt/">Carrie Chapman Catt</a> in the US, leader of the militant Women’s Social and Political Union <a href="https://www.britannica.com/biography/Emmeline-Pankhurst">Emmeline Pankhurst</a> in the UK, and <a href="https://adb.anu.edu.au/biography/spence-catherine-helen-4627">Catherine Helen Spence</a> and <a href="https://adb.anu.edu.au/biography/goldstein-vida-jane-6418">Vida Goldstein</a> in Australia. This has tended to obscure the histories of non-white feminists like evangelist and social reformer <a href="https://www.britannica.com/biography/Sojourner-Truth">Sojourner Truth</a> and journalist, activist and researcher <a href="https://www.womenshistory.org/education-resources/biographies/ida-b-wells-barnett">Ida B. Wells</a>, who were fighting on multiple fronts – including anti-slavery and anti-lynching – as well as feminism. <h2>The second wave: from 1963</h2> The second wave coincided with the publication of US feminist Betty Friedan’s <a href="https://www.penguin.com.au/books/the-feminine-mystique-9780141192055">The Feminine Mystique</a> in 1963. Friedan’s “<a href="https://www.smithsonianmag.com/smithsonian-institution/powerful-complicated-legacy-betty-friedans-feminine-mystique-180976931/">powerful treatise</a>” raised critical interest in issues that came to define the women’s liberation movement until the early 1980s, like workplace equality, birth control and abortion, and women’s education. Women came together in “consciousness-raising” groups to share their individual experiences of oppression. These discussions informed and motivated public agitation for <a href="https://www.berghahnbooks.com/title/HaeberlenPolitics">gender equality and social change</a>. Sexuality and gender-based violence were other prominent second-wave concerns. Australian feminist Germaine Greer wrote <a href="https://www.harpercollins.com.au/9780007205011/the-female-eunuch/">The Female Eunuch</a>, published in 1970, which <a href="https://theconversation.com/friday-essay-the-female-eunuch-at-50-germaine-greers-fearless-feminist-masterpiece-147437">urged women to</a> “challenge the ties binding them to gender inequality and domestic servitude” – and to ignore repressive male authority by exploring their sexuality. Successful lobbying saw the establishment of refuges for women and children fleeing domestic violence and rape. In Australia, there were groundbreaking political appointments, including the world’s first Women’s Advisor to a national government (<a href="https://www.nma.gov.au/audio/landmark-women/transcripts/landmark-women-elizabeth-reid-181013.mp3-transcript">Elizabeth Reid</a>). In 1977, a <a href="https://www.whitlam.org/women-and-whitlam">Royal Commission on Human Relationships</a> examined families, gender and sexuality. Amid these developments, in 1975, Anne Summers published <a href="https://theconversation.com/damned-whores-and-gods-police-is-still-relevant-to-australia-40-years-on-mores-the-pity-47753">Damned Whores and God’s Police</a>, a scathing historical critique of women’s treatment in patriarchal Australia. At the same time as they made advances, so-called women’s libbers managed to anger earlier feminists with their distinctive claims to radicalism. Tireless campaigner <a href="https://adb.anu.edu.au/biography/rich-ruby-sophia-14202">Ruby Rich</a>, who was president of the Australian Federation of Women Voters from 1945 to 1948, responded by declaring the only difference was her generation had called their movement “<a href="https://nla.gov.au/nla.obj-296328435/findingaid">justice for women</a>”, not “liberation”. Like the first wave, mainstream second-wave activism proved largely irrelevant to non-white women, who faced oppression on intersecting gendered and racialised grounds. African American feminists produced their own critical texts, including bell hooks’ <a href="https://www.routledge.com/Aint-I-a-Woman-Black-Women-and-Feminism/hooks/p/book/9781138821514">Ain’t I a Woman? Black Women and Feminism</a> in 1981 and Audre Lorde’s <a href="https://www.penguinrandomhouse.com/books/198292/sister-outsider-by-audre-lorde/">Sister Outsider</a> in 1984. <h2>The third wave: from 1992</h2> The third wave was announced in the 1990s. The term is popularly attributed to Rebecca Walker, daughter of African American feminist activist and writer <a href="https://alicewalkersgarden.com/about/">Alice Walker</a> (author of <a href="https://www.hachette.com.au/alice-walker/the-color-purple-now-a-major-motion-picture-from-oprah-winfrey-and-steven-spielberg">The Color Purple</a>). Aged 22, Rebecca proclaimed in a 1992 Ms. magazine <a href="https://web.archive.org/web/20200404030632/http:/heathengrrl.blogspot.com/2007/02/becoming-third-wave-by-rebecca-walker.html">article</a>: “I am not a post-feminism feminist. I am the Third Wave.” Third wavers didn’t think gender equality had been more or less achieved. But they did share <a href="https://journals.sagepub.com/doi/10.1177/1464700119842555">post-feminists</a>’ belief that their foremothers’ concerns and demands were obsolete. They argued women’s experiences were now shaped by <a href="https://www.tandfonline.com/doi/full/10.1080/14680777.2016.1190046">very different</a> political, economic, technological and cultural conditions. The third wave has been described as “an <a href="https://www.smh.com.au/lifestyle/beauty/meet-the-woman-who-coined-the-term-third-wave-feminism-20180302-p4z2mw.html">individualised feminism</a> that can not exist without diversity, sex positivity and intersectionality”. Intersectionality, <a href="https://chicagounbound.uchicago.edu/cgi/viewcontent.cgi?article=1052&context=uclf">coined</a> in 1989 by African American legal scholar Kimberlé Crenshaw, recognises that people can experience intersecting layers of oppression due to race, gender, sexuality, class, ethnicity and more. Crenshaw notes this was a “lived experience” before it was a term. In 2000, Aileen Moreton Robinson’s <a href="https://www.uqp.com.au/books/talkin-up-to-the-white-woman-indigenous-women-and-feminism-20th-anniversary-edition">Talkin’ Up to the White Woman: Indigenous Women and Feminism</a> expressed Aboriginal and Torres Strait Islander women’s frustration that white feminism did not adequately address the legacies of dispossession, violence, racism, and sexism. Certainly, the third wave accommodated <a href="https://paromitapain.com/wp-content/uploads/2019/12/10.10072F978-3-319-72917-6.pdf#page=112%22">kaleidoscopic views</a>. Some scholars claimed it “grappled with fragmented interests and objectives” – or micropolitics. These included ongoing issues such as sexual harassment in the workplace and a scarcity of women in positions of power. The third wave also gave birth to the <a href="https://www.nme.com/blogs/nme-blogs/brief-history-riot-grrrl-space-reclaiming-90s-punk-movement-2542166">Riot Grrrl</a> movement and “girl power”. Feminist punk bands like <a href="https://bikinikill.com/about/">Bikini Kill</a> in the US, <a href="https://www.theguardian.com/music/2022/nov/28/pussy-riot-beaten-jailed-exiled-taunting-putin">Pussy Riot</a> in Russia and Australia’s <a href="https://www.vice.com/en/article/mbknev/little-ugly-girls-tractor-album-single-premiere-2018">Little Ugly Girls</a> sang about issues like homophobia, sexual harassment, misogyny, racism, and female empowerment. Riot Grrrl’s <a href="https://www.historyisaweapon.com/defcon1/riotgrrrlmanifesto.html">manifesto</a> states “we are angry at a society that tells us Girl = Dumb, Girl = Bad, Girl = Weak”. “Girl power” was epitomised by Britain’s more sugary, phenomenally popular Spice Girls, who were accused of peddling “<a href="https://www.theguardian.com/tv-and-radio/2021/sep/14/spice-girls-how-girl-power-changed-britain-review-fabulous-and-intimate">‘diluted feminism’ to the masses</a>”. <figure><iframe src="https://www.youtube.com/embed/tAbhaguKARw?