Pleural effusion is the abnormal accumulation of fluid in the pleural space.
Normally, only a thin layer of fluid separates the two layers of the pleura.
An excessive amount of fluid may accumulate for many reasons, including
heart failure, cirrhosis, pneumonia, and cancer. Depending on the cause, the
fluid may be either rich in protein (exudate) or watery (transudate). Family
doctors use this distinction to help determine the cause.
Blood in the pleural space (hemothorax) usually results from a chest injury.
Rarely, a blood vessel ruptures into the pleural space when no injury has
occurred, or a bulging area in the aorta (aortic aneurysm) leaks blood into
the pleural space. Because blood in the pleural space does not clot fully,
it is usually easy for a family doctor to remove using a large-bore needle
or a chest tube.
Pus in the pleural space (empyema) can accumulate when pneumonia or a lung
abscess spreads into the space. A wide range of bacteria as well as certain
fungi and mycobacteria (especially the mycobacterium that causes
tuberculosis) are the most common organisms causing pleural effusion.
Empyema may also complicate an infection from chest wounds, chest surgery,
rupture of the esophagus, or an abscess in the abdomen.
Milky fluid in the pleural space (chylothorax) is caused by an injury to the
main lymphatic duct in the chest (thoracic duct) or by a blockage of the
duct by a tumor.
High-cholesterol fluid in the pleural space results from a long-standing
pleural effusion caused by a condition such as tuberculosis or rheumatoid
arthritis.
Symptoms & Diagnosis
The most common symptoms, regardless of the type of fluid in the pleural
space or its cause, are shortness of breath and chest pain. However, many
people with pleural effusion have no symptoms at all.
A chest x-ray, which shows fluid in the pleural space, is usually the first
step in making the diagnosis. Computed tomography (CT) more clearly shows
the lung and the fluid and may show evidence of pneumonia, a lung abscess,
or a tumor. An ultrasound may help a family doctor determine the position of
a small accumulation of fluid.
A specimen of the fluid is almost always removed for examination using a
needle, a procedure called thoracentesis. The appearance of the fluid may
help a family doctor determine its cause. Certain laboratory tests evaluate
the chemical composition of the fluid and determine the presence of
bacteria, including the bacteria that cause tuberculosis. The fluid specimen
is also examined for the number and types of cells and for the presence of
cancerous cells.
If these tests cannot identify the cause of the pleural effusion, a biopsy
of the pleura may be needed, which can detect cancer and tuberculosis. Using
a biopsy needle, a family doctor removes a sample of the outer layer of the
pleura for analysis. If the specimen is too small for an accurate diagnosis,
a tissue sample must be taken through a small incision in the chest wall, a
procedure called an open pleural biopsy. Sometimes, a sample is obtained
using a thoracoscope (a viewing tube that allows a family doctor to examine
the pleural space and obtain samples.
Occasionally, bronchoscopy (a direct visual examination of the airways
through a viewing tube) helps the family doctor find the cause of the fluid.
In about 20% of people with pleural effusion, the cause is not obvious after
initial testing, and in some people a cause is never found, even after
extensive testing.
Common Causes of Pleural Effusion
Abscess under the diaphragm
Cirrhosis
Coccidioidomycosis and other fungal infections
Drugs such as hydralazine, procainamide, isoniazid, phenytoin,
chlorpromazine, nitrofurantoin, bromocriptine, dantrolene, procarbazine
Heart failure
Heart surgery
Improper placement of feeding tubes or intravenous catheters
Injury to the chest
Low protein levels in the blood
Pancreatitis
Pneumonia
Pulmonary embolus
Rheumatoid arthritis
Systemic lupus erythematosus
Tuberculosis
Tumors
Treatment
Small pleural effusions may require treatment of only the underlying cause.
Larger pleural effusions, especially those that cause shortness of breath,
may require drainage of the fluid. Usually, drainage dramatically relieves
shortness of breath. Often, fluid can be drained using thoracentesis. An
area of skin between two lower ribs is anesthetized, then a small needle is
inserted and gently pushed deeper until it reaches the fluid. A thin plastic
catheter is often guided over the needle into the fluid to lessen the chance
of puncturing the lung and causing a pneumothorax. Although thoracentesis is
usually performed for diagnostic purposes, a family doctor can safely remove
as much as 1.5 liters of fluid at a time using this procedure.
When larger amounts of fluid must be removed, a tube (chest tube) may be
inserted through the chest wall. After numbing the area by injecting a local
anesthetic, a family doctor inserts a plastic tube into the chest between
two ribs. Then the family doctor connects the tube to a water-sealed
drainage system that prevents air from leaking into the pleural space. A
chest x-ray is taken to check the tube's position. Drainage can be blocked
if the chest tube is incorrectly positioned or becomes kinked. If the fluid
is very thick or full of clots, it may not flow out.
An accumulation of pus from an infection (empyema) requires intravenous
antibiotics and drainage of the fluid. Tuberculosis or fungal infections
such as coccidioidomycosis require prolonged treatment with antibiotics or
antifungal drugs. If the pus is very thick or if it has formed within
fibrous compartments, drainage is more difficult. Sometimes drugs called
fibrinolytics are instilled into the pleura space to help drainage, which
may avoid the need for surgery. If surgery is needed, it can be performed by
a procedure called video-assisted thorascopic debridement or by thoracotomy.
During surgery, a thick peel of fibrous material is removed from the lung
surface to allow the lung to expand normally.
Fluid accumulation caused by tumors of the pleura may be difficult to treat
because fluid tends to reaccumulate rapidly. Draining the fluid and giving
antitumor drugs sometimes prevents further fluid accumulation. But if fluid
continues to accumulate, sealing the pleural space (pleurodesis) may be
helpful. All fluid is drained through a tube, which is then used to
administer a pleural irritant, such as a doxycycline solution or a talc
mixture, into the space. The irritant seals the two layers of pleura
together, so that no room remains for additional fluid to accumulate.
If blood has entered the pleural space, usually drainage through a tube is
all that is needed-as long as the bleeding has stopped. Drugs that help
break up blood clots, such as streptokinase and urokinase, are occasionally
administered through the drainage tube if a substantial portion of the clot
remains in the pleural space. Caution should be taken because these drugs
can trigger rebleeding. If the bleeding continues or if the accumulation of
fluid cannot be removed adequately with a tube, surgery may be needed.
Treatment of chylothorax focuses on repairing the damage to the lymphatic
duct. Such treatment may consist of surgery, chemotherapy, or radiation
treatment for a cancer that is blocking lymph flow. [AAFP]
Thursday, July 31, 2008
Monday, July 28, 2008
Menopause
What is menopause?
Menopause is the time in a woman's life when her periods stop and she can't
have children anymore. This happens because as a woman ages, her ovaries
stop making enough of the female hormones estrogen and progesterone.
When does menopause occur?
The average age for women to have their last period is about 50. But it's
normal for menopause to occur any time from age 41 to 59. A woman often goes
through menopause at about the same age as her mother.
Women who have both ovaries removed will go through "surgical menopause" at
the time of their surgery. If the uterus is taken out but the ovaries are
left, a woman won't have periods but she will only go through menopause when
her ovaries stop making estrogen.
If you stop having periods early--before age 40--your family doctor can do a
blood test to see if you're going through menopause.
Menopause is a gradual process that can take several years. You're not
really through menopause until you haven't had a period for 12 months.
(During this time, keep using birth control if you don't want to become
pregnant.)
Talk to your family doctor if you have:
A change in your monthly cycle
Heavy bleeding
Bleeding that lasts longer than usual
Bleeding more often than every 3 weeks
Bleeding after sexual intercourse
Any blood staining between periods
What are the common signs and symptoms of menopause?
Some women just stop having periods. Others experience symptoms, such as the
following:
A change in your menstrual cycle. This is one of the first signs of
menopause. You may skip periods or they may occur closer together. Your flow
may be lighter or heavier than usual.
Hot flashes. Hot flashes are the most common symptom of menopause.
When you have a hot flash, you'll feel warm from your chest to your head,
often in wave-like sensations. Your skin may turn red and you may sweat. You
may feel sick to your stomach and dizzy. You may also have a headache and
feel like your heart is beating very fast and hard.
Thinning of your vagina and vulva (the area around your vagina). The skin of
your vagina and vulva becomes thinner with menopause. Your vagina also loses
its ability to produce as much lubrication (wetness) during sexual arousal.
These changes can lead to pain during sex.
You can use an estrogen cream (put in and around your vagina) or a
water-based lubricant (such as K-Y Jelly) to make sex less painful.
Urinary tract problems. You're more likely to have bladder and urinary tract
infections during and after menopause. Talk to your family doctor if you
have to go to the bathroom often, feel an urgent need to urinate, feel a
burning sensation when urinating or are not able to urinate.
Headaches, night sweats, trouble sleeping and tiredness are other symptoms.
Trouble sleeping and feeling tired may be caused by hot flashes and night
sweats.
Does menopause have emotional symptoms?
Many women experience emotional symptoms during menopause. These symptoms
may include sadness, anxiety and loss of sleep. For some women, symptoms can
be severe. If you find that you're having emotional problems, talk to your
family doctor.
What is hormone replacement therapy?
Hormone replacement therapy (HRT) involves taking estrogen alone or estrogen
combined with another hormone, progestin. Some women have found that HRT can
relieve symptoms such as hot flashes, vaginal dryness and some urinary
problems. However, HRT is not for everyone. New information from recent
studies suggests that for many women, the risks of using HRT may outweigh
the benefits. Talk to your family doctor about the risks and benefits of
HRT.
Are other treatments available?
Yes. Medicines such as estrogen cream, antidepressants, soy products and
certain herbal supplements may help ease some menopausal symptoms. Discuss
these options with your family doctor.
Help for hot flashes
Turn your thermostat down. Sleep in a cool room.
Dress in layers, so you can remove clothing when you get too warm.
Wear cotton and other natural fabrics that "breathe" so you don't get
overheated. Use cotton sheets on your bed.
Drink cool water or other beverages when a hot flash starts.
Avoid alcohol. [AAFP]
Menopause is the time in a woman's life when her periods stop and she can't
have children anymore. This happens because as a woman ages, her ovaries
stop making enough of the female hormones estrogen and progesterone.
When does menopause occur?
The average age for women to have their last period is about 50. But it's
normal for menopause to occur any time from age 41 to 59. A woman often goes
through menopause at about the same age as her mother.
Women who have both ovaries removed will go through "surgical menopause" at
the time of their surgery. If the uterus is taken out but the ovaries are
left, a woman won't have periods but she will only go through menopause when
her ovaries stop making estrogen.
If you stop having periods early--before age 40--your family doctor can do a
blood test to see if you're going through menopause.
Menopause is a gradual process that can take several years. You're not
really through menopause until you haven't had a period for 12 months.
(During this time, keep using birth control if you don't want to become
pregnant.)
Talk to your family doctor if you have:
A change in your monthly cycle
Heavy bleeding
Bleeding that lasts longer than usual
Bleeding more often than every 3 weeks
Bleeding after sexual intercourse
Any blood staining between periods
What are the common signs and symptoms of menopause?
Some women just stop having periods. Others experience symptoms, such as the
following:
A change in your menstrual cycle. This is one of the first signs of
menopause. You may skip periods or they may occur closer together. Your flow
may be lighter or heavier than usual.
Hot flashes. Hot flashes are the most common symptom of menopause.
When you have a hot flash, you'll feel warm from your chest to your head,
often in wave-like sensations. Your skin may turn red and you may sweat. You
may feel sick to your stomach and dizzy. You may also have a headache and
feel like your heart is beating very fast and hard.
Thinning of your vagina and vulva (the area around your vagina). The skin of
your vagina and vulva becomes thinner with menopause. Your vagina also loses
its ability to produce as much lubrication (wetness) during sexual arousal.
These changes can lead to pain during sex.
You can use an estrogen cream (put in and around your vagina) or a
water-based lubricant (such as K-Y Jelly) to make sex less painful.
Urinary tract problems. You're more likely to have bladder and urinary tract
infections during and after menopause. Talk to your family doctor if you
have to go to the bathroom often, feel an urgent need to urinate, feel a
burning sensation when urinating or are not able to urinate.
Headaches, night sweats, trouble sleeping and tiredness are other symptoms.
Trouble sleeping and feeling tired may be caused by hot flashes and night
sweats.
Does menopause have emotional symptoms?
Many women experience emotional symptoms during menopause. These symptoms
may include sadness, anxiety and loss of sleep. For some women, symptoms can
be severe. If you find that you're having emotional problems, talk to your
family doctor.
What is hormone replacement therapy?
Hormone replacement therapy (HRT) involves taking estrogen alone or estrogen
combined with another hormone, progestin. Some women have found that HRT can
relieve symptoms such as hot flashes, vaginal dryness and some urinary
problems. However, HRT is not for everyone. New information from recent
studies suggests that for many women, the risks of using HRT may outweigh
the benefits. Talk to your family doctor about the risks and benefits of
HRT.
Are other treatments available?
Yes. Medicines such as estrogen cream, antidepressants, soy products and
certain herbal supplements may help ease some menopausal symptoms. Discuss
these options with your family doctor.
Help for hot flashes
Turn your thermostat down. Sleep in a cool room.
Dress in layers, so you can remove clothing when you get too warm.
Wear cotton and other natural fabrics that "breathe" so you don't get
overheated. Use cotton sheets on your bed.
Drink cool water or other beverages when a hot flash starts.
Avoid alcohol. [AAFP]
Sunday, July 27, 2008
Acute Bronchitis
What is acute bronchitis?
Acute bronchitis is an infection of the bronchial (say: "brawn-kee-ull")
tree. The bronchial tree is made up of the tubes that carry air into your
lungs. When these tubes get infected, they swell and mucus (thick fluid)
forms inside them. This makes it hard for you to breathe. You may cough up
mucus and wheeze (make a whistling sound when you breathe).
What causes acute bronchitis?
Acute bronchitis is almost always caused by viruses that attack the lining
of the bronchial tree and cause infection. As your body fights back against
these viruses, more swelling occurs and more mucus is made. It takes time
for your body to kill the viruses and heal the damage to your bronchial
tubes.
In most cases, the same viruses that cause colds cause acute bronchitis.
Research has shown that bacterial infection is a much less common cause of
bronchitis than we used to think. Very rarely, an infection caused by a
fungus can cause acute bronchitis.
How do people get acute bronchitis?
The viruses that cause acute bronchitis are sprayed into the air or onto
people's hands when they cough. You can get acute bronchitis if you breathe
in these viruses. You can also get it if you touch a hand that is coated
with the viruses.
If you smoke or are around damaging fumes (such as those in certain kinds of
factories), you are more likely to get acute bronchitis and to have it
longer. This is because your bronchial tree is already damaged.
How is acute bronchitis treated?
Most cases of acute bronchitis will go away on their own after a few days or
a week. It's a good idea to get plenty of rest, drink lots of noncaffeinated
fluids (for example, water and fruit juices) and increase the humidity in
your environment.
Because acute bronchitis is usually caused by viruses, antibiotics
(medicines that kill bacteria) usually do not help. Even if you cough up
mucus that is colored or thick, antibiotics probably won't help you get
better any faster.
If you smoke, you should cut down on the number of cigarettes you smoke, or
stop smoking altogether. This will help your bronchial tree heal faster.
For some people with acute bronchitis, family doctors prescribe medicines
that are usually used to treat asthma. These medicines can help open the
bronchial tubes and clear out mucus. They are usually given with an inhaler.
An inhaler sprays the medicine right into the bronchial tree. Your family
doctor will decide if this treatment is right for you.
How long will the cough from acute bronchitis last?
You should call your family doctor if:
* You continue to wheeze and cough for more than 2 weeks, especially at
night or when you are active.
* You continue to cough for more than 2 weeks and sometimes have a
bad-tasting fluid come up into your mouth.
* You have a cough, you feel very sick and weak, and you have a high fever
that doesn't go down.
You cough up blood.
* You have trouble breathing when you lie down.
* Your feet swell.
Sometimes the cough from acute bronchitis lasts for several weeks or months.
Usually this happens because the bronchial tree is taking a long time to
heal. However, a cough that doesn't go away may be a sign of another
problem, like asthma or pneumonia.
How can I keep from getting acute bronchitis again?
One of the best ways to keep from getting acute bronchitis is to wash your
hands often to get rid of any viruses.
If you smoke, the best defense against acute bronchitis is to quit. Smoking
damages your bronchial tree and makes it easier for viruses to cause
infection. Smoking also slows down the healing, so it takes longer for you
to get well. [AAFP]
Acute bronchitis is an infection of the bronchial (say: "brawn-kee-ull")
tree. The bronchial tree is made up of the tubes that carry air into your
lungs. When these tubes get infected, they swell and mucus (thick fluid)
forms inside them. This makes it hard for you to breathe. You may cough up
mucus and wheeze (make a whistling sound when you breathe).