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>Riot Grrrrl sang about issues like homophobia, sexual harassment, misogyny and racism.</figcaption></figure> <h2>The fourth wave: 2013 to now</h2> The fourth wave is epitomised by “<a href="https://vc.bridgew.edu/jiws/vol25/iss2/10/">digital or online feminism</a>” which gained currency in about <a href="https://www.vox.com/2018/3/20/16955588/feminism-waves-explained-first-second-third-fourth">2013</a>. This era is marked by mass online mobilisation. The fourth wave generation is connected via new communication technologies in ways that were not previously possible. Online mobilisation has led to spectacular street demonstrations, including the #metoo movement. #Metoo was first founded by Black activist <a href="https://www.womenshistory.org/education-resources/biographies/tarana-burke">Tarana Burke</a> in 2006, to support survivors of sexual abuse. The hashtag #metoo then went viral during the 2017 Harvey Weinstein <a href="https://www.npr.org/2022/10/28/1131500833/me-too-harvey-weinstein-anniversary">sexual abuse scandal</a>. It was used at least <a href="https://www.sciencedirect.com/science/article/abs/pii/S0747563221002193">19 million times</a> on Twitter (now X) alone. In January 2017, the <a href="https://www.womensmarch.com/">Women’s March</a> protested the inauguration of the decidedly misogynistic Donald Trump as US president. <a href="https://www.britannica.com/event/Womens-March-2017">Approximately 500,000</a> women marched in Washington DC, with demonstrations held simultaneously in <a href="https://www.routledge.com/Remembering-Womens-Activism/Crozier-De-Rosa-Mackie/p/book/9781138794894">81 nations</a> on all continents of the globe, even Antarctica. In 2021, the <a href="https://catalogue.nla.gov.au/catalog/8564388">Women’s March4Justice</a> saw some 110,000 women rallying at more than 200 events across Australian cities and towns, protesting workplace sexual harassment and violence against women, following high-profile cases like that of Brittany Higgins, revealing <a href="https://www.theguardian.com/australia-news/2023/nov/29/brittany-higgins-bruce-lehrmann-defamation-trial-evidence-stand-rape-allegations-liberal-party-ntwnfb#:%7E:text=Bruce%20Lehrmann%20has%20brought%20a,Wilkinson%20are%20defending%20the%20case.">sexual misconduct</a> in the Australian houses of parliament. Given the prevalence of online connection, it is not surprising fourth wave feminism has reached across geographic regions. The Global Fund for Women <a href="https://www.globalfundforwomen.org/movements/me-too/">reports</a> that #metoo transcends national borders. In China, it is, among other things, #米兔 (translated as “<a href="https://www.ft.com/content/61903744-9540-11e8-b67b-b8205561c3fe">rice bunny</a>”, pronounced as “mi tu”). In Nigeria, it’s <a href="https://www.youtube.com/watch?v=we-F0Gi0Lqs">#Sex4Grades</a>. In Turkey, it’s #<a href="https://ahvalnews.com/sexual-harrasment/dozens-turkish-womens-organisations-issue-statement-backing-latest-metoo-movement">UykularınızKaçsın</a> (“may you lose sleep”). In an inversion of the traditional narrative of the Global North leading the Global South in terms of feminist “progress”, Argentina’s “<a href="https://www.auswhn.com.au/blog/colour-green/">Green Wave</a>” has seen it decriminalise abortion, as has Colombia. Meanwhile, in 2022, the US Supreme Court <a href="https://theconversation.com/us-supreme-court-overturns-roe-v-wade-but-for-abortion-opponents-this-is-just-the-beginning-185768">overturned historic abortion legislation</a>. Whatever the nuances, the prevalence of such highly visible gender protests have led some feminists, like <a href="https://www.tandfonline.com/doi/abs/10.1080/14680777.2020.1804431">Red Chidgey</a>, lecturer in Gender and Media at King’s College London, to declare that feminism has transformed from “a dirty word and publicly abandoned politics” to an ideology sporting “a new cool status”. <h2>Where to now?</h2> How do we know when to pronounce the next “wave”? (Spoiler alert: I have no answer.) Should we even continue to use the term “waves”? The “wave” framework was first used to demonstrate feminist continuity and solidarity. However, whether interpreted as disconnected chunks of feminist activity or connected periods of feminist activity and inactivity, represented by the crests and troughs of waves, some believe it encourages binary thinking that produces <a href="https://www.tandfonline.com/doi/full/10.1080/14680777.2016.1190046">intergenerational antagonism</a>. Back in 1983, Australian writer and second-wave feminist Dale Spender, who died last year, <a href="https://www.historyworkshop.org.uk/feminism/radical-books-dale-spender-theres-always-been-a-womens-movement-this-century-1983/">confessed her fear</a> that if each generation of women did not know they had robust histories of struggle and achievement behind them, they would labour under the illusion they’d have to develop feminism anew. Surely, this would be an overwhelming prospect. What does this mean for “waves” in 2024 and beyond? To build vigorous varieties of feminism going forward, we might reframe the “waves”. We need to let emerging generations of feminists know they are not living in an isolated moment, with the onerous job of starting afresh. Rather, they have the momentum created by generations upon generations of women to build on.<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/224153/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/sharon-crozier-de-rosa-122804">Sharon Crozier-De Rosa</a>, Professor, <a href="https://theconversation.com/institutions/university-of-wollongong-711">University of Wollongong</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-are-the-four-waves-of-feminism-and-what-comes-next-224153">original article</a>.