What causes acute bronchitis?
Acute bronchitis is almost always caused by viruses that attack the lining
of the bronchial tree and cause infection. As your body fights back against
these viruses, more swelling occurs and more mucus is made. It takes time
for your body to kill the viruses and heal the damage to your bronchial
tubes.
In most cases, the same viruses that cause colds cause acute bronchitis.
Research has shown that bacterial infection is a much less common cause of
bronchitis than we used to think. Very rarely, an infection caused by a
fungus can cause acute bronchitis.
How do people get acute bronchitis?
The viruses that cause acute bronchitis are sprayed into the air or onto
people's hands when they cough. You can get acute bronchitis if you breathe
in these viruses. You can also get it if you touch a hand that is coated
with the viruses.
If you smoke or are around damaging fumes (such as those in certain kinds of
factories), you are more likely to get acute bronchitis and to have it
longer. This is because your bronchial tree is already damaged.
How is acute bronchitis treated?
Most cases of acute bronchitis will go away on their own after a few days or
a week. It's a good idea to get plenty of rest, drink lots of noncaffeinated
fluids (for example, water and fruit juices) and increase the humidity in
your environment.
Because acute bronchitis is usually caused by viruses, antibiotics
(medicines that kill bacteria) usually do not help. Even if you cough up
mucus that is colored or thick, antibiotics probably won't help you get
better any faster.
If you smoke, you should cut down on the number of cigarettes you smoke, or
stop smoking altogether. This will help your bronchial tree heal faster.
For some people with acute bronchitis, family doctors prescribe medicines
that are usually used to treat asthma. These medicines can help open the
bronchial tubes and clear out mucus. They are usually given with an inhaler.
An inhaler sprays the medicine right into the bronchial tree. Your family
doctor will decide if this treatment is right for you.
How long will the cough from acute bronchitis last?
You should call your family doctor if:
* You continue to wheeze and cough for more than 2 weeks, especially at
night or when you are active.
* You continue to cough for more than 2 weeks and sometimes have a
bad-tasting fluid come up into your mouth.
* You have a cough, you feel very sick and weak, and you have a high fever
that doesn't go down.
You cough up blood.
* You have trouble breathing when you lie down.
* Your feet swell.
Sometimes the cough from acute bronchitis lasts for several weeks or months.
Usually this happens because the bronchial tree is taking a long time to
heal. However, a cough that doesn't go away may be a sign of another
problem, like asthma or pneumonia.
How can I keep from getting acute bronchitis again?
One of the best ways to keep from getting acute bronchitis is to wash your
hands often to get rid of any viruses.
If you smoke, the best defense against acute bronchitis is to quit. Smoking
damages your bronchial tree and makes it easier for viruses to cause
infection. Smoking also slows down the healing, so it takes longer for you
to get well. [AAFP]
Wednesday, July 23, 2008
Occupational Exposure to Lead
How might I be exposed to lead?
Lead can get into your body in two ways: inhalation (breathing it in) and
ingestion (eating it). You might breathe in lead dust or lead fumes without
even knowing it. You can swallow lead dust if it gets in your food or drink.
You might even swallow lead dust if you eat without washing your hands
first.
What problems does lead cause?
Once lead gets into your body, it stays there for a long time. It builds up
over time even if you're exposed to only small amounts of it. As lead builds
up in your body, it can damage your brain, kidneys, nerves and blood cells.
This is called lead poisoning.
As a general rule, the more lead you have in your body, the more likely it
is that you'll have health problems. Your chance of having health problems
goes up the longer you have a high level of lead in your body. We don't know
just how much lead causes health problems because the effects of lead are
different for everyone.
What are the signs of lead poisoning?
These are some of the early signs of lead poisoning:
* Tiredness
* Irritability
* Muscle and joint pain
* Headaches
* Stomachaches and cramps
What is my employer's responsibility for lead in the workplace?
The Lead Standard is a federal and state regulation (law) that requires
employers to follow guidelines to protect workers from harmful lead
exposure. An important part of this standard says that lead in the air of a
workplace shouldn't be more than 50 µg (micrograms) per meter, averaged over
8 hours. Under the Lead Standard, workers have the right to the following:
* To receive a copy of the Standard.
* To receive a copy of air monitoring results.
* To receive medical evaluation and monitoring if they are exposed to
airborne lead levels above 30 µg per meter for more than 30 days a year. If
this occurs, the employer must provide workers with a medical surveillance
program. This program would include blood testing, a lead-specific medical
exam, treatment (if needed), removal from further exposure to lead if health
is at risk and medical clearance for use of a respirator. In some
circumstances, workers can be transferred to jobs that don't expose them to
lead without loss of pay or benefits.
Who can help me understand my blood lead test?
Your family doctor and your company safety officer can help if you're
worried about lead exposure. Your family doctor can test your blood for
lead.
Your family doctor can also help you understand your lead level and the
effects it might have on your health. It's important for your family doctor
to know that you are exposed to lead at work even if you don't notice any
health problems.
How can I protect myself from lead exposure?
The company safety officer can help you find out whether your work area has
been checked for high levels of lead in the air. He or she can also help you
avoid exposure by giving you protective equipment.
You can protect yourself and your family with these basic safe work
practices:
* Wear separate work clothes and shoes or boots while at work.
* Don't wear your work clothes and shoes or boots home from work, and don't
wear them when you aren't at work.
* Wash and dry your work clothes separately. Don't mix your work clothes
with clothes from other people in your family when the laundry is done.
* Wash your hands and face before you eat, drink or smoke.
* At work, eat, drink or smoke only in areas that are free of lead dust and
fumes.
* Avoid stirring up lead-containing dust with dry sweeping; wet cleaning is
safer.
* If you wear a respirator at work, make sure it fits well.
What about lead in my home?
Lead is present in lead-based paint and in lead-contaminated soil and water.
The older the home, the greater the chance lead-based paint was used. Lead
from paint can enter your body through dust or paint chips. The soil around
your home can pick up lead from sources such as exterior paint. Lead can
enter your drinking water through your plumbing. If you think the plumbing
in your house may contain lead, use only cold water for drinking and cooking
and run water for 30 seconds before using it. You may also need to replace
the pipes that supply water to the faucets in your home.
You can check your home for lead by having a professional inspect your paint
or assess any possible sources of lead. [AAFP]
Lead can get into your body in two ways: inhalation (breathing it in) and
ingestion (eating it). You might breathe in lead dust or lead fumes without
even knowing it. You can swallow lead dust if it gets in your food or drink.
You might even swallow lead dust if you eat without washing your hands
first.
What problems does lead cause?
Once lead gets into your body, it stays there for a long time. It builds up
over time even if you're exposed to only small amounts of it. As lead builds
up in your body, it can damage your brain, kidneys, nerves and blood cells.
This is called lead poisoning.
As a general rule, the more lead you have in your body, the more likely it
is that you'll have health problems. Your chance of having health problems
goes up the longer you have a high level of lead in your body. We don't know
just how much lead causes health problems because the effects of lead are
different for everyone.
What are the signs of lead poisoning?
These are some of the early signs of lead poisoning:
* Tiredness
* Irritability
* Muscle and joint pain
* Headaches
* Stomachaches and cramps
What is my employer's responsibility for lead in the workplace?
The Lead Standard is a federal and state regulation (law) that requires
employers to follow guidelines to protect workers from harmful lead
exposure. An important part of this standard says that lead in the air of a
workplace shouldn't be more than 50 µg (micrograms) per meter, averaged over
8 hours. Under the Lead Standard, workers have the right to the following:
* To receive a copy of the Standard.
* To receive a copy of air monitoring results.
* To receive medical evaluation and monitoring if they are exposed to
airborne lead levels above 30 µg per meter for more than 30 days a year. If
this occurs, the employer must provide workers with a medical surveillance
program. This program would include blood testing, a lead-specific medical
exam, treatment (if needed), removal from further exposure to lead if health
is at risk and medical clearance for use of a respirator. In some
circumstances, workers can be transferred to jobs that don't expose them to
lead without loss of pay or benefits.
Who can help me understand my blood lead test?
Your family doctor and your company safety officer can help if you're
worried about lead exposure. Your family doctor can test your blood for
lead.
Your family doctor can also help you understand your lead level and the
effects it might have on your health. It's important for your family doctor
to know that you are exposed to lead at work even if you don't notice any
health problems.
How can I protect myself from lead exposure?
The company safety officer can help you find out whether your work area has
been checked for high levels of lead in the air. He or she can also help you
avoid exposure by giving you protective equipment.
You can protect yourself and your family with these basic safe work
practices:
* Wear separate work clothes and shoes or boots while at work.
* Don't wear your work clothes and shoes or boots home from work, and don't
wear them when you aren't at work.
* Wash and dry your work clothes separately. Don't mix your work clothes
with clothes from other people in your family when the laundry is done.
* Wash your hands and face before you eat, drink or smoke.
* At work, eat, drink or smoke only in areas that are free of lead dust and
fumes.
* Avoid stirring up lead-containing dust with dry sweeping; wet cleaning is
safer.
* If you wear a respirator at work, make sure it fits well.
What about lead in my home?
Lead is present in lead-based paint and in lead-contaminated soil and water.
The older the home, the greater the chance lead-based paint was used. Lead
from paint can enter your body through dust or paint chips. The soil around
your home can pick up lead from sources such as exterior paint. Lead can
enter your drinking water through your plumbing. If you think the plumbing
in your house may contain lead, use only cold water for drinking and cooking
and run water for 30 seconds before using it. You may also need to replace
the pipes that supply water to the faucets in your home.
You can check your home for lead by having a professional inspect your paint
or assess any possible sources of lead. [AAFP]
Monday, July 21, 2008
Bad Reaction to Diet
Vogue made the proposal, but was it indecent?
Last September, Kate and Laura Mulleavy, the sibling designers of Rodarte,
received a phone call from a Vogue editor who suggested that they see a
trainer and go on a diet. The sisters, who said they wanted to be healthier
and balance their stress levels, agreed, accepted four months of personal
training and a meal delivery service paid for by the magazine, lost a
combined 50 pounds and kept a journal of their experiences, which appears in
the April issue.
"Kate and I have decided we have to do this program in a realistic way,"
Laura Mulleavy wrote in an Oct. 22 entry. "We'll have wine when we feel like
it and cheat on holidays."
Reactions to the issue have been blistering. Dozens of objections were
posted to an entry about the diet on the blog Jezebel.
Nonetheless, Cynthia M. Bulik, a professor of eating disorders, defended the
offer as it was presented in the magazine, noting that the designers had
written that a doctor had also told them to get in shape. She said she was
surprised by the controversy, given that Anna Wintour, in her editor's
letter, had challenged designers to use healthier looking models.
"I saw more of an emphasis on healthy eating and healthy fitness than an
order, 'You've got to lose weight,' " Dr. Bulik said.
The magazine has a track record of chronicling the diets of its staff, and
in 1998, Oprah Winfrey acknowledged that she had agreed to lose 20 pounds in
order to appear on its cover.
On top of this, Vogue has also been accused of racial stereotyping in its
cover: a black male athlete posing ferociously with his arm around a
skipping-to-my-lou supermodel. Some media critics compared the pose
unfavorably to images of King Kong and Fay Wray.
"We thought it was a strong and beautiful photo shoot," said Abigail Walch,
a senior editor at Vogue, who said the pose happened naturally. The Rodarte
article, she said, was intended to inspire women who have trouble
incorporating fitness into their hectic schedules. On subjects like weight
and shape, she added, dissension is to be expected.
"It's a hot topic that people love to talk about," Ms. Walch said. [NYT]
Last September, Kate and Laura Mulleavy, the sibling designers of Rodarte,
received a phone call from a Vogue editor who suggested that they see a
trainer and go on a diet. The sisters, who said they wanted to be healthier
and balance their stress levels, agreed, accepted four months of personal
training and a meal delivery service paid for by the magazine, lost a
combined 50 pounds and kept a journal of their experiences, which appears in
the April issue.
"Kate and I have decided we have to do this program in a realistic way,"
Laura Mulleavy wrote in an Oct. 22 entry. "We'll have wine when we feel like
it and cheat on holidays."
Reactions to the issue have been blistering. Dozens of objections were
posted to an entry about the diet on the blog Jezebel.
Nonetheless, Cynthia M. Bulik, a professor of eating disorders, defended the
offer as it was presented in the magazine, noting that the designers had
written that a doctor had also told them to get in shape. She said she was
surprised by the controversy, given that Anna Wintour, in her editor's
letter, had challenged designers to use healthier looking models.
"I saw more of an emphasis on healthy eating and healthy fitness than an
order, 'You've got to lose weight,' " Dr. Bulik said.
The magazine has a track record of chronicling the diets of its staff, and
in 1998, Oprah Winfrey acknowledged that she had agreed to lose 20 pounds in
order to appear on its cover.
On top of this, Vogue has also been accused of racial stereotyping in its
cover: a black male athlete posing ferociously with his arm around a
skipping-to-my-lou supermodel. Some media critics compared the pose
unfavorably to images of King Kong and Fay Wray.
"We thought it was a strong and beautiful photo shoot," said Abigail Walch,
a senior editor at Vogue, who said the pose happened naturally. The Rodarte
article, she said, was intended to inspire women who have trouble
incorporating fitness into their hectic schedules. On subjects like weight
and shape, she added, dissension is to be expected.
"It's a hot topic that people love to talk about," Ms. Walch said. [NYT]
Protein Keeps Hunger at Bay
Diets high in protein may be the best way to keep hunger in check,
researchers have said in a study that offers insight into how diets work.
They found that protein does the best job at keeping a hunger hormone in
check, while carbohydrates and fats may well deserve their current nasty
reputation.
The study, which will appear in the Journal of Clinical Endocrinology &
Metabolism, looked at the effectiveness of different nutrients at
suppressing ghrelin, a hormone secreted by the stomach that stimulates
appetite.
"Suppression of ghrelin is one of the ways that you lose your appetite as
you begin to eat and become sated," said Dr. David Cummings of the
University of Washington in Seattle, who worked on the study.
The researchers gave 16 people three different beverages, each with varying
levels of carbohydrates, fats, and proteins. They took blood samples before
the first beverage, then every 20 minutes for six hours afterward, measuring
ghrelin levels in each sample.
"The interesting findings were that fats suppress ghrelin quite poorly,"
Cummings said in a telephone interview. They fared the poorest overall.
"Proteins were the best suppressor of ghrelin in terms of the combination of
the depth and duration of suppression," he said. "That is truly satisfying
because high proteins are essentially common to almost all of the popular
diets."
They also found that eating carbohydrates resulted in a strong ghrelin
suppression at first, but ghrelin levels rebounded with a vengeance, rising
to an even higher level.
Basically, the carbohydrates eventually made people even hungrier than
before they had eaten.
Cummings said the findings may aid in future research on the effectiveness
of different diets.
And the study likely means that nightly bowl of ice cream is out. "That is a
bad idea no matter what," he said. [RT]
researchers have said in a study that offers insight into how diets work.
They found that protein does the best job at keeping a hunger hormone in
check, while carbohydrates and fats may well deserve their current nasty
reputation.
The study, which will appear in the Journal of Clinical Endocrinology &
Metabolism, looked at the effectiveness of different nutrients at
suppressing ghrelin, a hormone secreted by the stomach that stimulates
appetite.
"Suppression of ghrelin is one of the ways that you lose your appetite as
you begin to eat and become sated," said Dr. David Cummings of the
University of Washington in Seattle, who worked on the study.
The researchers gave 16 people three different beverages, each with varying
levels of carbohydrates, fats, and proteins. They took blood samples before
the first beverage, then every 20 minutes for six hours afterward, measuring
ghrelin levels in each sample.
"The interesting findings were that fats suppress ghrelin quite poorly,"
Cummings said in a telephone interview. They fared the poorest overall.
"Proteins were the best suppressor of ghrelin in terms of the combination of
the depth and duration of suppression," he said. "That is truly satisfying
because high proteins are essentially common to almost all of the popular
diets."
They also found that eating carbohydrates resulted in a strong ghrelin
suppression at first, but ghrelin levels rebounded with a vengeance, rising
to an even higher level.
Basically, the carbohydrates eventually made people even hungrier than
before they had eaten.
Cummings said the findings may aid in future research on the effectiveness
of different diets.
And the study likely means that nightly bowl of ice cream is out. "That is a
bad idea no matter what," he said. [RT]
Online Social Networks Are Powerful & Ineffectual All At Once
Nothing demonstrates the wildfire spread of online social networks such as
MySpace and Facebook better than the experience 73 students had last fall.
They were enrolled in the computer science course Creating Engaging Web
Applications Using Metrics and Learning on Facebook-and did they ever
engage. At a public session held at the Alumni Center toward the end of the
quarter, 500 people heard how "10 million [users] in 10 weeks" were expected
to have installed the students' free applications, some of which were
reportedly generating enough ad revenue to pay tuitions.