Caring

Longing for the ‘golden age’ of air travel? Be careful what you wish for

<a href="https://theconversation.com/profiles/janet-bednarek-144872">Janet Bednarek</a>, <a href="https://theconversation.com/institutions/university-of-dayton-1726">University of Dayton</a> Long lines at security checkpoints, tiny plastic cups of soda, small bags of pretzels, planes filled to capacity, fees attached to every amenity – all reflect the realities of 21st century commercial air travel. It’s no wonder that many travelers have become nostalgic for the so-called “golden age” of air travel in the United States. During the 1950s, airlines promoted commercial air travel as glamorous: stewardesses served full meals on real china, airline seats were large (and frequently empty) with ample leg-room, and passengers always dressed well. After jets were introduced in the late 1950s, passengers could travel to even the most distant locations at speeds unimaginable a mere decade before. An airline trip from New York to London that could take up to 15 hours in the early 1950s could be made in less than seven hours by the early 1960s. But airline nostalgia can be tricky, and “golden ages” are seldom as idyllic as they seem. Until the introduction of jets in 1958, most of the nation’s commercial planes were propeller-driven aircraft, like the DC-4. Most of these planes were unpressurized, and with a maximum cruising altitude of 10,000 to 12,000 feet, they were unable to fly over bad weather. Delays were frequent, turbulence common, and air sickness bags often needed. Some planes were spacious and pressurized: the <a href="http://everythingnice.org/wp-content/uploads/2009/07/PanAm-cutawayS.jpg">Boeing Stratocruiser</a>, for example, could seat 50 first class passengers or 81 coach passengers compared to the DC-3’s 21 passengers. It could cruise at 32,000 feet, which allowed Stratocruiser to fly above most bad weather it encountered. But only 56 of these planes were ever in service. While the later DC-6 and DC-7 were pressurized, they still flew much lower than the soon-to-appear jets – 20,000 feet compared to 30,000 feet – and often encountered turbulence. The piston engines were bulky, complex and difficult to maintain, which contributed to frequent delays. For much of this period, the old saying “Time to spare, go by air” still rang true. Through the 1930s and into the 1940s, almost everyone flew first class. Airlines did encourage more people to fly in the 1950s and 1960s by introducing coach or tourist fares, but the savings were relative: less expensive than first class, but still pricey. In 1955, for example, so-called “bargain fares” from New York to Paris were the equivalent of just over $2,600 in 2014 dollars. Although the advent of jets did result in lower fares, the cost was still out of reach of most Americans. The most likely frequent flier was a white, male businessman traveling on his company’s expense account, and in the 1960s, airlines – with young attractive stewardesses in short skirts – clearly catered to their most frequent flyers. The demographics of travelers did begin to shift during this period. More women, more young people, and retirees began to fly; still, airline travel remained financially out-of-reach for most. If it was a golden age, it only was for the very few. <figure><iframe src="https://www.youtube.com/embed/bKqQgNZylLw?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>Jet planes were introduced in the late 1950s, resulting in shorter flight times. But their ticket prices out of reach for the average traveler.</figcaption></figure> People also forget that well into the 1960s, air travel was far more dangerous than it is today. In the 1950s and 1960s US airlines experienced at least a half dozen crashes per year – most leading to fatalities of all on board. People today may bemoan the crowded airplanes and lack of on-board amenities, but the number of fatalities per million miles flown has dropped dramatically since since the late 1970s, especially compared to the 1960s. Through at least the 1970s, airports even prominently featured kiosks selling flight insurance. And we can’t forget hijackings. By the mid-1960s so many airplanes had been hijacked that <a href="http://www.latinamericanstudies.org/hijackers/flying-high.htm">“Take me to Cuba”</a> became a punch line for stand-up comics. In 1971 <a href="http://nymag.com/news/features/39593/index2.html">D.B. Cooper</a> – a hijacker who parachuted from a Boeing 727 after extorting $200,000 – might have been able to achieve folk hero status. But one reason US airline passengers today (generally) tolerate security checkpoints is that they want some kind of assurance that their aircraft will remain safe. And if the previous examples don’t dull the sheen of air travel’s “golden age,” remember: in-flight smoking was both permitted and encouraged.<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/34177/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/janet-bednarek-144872">Janet Bednarek</a>, Professor of History, <a href="https://theconversation.com/institutions/university-of-dayton-1726">University of Dayton</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/longing-for-the-golden-age-of-air-travel-be-careful-what-you-wish-for-34177">original article</a>.

Travel Trouble

Does the royal family have a right to privacy? What the law says

<a href="https://theconversation.com/profiles/gemma-horton-1515949">Gemma Horton</a>, <a href="https://theconversation.com/institutions/university-of-sheffield-1147">University of Sheffield</a> From court cases to conspiracy theories, the royal family’s right to privacy is, somewhat ironically, nearly always in the spotlight. The latest focus is Kate Middleton, Princess of Wales, whose whereabouts have been the subject of <a href="https://www.townandcountrymag.com/society/tradition/a60008117/kate-middleton-health-speculation-conspiracy-theories-online/">online speculation</a> after it was announced she was undergoing abdominal surgery and would be away from public duties until after Easter. This comes just weeks after King Charles <a href="https://www.bbc.co.uk/news/uk-68208157">revealed that he is undergoing treatment for cancer</a>, and a legal settlement between Prince Harry and Mirror Group Newspapers over <a href="https://www.bbc.co.uk/news/uk-68249009">illegal phone hacking</a>. Interest in the personal lives of the royals and other celebrities <a href="https://www.tandfonline.com/doi/full/10.1080/1461670X.2016.1150193">is a constant</a>, driving newspaper sales and online clicks for decades. You only needs to consider the media frenzy that followed Princess Diana to <a href="https://www.tandfonline.com/doi/full/10.1080/17512786.2013.833678">see this</a>, and its potentially devastating consequences. From a legal perspective, the British courts have ruled that everyone – the royal family included – is entitled to a right to privacy. The Human Rights Act incorporates into British law the rights set out by the European Convention on Human Rights. This includes article 8, which focuses on the right to privacy. In the years after the Human Rights Act came into force, courts ruled on a string of cases from celebrities claiming that the press invaded their privacy. Courts had to balance article 8 of the convention against article 10, the right to freedom of expression. Rulings repeatedly stated that, despite being in and sometimes seeking the limelight, celebrities should still be afforded a right to privacy. Some disagree with this position, such as prominent journalist <a href="https://www.independent.co.uk/news/uk/home-news/prince-harry-hacking-piers-morgan-b2336442.html">Piers Morgan, who has criticised</a> the Duke and Duchess of Sussex asking for privacy when they have also released a Netflix documentary, a broadcast interview with Oprah Winfrey and published a memoir. But the courts have made the position clear, as in the case concerning Catherine Zeta-Jones and Michael Douglas after Hello! Magazine published unauthorised photographs from their wedding. The <a href="https://eprints.whiterose.ac.uk/190559/3/Final%20Edited%20Version%20-%20Celebrity%20Privacy%20and%20Celebrity%20Journalism-%20Has%20anything%20changed%20since%20the%20Leveson%20Inquiry_.pdf">court stated</a> that: “To hold that those who have sought any publicity lose all protection would be to repeal article 8’s application to very many of those who are likely to need it.” There is no universal definition of privacy, but scholars have identified key concepts encompassing what privacy can entail. In my own research, I have argued that the <a href="https://eprints.whiterose.ac.uk/190559/3/Final%20Edited%20Version%20-%20Celebrity%20Privacy%20and%20Celebrity%20Journalism-%20Has%20anything%20changed%20since%20the%20Leveson%20Inquiry_.pdf">notion of choice</a> is one of these. Privacy allows us to control the spread of information about ourselves and disclose information to whom we want. <h2>Privacy and the public interest</h2> There are exceptions to these protections if the person involved had no reasonable expectation of privacy, or if it was in the public interest for this information to be revealed. There is no solid, legal definition of the “public interest”, so this is decided on a case-by-case basis. <a href="https://www.tandfonline.com/doi/full/10.1080/17577632.2021.1889866">In the past</a>, the public interest defence has been applied because a public figure or official has acted hypocritically and the courts have stated there is a right for a publisher to set the record straight. When it comes to medical records and information concerning health, case law and journalistic <a href="https://www.ipso.co.uk/editors-code-of-practice/">editorial codes of conduct</a> are clear that this information is afforded the utmost protection. Model Naomi Campbell was pictured leaving a Narcotics Anonymous meeting and these images were published by the Daily Mirror. The court found that there had been a public interest in revealing the fact she was attending these meetings, as she had previously denied substance abuse. The House of Lords accepted that there was a public interest in the press “setting the record straight”. Nonetheless, the publication of additional, confidential details, and the photographs of her leaving the meeting were a <a href="https://www.theguardian.com/media/2004/may/06/mirror.pressandpublishing1">step too far</a>. The House of Lords highlighted the importance of being able to keep medical records and information private. <h2>Royal health</h2> When it comes to the royals, the history of <a href="https://www.townandcountrymag.com/society/tradition/a23798094/lindo-wing-st-marys-hospital-facts-photos/">publicity</a> around royal births, often posing with the newborn royal baby outside of the hospital, has set a precedent for what the public can expect about the royals’ medical information. When they choose to go against this tradition, it can frustrate both royal-watchers and publishers. King Charles made the choice to openly speak about his enlarged prostate to “assist public understanding”. And, as Prostate Cancer UK noted, this has worked – they noted a <a href="https://www.independent.co.uk/news/uk/home-news/king-charles-cancer-statement-treatment-b2494190.html">500% increase in people visiting their website</a>. However, he has chosen to not to divulge information about his cancer diagnosis beyond the fact that he is receiving treatment. This is his right. While revealing further information might stop speculation and rumours about his health, it is not the king’s duty to divulge private, medical information. However, if his health begins to impact his ability to act as monarch, the situation could change. It might be that the press finds more information about his health without his knowledge, but unless they have a genuine public interest in publishing this information, privacy should prevail. You would no doubt want your private medical information kept secret, not shared around your workplace and speculated on unless it was absolutely necessary. It is thanks to these laws and court precedent that you don’t have to worry about this. The royal family, regardless of their position, should expect the same standard. <a href="https://theconversation.com/profiles/gemma-horton-1515949">Gemma Horton</a>, Impact Fellow for Centre for Freedom of the Media, <a href="https://theconversation.com/institutions/university-of-sheffield-1147">University of Sheffield</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/does-the-royal-family-have-a-right-to-privacy-what-the-law-says-224881">original article</a>.