Most of the apps resemble party games or amusements-ScribbledPhotos lets
users draw graffiti on Facebook photos; with KissMe, members can bestow
kisses-although some focus on generating useful information. But
co-instructor BJ Fogg, an experimental social psychologist whose Persuasive
Technology Lab studies how computer technology changes people's beliefs and
behaviors, dismisses critics like one blogger who called the applications
"monumental drivel." The point was for students to learn how to think, using
psychology and metrics to make their applications more appealing. And by
quarter's end, 10 million proved an underestimate: "What other class in the
history of the world created student projects that reached 16 million people
in 10 weeks?" asks Fogg.
It's that kind of dramatic result that has a growing number of academics
starting to look at how online social networks function and what they
deliver compared with traditional, offline connections. Fogg can envision
revolutions; others are not so sure.
Students and teachers in the Facebook class share in the credit, of course,
but much of their success must be attributed to the intrinsic power of
Facebook-which Fogg proclaims "the No. 1 persuasive technology and maybe of
all time." Online social networks are inherently "viral," built through
overlapping circles of friends, relatives, colleagues or acquaintances. In
most other businesses, referrals and positive word of mouth come from good
service. But to make almost any use of a networking site, you first must be
connected to people. So new users quickly start "friending," or inviting,
others, in effect shilling for the site before they've really tried it
themselves. Because the major sites enable users to import their e-mail
contact lists, it's easy to invite everybody you know with one click. True,
the invited must accept to join, but joining is free and declining or
ignoring a friend request can feel awkward.
As a site reaches critical mass, bandwagon-like "network effects" feed
further growth: since new users want to be where others are, numbers can
grow with epidemic speed. Today, hundreds of millions of people worldwide
belong to at least one online social network, making MySpace (with 110
million members) and Facebook (70 million) among the web's top 10 sites.
Beside these behemoths are many others, each with its own slant. LinkedIn,
for example, is generally regarded as the most popular professional network,
with 20 million users.
Such hyper-connectedness sets today's social networks apart from the online
communities that have been around since the dawn of the Internet, where
people gather to share common interests from hobbies to rare medical
problems. The newer networks offer enough services-and entertainment-to keep
users glued to the screen for hours a day. For some, MySpace and Facebook
are integral to their lives and identities: users can endlessly spruce up
their profile pages; share photos and videos; play games; compare tastes in
books, movies and music; keep up to date on the goings-on of friends (and
strangers); buy and sell through classified ads. On Facebook, users can
engage in more civic-minded pursuits, too-rallying around political causes,
supporting charities, coordinating blood drives and even lending money.
But all these activities aren't Facebook's main draw, Fogg concludes from
his survey of students. "It's mainly about connecting with others in a
convenient way," he says-keeping in touch with old friends, building new
relationships and expressing your identity and views. "The games are an
excuse to do these other things." MySpace, Fogg observes, is more about
entertainment and playing with identities.
On the all-business LinkedIn, less colorful and time-consuming by design,
users can tap into their networks for job leads, employees or vendors; try
to get the inside scoop on job candidates or prospective bosses; introduce
one person in their network to another; ask questions or build their
reputations by answering questions; or just put up their profiles in hopes
that opportunity knocks.
How much does all this differ from what people do offline? Not very, some
observers say. "Social networking is an intrinsically human activity that
goes a long way back and is closely tied to what we consider progress and
civilization-as well as nastier things like organized warfare," says Howard
Rheingold, a lecturer in communication and the author of The Virtual
Community (Basic Books, 1993) and Smart Mobs (Basic Books, 2002), among
other books about the Internet's social effects. He says that social
networking technology has merely lowered distance barriers to communication,
much the way the printing press did in its time.
Bernardo Huberman, a consulting professor of applied physics, concurs. He
also is director of the Social Computing Lab at HP Laboratories and is the
author of The Laws of the Web (MIT Press, 2001). "The main effect of the
sites has been the immense collapse of distance and cost," he says, likening
the situation to what happened after the cost of telephone calls fell.
"Twelve to 15 years ago, a long-distance call was expensive. Even though you
may have had friends in London, you didn't call your friends in London every
day."
Online social networks also let you broadcast information to everyone at
once. Establishing and perhaps maintaining a relationship is much easier
online than in the so-called real world, says anthropology lecturer and
academic technology specialist Claudia Engel, who has taught classes on
digital ethnography. "The cost-benefit balance changes dramatically." It's
not just about dollars and cents, either. "Sweaty palms, fear of
rejection-all that disappears online," Huberman notes.
Much of this is true of e-mail, too, which-at the worst extreme-lets users
spam millions of others at shockingly low cost to the spammer. But computer
scientist Ashish Goel, associate professor in management science and
engineering, says there's something more intriguing about social networks
than pushing information out-namely, pulling in information from diverse
sources. On LinkedIn, for example, you can quickly find out who in your
network knows a particular individual. "It's very hard to call all 250 of
your friends and ask, 'Do you know this person?'" Goel observes.
Getting a promising job lead, for example, "is not dependent on your cousin
remembering who they might have worked with a couple years ago in
Cincinnati," says Ingrid Erickson, a graduate student at the Center for Work
Technology & Organization in the department of management science and
engineering. LinkedIn, in which users' public profiles are essentially
résumés, provides an up-to-date record of skills, experience and
connections. "There's a bit of a knee-jerk reaction that face-to-face is the
gold standard," Erickson says. She argues that online exchanges sometimes
can be better. Because your online profile remains accessible, you can make
a stronger, longer-lasting impression-and perhaps connect in person later.
Conference attendees, for example, can learn about each other beforehand,
making their face-to-face networking more targeted and effective than in the
days of exchanging business cards around the punch bowl.
No one disputes the exponentially greater accessibility of information and
connections online, but opinions vary on how genuine or effective online
relationships can be.
Some critics point to the meaninglessness of amassing online "friends" the
way you might collect baseball cards. The sites themselves are partly to
blame, Fogg suggests. "A thousand connections-on LinkedIn, that's a status
marker," he says, noting that the interface was clearly designed to display
everybody's number. "And given that it was used in Silicon Valley first,
among competitive people, that number became like a video-game score."
"There has to be a trade-off between the volume of connections and the
quality," says economics professor Matthew O. Jackson, author of the
forthcoming book Social and Economic Networks (Princeton University Press).
He points out that having quick, easy access doesn't ensure strong
possibilities for trust to develop and valuable transactions to occur.
"There's informational value, but ultimately how valuable a particular
relationship becomes depends on how much people interact."
Fogg agrees. "At the beginning, the label 'friend' suggests you're going to
watch each other's back," he says, "but after you get 60 connections or
whatever your social capacity is, it doesn't mean you'll travel the world
and ring in the new year together." We have room for only so many
relationships in our lives, which is why the costs of real networking-not
exchanging virtual gifts on Facebook or inviting your former co-workers to
join your LinkedIn network, but helping others as you hope they may one day
help you-stay stubbornly high.
There's another way in which online networks are a poor approximation of an
offline network: they take a crude, binary view of human connection. On the
sites, someone is either your friend or not, and early attempts to let users
subdivide friends (such as Facebook's Friend List feature) still seem
robotic and inadequate. That lack of nuance leads to a host of problems,
Fogg says. "If somebody sees that Felix is my friend, and let's say Felix is
[really] an acquaintance or stranger, they're going to make assumptions
about Felix that he's a great guy-and that gets into problems of trust and
credibility."
Just as in the offline world, social networks rely on trust-but trust online
doesn't always work the way users expect. For example, I asked LinkedIn's
co-founder and VP of product strategy Allen Blue, why I might have trouble
getting hold of somebody who on LinkedIn is a connection of a connection.
"Every person within the system acts as a gatekeeper for everybody else in
the system," he told me. "There's no assurance that any of those gates are
going to work at any given time. You rely on the quality of the relationship
you have with somebody, and that person relies on the quality of the
relationship they have with somebody else."
Sociology professor Karen Cook, whose current research centers on trust in
social relations and networks, says that even if all the relationships in
the chain are strong, trust goes only so far. And to be worthy of our trust,
someone must be both competent and well-meaning. "I may trust my husband
with a child," explains Cook, "because he's highly motivated to take care of
the child, but not trust him with a checkbook-but that's more about
competence."
We have room for only so many relationships in our lives, which is why the
costs of real networking stay stubbornly high.
What's more, trust is not transitive. As Rheingold puts it, borrowing from
the writer Clay Shirky, "I may trust my friend's friend, but I don't trust
my friend's friend's crack dealer." Trust decays across the network, Cook
explains, because the farther removed someone is, the less we know about why
and how much others in the chain trust that person.
Still, there is at least a theoretical basis for thinking that online
networks might trump narrower offline connections, especially for business
purposes. Sociology professor Mark Granovetter wasn't thinking about online
networks when he coined the phrase "the strength of weak ties." It was the
1970s, and Granovetter was studying how people found employment. The most
fruitful connections for job leads, he found, were not close friends and
family, but more tenuous contacts-weak ties. That's because people close to
you are privy to more or less the same information you are; those outside
your inner circle will know of opportunities that you and your friends
don't. With the rise of online social networks, where people can maintain
many more weak ties, Granovetter's idea took on new legs.
So did the even older theory, popularly known as "six degrees of
separation," that any two people in the world are connected by at most a
few intermediaries. The idea gained traction following Stanley Milgram's
Small World Experiment. Milgram aimed to discover how many steps it would
take for a package-sent by one person to an acquaintance who in turn would
send it to a friend, and so on-to reach the hands of a total stranger.
Over the years, the popular imagination has distorted Milgram's results, as
psychologist Judith Kleinfeld uncovered more than 30 years later. The
endpoints of Milgram's original experiment were not random strangers around
the globe, but a small sample of Americans in Massachusetts and Nebraska.
Moreover, Milgram's six degrees was an average, not a maximum. In fact, the
overwhelming majority of packets never reached their targets.
Yet the legend of six degrees persisted, and online social networks added
credibility. We're comforted to know that it's a small world after all, and
it's nice to think we can connect to opportunities through people we already
know. The defunct SixDegrees.com made this promise explicit, but other
networks at least hint at the same possibility.
Certainly, social networks exhibit the "small-world property." Some
individuals know many more people than the rest-think politicians, agents,
hairstylists-and because of these well-connected hubs, it takes far fewer
jumps from node to node to connect any two individuals on a social graph
than if social ties were distributed evenly. But mere connection isn't
enough: many of Milgram's subjects didn't so much as mail a packet forward
in the chain. The mathematical sociologist Duncan Watts, author of Six
Degrees: the Science of a Connected Age (Norton, 2003), has been replicating
Milgram's study on a large scale, using e-mail, and has found the same
problem with messages not reaching their targets.
Software like LinkedIn's can lessen that problem by revealing the shortest
path between you and another individual in the network. But there's a
greater obstacle that databases can't overcome. Small-world networks work
through hubs, but most of the hubs' ties are, almost by definition, weak.
And, as Graduate School of Business professor of organizational behavior
Hayagreeva Rao puts it, "Typically, you get information from weak ties, but
you can't count on them to get anything done." This is true online and off.
"It's costless to add a connection," Rao says, "but when the person asks for
an actual favor that implies trust or some hassle, you're going to say,
'Wait a minute.'"
Granovetter's research suggests the same thing. People he studied didn't
find jobs through chains longer than one or two-either a friend or a friend
of a friend. "Beyond that point, it's no longer more effective than the
newspaper," he says. Interestingly, a quarter of LinkedIn's revenue comes
from newspaper-style job listings.
In 2004, three years before Facebook became a household word, Peter Thiel
invested $500,000 in the fledgling social networking site. Thiel, learned
about the investment opportunity from his close friend and former PayPal
colleague Reid Hoffman, himself a co-founder of LinkdIn. Hoffman had found
out about the Facebook opportunity almost by chance. Its founder, Mark
Zuckerberg, had moved from Boston to Palo Alto and became housemates with
the Internet entrepreneur Sean Parker. "I knew Sean, and I liked Sean a
lot," Hoffman told a San Jose Mercury News reporter. Hoffman thought highly
of Facebook, too, so he introduced Zuckerberg to Thiel. Today, Thiel's stake
in Facebook, at least on paper, is worth about $1 billion, and everyone else
in this chain has reaped benefits, too.
Yet online networking played no role in matching up these online networking
insiders. "The vast majority of economically significant networks are not
online, they're offline," says Graduate School of Business assistant
marketing professor Harikesh Nair, who studies economic implications of
social networks.
Granovetter, who has been studying Silicon Valley networks, says that
high-level VCs "are going to avoid those social networking sites like the
plague. Their whole stock-in-trade is their network, but they're never going
to manage those networks online: it's too democratic." For them, the costs
of belonging-notably loss of privacy-presumably do not justify any possible
benefits. (However, several online social networks restricted to VIPs have
sprung up; time will tell their effect on offline life.)
The economic benefits of online networking are hard to determine-in part
because any tangible payoff occurs offline. "I don't think we have good
studies of it," Granovetter says, "but as far as I can tell, online social
networking hasn't made any substantial difference in how people find jobs."
That could change, as job search sites like Jobster and CareerBuilder link
up with Facebook and members increasingly use the site to network for jobs
instead of purely socializing.
But for BJ Fogg, the important thing is that technology can lead to
interpersonal persuasion on a massive scale, and his lab's next initiative
is a lofty one. Peace Innovation aims to inspire international peacemaking
experiments using YouTube, Flickr or other second-generation web services.
The ultimate goal: world peace in 30 years. Fogg knows that sounds
ambitious, even a bit crazy. "But I think it's crazier to not try," he says.
"The world's in pretty bad shape, but we have some amazing tools to connect
and change people. We're not going to sell laundry detergent with them."
[SM]
MySpace and Facebook better than the experience 73 students had last fall.
They were enrolled in the computer science course Creating Engaging Web
Applications Using Metrics and Learning on Facebook-and did they ever
engage. At a public session held at the Alumni Center toward the end of the
quarter, 500 people heard how "10 million [users] in 10 weeks" were expected
to have installed the students' free applications, some of which were
reportedly generating enough ad revenue to pay tuitions.
Most of the apps resemble party games or amusements-ScribbledPhotos lets
users draw graffiti on Facebook photos; with KissMe, members can bestow
kisses-although some focus on generating useful information. But
co-instructor BJ Fogg, an experimental social psychologist whose Persuasive
Technology Lab studies how computer technology changes people's beliefs and
behaviors, dismisses critics like one blogger who called the applications
"monumental drivel." The point was for students to learn how to think, using
psychology and metrics to make their applications more appealing. And by
quarter's end, 10 million proved an underestimate: "What other class in the
history of the world created student projects that reached 16 million people
in 10 weeks?" asks Fogg.
It's that kind of dramatic result that has a growing number of academics
starting to look at how online social networks function and what they
deliver compared with traditional, offline connections. Fogg can envision
revolutions; others are not so sure.
Students and teachers in the Facebook class share in the credit, of course,
but much of their success must be attributed to the intrinsic power of
Facebook-which Fogg proclaims "the No. 1 persuasive technology and maybe of
all time." Online social networks are inherently "viral," built through
overlapping circles of friends, relatives, colleagues or acquaintances. In
most other businesses, referrals and positive word of mouth come from good
service. But to make almost any use of a networking site, you first must be
connected to people. So new users quickly start "friending," or inviting,
others, in effect shilling for the site before they've really tried it
themselves. Because the major sites enable users to import their e-mail
contact lists, it's easy to invite everybody you know with one click. True,
the invited must accept to join, but joining is free and declining or
ignoring a friend request can feel awkward.
As a site reaches critical mass, bandwagon-like "network effects" feed
further growth: since new users want to be where others are, numbers can
grow with epidemic speed. Today, hundreds of millions of people worldwide
belong to at least one online social network, making MySpace (with 110
million members) and Facebook (70 million) among the web's top 10 sites.
Beside these behemoths are many others, each with its own slant. LinkedIn,
for example, is generally regarded as the most popular professional network,
with 20 million users.
Such hyper-connectedness sets today's social networks apart from the online
communities that have been around since the dawn of the Internet, where
people gather to share common interests from hobbies to rare medical
problems. The newer networks offer enough services-and entertainment-to keep
users glued to the screen for hours a day. For some, MySpace and Facebook
are integral to their lives and identities: users can endlessly spruce up
their profile pages; share photos and videos; play games; compare tastes in
books, movies and music; keep up to date on the goings-on of friends (and
strangers); buy and sell through classified ads. On Facebook, users can
engage in more civic-minded pursuits, too-rallying around political causes,
supporting charities, coordinating blood drives and even lending money.
But all these activities aren't Facebook's main draw, Fogg concludes from
his survey of students. "It's mainly about connecting with others in a
convenient way," he says-keeping in touch with old friends, building new
relationships and expressing your identity and views. "The games are an
excuse to do these other things." MySpace, Fogg observes, is more about
entertainment and playing with identities.