Legal

We talked to dozens of people about their experience of grief. Here’s what we learned (and how it’s different from what you might think)

<a href="https://theconversation.com/profiles/michelle-peterie-564209">Michelle Peterie</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/alex-broom-121063">Alex Broom</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Have you ever felt a sudden pang of sadness? A bird seems to stop and look you in the eye. A photo drops out of a messy drawer from long ago, in the mundanity of a weekend spring clean. Your day is immediately derailed, unsettled. You are pulled into something you thought was past. And yet, in being pulled back, you are grateful, reconnected, and grief-stricken all over again. “You’ll get over it”. “Give it time”. “You need time to move on”. These are common cultural refrains in the face of loss. But what if grief doesn’t play by the rules? What if grief is a different thing altogether? We talked to 95 people about their experiences of grief surrounding the loss of a loved one, and <a href="https://journals.sagepub.com/doi/10.1177/00380261241228412">their stories</a> provided a fundamentally different account of grief to the one often presented to us culturally. <h2>Disordered grief?</h2> Grief is often imagined as a time-bound period in which one processes the pain of loss – that is, adjusts to absence and works toward “moving on”. The bereaved are expected to process their pain within the confines of what society deems “normal”. The <a href="https://theconversation.com/explainer-what-is-the-dsm-and-how-are-mental-disorders-diagnosed-9568">DSM-5 psychiatric manual</a> says if grief drags on too long, in fact, it becomes a pathology (a condition with a medical diagnosis). “Prolonged grief disorder” is the name given to “persistent difficulties associated with bereavement that exceeded expected social, cultural, or religious expectations”. While there can be <a href="https://theconversation.com/why-prolonged-grief-should-be-listed-as-a-mental-disorder-4262">value</a> in clinical diagnostic categories such as this, the danger is they put artificial boundaries around emotions. The pathologisation of grief can be deeply alienating to those experiencing it, for whom the pressure to “move on” can be hurtful and counterproductive. The stories we gathered in our research were raw, complex and often fraught. They did not sit comfortably with commonsense understandings of how grief “should” progress. As bereaved daughter Barbara told us: "Grief is not in the little box, it doesn’t even come close to a little box." <h2>Grief starts early</h2> The tendency is to think of grief as something that happens post death. The person we love dies, we have a funeral, and the grief sets in. Then it slowly subsides with the steady march of time. In fact, grief often begins earlier, often in a clinical consultation where the words “terminal” or “nothing more we can do” are used. Or when a loved one is told “go home and get your life in order”. Grief can begin months or even years before bereavement. As the people we interviewed experienced it, loss was also cumulative. The gradual deterioration of a loved one’s health in the years or months before their death imposed other painful losses: the loss of chosen lifestyles, the loss of longstanding relational rhythms, the loss of shared hopes and anticipated futures. Many participants felt their loved ones – and, indeed, the lives they shared with them – slipping away long before their physical deaths. <h2>Living with the dead</h2> Yet the dead do not simply leave us. They remain with us, in memories, rituals and cultural events. From <a href="https://theconversation.com/what-ancient-cultures-teach-us-about-grief-mourning-and-continuity-of-life-86199">Mexico’s Dia de los Muertos</a> to <a href="https://theconversation.com/japans-obon-festival-how-family-commemoration-and-ancestral-worship-shapes-daily-life-179890">Japan’s Opon</a>, festivals of the dead play a key role in cultures around the world. In that way, remembering the dead remains a critical aspect of living. So too does <a href="https://theconversation.com/theres-not-always-closure-in-the-never-ending-story-of-grief-3096">the ongoing experience of grief</a>. Events of this kind are not merely celebratory. They are critical forms through which life and death, joy and grief, are brought together and integrated. The absence of remembering can hold its own trouble, as our participants’ accounts revealed. As bereaved wife Anna explained: "I just find it really frustrating and I do get quite angry and upset sometimes. I know that life goes on. I’d be talking to girlfriends and stuff like that and it’s like they’ve forgotten that I’ve lost my husband. They haven’t, but nothing really changed in their life. But for me, and my family, it has." Part of the problem, here, is the ambivalent role grief plays in advanced industrialised societies like ours. Many of our participants felt pressure to perform resilience or (in clinical terms) to <a href="https://journals.sagepub.com/doi/full/10.1177/1363459317724854">“recover” quickly after loss</a>. But whose interests does a swift recovery serve? An employer’s? Friends who just want to get on with a death-free life? And, even more importantly, mightn’t ongoing connections with the dead enable better living? Might bringing the dead along with us actually make for better deaths and better lives? Many of our participants felt their loved ones remained with them, and experienced their “absent presence” as a source of comfort. Grieving, in this context, involved spending time “with” the dead. Anna described her practice as follows: "I had a diary, so I just write stuff in it about how I’m feeling or something happened and I’ll say to [my deceased husband], it’s all to [my deceased husband], “Do you remember, blah, blah, blah.” I’ll just talk about that memory that I have of that particular time and I find that that helps." <h2>Caring for those who grieve</h2> Grief does not begin at death, but neither do relationships end there. To rush the bereaved through grief – to usher them towards “recovery” and the more comfortable territories of happiness and productivity – is to do them a disservice. And, perhaps more critically, ridding our lives of the dead and grief may, in the end, make for more limited and muted emotional lives.<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/223848/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/michelle-peterie-564209">Michelle Peterie</a>, Research Fellow, Sydney Centre for Healthy Societies, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/alex-broom-121063">Alex Broom</a>, Professor of Sociology & Director, Sydney Centre for Healthy Societies, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of 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/we-talked-to-dozens-of-people-about-their-experience-of-grief-heres-what-we-learned-and-how-its-different-from-what-you-might-think-223848">original article</a>.