On the all-business LinkedIn, less colorful and time-consuming by design,
users can tap into their networks for job leads, employees or vendors; try
to get the inside scoop on job candidates or prospective bosses; introduce
one person in their network to another; ask questions or build their
reputations by answering questions; or just put up their profiles in hopes
that opportunity knocks.
How much does all this differ from what people do offline? Not very, some
observers say. "Social networking is an intrinsically human activity that
goes a long way back and is closely tied to what we consider progress and
civilization-as well as nastier things like organized warfare," says Howard
Rheingold, a lecturer in communication and the author of The Virtual
Community (Basic Books, 1993) and Smart Mobs (Basic Books, 2002), among
other books about the Internet's social effects. He says that social
networking technology has merely lowered distance barriers to communication,
much the way the printing press did in its time.
Bernardo Huberman, a consulting professor of applied physics, concurs. He
also is director of the Social Computing Lab at HP Laboratories and is the
author of The Laws of the Web (MIT Press, 2001). "The main effect of the
sites has been the immense collapse of distance and cost," he says, likening
the situation to what happened after the cost of telephone calls fell.
"Twelve to 15 years ago, a long-distance call was expensive. Even though you
may have had friends in London, you didn't call your friends in London every
day."
Online social networks also let you broadcast information to everyone at
once. Establishing and perhaps maintaining a relationship is much easier
online than in the so-called real world, says anthropology lecturer and
academic technology specialist Claudia Engel, who has taught classes on
digital ethnography. "The cost-benefit balance changes dramatically." It's
not just about dollars and cents, either. "Sweaty palms, fear of
rejection-all that disappears online," Huberman notes.
Much of this is true of e-mail, too, which-at the worst extreme-lets users
spam millions of others at shockingly low cost to the spammer. But computer
scientist Ashish Goel, associate professor in management science and
engineering, says there's something more intriguing about social networks
than pushing information out-namely, pulling in information from diverse
sources. On LinkedIn, for example, you can quickly find out who in your
network knows a particular individual. "It's very hard to call all 250 of
your friends and ask, 'Do you know this person?'" Goel observes.
Getting a promising job lead, for example, "is not dependent on your cousin
remembering who they might have worked with a couple years ago in
Cincinnati," says Ingrid Erickson, a graduate student at the Center for Work
Technology & Organization in the department of management science and
engineering. LinkedIn, in which users' public profiles are essentially
résumés, provides an up-to-date record of skills, experience and
connections. "There's a bit of a knee-jerk reaction that face-to-face is the
gold standard," Erickson says. She argues that online exchanges sometimes
can be better. Because your online profile remains accessible, you can make
a stronger, longer-lasting impression-and perhaps connect in person later.
Conference attendees, for example, can learn about each other beforehand,
making their face-to-face networking more targeted and effective than in the
days of exchanging business cards around the punch bowl.
No one disputes the exponentially greater accessibility of information and
connections online, but opinions vary on how genuine or effective online
relationships can be.
Some critics point to the meaninglessness of amassing online "friends" the
way you might collect baseball cards. The sites themselves are partly to
blame, Fogg suggests. "A thousand connections-on LinkedIn, that's a status
marker," he says, noting that the interface was clearly designed to display
everybody's number. "And given that it was used in Silicon Valley first,
among competitive people, that number became like a video-game score."
"There has to be a trade-off between the volume of connections and the
quality," says economics professor Matthew O. Jackson, author of the
forthcoming book Social and Economic Networks (Princeton University Press).
He points out that having quick, easy access doesn't ensure strong
possibilities for trust to develop and valuable transactions to occur.
"There's informational value, but ultimately how valuable a particular
relationship becomes depends on how much people interact."
Fogg agrees. "At the beginning, the label 'friend' suggests you're going to
watch each other's back," he says, "but after you get 60 connections or
whatever your social capacity is, it doesn't mean you'll travel the world
and ring in the new year together." We have room for only so many
relationships in our lives, which is why the costs of real networking-not
exchanging virtual gifts on Facebook or inviting your former co-workers to
join your LinkedIn network, but helping others as you hope they may one day
help you-stay stubbornly high.
There's another way in which online networks are a poor approximation of an
offline network: they take a crude, binary view of human connection. On the
sites, someone is either your friend or not, and early attempts to let users
subdivide friends (such as Facebook's Friend List feature) still seem
robotic and inadequate. That lack of nuance leads to a host of problems,
Fogg says. "If somebody sees that Felix is my friend, and let's say Felix is
[really] an acquaintance or stranger, they're going to make assumptions
about Felix that he's a great guy-and that gets into problems of trust and
credibility."
Just as in the offline world, social networks rely on trust-but trust online
doesn't always work the way users expect. For example, I asked LinkedIn's
co-founder and VP of product strategy Allen Blue, why I might have trouble
getting hold of somebody who on LinkedIn is a connection of a connection.
"Every person within the system acts as a gatekeeper for everybody else in
the system," he told me. "There's no assurance that any of those gates are
going to work at any given time. You rely on the quality of the relationship
you have with somebody, and that person relies on the quality of the
relationship they have with somebody else."
Sociology professor Karen Cook, whose current research centers on trust in
social relations and networks, says that even if all the relationships in
the chain are strong, trust goes only so far. And to be worthy of our trust,
someone must be both competent and well-meaning. "I may trust my husband
with a child," explains Cook, "because he's highly motivated to take care of
the child, but not trust him with a checkbook-but that's more about
competence."
We have room for only so many relationships in our lives, which is why the
costs of real networking stay stubbornly high.
What's more, trust is not transitive. As Rheingold puts it, borrowing from
the writer Clay Shirky, "I may trust my friend's friend, but I don't trust
my friend's friend's crack dealer." Trust decays across the network, Cook
explains, because the farther removed someone is, the less we know about why
and how much others in the chain trust that person.
Still, there is at least a theoretical basis for thinking that online
networks might trump narrower offline connections, especially for business
purposes. Sociology professor Mark Granovetter wasn't thinking about online
networks when he coined the phrase "the strength of weak ties." It was the
1970s, and Granovetter was studying how people found employment. The most
fruitful connections for job leads, he found, were not close friends and
family, but more tenuous contacts-weak ties. That's because people close to
you are privy to more or less the same information you are; those outside
your inner circle will know of opportunities that you and your friends
don't. With the rise of online social networks, where people can maintain
many more weak ties, Granovetter's idea took on new legs.
So did the even older theory, popularly known as "six degrees of
separation," that any two people in the world are connected by at most a
few intermediaries. The idea gained traction following Stanley Milgram's
Small World Experiment. Milgram aimed to discover how many steps it would
take for a package-sent by one person to an acquaintance who in turn would
send it to a friend, and so on-to reach the hands of a total stranger.
Over the years, the popular imagination has distorted Milgram's results, as
psychologist Judith Kleinfeld uncovered more than 30 years later. The
endpoints of Milgram's original experiment were not random strangers around
the globe, but a small sample of Americans in Massachusetts and Nebraska.
Moreover, Milgram's six degrees was an average, not a maximum. In fact, the
overwhelming majority of packets never reached their targets.
Yet the legend of six degrees persisted, and online social networks added
credibility. We're comforted to know that it's a small world after all, and
it's nice to think we can connect to opportunities through people we already
know. The defunct SixDegrees.com made this promise explicit, but other
networks at least hint at the same possibility.
Certainly, social networks exhibit the "small-world property." Some
individuals know many more people than the rest-think politicians, agents,
hairstylists-and because of these well-connected hubs, it takes far fewer
jumps from node to node to connect any two individuals on a social graph
than if social ties were distributed evenly. But mere connection isn't
enough: many of Milgram's subjects didn't so much as mail a packet forward
in the chain. The mathematical sociologist Duncan Watts, author of Six
Degrees: the Science of a Connected Age (Norton, 2003), has been replicating
Milgram's study on a large scale, using e-mail, and has found the same
problem with messages not reaching their targets.
Software like LinkedIn's can lessen that problem by revealing the shortest
path between you and another individual in the network. But there's a
greater obstacle that databases can't overcome. Small-world networks work
through hubs, but most of the hubs' ties are, almost by definition, weak.
And, as Graduate School of Business professor of organizational behavior
Hayagreeva Rao puts it, "Typically, you get information from weak ties, but
you can't count on them to get anything done." This is true online and off.
"It's costless to add a connection," Rao says, "but when the person asks for
an actual favor that implies trust or some hassle, you're going to say,
'Wait a minute.'"
Granovetter's research suggests the same thing. People he studied didn't
find jobs through chains longer than one or two-either a friend or a friend
of a friend. "Beyond that point, it's no longer more effective than the
newspaper," he says. Interestingly, a quarter of LinkedIn's revenue comes
from newspaper-style job listings.
In 2004, three years before Facebook became a household word, Peter Thiel
invested $500,000 in the fledgling social networking site. Thiel, learned
about the investment opportunity from his close friend and former PayPal
colleague Reid Hoffman, himself a co-founder of LinkdIn. Hoffman had found
out about the Facebook opportunity almost by chance. Its founder, Mark
Zuckerberg, had moved from Boston to Palo Alto and became housemates with
the Internet entrepreneur Sean Parker. "I knew Sean, and I liked Sean a
lot," Hoffman told a San Jose Mercury News reporter. Hoffman thought highly
of Facebook, too, so he introduced Zuckerberg to Thiel. Today, Thiel's stake
in Facebook, at least on paper, is worth about $1 billion, and everyone else
in this chain has reaped benefits, too.
Yet online networking played no role in matching up these online networking
insiders. "The vast majority of economically significant networks are not
online, they're offline," says Graduate School of Business assistant
marketing professor Harikesh Nair, who studies economic implications of
social networks.
Granovetter, who has been studying Silicon Valley networks, says that
high-level VCs "are going to avoid those social networking sites like the
plague. Their whole stock-in-trade is their network, but they're never going
to manage those networks online: it's too democratic." For them, the costs
of belonging-notably loss of privacy-presumably do not justify any possible
benefits. (However, several online social networks restricted to VIPs have
sprung up; time will tell their effect on offline life.)
The economic benefits of online networking are hard to determine-in part
because any tangible payoff occurs offline. "I don't think we have good
studies of it," Granovetter says, "but as far as I can tell, online social
networking hasn't made any substantial difference in how people find jobs."
That could change, as job search sites like Jobster and CareerBuilder link
up with Facebook and members increasingly use the site to network for jobs
instead of purely socializing.
But for BJ Fogg, the important thing is that technology can lead to
interpersonal persuasion on a massive scale, and his lab's next initiative
is a lofty one. Peace Innovation aims to inspire international peacemaking
experiments using YouTube, Flickr or other second-generation web services.
The ultimate goal: world peace in 30 years. Fogg knows that sounds
ambitious, even a bit crazy. "But I think it's crazier to not try," he says.
"The world's in pretty bad shape, but we have some amazing tools to connect
and change people. We're not going to sell laundry detergent with them."
[SM]
Chronic Illness: Taking Charge of Your Health
What is a chronic illness?
There are 2 main types of illness: acute and chronic. An acute illness doesn
't last very long. It goes away either on its own or in response to
treatment, such as taking medicine or having surgery. Strep throat is an
example of an acute illness.
A chronic illness is ongoing. It affects your health over a long period of
time--possibly your entire life. In many cases, there is no way to cure a
chronic illness. Diabetes and high blood pressure are examples of chronic
illnesses.
What can I do if I have a chronic illness?
It's important to understand that your chronic illness is a serious problem.
If you don't believe this, you'll never be motivated to manage your illness
effectively. Managing your illness involves making lifestyle choices and
using prescribed medical treatments to be as healthy as possible. Unless you
take care of your body, your chronic illness can cause more problems in the
future.
When you have a chronic health problem, it's easy to feel overwhelmed and
helpless, as if the illness has taken over your life. For example, you may
need to take daily insulin injections, use an inhaler or monitor your blood
pressure. However, you can take steps to control the negative effects of a
chronic illness on your health. One method of taking control is called
"self-management."
What is self-management of chronic illness?
Self-management of chronic illness means that you take responsibility for
doing what it takes to manage your illness effectively. It's important for
you to be responsible for your health because the treatment recommendations
your family doctor makes won't do any good unless you follow them. He or she
can't make decisions for you or make you change your behavior. Only you can
do these things.
In self-management, you and your family doctor are partners in care. Your
family doctor can provide valuable advice and information to help you deal
with your illness. However, the treatment plan that works best for one
person with your condition won't necessarily work best for you. Talk to your
family doctor about the different treatment options available and help him
or her create a plan that's right for you. After all, nobody knows more than
you do about your feelings, your actions and how your health problems affect
you.
As part of self-management, it's also your responsibility to ask for the
help you need to deal with your illness. This support can come from friends
and family members, as well as from your family doctor or a support group
for people with your health problem.
How can self-management help a person who has a chronic illness?
Once you've decided to take an active role in managing your illness, you and
your family doctor can work together to set goals that will lead to better
health. These goals will be part of an overall treatment plan.
Pick a problem. Take an honest look at the unhealthy aspects of your
lifestyle. Start with a particular behavior that you'd like to change in
order to have better control of your illness. For example, you might decide
that you don't eat enough vegetables, get enough exercise or take your
medicines as your family doctor tells you to.
Get specific. Once you've identified a problem, state a specific goal for
dealing with it. The more specific your goal is, the more likely you are to
succeed. For example, instead of saying, "I'm going to exercise more,"
decide what kind of exercise you'll do. Be specific about what days of the
week you'll exercise and what times you'll exercise on those days. Your new
goal might be: "During my lunch hour on Mondays, Wednesdays and Fridays, I'm
going to walk 1 mile in the park."
Plan ahead. After you've stated your goal, think of things that could go
wrong and plan how you'll deal with them. For example, if it rains and you
can't go to the park, where will you go to walk? If you plan how to handle
problems in advance, they won't prevent you from meeting your goals.
Check your confidence level. Ask yourself, "How confident am I that I'll be
able to meet this goal?" If the answer is "Not very confident," you may need
to start with a more realistic goal.
Follow up. As you're working toward your goal, check in regularly with your
family doctor to let him or her know how you're doing. If you're having
trouble following the plan, talk to your family doctor to figure out why.
Your setbacks can be learning experiences that help you make a new plan for
success.
One of the most important things to remember is that you can change your
behavior. Even though your illness makes you feel helpless at times, if you
work with your family doctor to set goals and you take responsibility for
following through with them, you can make changes that will lead to better
health. [AAFP]
There are 2 main types of illness: acute and chronic. An acute illness doesn
't last very long. It goes away either on its own or in response to
treatment, such as taking medicine or having surgery. Strep throat is an
example of an acute illness.
A chronic illness is ongoing. It affects your health over a long period of
time--possibly your entire life. In many cases, there is no way to cure a
chronic illness. Diabetes and high blood pressure are examples of chronic
illnesses.
What can I do if I have a chronic illness?
It's important to understand that your chronic illness is a serious problem.
If you don't believe this, you'll never be motivated to manage your illness
effectively. Managing your illness involves making lifestyle choices and
using prescribed medical treatments to be as healthy as possible. Unless you
take care of your body, your chronic illness can cause more problems in the
future.
When you have a chronic health problem, it's easy to feel overwhelmed and
helpless, as if the illness has taken over your life. For example, you may
need to take daily insulin injections, use an inhaler or monitor your blood
pressure. However, you can take steps to control the negative effects of a
chronic illness on your health. One method of taking control is called
"self-management."
What is self-management of chronic illness?
Self-management of chronic illness means that you take responsibility for
doing what it takes to manage your illness effectively. It's important for
you to be responsible for your health because the treatment recommendations
your family doctor makes won't do any good unless you follow them. He or she
can't make decisions for you or make you change your behavior. Only you can
do these things.
In self-management, you and your family doctor are partners in care. Your
family doctor can provide valuable advice and information to help you deal
with your illness. However, the treatment plan that works best for one
person with your condition won't necessarily work best for you. Talk to your
family doctor about the different treatment options available and help him
or her create a plan that's right for you. After all, nobody knows more than
you do about your feelings, your actions and how your health problems affect
you.
As part of self-management, it's also your responsibility to ask for the
help you need to deal with your illness. This support can come from friends
and family members, as well as from your family doctor or a support group
for people with your health problem.
How can self-management help a person who has a chronic illness?
Once you've decided to take an active role in managing your illness, you and
your family doctor can work together to set goals that will lead to better
health. These goals will be part of an overall treatment plan.
Pick a problem. Take an honest look at the unhealthy aspects of your
lifestyle. Start with a particular behavior that you'd like to change in
order to have better control of your illness. For example, you might decide
that you don't eat enough vegetables, get enough exercise or take your
medicines as your family doctor tells you to.
Get specific. Once you've identified a problem, state a specific goal for
dealing with it. The more specific your goal is, the more likely you are to
succeed. For example, instead of saying, "I'm going to exercise more,"
decide what kind of exercise you'll do. Be specific about what days of the
week you'll exercise and what times you'll exercise on those days. Your new
goal might be: "During my lunch hour on Mondays, Wednesdays and Fridays, I'm
going to walk 1 mile in the park."
Plan ahead. After you've stated your goal, think of things that could go
wrong and plan how you'll deal with them. For example, if it rains and you
can't go to the park, where will you go to walk? If you plan how to handle
problems in advance, they won't prevent you from meeting your goals.
Check your confidence level. Ask yourself, "How confident am I that I'll be
able to meet this goal?" If the answer is "Not very confident," you may need
to start with a more realistic goal.
Follow up. As you're working toward your goal, check in regularly with your
family doctor to let him or her know how you're doing. If you're having
trouble following the plan, talk to your family doctor to figure out why.
Your setbacks can be learning experiences that help you make a new plan for
success.
One of the most important things to remember is that you can change your
behavior. Even though your illness makes you feel helpless at times, if you
work with your family doctor to set goals and you take responsibility for
following through with them, you can make changes that will lead to better
health. [AAFP]
Inactivity in Men Is Linked to Broken Bones
Inactive men may have a substantially increased risk for broken bones of all
kinds, and especially for hip fractures, a study has found.
Even after controlling for health and behavioral variables, researchers
reported, sedentary men were more than one and a half times as likely as
active ones to suffer a broken bone, and more than two and a half times as
likely to break a hip.
Although they are unsure of the mechanism, the authors theorize that
exercise may work by increasing skeletal strength and muscle mass, and
improving balance. The active men in the study did three or more hours a
week of intense physical activity.
The researchers studied health records of 2,205 men beginning at age 49 to
51, and then followed them for up to 35 years, during which 482 men had at
least one fracture. The men were interviewed and examined again at ages 60,
70, 77 and 82. At the end of the follow-up period, 896 of the men were still
living.
At each of the five interviews, the scientists posed the same questions
about watching television and movies, engaging in other sedentary
activities, walking or cycling for pleasure, and engaging in sports. They
also administered exercise tests and performed muscle biopsies to measure
physical fitness, confirming that the men who reported higher levels of
exercise were in fact more fit. By linking records with job titles, they
were also able to include information on physical activity at work.
The researchers found that the men who maintained the highest levels of
activity had the fewest fractures, and that those with the lowest levels had
the most. The association held true for all fractures, but was especially
strong for broken hips. Moreover, men who increased their exercise saw a
corresponding decrease in the number of fractures.
"It's never too late to start exercising," said Dr. Karl Michaelsson, the
lead author and a professor of surgery and epidemiology at Uppsala
University in Uppsala, Sweden. But he was reluctant to offer specific
exercise advice.
"You can't say to an 85-year-old that he should start vigorous exercise
three hours a week," Dr. Michaelsson said. "Also, we only asked if the men
were engaged in physical activity regularly. What kind of physical activity
has the greatest effect, we don't really know."
The scientists controlled for a large range of variables that might
influence physical activity and fracture risk: smoking; marital status;
education; alcohol use; body mass index; self-reported chest, joint, or back
pain; plus a large number of illnesses including cardiovascular,
gastrointestinal, neurological, inflammatory and others.
Dr. Elizabeth Shane, a professor of medicine and osteoporosis specialist who
was not involved in the study, said she was impressed with the methodology.
"The stress testing and muscle biopsies increase the biological plausibility
of the results," Dr. Shane said. "We always recommend physical activity to
our patients, and it's helpful to know that it does seem to be associated
with a decreased risk of fracture."
The study has other significant strengths, even though it was not a
randomized trial. The researchers began monitoring the men before the age
when most fractures occur, and the data, gathered from registers using the
individual personal registration number given to all Swedish citizens, is
highly reliable. Finally, the long follow-up allowed researchers to take
health and lifestyle changes over time into account. [RT]
kinds, and especially for hip fractures, a study has found.
Even after controlling for health and behavioral variables, researchers
reported, sedentary men were more than one and a half times as likely as
active ones to suffer a broken bone, and more than two and a half times as
likely to break a hip.
Although they are unsure of the mechanism, the authors theorize that
exercise may work by increasing skeletal strength and muscle mass, and
improving balance. The active men in the study did three or more hours a
week of intense physical activity.
The researchers studied health records of 2,205 men beginning at age 49 to
51, and then followed them for up to 35 years, during which 482 men had at
least one fracture. The men were interviewed and examined again at ages 60,
70, 77 and 82. At the end of the follow-up period, 896 of the men were still
living.
At each of the five interviews, the scientists posed the same questions
about watching television and movies, engaging in other sedentary
activities, walking or cycling for pleasure, and engaging in sports. They
also administered exercise tests and performed muscle biopsies to measure
physical fitness, confirming that the men who reported higher levels of
exercise were in fact more fit. By linking records with job titles, they
were also able to include information on physical activity at work.
The researchers found that the men who maintained the highest levels of
activity had the fewest fractures, and that those with the lowest levels had
the most. The association held true for all fractures, but was especially
strong for broken hips. Moreover, men who increased their exercise saw a
corresponding decrease in the number of fractures.
"It's never too late to start exercising," said Dr. Karl Michaelsson, the
lead author and a professor of surgery and epidemiology at Uppsala
University in Uppsala, Sweden. But he was reluctant to offer specific
exercise advice.
"You can't say to an 85-year-old that he should start vigorous exercise
three hours a week," Dr. Michaelsson said. "Also, we only asked if the men
were engaged in physical activity regularly. What kind of physical activity
has the greatest effect, we don't really know."
The scientists controlled for a large range of variables that might
influence physical activity and fracture risk: smoking; marital status;
education; alcohol use; body mass index; self-reported chest, joint, or back
pain; plus a large number of illnesses including cardiovascular,
gastrointestinal, neurological, inflammatory and others.
Dr. Elizabeth Shane, a professor of medicine and osteoporosis specialist who
was not involved in the study, said she was impressed with the methodology.
"The stress testing and muscle biopsies increase the biological plausibility
of the results," Dr. Shane said. "We always recommend physical activity to
our patients, and it's helpful to know that it does seem to be associated
with a decreased risk of fracture."
The study has other significant strengths, even though it was not a
randomized trial. The researchers began monitoring the men before the age
when most fractures occur, and the data, gathered from registers using the
individual personal registration number given to all Swedish citizens, is
highly reliable. Finally, the long follow-up allowed researchers to take
health and lifestyle changes over time into account. [RT]
Sunday, July 13, 2008
Diabetes Health Goes Beyond Blood Sugar
The startling findings of a major study on the effects of lowering blood
sugar are unlikely to change the way most people with Type 2 diabetes manage
their illness, doctors said.
The study, showed that an intensive program to lower blood sugar actually
increased risk of death. The findings were so surprising that the study was
stopped early, and they seemed to undercut the accepted wisdom that people
with diabetes should do everything possible to get their blood sugar down to
normal.
But the methods used in the study, called Accord (for Action to Control
Cardiovascular Risk in Diabetes), bear little resemblance to the techniques
most doctors and patients use to manage blood sugar levels. And the patients
in the study were typically far sicker than many people with diabetes today.
"The intensity of what we did is done virtually nowhere on the planet," said
Dr. John Buse, vice chairman of the study's steering committee and the
president of medicine and science at the American Diabetes Association. "It'
s far beyond what's common in clinical practice." Dr. Buse called the study'
s regimen to lower blood sugar a "brutal program."
Still, doctors are likely to reconsider their emphasis on lowering blood
sugar at all costs, because it is becoming clear that other factors
influence the overall health of patients with diabetes.
The New England Journal of Medicine published a study this week showing that
a three-pronged approach of managing sugar, blood pressure and cholesterol -
combined with low doses of aspirin - prolonged the lives of people with
diabetes. The patients who did best in that study did not reach the nearly
normal sugar levels that were the aim of the Accord study. Instead, their
levels were just slightly higher than normal.
In the Accord study, the group of patients who were randomly assigned to
lower their blood sugar levels to nearly normal had 54 more deaths than the
group whose levels were less rigidly controlled. The patients were in the
study for an average of four years when investigators stopped the intense
regimen and put all of them on the less intense one.
"When we look at mortality in patients with Type 2 diabetes, it's not only
the blood sugar," said Dr. Joel Zonszein, director of the Clinical Diabetes
Center. "What the study shows is that just lowering blood sugar is not
protecting you from dying sooner. Blood sugar is important, but so is blood
pressure and cholesterol."
Patients with newly diagnosed diabetes still appear to have much to gain by
keeping their blood sugar levels as close to normal as possible through
healthful eating and exercise. But patients who have had a heart attack and
have other risk factors need not feel guilty if they cannot get their blood
sugar to normal levels, Dr. Buse said.
"The most important thing is get your blood pressure controlled, cholesterol
controlled, and do a reasonable job on your diabetes, but don't go wild," he
said. "We are backing away from notion that we always have to push, push,
push to get blood sugar lower."
Today, many patients with diabetes take two or three drugs to manage their
blood sugar levels. In the Accord study, many patients took multiple drugs
and insulin shots, adhered to strict diets and regularly met with counselors
and doctors who monitored them. No single drug treatment was prescribed;
doctors used whatever combination of various treatments that appeared to
work best in each patients.
The researchers still have to sift through the data on those who died to
find out whether there was any pattern that might help explain why patients
in the intense treatment group fared worse. It may be that they were simply
sicker to begin with. It may have been the number of drugs they used or the
pace at which their blood sugar dropped.
Dr. Buse said one little-discussed issue was the sheer stress of the
treatment program itself. He noted that the program demanded a lot of effort
from patients but that it was still exceedingly difficult for any of them to
achieve the blood sugar levels that had been set for them. Many patients
with diabetes feel stressed when they fail to meet blood sugar goals set by
their doctors.
"At some level I just wonder if some of them were just overwhelmed by this
psychologically," Dr. Buse said. "Could it be the stress of 'I'm trying so
hard, but I can't get it done'?" [NYT]
sugar are unlikely to change the way most people with Type 2 diabetes manage
their illness, doctors said.
The study, showed that an intensive program to lower blood sugar actually
increased risk of death. The findings were so surprising that the study was
stopped early, and they seemed to undercut the accepted wisdom that people
with diabetes should do everything possible to get their blood sugar down to
normal.
But the methods used in the study, called Accord (for Action to Control
Cardiovascular Risk in Diabetes), bear little resemblance to the techniques
most doctors and patients use to manage blood sugar levels. And the patients
in the study were typically far sicker than many people with diabetes today.
"The intensity of what we did is done virtually nowhere on the planet," said
Dr. John Buse, vice chairman of the study's steering committee and the
president of medicine and science at the American Diabetes Association. "It'
s far beyond what's common in clinical practice." Dr. Buse called the study'
s regimen to lower blood sugar a "brutal program."
Still, doctors are likely to reconsider their emphasis on lowering blood
sugar at all costs, because it is becoming clear that other factors
influence the overall health of patients with diabetes.
The New England Journal of Medicine published a study this week showing that
a three-pronged approach of managing sugar, blood pressure and cholesterol -
combined with low doses of aspirin - prolonged the lives of people with
diabetes. The patients who did best in that study did not reach the nearly
normal sugar levels that were the aim of the Accord study. Instead, their
levels were just slightly higher than normal.
In the Accord study, the group of patients who were randomly assigned to
lower their blood sugar levels to nearly normal had 54 more deaths than the
group whose levels were less rigidly controlled. The patients were in the
study for an average of four years when investigators stopped the intense
regimen and put all of them on the less intense one.
"When we look at mortality in patients with Type 2 diabetes, it's not only
the blood sugar," said Dr. Joel Zonszein, director of the Clinical Diabetes
Center. "What the study shows is that just lowering blood sugar is not
protecting you from dying sooner. Blood sugar is important, but so is blood
pressure and cholesterol."
Patients with newly diagnosed diabetes still appear to have much to gain by
keeping their blood sugar levels as close to normal as possible through
healthful eating and exercise. But patients who have had a heart attack and
have other risk factors need not feel guilty if they cannot get their blood
sugar to normal levels, Dr. Buse said.
"The most important thing is get your blood pressure controlled, cholesterol
controlled, and do a reasonable job on your diabetes, but don't go wild," he
said. "We are backing away from notion that we always have to push, push,
push to get blood sugar lower."
Today, many patients with diabetes take two or three drugs to manage their
blood sugar levels. In the Accord study, many patients took multiple drugs
and insulin shots, adhered to strict diets and regularly met with counselors
and doctors who monitored them. No single drug treatment was prescribed;
doctors used whatever combination of various treatments that appeared to
work best in each patients.
The researchers still have to sift through the data on those who died to
find out whether there was any pattern that might help explain why patients
in the intense treatment group fared worse. It may be that they were simply
sicker to begin with. It may have been the number of drugs they used or the
pace at which their blood sugar dropped.
Dr. Buse said one little-discussed issue was the sheer stress of the
treatment program itself. He noted that the program demanded a lot of effort
from patients but that it was still exceedingly difficult for any of them to
achieve the blood sugar levels that had been set for them. Many patients
with diabetes feel stressed when they fail to meet blood sugar goals set by
their doctors.
"At some level I just wonder if some of them were just overwhelmed by this
psychologically," Dr. Buse said. "Could it be the stress of 'I'm trying so
hard, but I can't get it done'?" [NYT]
Society Promotes Obesity
Individuals cannot take all the blame if they are obese - modern society
adds pressure to put on weight, according to a report.
The study by think-tank Foresight called for greater help to counter the
"'obesogenic' environment" by designing towns and cities to promote walking
and cycling and encouraging people to buy healthier food.
But it could take 30 years to tackle the problem, it said. Obesity rates
have more than doubled in the last 25 years - in 2004, nearly a quarter of
men and women were obese.
"There is compelling evidence that humans are predisposed to put on weight
by their biology," the report said.
"Although personal responsibility plays a crucial part in weight gain, human
biology is being overwhelmed by the effects of today's 'obesogenic'
environment, with its abundance of energy-dense food, motorised transport
and sedentary lifestyles.
"As a result, the people are inexorably becoming heavier simply by living of
today."
Some experts said the report confirmed what the government had known for
years and accused it of failing to act.
Peter Hollins, chief executive of the Heart Foundation, said it was "hardly
a wake-up call".
"Reports like this, which should have had alarm bells ringing ... long ago,
have been met only by repeated pushes of the government's snooze button," he
said.
Govt has launched a campaign for greater participation in sports at school
to combat the looming obesity crisis, which Health Secretary Alan Johnson
was potentially on the scale of climate change.
Government-commissioned research suggested half of all people will be obese
in 25 years if current trends are not halted; furthermore, 86 per cent of
men will be overweight in 15 years and 70 per cent of women in 20, it
suggested. [SMH]
adds pressure to put on weight, according to a report.
The study by think-tank Foresight called for greater help to counter the
"'obesogenic' environment" by designing towns and cities to promote walking
and cycling and encouraging people to buy healthier food.
But it could take 30 years to tackle the problem, it said. Obesity rates
have more than doubled in the last 25 years - in 2004, nearly a quarter of
men and women were obese.
"There is compelling evidence that humans are predisposed to put on weight
by their biology," the report said.
"Although personal responsibility plays a crucial part in weight gain, human
biology is being overwhelmed by the effects of today's 'obesogenic'
environment, with its abundance of energy-dense food, motorised transport
and sedentary lifestyles.
"As a result, the people are inexorably becoming heavier simply by living of
today."
Some experts said the report confirmed what the government had known for
years and accused it of failing to act.
Peter Hollins, chief executive of the Heart Foundation, said it was "hardly
a wake-up call".
"Reports like this, which should have had alarm bells ringing ... long ago,
have been met only by repeated pushes of the government's snooze button," he
said.
Govt has launched a campaign for greater participation in sports at school
to combat the looming obesity crisis, which Health Secretary Alan Johnson
was potentially on the scale of climate change.
Government-commissioned research suggested half of all people will be obese
in 25 years if current trends are not halted; furthermore, 86 per cent of
men will be overweight in 15 years and 70 per cent of women in 20, it
suggested. [SMH]
Cell Phones Don't Cause Brain Cancer
You can stop worrying about getting brain cancer from your cell phone. A
massive study of just about every private cell phone user in Denmark shows
no link between gabbing on your mobile and the development of brain tumors.
The 420,000 participants averaged about 8.5 years of cell phone use,
although some of them had been using cell phones for as long as 21 years.
But there was not even a hint of an increase in brain cancer incidence the
longer they used the phone.
A closer examination of different types of brain cancer-from gliomas to
acoutsic neuromas-showed no increase in brain cancer subtypes either,
according to investigators, led by Joachim Schuz of the Institute of Cancer
Epidemiology of the Danish Cancer Society in Copenhagen.