Caring

"What a life lived!": Fashion icon dies age 102

New York designer and style icon Iris Apfel has passed away aged 102. Her death was confirmed by her commercial agent, Lori Sale, who called Apfel "extraordinary", although no cause of death was given. Apfel, who was born on August 29, 1921, was known for her eccentric outfits, oversized black-rimmed glasses, bright red lipstick and short white hair. Her death was also announced on the fashion icon's official Instagram page, on Friday US time, just one day after she celebrated her 102nd-and-a-half birthday. "Working alongside her was the honour of a lifetime. I will miss her daily calls, always greeted with the familiar question: 'What have you got for me today?'" Sale said in a statement. "She was a visionary in every sense of the word. She saw the world through a unique lens — one adorned with giant, distinctive spectacles that sat atop her nose." <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/C3_geMFu15Y/?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/C3_geMFu15Y/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Iris Apfel (@iris.apfel)</a> </div> </blockquote> Apfel was an expert on textiles and antique fabrics. She and her husband Carl owned textile manufacturing company, Old World Weavers, which specialised in restoration work, including projects at the White House under six different US presidents. Apfel first rose to fame in 2005 when the curator of the Metropolitan Museum of Art’s Costume Institute hosted a show about her called "Rara Avis". Latin for "rare bird". They showcased the personal collection of vintage and designer accessories which were style on mannequins dressed in clothes Apfel would wear, and the exhibit became an instant success. Following the exhibit Apfel was awarded several opportunities including featuring in a 2007 coffee table book, a 2012 MAC Cosmetics campaign, and a 2014 documentary about her life, which was nominated for an Emmy award three years later. Apfel was also gained popularity among the younger generation, with over 3 million followers on Instagram, and over 250,000 on TikTok. "More is more & Less is a Bore," the bio read across her social media platforms. Despite her age, Apfel never retired, and told Today: "I think retiring at any age is a fate worse than death. Just because a number comes up doesn't mean you have to stop." Tributes have poured in from fans across the world. "What a life lived! What an example set! What footsteps you have left behind! Rest peacefully, icon!" one wrote. "She inspired so many women to be bold, and brave and truly authentic….to ignore the number of years we have lived and view age as an opportunity to shine. What a beautiful legacy," another added. "What a blessing to live that long and look that fabulous doing it," wrote a third. The style icon was married to Carl Apfel for 67 years until his death in 2015. They had no children. Images: Instagram

Caring

We looked at 700 plant-based foods to see how healthy they really are. Here’s what we found

<a href="https://theconversation.com/profiles/laura-marchese-1271636">Laura Marchese</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> and <a href="https://theconversation.com/profiles/katherine-livingstone-324808">Katherine Livingstone</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> If you’re thinking about buying plant-based foods, a trip to the supermarket can leave you bewildered. There are plant-based burgers, sausages and mince. The fridges are loaded with non-dairy milk, cheese and yoghurt. Then there are the tins of beans and packets of tofu. But how much is actually healthy? Our nutritional audit of more than 700 plant-based foods for sale in Australian supermarkets has just been <a href="https://www.sciencedirect.com/science/article/pii/S0889157524000516">published</a>. We found some products are so high in salt or saturated fat, we’d struggle to call them “healthy”. <h2>We took (several) trips to the supermarket</h2> In 2022, we visited two of each of four major supermarket retailers across Melbourne to collect information on the available range of plant-based alternatives to meat and dairy products. We took pictures of the products and their nutrition labels. We then analysed the nutrition information on the packaging of more than 700 of these products. This included 236 meat substitutes, 169 legumes and pulses, 50 baked beans, 157 dairy milk substitutes, 52 cheese substitutes and 40 non-dairy yoghurts. <h2>Plant-based meats were surprisingly salty</h2> We found a wide range of plant-based meats for sale. So, it’s not surprising we found large variations in their nutrition content. Sodium, found in added salt and which contributes to <a href="https://www.heartfoundation.org.au/bundles/healthy-living-and-eating/salt-and-heart-health">high blood pressure</a>, was our greatest concern. The sodium content varied from 1 milligram per 100 grams in products such as tofu, to 2,000mg per 100g in items such as plant-based mince products. This means we could eat our entire <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/salt">daily recommended sodium intake</a> in just one bowl of plant-based mince. An <a href="https://www.tandfonline.com/doi/full/10.1080/09637486.2022.2137786">audit</a> of 66 plant-based meat products in Australian supermarkets conducted in 2014 found sodium ranged from 316mg in legume-based products to 640mg in tofu products, per 100g. In a <a href="https://www.mdpi.com/2072-6643/11/11/2603">2019 audit</a> of 137 products, the range was up to 1,200mg per 100g. In other words, the results of our audit seems to show a consistent trend of plant-based meats <a href="https://www.tandfonline.com/doi/full/10.1080/09637486.2022.2137786">getting saltier</a>. <h2>What about plant-based milks?</h2> Some 70% of the plant-based milks we audited were fortified with calcium, a nutrient important for <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/calcium">bone health</a>. This is good news as a <a href="https://www.mdpi.com/2072-6643/12/5/1254">2019-2020 audit</a> of 115 plant-based milks from Melbourne and Sydney found only 43% of plant-based milks were fortified with calcium. Of the fortified milks in our audit, almost three-quarters (73%) contained the <a href="https://www.eatforhealth.gov.au/food-essentials/five-food-groups/milk-yoghurt-cheese-andor-their-alternatives-mostly-reduced-fat">recommended amount of calcium</a> – at least 100mg per 100mL. We also looked at the saturated fat content of plant-based milks. Coconut-based milks had on average up to six times higher saturated fat content than almond, oat or soy milks. <a href="https://www.mdpi.com/2072-6643/12/5/1254">Previous audits</a> also found coconut-based milks were much higher in saturated fat than all other categories of milks. <h2>A first look at cheese and yoghurt alternatives</h2> Our audit is the first study to identify the range of cheese and yoghurt alternatives available in Australian supermarkets. Calcium was only labelled on a third of plant-based yoghurts, and only 20% of supermarket options met the recommended 100mg of calcium per 100g. For plant-based cheeses, most (92%) were not fortified with calcium. Their sodium content varied from 390mg to 1,400mg per 100g, and saturated fat ranged from 0g to 28g per 100g. <h2>So, what should we consider when shopping?</h2> As a general principle, try to choose whole plant foods, such as unprocessed legumes, beans or tofu. These foods are packed with vitamins and minerals. They’re also high in dietary fibre, which is good for your gut health and keeps you fuller for longer. If opting for a processed plant-based food, here are five tips for choosing a healthier option. 1. Watch the sodium Plant-based meat alternatives can be high in sodium, so look for products that have <a href="https://www.eatforhealth.gov.au/eating-well/how-understand-food-labels/food-labels-what-look">around</a> 150-250mg sodium per 100g. 2. Pick canned beans and legumes Canned chickpeas, lentils and beans can be healthy and low-cost <a href="https://www.heartfoundation.org.au/getmedia/71522940-decf-436a-ba44-cd890dc18036/Meat-Free-Recipe-Booklet.pdf">additions to many meals</a>. Where you can, choose canned varieties with no added salt, especially when buying baked beans. 3. Add herbs and spices to your tofu Tofu can be a great alternative to meat. Check the label and pick the option with the highest calcium content. We found flavoured tofu was higher in salt and sugar content than minimally processed tofu. So it’s best to pick an unflavoured option and add your own flavours with spices and herbs. 4. Check the calcium When choosing a non-dairy alternative to milk, such as those made from soy, oat, or rice, check it is fortified with calcium. A good alternative to traditional dairy will have at least 100mg of calcium per 100g. 5. Watch for saturated fat If looking for a lower saturated fat option, almond, soy, rice and oat varieties of milk and yoghurt alternatives have much lower saturated fat content than coconut options. Pick those with less than 3g per 100g.<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/222991/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/laura-marchese-1271636">Laura Marchese</a>, PhD Student at the Institute for Physical Activity and Nutrition, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> and <a href="https://theconversation.com/profiles/katherine-livingstone-324808">Katherine Livingstone</a>, NHMRC Emerging Leadership Fellow and Senior Research Fellow at the Institute for Physical Activity and Nutrition, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin 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/we-looked-at-700-plant-based-foods-to-see-how-healthy-they-really-are-heres-what-we-found-222991">original article</a>.