Bizarrely, the cell-phone study, which was published in the Journal of the
National Cancer Institute, showed some unexpected benefits. Male cell phone
users were less likely to develop lung cancer. But that's probably a result
of the fact that the first people to use cell phones in Denmark were quite
well-off, and rich men are less likely to smoke cigarettes than poorer men.
Rich women are just as likely to smoke as poor women in Denmark and so
female cell-phone users were just as likely to develop lung cancer as their
non-cell-phone-user counterparts.
More difficult to explain is the finding that women who had used cell phones
for a long time were more likely to develop cervical cancer and kidney
cancer. Since cervical cancer is typically caused by a sexually transmitted
virus, it's possible, the study authors say, that early adopters were also
more likely to have sex with several partners. But researchers have no
explanation for why there was an uptick in kidney cancer.
The study was funded by the Danish Strategic Research Council and the Danish
Cancer Society.
What it Means:
The largest study to date has found no link between brain cancer and cell
phone use. So if a link does indeed exist, it is likely to be very small.
The results do not necessarily apply to children since anyone under the age
of 18 was excluded from the study. [TM]
massive study of just about every private cell phone user in Denmark shows
no link between gabbing on your mobile and the development of brain tumors.
The 420,000 participants averaged about 8.5 years of cell phone use,
although some of them had been using cell phones for as long as 21 years.
But there was not even a hint of an increase in brain cancer incidence the
longer they used the phone.
A closer examination of different types of brain cancer-from gliomas to
acoutsic neuromas-showed no increase in brain cancer subtypes either,
according to investigators, led by Joachim Schuz of the Institute of Cancer
Epidemiology of the Danish Cancer Society in Copenhagen.
Bizarrely, the cell-phone study, which was published in the Journal of the
National Cancer Institute, showed some unexpected benefits. Male cell phone
users were less likely to develop lung cancer. But that's probably a result
of the fact that the first people to use cell phones in Denmark were quite
well-off, and rich men are less likely to smoke cigarettes than poorer men.
Rich women are just as likely to smoke as poor women in Denmark and so
female cell-phone users were just as likely to develop lung cancer as their
non-cell-phone-user counterparts.
More difficult to explain is the finding that women who had used cell phones
for a long time were more likely to develop cervical cancer and kidney
cancer. Since cervical cancer is typically caused by a sexually transmitted
virus, it's possible, the study authors say, that early adopters were also
more likely to have sex with several partners. But researchers have no
explanation for why there was an uptick in kidney cancer.
The study was funded by the Danish Strategic Research Council and the Danish
Cancer Society.
What it Means:
The largest study to date has found no link between brain cancer and cell
phone use. So if a link does indeed exist, it is likely to be very small.
The results do not necessarily apply to children since anyone under the age
of 18 was excluded from the study. [TM]
Cell Phones Don't Cause Brain Cancer
You can stop worrying about getting brain cancer from your cell phone. A
massive study of just about every private cell phone user in Denmark shows
no link between gabbing on your mobile and the development of brain tumors.
The 420,000 participants averaged about 8.5 years of cell phone use,
although some of them had been using cell phones for as long as 21 years.
But there was not even a hint of an increase in brain cancer incidence the
longer they used the phone.
A closer examination of different types of brain cancer-from gliomas to
acoutsic neuromas-showed no increase in brain cancer subtypes either,
according to investigators, led by Joachim Schuz of the Institute of Cancer
Epidemiology of the Danish Cancer Society in Copenhagen.
Bizarrely, the cell-phone study, which was published in the Journal of the
National Cancer Institute, showed some unexpected benefits. Male cell phone
users were less likely to develop lung cancer. But that's probably a result
of the fact that the first people to use cell phones in Denmark were quite
well-off, and rich men are less likely to smoke cigarettes than poorer men.
Rich women are just as likely to smoke as poor women in Denmark and so
female cell-phone users were just as likely to develop lung cancer as their
non-cell-phone-user counterparts.
More difficult to explain is the finding that women who had used cell phones
for a long time were more likely to develop cervical cancer and kidney
cancer. Since cervical cancer is typically caused by a sexually transmitted
virus, it's possible, the study authors say, that early adopters were also
more likely to have sex with several partners. But researchers have no
explanation for why there was an uptick in kidney cancer.
The study was funded by the Danish Strategic Research Council and the Danish
Cancer Society.
What it Means:
The largest study to date has found no link between brain cancer and cell
phone use. So if a link does indeed exist, it is likely to be very small.
The results do not necessarily apply to children since anyone under the age
of 18 was excluded from the study. [TM]
massive study of just about every private cell phone user in Denmark shows
no link between gabbing on your mobile and the development of brain tumors.
The 420,000 participants averaged about 8.5 years of cell phone use,
although some of them had been using cell phones for as long as 21 years.
But there was not even a hint of an increase in brain cancer incidence the
longer they used the phone.
A closer examination of different types of brain cancer-from gliomas to
acoutsic neuromas-showed no increase in brain cancer subtypes either,
according to investigators, led by Joachim Schuz of the Institute of Cancer
Epidemiology of the Danish Cancer Society in Copenhagen.
Bizarrely, the cell-phone study, which was published in the Journal of the
National Cancer Institute, showed some unexpected benefits. Male cell phone
users were less likely to develop lung cancer. But that's probably a result
of the fact that the first people to use cell phones in Denmark were quite
well-off, and rich men are less likely to smoke cigarettes than poorer men.
Rich women are just as likely to smoke as poor women in Denmark and so
female cell-phone users were just as likely to develop lung cancer as their
non-cell-phone-user counterparts.
More difficult to explain is the finding that women who had used cell phones
for a long time were more likely to develop cervical cancer and kidney
cancer. Since cervical cancer is typically caused by a sexually transmitted
virus, it's possible, the study authors say, that early adopters were also
more likely to have sex with several partners. But researchers have no
explanation for why there was an uptick in kidney cancer.
The study was funded by the Danish Strategic Research Council and the Danish
Cancer Society.
What it Means:
The largest study to date has found no link between brain cancer and cell
phone use. So if a link does indeed exist, it is likely to be very small.
The results do not necessarily apply to children since anyone under the age
of 18 was excluded from the study. [TM]
Wednesday, July 9, 2008
Is Brown Sugar Healthier Than White Sugar?
We all know that brown rice is better for you than white rice, and whole
wheat bread comes out on top over white bread, but does this pattern extend
to sugar as well?
It is often said that brown sugar is a healthier option than white sugar.
But you can chalk that up to clever marketing or plain and simple illusion.
In reality, brown sugar is most often ordinary table sugar that is turned
brown by the reintroduction of molasses. Normally, molasses is separated and
removed when sugar is created from sugarcane plants.
In some cases, brown sugar - particularly when it is referred to as "raw
sugar" - is merely sugar that has not been fully refined. But more often
than not, manufacturers prefer to reintroduce molasses to fine white sugar -
creating a mixture with about 5 percent to 10 percent molasses - because it
allows them to better control the color and size of the crystals in the
final product.
So the two varieties of sugar are similar nutritionally. According to the
USDA, brown sugar contains about 17 kilocalories per teaspoon, compared with
16 kilocalories per teaspoon for white sugar.
Because of its molasses content, brown sugar does contain certain minerals,
most notably calcium, potassium, iron and magnesium (white sugar contains
none of these). But since these minerals are present in only minuscule
amounts, there is no real health benefit to using brown sugar. The real
differences between the two are taste and the effects on baked goods.
Nutritionally, brown sugar and white sugar are not much different. [NYT]
wheat bread comes out on top over white bread, but does this pattern extend
to sugar as well?
It is often said that brown sugar is a healthier option than white sugar.
But you can chalk that up to clever marketing or plain and simple illusion.
In reality, brown sugar is most often ordinary table sugar that is turned
brown by the reintroduction of molasses. Normally, molasses is separated and
removed when sugar is created from sugarcane plants.
In some cases, brown sugar - particularly when it is referred to as "raw
sugar" - is merely sugar that has not been fully refined. But more often
than not, manufacturers prefer to reintroduce molasses to fine white sugar -
creating a mixture with about 5 percent to 10 percent molasses - because it
allows them to better control the color and size of the crystals in the
final product.
So the two varieties of sugar are similar nutritionally. According to the
USDA, brown sugar contains about 17 kilocalories per teaspoon, compared with
16 kilocalories per teaspoon for white sugar.
Because of its molasses content, brown sugar does contain certain minerals,
most notably calcium, potassium, iron and magnesium (white sugar contains
none of these). But since these minerals are present in only minuscule
amounts, there is no real health benefit to using brown sugar. The real
differences between the two are taste and the effects on baked goods.
Nutritionally, brown sugar and white sugar are not much different. [NYT]
10 Foods to Make You Happy
Feeling blue? Mung beans, lobster, turkey, asparagus, sunflower seeds,
cottage cheese, pineapple, tofu, spinach and bananas could lift your
spirits.
A diet high in tryptophan - an amino acid converted by the body into the
feel-good chemical serotonin - can improve mood and wellbeing, pediatrician
Caroline Longmore said.
The body cannot produce tryptophan so unless we get enough through our
diets, we may suffer a deficiency, leading to low serotonin levels which are
associated with mood disorders, anxiety, cravings and irritable bowel
syndrome (IBS).
"Following a diet which contains foods rich in naturally occurring serotonin
will improve your mood, leaving you energised and in a state of harmony and
wellbeing," Dr Longmore said.
Mental health experts say while the theory behind tryptophans for improving
mood is solid, its use by depressed patients has a chequered history.
Gordon Parker, said tryptophan supplements were widely used before the 1990s
but after a number of patients suffered serious side effects from a
contaminated batch, they were temporarily taken off the market.
Professor Parker said while some patients strongly believed such supplements
were beneficial, scientific evidence was lacking.
"I would say it's something that can be useful for some people but the
quality control varies enormously," he said.
In her ebook The Serotonin Secret, Dr Longmore claims the best way to get
optimum tryptophan levels is through a carefully devised eating plan. She
rates dozens of foods for their levels of tryptophan.
Written with medical scientist Katrin Hempel, the book has 50 recipes
designed to solve serotonin imbalance without drugs. The concept works on
the same principle as selective serotonin re-uptake inhibitors (SSRIs), such
as popular antidepressant Prozac.
Britain's Food and Mood Project recommends eating chicken, sardines, turkey,
salmon, fresh tuna, nuts and seeds to boost serotonin levels. But Professor
Michael Baigent, said there was only low-level evidence to suggest
tryptophans have a medical effect.
Statistics show that in any 12 months, almost 17 per cent of adult have a
mental disorder with anxiety, depression, bipolar and substance misuse the
most common. [SMH]
cottage cheese, pineapple, tofu, spinach and bananas could lift your
spirits.
A diet high in tryptophan - an amino acid converted by the body into the
feel-good chemical serotonin - can improve mood and wellbeing, pediatrician
Caroline Longmore said.
The body cannot produce tryptophan so unless we get enough through our
diets, we may suffer a deficiency, leading to low serotonin levels which are
associated with mood disorders, anxiety, cravings and irritable bowel
syndrome (IBS).
"Following a diet which contains foods rich in naturally occurring serotonin
will improve your mood, leaving you energised and in a state of harmony and
wellbeing," Dr Longmore said.
Mental health experts say while the theory behind tryptophans for improving
mood is solid, its use by depressed patients has a chequered history.
Gordon Parker, said tryptophan supplements were widely used before the 1990s
but after a number of patients suffered serious side effects from a
contaminated batch, they were temporarily taken off the market.
Professor Parker said while some patients strongly believed such supplements
were beneficial, scientific evidence was lacking.
"I would say it's something that can be useful for some people but the
quality control varies enormously," he said.
In her ebook The Serotonin Secret, Dr Longmore claims the best way to get
optimum tryptophan levels is through a carefully devised eating plan. She
rates dozens of foods for their levels of tryptophan.
Written with medical scientist Katrin Hempel, the book has 50 recipes
designed to solve serotonin imbalance without drugs. The concept works on
the same principle as selective serotonin re-uptake inhibitors (SSRIs), such
as popular antidepressant Prozac.
Britain's Food and Mood Project recommends eating chicken, sardines, turkey,
salmon, fresh tuna, nuts and seeds to boost serotonin levels. But Professor
Michael Baigent, said there was only low-level evidence to suggest
tryptophans have a medical effect.
Statistics show that in any 12 months, almost 17 per cent of adult have a
mental disorder with anxiety, depression, bipolar and substance misuse the
most common. [SMH]
Monday, July 7, 2008
Why We Love
The last time you had sex, there was arguably not a thought in your head.
O.K., if it was very familiar sex with a very familiar partner, the kind
that-truth be told-you probably have most of the time, your mind may have
wandered off to such decidedly nonerotic matters as balancing your checkbook
or planning your week. If it was the kind of sex you shouldn't have been
having in the first place-the kind you were regretting even as it was taking
place-you might have already been flashing ahead to the likely consequences.
But if it was that kind of sex that's the whole reason you took up having
sex in the first place-the out-of-breath, out-of-body,
can-you-believe-this-is-actually-happening kind of sex-the rational you had
probably taken a powder.
Losing our faculties over a matter like sex ought not to make much sense for
a species like ours that relies on its wits. A savanna full of predators,
after all, was not a place to get distracted. But the lure of losing our
faculties is one of the things that makes sex thrilling-and one of the very
things that keeps the species going. As far as your genes are concerned,
your principal job while you're alive is to conceive offspring, bring them
to adulthood and then obligingly die so you don't consume resources better
spent on the young. Anything that encourages you to breed now and breed
plenty gets that job done.
But mating and the rituals surrounding it make us come unhinged in other
ways too, ones that are harder to explain by the mere babymaking imperative.
There's the transcendent sense of tenderness you feel toward a person who
sparks your interest. There's the sublime feeling of relief and reward when
that interest is returned. There are the flowers you buy and the poetry you
write and the impulsive trip you make to the other side of the world just so
you can spend 48 hours in the presence of a lover who's far away. That's an
awful lot of busywork just to get a sperm to meet an egg-if merely getting a
sperm to meet an egg is really all that it's about.
Human beings make a terrible fuss about a lot of things but none more than
romance. Eating and drinking are just as important for keeping the species
going-more so actually, since a celibate person can at least continue living
but a starving person can't. Yet while we may build whole institutions
around the simple ritual of eating, it never turns us flat-out nuts. Romance
does. "People compose poetry, novels, sitcoms for love," says Helen Fisher,
an anthropologist at Rutgers University and something of the Queen Mum of
romance research. "They live for love, die for love, kill for love. It can
be stronger than the drive to stay alive."
On its good days (and love has a lot of them), all this seems to make
perfect sense. Nearly 30 years ago, psychologist Elaine Hatfield of the
University of Hawaii and sociologist Susan Sprecher now of Illinois State
University developed a 15-item questionnaire that ranks people along what
the researchers call the passionate-love scale. Hatfield has administered
the test in places as varied as the U.S., Pacific islands, Russia, Mexico,
Pakistan and, most recently, India and has found that no matter where she
looks, it's impossible to squash love. "It seemed only people in the West
were goofy enough to marry for passionate love," she says. "But in all of
the cultures I've studied, people love wildly."
What scientists, not to mention the rest of us, want to know is, Why? What
makes us go so loony over love? Why would we bother with this elaborate
exercise in fan dances and flirtations, winking and signaling, joy and
sorrow? "We have only a very limited understanding of what romance is in a
scientific sense," admits John Bancroft, emeritus director of the Kinsey
Institute in Bloomington, Ind., a place where they know a thing or two about
the way human beings pair up. But that limited understanding is expanding.
The more scientists look, the more they're able to tease romance apart into
its individual strands-the visual, auditory, olfactory, tactile,
neurochemical processes that make it possible. None of those things may be
necessary for simple procreation, but all of them appear essential for
something larger. What that something is-and how we achieve it- is only now
coming clear.
The Love Hunt
If human reproductive behavior is a complicated thing, part of the reason is
that it's designed to serve two clashing purposes. On the one hand, we're
driven to mate a lot. On the other hand, we want to mate well so that our
offspring survive. If you're a female, you get only a few rolls of the
reproductive dice in a lifetime. If you're a male, your freedom to conceive
is limited only by the availability of willing partners, but the demands of
providing for too big a brood are a powerful incentive to limit your
pairings to the female who will give you just a few strong young. For that
reason, no sooner do we reach sexual maturity than we learn to look for
signals of good genes and reproductive fitness in potential partners and,
importantly, to display them ourselves. "Every living human is a descendant
of a long line of successful maters," says David Buss, an evolutionary
psychologist at the University of Texas at Austin. "We've adapted to pick
certain types of mates and to fulfill the desires of the opposite sex."