Food & Wine

"What a life I’ve had": Author announces own death after years of battling dementia

Wendy Mitchell has died aged 68 after documenting her brave battle with dementia. The author from Walkington, East Yorkshire, became the best-selling writer after she was diagnosed with early onset vascular dementia and Alzheimer's in July 2014. She shared her philosophical outlook on living with the condition in her acclaimed 2018 memoir Somebody I Used To Know and in her 2022 book What I Wish I Knew About Dementia. In an <a href="https://whichmeamitoday.wordpress.com/2024/02/22/my-final-hug-in-a-mug/" target="_blank" rel="noopener">open letter</a> shared online, the author announced her death and revealed that she had refused to eat or drink towards the end of her battle. "If you’re reading this, it means this has probably been posted by my daughters as I’ve sadly died," she began. "Sorry to break the news to you this way, but if I hadn’t, my inbox would eventually have been full of emails asking if I’m OK, which would have been hard for my daughters to answer… "In the end I died simply by deciding not to eat or drink any more," she wrote. She added that the last cup of tea she had, her "final hug in a mug" was "the hardest thing to let go of". "Dementia is a cruel disease that plays tricks on your very existence. I’ve always been a glass half full person, trying to turn the negatives of life around and creating positives, because that’s how I cope." Mitchell said that the language used by doctors can "make or break" how someone copes with dementia, and instead of saying there's "nothing they can do" it is better to tell them they will have to "adapt to a new way of living". "Well I suppose dementia was the ultimate challenge. Yes, dementia is a bummer, but oh what a life I’ve had playing games with this adversary of mine to try and stay one step ahead," she wrote in her final blog post. She also said that she had always been resilient, which has helped her cope with whatever life throws in her way. Mitchell has been an advocate for assisted dying in the UK, and said that "the only legal choice we shouldn’t have in life is when to be born; for everything else, we, as humans, should have a choice; a choice of how we live and a choice of how we die." She added that the way she died was an active choice as she doesn't want "to be an inpatient in a hospital, or a resident in a Care Home," as "it’s just not the place I want to end my years." "My girls have always been the two most important people in my life. I didn’t take this decision lightly, without countless conversations. They were the hardest conversations I’ve ever had to put them through. "This was all MY CHOICE, my decision. So please respect my daughters' privacy, as they didn’t choose the life I chose, of standing up to and speaking out against dementia." She then thanked everyone for their support and left with a touching final message. "So, enjoy this knowing that dementia didn’t play the winning card – I did." Images: Daily Mail

Caring

What ‘psychological warfare’ tactics do scammers use, and how can you protect yourself?

<a href="https://theconversation.com/profiles/mike-johnstone-106590">Mike Johnstone</a>, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a> and <a href="https://theconversation.com/profiles/georgia-psaroulis-1513050">Georgia Psaroulis</a>, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a> Not a day goes by without a headline <a href="https://www.vice.com/en/article/qjvaym/people-share-worst-scam-stories">about a victim being scammed</a> and losing money. We are constantly warned about new scams and staying safe from cybercriminals. Scamwatch has <a href="https://www.scamwatch.gov.au/research-and-resources/tools-resources/online-resources/spot-the-scam-signs">no shortage of resources</a>, too. So why are people still getting scammed, and sometimes spectacularly so? Scammers use sophisticated psychological techniques. They exploit our deepest human vulnerabilities and bypass rational thought to tap into our emotional responses. This “<a href="https://www.thecut.com/article/amazon-scam-call-ftc-arrest-warrants.html">psychological warfare</a>” coerces victims into making impulsive decisions. Sometimes scammers spread their methods around many potential victims to see who is vulnerable. Other times, criminals focus on a specific person. Let’s unpack some of these psychological techniques, and how you can defend against them. <h2>1. Random phone calls</h2> Scammers start with small requests to establish a sense of commitment. After agreeing to these minor requests, we are more likely to comply with larger demands, driven by a desire to act consistently. The call won’t come from a number in your contacts or one you recognise, but the scammer may pretend to be someone you’ve engaged to work on your house, or perhaps one of your children using a friend’s phone to call you. If it is a scammer, maybe keeping you on the phone for a long time gives them an opportunity to find out things about you or people you know. They can use this info either immediately or at a later date. <h2>2. Creating a sense of urgency</h2> Scammers fabricate scenarios that require immediate action, like claiming a bank account is at risk of closure or an offer is about to expire. This tactic aims to prevent victims from assessing the situation logically or seeking advice, pressuring them into rushed decisions. The scammer creates an artificial situation in which you are frightened into doing something you wouldn’t ordinarily do. Scam calls <a href="https://theconversation.com/we-have-filed-a-case-under-your-name-beware-of-tax-scams-theyll-be-everywhere-this-eofy-162171">alleging to be from the Australian Tax Office</a> (ATO) are a great example. You have a debt to pay (apparently) and things will go badly if you don’t pay right now. Scammers play on your emotions to provoke reactions that cloud judgement. They may threaten legal trouble to instil fear, promise high investment returns to exploit greed, or share fabricated distressing stories to elicit sympathy and financial assistance. <h2>3. Building rapport with casual talk</h2> Through extended conversation, scammers build a psychological commitment to their scheme. No one gets very far by just demanding your password, but it’s natural to be friendly with people who are friendly towards us. After staying on the line for long periods of time, the victim also becomes cognitively fatigued. This not only makes the victim more open to suggestions, but also isolates them from friends or family who might recognise and counteract the scam. <h2>4. Help me to help you</h2> In this case, the scammer creates a situation where they help you to solve a real or imaginary problem (that they actually created). They work their “IT magic” and the problem goes away. Later, they ask you for something you wouldn’t normally do, and you do it because of the “social debt”: they helped you first. For example, a hacker might attack a corporate network, causing it to slow down. Then they call you, pretending to be from your organisation, perhaps as a recent hire not yet on the company’s contact list. They “help” you by turning off the attack, leaving you suitably grateful. Perhaps a week later, they call again and ask for sensitive information, such as the CEO’s password. You know company policy is to not divulge it, but the scammer will ask if you remember them (of course you do) and come up with an excuse for why they really need this password. The balance of the social debt says you will help them. <h2>5. Appealing to authority</h2> By posing as line managers, officials from government agencies, banks, or other authoritative bodies, scammers exploit our natural tendency to obey authority. Such scams operate at varying levels of sophistication. The simple version: your manager messages you with an urgent request to purchase some gift cards and send through their numbers. The complex version: your manager calls and asks to urgently transfer a large sum of money to an account you don’t recognise. You do this because <a href="https://www.wsj.com/articles/fraudsters-use-ai-to-mimic-ceos-voice-in-unusual-cybercrime-case-11567157402">it sounds exactly</a> like your manager on the phone – but the scammer <a href="https://www.forbes.com/sites/thomasbrewster/2021/10/14/huge-bank-fraud-uses-deep-fake-voice-tech-to-steal-millions/?sh=1329b80e7559">is using a voice deepfake</a>. In a recent major case in Hong Kong, such a scam even involved a <a href="https://edition.cnn.com/2024/02/04/asia/deepfake-cfo-scam-hong-kong-intl-hnk/index.html">deepfake video call</a>. This is deeply challenging because artificial intelligence tools, such as Microsoft’s VALL-E, can create <a href="https://arstechnica.com/information-technology/2023/01/microsofts-new-ai-can-simulate-anyones-voice-with-3-seconds-of-audio/">a voice deepfake</a> using just three seconds of sampled audio from a real person. <h2>How can you defend against a scam?</h2> First and foremost, verify identity. Find another way to contact the person to verify who they are. For example, you can call a generic number for the business and ask to be connected. In the face of rampant voice deepfakes, it can be helpful to agree on a “safe word” with your family members. If they call from an unrecognised number and you don’t hear the safe word just hang up. Watch out for pressure tactics. If the conversation is moving too fast, remember that someone else’s problem is not yours to solve. Stop and run the problem past a colleague or family member for a sanity check. A legitimate business will have no problem with you doing this. Lastly, if you are not sure about even the slightest detail, the simplest thing is to hang up or not respond. If you really owe a tax debt, the ATO will write to you.<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/223959/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/mike-johnstone-106590">Mike Johnstone</a>, Security Researcher, Associate Professor in Resilient Systems, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a> and <a href="https://theconversation.com/profiles/georgia-psaroulis-1513050">Georgia Psaroulis</a>, Postdoctoral research fellow, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan 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/what-psychological-warfare-tactics-do-scammers-use-and-how-can-you-protect-yourself-223959">original article</a>.

Money & Banking

"What a legend": Michael J Fox receives emotional standing ovation

Michael J Fox, who has Parkinson's disease, made a surprise appearance at the BAFTA Awards in London. The Back to the Future actor came onstage in a wheelchair, but he insisted on standing up at the podium to present the Best Film award. The star-studded audience all rose to their feet and gave the actor a standing ovation. When presenting the award, Fox described cinema as "magic" which can "change your life". "Five films were nominated in this category tonight and all five have something in common. They are the best of what we do," he said. He added that films can bring people together "no matter who you are or where you're from". "There's a reason why they say movies are magic because movies can change your day. "It can change your outlook. Sometimes it can change your life." Fox, who was diagnosed with Parkinson's in the 1990s, rarely makes public appearances. Many fans were pleasantly surprised at his appearance as he presented the night’s biggest award, Best Film, to Oppenheimer. "I was in tears the moment Michael J Fox came on the stage," one fan wrote on X, formerly known as Twitter. "THE MAN IS A LEGEND" <blockquote class="twitter-tweet"> i was in tears the moment Michael J Fox came on the stage 😥😥😥 THE MAN IS A LEGEND <a href="https://twitter.com/hashtag/BAFTAs?src=hash&ref_src=twsrc%5Etfw">#BAFTAs</a> <a href="https://twitter.com/hashtag/BAFTA2024?src=hash&ref_src=twsrc%5Etfw">#BAFTA2024</a> <a href="https://twitter.com/hashtag/EEBAFTAs?src=hash&ref_src=twsrc%5Etfw">#EEBAFTAs</a> <a href="https://t.co/Uud368S9gb">pic.twitter.com/Uud368S9gb</a> — RanaJi🏹 (@RanaTells) <a href="https://twitter.com/RanaTells/status/1759323180060299726?ref_src=twsrc%5Etfw">February 18, 2024</a></blockquote> "Michael J Fox. Absolute hero. What a legend," wrote another. <blockquote class="twitter-tweet"> Michael J Fox. Absolute hero. What a legend. <a href="https://twitter.com/hashtag/BAFTAs?src=hash&ref_src=twsrc%5Etfw">#BAFTAs</a> <a href="https://t.co/62lxpCy3mn">pic.twitter.com/62lxpCy3mn</a> — Jules 🌼 (@JulesItsjules) <a href="https://twitter.com/JulesItsjules/status/1759320058583568638?ref_src=twsrc%5Etfw">February 18, 2024</a></blockquote> "All those stars in the room, and still the biggest and most affectionate reaction is for Michael J Fox, because the man is a legend," added a third. <blockquote class="twitter-tweet"> All those stars in the room, and still the biggest and most affectionate reaction is for Michael J Fox, because the man is a legend. <a href="https://twitter.com/hashtag/EEBAFTAs?src=hash&ref_src=twsrc%5Etfw">#EEBAFTAs</a> — Declan Cashin (@Tweet_Dec) <a href="https://twitter.com/Tweet_Dec/status/1759319831696855281?ref_src=twsrc%5Etfw">February 18, 2024</a></blockquote> "He's a total legend and wonderful human," wrote a fourth. The actor has spoken <a href="https://www.oversixty.com.au/health/caring/i-m-not-gonna-be-80-michael-j-fox-s-tragic-admission" target="_blank" rel="noopener">candidly</a> about his experience with Parkinson's over the years, and has said that he has made peace with the degenerative nature of the disease. In a previous interview with AARP magazine profile, the actor admitted that he did not fear death. “I am genuinely a happy guy. I don’t have a morbid thought in my head — I don’t fear death. At all," he told the publication. Images: Getty

What is doxing, and how can you protect yourself?