One of the most primal of those desires is that a possible partner smells
right. Good smells and bad smells are fundamentally no different from each
other; both are merely volatile molecules wafting off an object and
providing some clue as to the thing that emitted them. Humans, like all
animals, quickly learn to assign values to those scents, recognizing that,
say, putrefying flesh can carry disease and thus recoiling from its smell
and that warm cookies carry the promise of vanilla, sugar and butter and
thus being drawn to them. Other humans carry telltale smells of their own,
and those can affect us in equally powerful ways.
The best-known illustration of the invisible influence of scent is the way
the menstrual cycles of women who live communally tend to synchronize. In a
state of nature, this is a very good idea. It's not in a tribe's or
community's interests for one ovulating female to monopolize the
reproductive attention of too many males. Better to have all the females
become fertile at once and allow the fittest potential mates to compete with
one another for them.
But how does one female signal the rest? The answer is almost certainly
smell. Pheromones-or scent-signaling chemicals-are known to exist among
animals, and while scientists have had a hard time unraveling the pheromonal
system in humans, they have isolated a few of the compounds. One type, known
as driver pheromones, appears to affect the endocrine systems of others.
Since the endocrine system plays a critical role in the timing of
menstruation, there is at least a strong circumstantial case that the two
are linked. "It's thought that there is a driver female who gives off
something that changes the onset of menstruation in the other women," says
chemist Charles Wysocki of the Monell Chemical Senses Center in
Philadelphia.
It's not just women who respond to such olfactory cues. One surprising study
published last October in the journal Evolution and Human Behavior showed
that strippers who are ovulating average $70 in tips per hour; those who are
menstruating make $35; those who are not ovulating or menstruating make $50.
Other studies suggest that men can react in more romantic ways to olfactory
signals. In work conducted by Martie Haselton, an associate professor of
psychology at UCLA, women report that when they're ovulating, their partners
are more loving and attentive and, significantly, more jealous of other men.
"The men are picking up on something in their partner's behavior that tells
them to do more mate-guarding," Haselton says.
Scent not only tells males which females are primed to conceive, but it also
lets both sexes narrow their choices of potential partners. Among the
constellation of genes that control the immune system are those known as the
major histocompatibility complex (MHC), which influence tissue rejection.
Conceive a child with a person whose MHC is too similar to your own, and the
risk increases that the womb will expel the fetus. Find a partner with
sufficiently different MHC, and you're likelier to carry a baby to term.
Studies show that laboratory mice can smell too-similar MHC in the urine of
other mice and will avoid mating with those individuals. In later work
conducted at the University of Bern in Switzerland, human females were asked
to smell T shirts worn by anonymous males and then pick which ones appealed
to them. Time and again, they chose the ones worn by men with a safely
different MHC. And if the smell of MHC isn't a deal maker or breaker, the
taste is. Saliva also contains the compound, a fact that Haselton believes
may partly explain the custom of kissing, particularly those protracted
sessions that stop short of intercourse. "Kissing," she says simply, "might
be a taste test."
Precise as the MHC-detection system is, it can be confounded. One thing that
throws us off the scent is the birth-control pill. Women who are on the
Pill-which chemically simulates pregnancy-tend to choose wrong in the
T-shirt test. When they discontinue the daily hormone dose, the protective
smell mechanism kicks back in. "A colleague of mine wonders if the Pill may
contribute to divorce," says Wysocki. "Women pick a husband when they're on
birth control, then quit to have a baby and realize they've made a mistake."
Less surprising than the importance of the way a partner smells is the way
that partner looks and sounds. Humans are suckers for an attractive face and
a sexy shape. Men see ample breasts and broad hips as indicators of a
woman's ability to bear and nurse children-though most don't think about
such matters so lucidly. Women see a broad chest and shoulders as a sign of
someone who can clobber a steady supply of meat and keep lions away from the
cave. And while a hairy chest and a full beard have fallen out of favor in
the waxed and buffed 21st century, they are historically-if
unconsciously-seen as signs of healthy testosterone flow that gives rise to
both fertility and strength.
A deep voice, also testosterone driven, can have similarly seductive power.
Psychology professor David Feinberg of McMaster University in Ontario
studied Tanzania's Hadza tribesmen, one of the world's last hunter-gatherer
communities, and found that the richer and lower a man's voice, the more
children he had. Researchers at the University of Albany recently conducted
related research in which they had a sample group of 149 volunteers listen
to recordings of men's and women's voices and then rate the way they sound
on a scale from "very unattractive" to "very attractive." On the whole, the
people whose voices scored high on attractiveness also had physical features
considered sexually appealing, such as broad shoulders in men and a low
waist-to-hip ratio in women. This suggests either that an alluring voice is
part of a suite of sexual qualities that come bundled together or that
simply knowing you look appealing encourages you to develop a voice to
match. Causation and mere correlation often get muddied in studies like
this, but either way, a sexy voice at least appears to sell the goods. "It
might convey subtle information about body configuration and sexual
behavior," says psychologist Gordon Gallup, who co-authored the study.
The internal chemical tempest that draws us together hits Category 5 when
sex gets involved. If it's easy for a glance to become a kiss and a kiss to
become much more, that's because your system is trip-wired to make it hard
to turn back once you're aroused. That the kiss is the first snare is no
accident.
Not only does kissing serve the utilitarian purpose of providing a sample of
MHC, but it also magnifies the other attraction signals-if only as a result
of proximity. Scent is amplified up close, as are sounds and breaths and
other cues. And none of that begins to touch the tactile experience that was
entirely lacking until intimate contact was made. "At the moment of a kiss,
there's a rich and complicated exchange of postural, physical and chemical
information," says Gallup. "There are hardwired mechanisms that process all
this."
What's more, every kiss may also carry a chemical Mickey, slipped in by the
male. Though testosterone is found in higher concentrations in men than in
women, it is present in both genders and is critical in maintaining arousal
states. Traces of testosterone make it into men's saliva, particularly among
men who have high blood levels of the hormone to start with, and it's
possible that a lot of kissing over a long period may be a way to pass some
of that natural aphrodisiac to the woman, increasing her arousal and making
her more receptive to even greater intimacy.
When Mating Becomes Love
If we've succeeded in becoming such efficient reproductive machines-equipped
with both a generous appetite for mates and a cool ability to screen them
for genetic qualities-why muddy things up with romance? For one thing, we
may not be able to help it. Just being attracted to someone doesn't mean
that that person is attracted back, and few things drive us crazier than
wanting something we may not get. Cultural customs that warn against sex on
the first date may have emerged for such practical reasons as avoiding
pregnancy or sexually transmitted diseases, but they're also there for
tactical reasons. Males or females who volunteer their babymaking services
too freely may not be offering up very valuable genes. Those who seem more
discerning are likelier to be holding a winning genetic hand-and are in a
better position to demand one in return.
The elaborate ritual of dating is how this screening takes place. It's when
that process pays off-when you finally feel you've found the right
person-that the true-love thrill hits, and studies of the brain with
functional magnetic resonance imagers (fMRIs) show why it feels so good. The
earliest fMRIs of brains in love were taken in 2000, and they revealed that
the sensation of romance is processed in three areas. The first is the
ventral tegmental, a clump of tissue in the brain's lower regions, which is
the body's central refinery for dopamine. Dopamine does a lot of jobs, but
the thing we notice most is that it regulates reward. When you win a hand of
poker, it's a dopamine jolt that's responsible for the thrill that follows.
When you look forward to a big meal or expect a big raise, it's a steady
flow of dopamine that makes the anticipation such a pleasure.
Fisher and her colleagues have conducted recent fMRI scans of people who are
not just in love but newly in love and have found that their ventral
tegmental areas are working particularly hard. "This little factory near the
base of the brain is sending dopamine to higher regions," she says. "It
creates craving, motivation, goal-oriented behavior-and ecstasy."
When Love Becomes a Habit
Even with its intoxicating supply of dopamine, the ventral tegmental
couldn't do the love job on its own. Most people eventually do leave the
poker game or the dinner table, after all. Something has to turn the
exhilaration of a new partner into what can approach an obsession, and that
something is the brain's nucleus accumbens, located slightly higher and
farther forward than the ventral tegmental. Thrill signals that start in the
lower brain are processed in the nucleus accumbens via not just dopamine but
also serotonin and, importantly, oxytocin. If ever there was a substance
designed to bind, it's oxytocin.
New mothers are flooded with the stuff during labor and nursing-one reason
they connect so ferociously to their babies before they know them as
anything more than a squirmy body and a hungry mouth. Live-in fathers whose
partners are pregnant experience elevated oxytocin too, a good thing if
they're going to stick around through months of gestation and years of
child-rearing. So powerful is oxytocin that a stranger who merely walks into
its line of fire can suddenly seem appealing.
"In one study, an aide who was not involved with the birth of a baby would
stand in a hospital room while the mother was in labor," says Sue Carter, a
professor of psychiatry at the University of Illinois. "The mothers later
reported that they found the person very sympathetic, even though she was
doing nothing at all."
The last major stops for love signals in the brain are the caudate nuclei, a
pair of structures on either side of the head, each about the size of a
shrimp. It's here that patterns and mundane habits, such as knowing how to
type and drive a car, are stored. Motor skills like those can be hard to
lose, thanks to the caudate nuclei's indelible memory. Apply the same
permanence to love, and it's no wonder that early passion can gel so quickly
into enduring commitment. The idea that even one primal part of the brain is
involved in processing love would be enough to make the feeling powerful.
The fact that three are at work makes that powerful feeling consuming.
Love Gone Wrong
The problem with romance is that it doesn't always deliver the goods. For
all the joy it promises, it can also play us for fools, particularly when it
convinces us that we've found the right person, only to upend our
expectations later. Birth-control pills that mask a woman's ability to
detect her mate's incompatible MHC are one way bad love can slip past our
perimeters. Adrenaline is another. Any overwhelming emotional experience
that ratchets up your sensory system can distort your perceptions,
persuading you to take a chance on someone you should avoid.
Psychologist Arthur Aron of the State University of New York at Stony Brook
says people who meet during a crisis-an emergency landing of their airplane,
say-may be much more inclined to believe they've found the person meant for
them. "It's not that we fall in love with such people because they're
immensely attractive," he says. "It's that they seem immensely attractive
because we've fallen in love with them."
If that sounds a lot like what happens when people meet and date under the
regular influence of drugs or alcohol, only to sober up later and wonder
what in the world they were thinking, that's because in both cases powerful
chemistry is running the show. When hormones and natural opioids get
activated, explains psychologist and sex researcher Jim Pfaus of Concordia
University in Montreal, you start drawing connections to the person who was
present when those good feelings were created. "You think someone made you
feel good," Pfaus says, "but really it's your brain that made you feel
good."
Of course, even a love fever that's healthily shared breaks eventually, if
only because-like any fever-it's unsustainable over time. Fisher sees the
dangers of maladaptive love in fMRI studies she's conducting of people who
have been rejected by a lover and can't shake the pain. In these subjects,
as with all people in love, there is activity in the caudate nucleus, but
it's specifically in a part that's adjacent to a brain region associated
with addiction. If the two areas indeed overlap, as Fisher suspects, that
helps explain why telling a jilted lover that it's time to move on can be
fruitless-as fruitless as admonishing a drunk to put a cork in the bottle.
Happily, romance needn't come to ruin. Even irrational animals like
ourselves would have quit trying if the bet didn't pay off sometimes. The
eventual goal of any couple is to pass beyond serial dating-beyond even the
thrill of early love-and into what's known as companionate love. That's the
coffee-and-Sunday-paper phase, the board-games-when-it's-raining phase, and
the fact is, there's not a lick of excitement about it. But that, for better
or worse, is adaptive too. If partners are going to stay together for the
years of care that children require, they need a love that bonds them to
each other but without the passion that would be a distraction. As early
humans relied more on their brainpower to survive-and the dependency period
of babies lengthened to allow for the necessary learning-companionate
bonding probably became more pronounced.
That's not to say that people can't stay in love or that those couples who
say they still feel romantic after years of being together are imagining
things. Aron has conducted fMRI studies of some of those stubbornly loving
pairs, and initial results show that their brains indeed look very much like
those of people newly in love, with all the right regions lighting up in all
the right ways. "We wondered if they were really feeling these things," Aron
says. "But it looks like this is really happening."
These people, however, are the exceptions, and nearly all relationships must
settle and cool. That's a hard truth, but it's a comforting one too. Long
for the heat of early love if you want, but you'd have to pay for it with
the solidity you've built over the years. "You've got to make a transition
to a stabler state," says Barry McCarthy, a psychologist and sex therapist
based in Washington. If love can be mundane, that's because sometimes it's
meant to be.
Calling something like love mundane, of course, is true only as far as it
goes. Survival of a species is a ruthless and reductionist matter, but if
staying alive were truly all it was about, might we not have arrived at ways
to do it without joy-as we could have developed language without literature,
rhythm without song, movement without dance? Romance may be nothing more
than reproductive filigree, a bit of decoration that makes us want to
perpetuate the species and ensures that we do it right. But nothing could
convince a person in love that there isn't something more at work-and the
fact is, none of us would want to be convinced. That's a nut science may
never fully crack. [TM]
O.K., if it was very familiar sex with a very familiar partner, the kind
that-truth be told-you probably have most of the time, your mind may have
wandered off to such decidedly nonerotic matters as balancing your checkbook
or planning your week. If it was the kind of sex you shouldn't have been
having in the first place-the kind you were regretting even as it was taking
place-you might have already been flashing ahead to the likely consequences.
But if it was that kind of sex that's the whole reason you took up having
sex in the first place-the out-of-breath, out-of-body,
can-you-believe-this-is-actually-happening kind of sex-the rational you had
probably taken a powder.
Losing our faculties over a matter like sex ought not to make much sense for
a species like ours that relies on its wits. A savanna full of predators,
after all, was not a place to get distracted. But the lure of losing our
faculties is one of the things that makes sex thrilling-and one of the very
things that keeps the species going. As far as your genes are concerned,
your principal job while you're alive is to conceive offspring, bring them
to adulthood and then obligingly die so you don't consume resources better
spent on the young. Anything that encourages you to breed now and breed
plenty gets that job done.
But mating and the rituals surrounding it make us come unhinged in other
ways too, ones that are harder to explain by the mere babymaking imperative.
There's the transcendent sense of tenderness you feel toward a person who
sparks your interest. There's the sublime feeling of relief and reward when
that interest is returned. There are the flowers you buy and the poetry you
write and the impulsive trip you make to the other side of the world just so
you can spend 48 hours in the presence of a lover who's far away. That's an
awful lot of busywork just to get a sperm to meet an egg-if merely getting a
sperm to meet an egg is really all that it's about.
Human beings make a terrible fuss about a lot of things but none more than
romance. Eating and drinking are just as important for keeping the species
going-more so actually, since a celibate person can at least continue living
but a starving person can't. Yet while we may build whole institutions
around the simple ritual of eating, it never turns us flat-out nuts. Romance
does. "People compose poetry, novels, sitcoms for love," says Helen Fisher,
an anthropologist at Rutgers University and something of the Queen Mum of
romance research. "They live for love, die for love, kill for love. It can
be stronger than the drive to stay alive."
On its good days (and love has a lot of them), all this seems to make
perfect sense. Nearly 30 years ago, psychologist Elaine Hatfield of the
University of Hawaii and sociologist Susan Sprecher now of Illinois State
University developed a 15-item questionnaire that ranks people along what
the researchers call the passionate-love scale. Hatfield has administered
the test in places as varied as the U.S., Pacific islands, Russia, Mexico,
Pakistan and, most recently, India and has found that no matter where she
looks, it's impossible to squash love. "It seemed only people in the West
were goofy enough to marry for passionate love," she says. "But in all of
the cultures I've studied, people love wildly."
What scientists, not to mention the rest of us, want to know is, Why? What
makes us go so loony over love? Why would we bother with this elaborate
exercise in fan dances and flirtations, winking and signaling, joy and
sorrow? "We have only a very limited understanding of what romance is in a
scientific sense," admits John Bancroft, emeritus director of the Kinsey
Institute in Bloomington, Ind., a place where they know a thing or two about
the way human beings pair up. But that limited understanding is expanding.
The more scientists look, the more they're able to tease romance apart into
its individual strands-the visual, auditory, olfactory, tactile,
neurochemical processes that make it possible. None of those things may be
necessary for simple procreation, but all of them appear essential for
something larger. What that something is-and how we achieve it- is only now
coming clear.
The Love Hunt
If human reproductive behavior is a complicated thing, part of the reason is
that it's designed to serve two clashing purposes. On the one hand, we're
driven to mate a lot. On the other hand, we want to mate well so that our
offspring survive. If you're a female, you get only a few rolls of the
reproductive dice in a lifetime. If you're a male, your freedom to conceive
is limited only by the availability of willing partners, but the demands of
providing for too big a brood are a powerful incentive to limit your
pairings to the female who will give you just a few strong young. For that
reason, no sooner do we reach sexual maturity than we learn to look for
signals of good genes and reproductive fitness in potential partners and,
importantly, to display them ourselves. "Every living human is a descendant
of a long line of successful maters," says David Buss, an evolutionary
psychologist at the University of Texas at Austin. "We've adapted to pick
certain types of mates and to fulfill the desires of the opposite sex."