<a href="https://theconversation.com/profiles/rob-cover-13135">Rob Cover</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a> The Australian government has brought forward <a href="https://www.theguardian.com/australia-news/2024/feb/12/albanese-government-to-propose-legislation-to-crack-down-on-doxing">plans to criminalise doxing</a>, bringing nationwide attention to the harms of releasing people’s private information to the wider public. The government response comes after the <a href="https://www.smh.com.au/national/hundreds-of-jewish-creatives-have-names-details-taken-in-leak-published-online-20240208-p5f3if.html">public release of almost 600 names</a> and private chat logs of a WhatsApp group of Australian Jewish creative artists discussing the Israel-Hamas war. As a result, some of the people whose details were leaked claim they were harassed, <a href="https://www.theguardian.com/australia-news/2024/feb/09/josh-burns-jewish-whatsapp-group-channel-publication-israel-palestine-clementine-ford">received death threats</a> and even had to go into hiding. While we wait for <a href="https://www.smh.com.au/national/australia-news-live-federal-laws-on-doxxing-to-be-brought-forward-anniversary-of-stolen-generations-apology-20240213-p5f4eh.html?post=p55nen#p55nen">new penalties</a> for doxers under the federal Privacy Act review, understanding doxing and its harms can help. And there are also steps we can all take to minimise the risk. <h2>What is doxing?</h2> <a href="https://www.kaspersky.com/resource-center/definitions/what-is-doxing">Doxing</a> (or doxxing) is releasing private information — or “docs”, short for documents — online to the wider public without the user’s consent. This includes information that may put users at risk of harm, especially names, addresses, employment details, medical or financial records, and names of family members. The Australian government <a href="https://ministers.ag.gov.au/media-centre/transcripts/media-conference-parliament-house-13-02-2024">currently defines doxing</a> as the “malicious release” of people’s private information without their consent. Doxing began as a form of unmasking anonymous users, trolls and those using hate speech while <a href="https://www.theatlantic.com/technology/archive/2022/04/doxxing-meaning-libs-of-tiktok/629643/">hiding behind a pseudonym</a>. Recently, it has become a weapon for online abuse, harassment, hate speech and adversarial politics. It is often the outcome of online arguments or polarised public views. It is also becoming more common. Although there is no data for Australia yet, according to media company <a href="https://www.safehome.org/family-safety/doxxing-online-harassment-research/">SafeHome.org</a>, about 4% of Americans report having been doxed, with about half saying their private emails or home addresses have been made public. Doxing is a crime in some countries such as the Netherlands and South Korea. In other places, including Australia, privacy laws haven’t yet caught up. <h2>Why is doxing harmful?</h2> In the context of the <a href="https://theconversation.com/au/topics/israel-hamas-war-146714">Israel-Hamas war</a>, doxing has affected <a href="https://www.haaretz.com/world-news/asia-and-australia/2024-02-06/ty-article/death-threats-boycotts-target-jewish-creatives-in-australia/0000018d-7e43-d636-adef-7eefae580000">both Jewish</a> and <a href="https://edition.cnn.com/2023/10/15/business/palestinian-americans-activists-doxxing/index.html">pro-Palestinian communities and activists</a> in Australia and abroad. Doxing is harmful because it treats a user as an object and takes away their agency to decide what, and how much, personal information they want shared with the wider public. This puts people at very real risk of physical threats and violence, particularly when public disagreement becomes heated. From a broader perspective, doxing also damages the digital ecology, reducing people’s ability to freely participate in public or even private debate through social media. Although doxing is sometimes just inconvenient, it is often used to publicly shame or humiliate someone for their private views. This can take a toll on a person’s mental health and wellbeing. It can also affect a person’s employment, especially for people whose employers require them to keep their attitudes, politics, affiliations and views to themselves. Studies have shown doxing particularly impacts <a href="https://journals.sagepub.com/doi/full/10.1177/0306422015605714">women</a>, including those using dating apps or experiencing family violence. In some cases, children and family members have been threatened because a high-profile relative has been doxed. Doxing is also harmful because it oversimplifies a person’s affiliations or attitudes. For example, releasing the names of people who have joined a private online community to navigate complex views can represent them as only like-minded stereotypes or as participants in a group conspiracy. <h2>What can you do to protect yourself from doxing?</h2> Stronger laws and better platform intervention are necessary to reduce doxing. Some experts believe that the fear of <a href="https://dl.acm.org/doi/abs/10.1145/3476075">punishment</a> can help shape better online behaviours. These punishments may include criminal <a href="https://www.esafety.gov.au/report/what-you-can-report-to-esafety">penalties</a> for perpetrators and <a href="https://www.theaustralian.com.au/breaking-news/doxxing-attack-on-jewish-australians-prompts-call-for-legislative-change/news-story/9a2f3615dbf5594fb521a8959739e1f8#:%7E:text=Alongside%20legislative%20reform%2C%20the%20ECAJ,information%2C%E2%80%9D%20Mr%20Aghion%20said.">deactivating social media accounts</a> for repeat offenders. But better education about the risks and harms is often the best treatment. And you can also protect yourself without needing to entirely withdraw from social media: <ol> <li> never share a home or workplace address, phone number or location, including among a private online group or forum with trusted people </li> <li> restrict your geo-location settings </li> <li> avoid giving details of workplaces, roles or employment on public sites not related to your work </li> <li> avoid adding friends or connections on social media services of people you do not know </li> <li> if you suspect you risk being doxed due to a heated online argument, temporarily shut down or lock any public profiles </li> <li> avoid becoming a target by pursuing haters when it reaches a certain point. Professional and courteous engagement can help avoid the anger of those who might disagree and try to harm you. </li> </ol> Additionally, hosts of private online groups must be very vigilant about who joins a group. They should avoid the trap of accepting members just to increase the group’s size, and appropriately check new members (for example, with a short survey or key questions that keep out people who may be there to gather information for malicious purposes). Employers who require their staff to have online profiles or engage with the public should provide information and strategies for doing so safely. They should also provide immediate support for staff who have been doxed.<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/223428/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/rob-cover-13135">Rob Cover</a>, Professor of Digital Communication and Co-Director of the RMIT Digital Ethnography Research Centre, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT 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-is-doxing-and-how-can-you-protect-yourself-223428">original article</a>.

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

Surgery won’t fix my chronic back pain, so what will?

Do optimists really live longer? Here’s what the research says

Silent cancers: here’s what you need to know when there are no obvious symptoms

There are new flu vaccines on offer for 2024. Should I get one? What do I need to know?

Eating some chocolate really might be good for you – here’s what the research says

What are the most common symptoms of menopause? And which can hormone therapy treat?

What if there was a hearing aid that understood your listening intentions?

What’s the difference between autism and Asperger’s disorder?

Kate Middleton is having ‘preventive chemotherapy’ for cancer. What does this mean?

What are the four waves of feminism? And what comes next?

Longing for the ‘golden age’ of air travel? Be careful what you wish for

Does the royal family have a right to privacy? What the law says

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"What a life lived!": Fashion icon dies age 102

We looked at 700 plant-based foods to see how healthy they really are. Here’s what we found

"What a life I’ve had": Author announces own death after years of battling dementia

What ‘psychological warfare’ tactics do scammers use, and how can you protect yourself?

"What a legend": Michael J Fox receives emotional standing ovation

What is doxing, and how can you protect yourself?

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