One of the most primal of those desires is that a possible partner smells
right. Good smells and bad smells are fundamentally no different from each
other; both are merely volatile molecules wafting off an object and
providing some clue as to the thing that emitted them. Humans, like all
animals, quickly learn to assign values to those scents, recognizing that,
say, putrefying flesh can carry disease and thus recoiling from its smell
and that warm cookies carry the promise of vanilla, sugar and butter and
thus being drawn to them. Other humans carry telltale smells of their own,
and those can affect us in equally powerful ways.
The best-known illustration of the invisible influence of scent is the way
the menstrual cycles of women who live communally tend to synchronize. In a
state of nature, this is a very good idea. It's not in a tribe's or
community's interests for one ovulating female to monopolize the
reproductive attention of too many males. Better to have all the females
become fertile at once and allow the fittest potential mates to compete with
one another for them.
But how does one female signal the rest? The answer is almost certainly
smell. Pheromones-or scent-signaling chemicals-are known to exist among
animals, and while scientists have had a hard time unraveling the pheromonal
system in humans, they have isolated a few of the compounds. One type, known
as driver pheromones, appears to affect the endocrine systems of others.
Since the endocrine system plays a critical role in the timing of
menstruation, there is at least a strong circumstantial case that the two
are linked. "It's thought that there is a driver female who gives off
something that changes the onset of menstruation in the other women," says
chemist Charles Wysocki of the Monell Chemical Senses Center in
Philadelphia.
It's not just women who respond to such olfactory cues. One surprising study
published last October in the journal Evolution and Human Behavior showed
that strippers who are ovulating average $70 in tips per hour; those who are
menstruating make $35; those who are not ovulating or menstruating make $50.
Other studies suggest that men can react in more romantic ways to olfactory
signals. In work conducted by Martie Haselton, an associate professor of
psychology at UCLA, women report that when they're ovulating, their partners
are more loving and attentive and, significantly, more jealous of other men.
"The men are picking up on something in their partner's behavior that tells
them to do more mate-guarding," Haselton says.
Scent not only tells males which females are primed to conceive, but it also
lets both sexes narrow their choices of potential partners. Among the
constellation of genes that control the immune system are those known as the
major histocompatibility complex (MHC), which influence tissue rejection.
Conceive a child with a person whose MHC is too similar to your own, and the
risk increases that the womb will expel the fetus. Find a partner with
sufficiently different MHC, and you're likelier to carry a baby to term.
Studies show that laboratory mice can smell too-similar MHC in the urine of
other mice and will avoid mating with those individuals. In later work
conducted at the University of Bern in Switzerland, human females were asked
to smell T shirts worn by anonymous males and then pick which ones appealed
to them. Time and again, they chose the ones worn by men with a safely
different MHC. And if the smell of MHC isn't a deal maker or breaker, the
taste is. Saliva also contains the compound, a fact that Haselton believes
may partly explain the custom of kissing, particularly those protracted
sessions that stop short of intercourse. "Kissing," she says simply, "might
be a taste test."
Precise as the MHC-detection system is, it can be confounded. One thing that
throws us off the scent is the birth-control pill. Women who are on the
Pill-which chemically simulates pregnancy-tend to choose wrong in the
T-shirt test. When they discontinue the daily hormone dose, the protective
smell mechanism kicks back in. "A colleague of mine wonders if the Pill may
contribute to divorce," says Wysocki. "Women pick a husband when they're on
birth control, then quit to have a baby and realize they've made a mistake."
Less surprising than the importance of the way a partner smells is the way
that partner looks and sounds. Humans are suckers for an attractive face and
a sexy shape. Men see ample breasts and broad hips as indicators of a
woman's ability to bear and nurse children-though most don't think about
such matters so lucidly. Women see a broad chest and shoulders as a sign of
someone who can clobber a steady supply of meat and keep lions away from the
cave. And while a hairy chest and a full beard have fallen out of favor in
the waxed and buffed 21st century, they are historically-if
unconsciously-seen as signs of healthy testosterone flow that gives rise to
both fertility and strength.
A deep voice, also testosterone driven, can have similarly seductive power.
Psychology professor David Feinberg of McMaster University in Ontario
studied Tanzania's Hadza tribesmen, one of the world's last hunter-gatherer
communities, and found that the richer and lower a man's voice, the more
children he had. Researchers at the University of Albany recently conducted
related research in which they had a sample group of 149 volunteers listen
to recordings of men's and women's voices and then rate the way they sound
on a scale from "very unattractive" to "very attractive." On the whole, the
people whose voices scored high on attractiveness also had physical features
considered sexually appealing, such as broad shoulders in men and a low
waist-to-hip ratio in women. This suggests either that an alluring voice is
part of a suite of sexual qualities that come bundled together or that
simply knowing you look appealing encourages you to develop a voice to
match. Causation and mere correlation often get muddied in studies like
this, but either way, a sexy voice at least appears to sell the goods. "It
might convey subtle information about body configuration and sexual
behavior," says psychologist Gordon Gallup, who co-authored the study.
The internal chemical tempest that draws us together hits Category 5 when
sex gets involved. If it's easy for a glance to become a kiss and a kiss to
become much more, that's because your system is trip-wired to make it hard
to turn back once you're aroused. That the kiss is the first snare is no
accident.
Not only does kissing serve the utilitarian purpose of providing a sample of
MHC, but it also magnifies the other attraction signals-if only as a result
of proximity. Scent is amplified up close, as are sounds and breaths and
other cues. And none of that begins to touch the tactile experience that was
entirely lacking until intimate contact was made. "At the moment of a kiss,
there's a rich and complicated exchange of postural, physical and chemical
information," says Gallup. "There are hardwired mechanisms that process all
this."
What's more, every kiss may also carry a chemical Mickey, slipped in by the
male. Though testosterone is found in higher concentrations in men than in
women, it is present in both genders and is critical in maintaining arousal
states. Traces of testosterone make it into men's saliva, particularly among
men who have high blood levels of the hormone to start with, and it's
possible that a lot of kissing over a long period may be a way to pass some
of that natural aphrodisiac to the woman, increasing her arousal and making
her more receptive to even greater intimacy.
When Mating Becomes Love
If we've succeeded in becoming such efficient reproductive machines-equipped
with both a generous appetite for mates and a cool ability to screen them
for genetic qualities-why muddy things up with romance? For one thing, we
may not be able to help it. Just being attracted to someone doesn't mean
that that person is attracted back, and few things drive us crazier than
wanting something we may not get. Cultural customs that warn against sex on
the first date may have emerged for such practical reasons as avoiding
pregnancy or sexually transmitted diseases, but they're also there for
tactical reasons. Males or females who volunteer their babymaking services
too freely may not be offering up very valuable genes. Those who seem more
discerning are likelier to be holding a winning genetic hand-and are in a
better position to demand one in return.
The elaborate ritual of dating is how this screening takes place. It's when
that process pays off-when you finally feel you've found the right
person-that the true-love thrill hits, and studies of the brain with
functional magnetic resonance imagers (fMRIs) show why it feels so good. The
earliest fMRIs of brains in love were taken in 2000, and they revealed that
the sensation of romance is processed in three areas. The first is the
ventral tegmental, a clump of tissue in the brain's lower regions, which is
the body's central refinery for dopamine. Dopamine does a lot of jobs, but
the thing we notice most is that it regulates reward. When you win a hand of
poker, it's a dopamine jolt that's responsible for the thrill that follows.
When you look forward to a big meal or expect a big raise, it's a steady
flow of dopamine that makes the anticipation such a pleasure.
Fisher and her colleagues have conducted recent fMRI scans of people who are
not just in love but newly in love and have found that their ventral
tegmental areas are working particularly hard. "This little factory near the
base of the brain is sending dopamine to higher regions," she says. "It
creates craving, motivation, goal-oriented behavior-and ecstasy."
When Love Becomes a Habit
Even with its intoxicating supply of dopamine, the ventral tegmental
couldn't do the love job on its own. Most people eventually do leave the
poker game or the dinner table, after all. Something has to turn the
exhilaration of a new partner into what can approach an obsession, and that
something is the brain's nucleus accumbens, located slightly higher and
farther forward than the ventral tegmental. Thrill signals that start in the
lower brain are processed in the nucleus accumbens via not just dopamine but
also serotonin and, importantly, oxytocin. If ever there was a substance
designed to bind, it's oxytocin.
New mothers are flooded with the stuff during labor and nursing-one reason
they connect so ferociously to their babies before they know them as
anything more than a squirmy body and a hungry mouth. Live-in fathers whose
partners are pregnant experience elevated oxytocin too, a good thing if
they're going to stick around through months of gestation and years of
child-rearing. So powerful is oxytocin that a stranger who merely walks into
its line of fire can suddenly seem appealing.
"In one study, an aide who was not involved with the birth of a baby would
stand in a hospital room while the mother was in labor," says Sue Carter, a
professor of psychiatry at the University of Illinois. "The mothers later
reported that they found the person very sympathetic, even though she was
doing nothing at all."
The last major stops for love signals in the brain are the caudate nuclei, a
pair of structures on either side of the head, each about the size of a
shrimp. It's here that patterns and mundane habits, such as knowing how to
type and drive a car, are stored. Motor skills like those can be hard to
lose, thanks to the caudate nuclei's indelible memory. Apply the same
permanence to love, and it's no wonder that early passion can gel so quickly
into enduring commitment. The idea that even one primal part of the brain is
involved in processing love would be enough to make the feeling powerful.
The fact that three are at work makes that powerful feeling consuming.
Love Gone Wrong
The problem with romance is that it doesn't always deliver the goods. For
all the joy it promises, it can also play us for fools, particularly when it
convinces us that we've found the right person, only to upend our
expectations later. Birth-control pills that mask a woman's ability to
detect her mate's incompatible MHC are one way bad love can slip past our
perimeters. Adrenaline is another. Any overwhelming emotional experience
that ratchets up your sensory system can distort your perceptions,
persuading you to take a chance on someone you should avoid.
Psychologist Arthur Aron of the State University of New York at Stony Brook
says people who meet during a crisis-an emergency landing of their airplane,
say-may be much more inclined to believe they've found the person meant for
them. "It's not that we fall in love with such people because they're
immensely attractive," he says. "It's that they seem immensely attractive
because we've fallen in love with them."
If that sounds a lot like what happens when people meet and date under the
regular influence of drugs or alcohol, only to sober up later and wonder
what in the world they were thinking, that's because in both cases powerful
chemistry is running the show. When hormones and natural opioids get
activated, explains psychologist and sex researcher Jim Pfaus of Concordia
University in Montreal, you start drawing connections to the person who was
present when those good feelings were created. "You think someone made you
feel good," Pfaus says, "but really it's your brain that made you feel
good."
Of course, even a love fever that's healthily shared breaks eventually, if
only because-like any fever-it's unsustainable over time. Fisher sees the
dangers of maladaptive love in fMRI studies she's conducting of people who
have been rejected by a lover and can't shake the pain. In these subjects,
as with all people in love, there is activity in the caudate nucleus, but
it's specifically in a part that's adjacent to a brain region associated
with addiction. If the two areas indeed overlap, as Fisher suspects, that
helps explain why telling a jilted lover that it's time to move on can be
fruitless-as fruitless as admonishing a drunk to put a cork in the bottle.
Happily, romance needn't come to ruin. Even irrational animals like
ourselves would have quit trying if the bet didn't pay off sometimes. The
eventual goal of any couple is to pass beyond serial dating-beyond even the
thrill of early love-and into what's known as companionate love. That's the
coffee-and-Sunday-paper phase, the board-games-when-it's-raining phase, and
the fact is, there's not a lick of excitement about it. But that, for better
or worse, is adaptive too. If partners are going to stay together for the
years of care that children require, they need a love that bonds them to
each other but without the passion that would be a distraction. As early
humans relied more on their brainpower to survive-and the dependency period
of babies lengthened to allow for the necessary learning-companionate
bonding probably became more pronounced.
That's not to say that people can't stay in love or that those couples who
say they still feel romantic after years of being together are imagining
things. Aron has conducted fMRI studies of some of those stubbornly loving
pairs, and initial results show that their brains indeed look very much like
those of people newly in love, with all the right regions lighting up in all
the right ways. "We wondered if they were really feeling these things," Aron
says. "But it looks like this is really happening."
These people, however, are the exceptions, and nearly all relationships must
settle and cool. That's a hard truth, but it's a comforting one too. Long
for the heat of early love if you want, but you'd have to pay for it with
the solidity you've built over the years. "You've got to make a transition
to a stabler state," says Barry McCarthy, a psychologist and sex therapist
based in Washington. If love can be mundane, that's because sometimes it's
meant to be.
Calling something like love mundane, of course, is true only as far as it
goes. Survival of a species is a ruthless and reductionist matter, but if
staying alive were truly all it was about, might we not have arrived at ways
to do it without joy-as we could have developed language without literature,
rhythm without song, movement without dance? Romance may be nothing more
than reproductive filigree, a bit of decoration that makes us want to
perpetuate the species and ensures that we do it right. But nothing could
convince a person in love that there isn't something more at work-and the
fact is, none of us would want to be convinced. That's a nut science may
never fully crack. [TM]
Health Myths Revealed
Reading in dim light won't damage your eyes, you don't need eight glasses of
water a day to stay healthy and shaving your legs won't make the hair grow
back faster.
These well-worn theories are among seven "medical myths" exposed in a paper
published in the British Medical Journal. Two researchers took seven common
beliefs and searched the archives for evidence to support them.
Despite frequent mentions in the popular press of the need to drink eight
glasses of water, they found no scientific basis for the claim.
The complete lack of evidence has been recorded in a study published the
American Journal of Psychology, they said.
The other six "myths" are:
* Reading in dim light ruins your eyesight
The majority of eye experts believe it is unlikely to do any permanent
damage, but it may make you squint, blink more and have trouble focusing,
the researchers said.
* Shaving makes hair grow back faster or coarser
It has no effect on the thickness or rate of hair regrowth, studies say. But
stubble lacks the finer taper of unshaven hair, giving the impression of
coarseness.
* Eating turkey makes you drowsy
It does contain an amino acid called tryptophan that is involved in sleep
and mood control. But turkey has no more of the acid than chicken or minced
beef. Eating lots of food and drink at Christmas is probably the real cause
of sleepiness.
* We use only 10 per cent of our brains
This myth arose as early as 1907 but imaging shows no area of the brain is
silent or completely inactive.
* Hair and fingernails continue to grow after death
This idea may stem from ghoulish novels. The researchers said the skin dries
out and retracts after death, giving the appearance of longer hair or nails.
* Mobile phones are dangerous in hospitals
Despite widespread concerns, studies have found minimal interference with
medical equipment. [RT]
water a day to stay healthy and shaving your legs won't make the hair grow
back faster.
These well-worn theories are among seven "medical myths" exposed in a paper
published in the British Medical Journal. Two researchers took seven common
beliefs and searched the archives for evidence to support them.
Despite frequent mentions in the popular press of the need to drink eight
glasses of water, they found no scientific basis for the claim.
The complete lack of evidence has been recorded in a study published the
American Journal of Psychology, they said.
The other six "myths" are:
* Reading in dim light ruins your eyesight
The majority of eye experts believe it is unlikely to do any permanent
damage, but it may make you squint, blink more and have trouble focusing,
the researchers said.
* Shaving makes hair grow back faster or coarser
It has no effect on the thickness or rate of hair regrowth, studies say. But
stubble lacks the finer taper of unshaven hair, giving the impression of
coarseness.
* Eating turkey makes you drowsy
It does contain an amino acid called tryptophan that is involved in sleep
and mood control. But turkey has no more of the acid than chicken or minced
beef. Eating lots of food and drink at Christmas is probably the real cause
of sleepiness.
* We use only 10 per cent of our brains
This myth arose as early as 1907 but imaging shows no area of the brain is
silent or completely inactive.
* Hair and fingernails continue to grow after death
This idea may stem from ghoulish novels. The researchers said the skin dries
out and retracts after death, giving the appearance of longer hair or nails.
* Mobile phones are dangerous in hospitals
Despite widespread concerns, studies have found minimal interference with
medical equipment. [RT]
Food: Rethink on Allergies
We are the greatest hypochondriacs when it comes to food allergies, wrongly
blaming their meals for everything from acne to headaches - and celebrities
are often at fault, skin specialists said.
More than 10 per cent of adults claimed to suffer from some sort of food
allergy, and most people blamed dairy and wheat for their ills, but less
than 2 per cent had a true allergy, said Connie Katelaris, a professor of
immunology and allergy.
"These imagined food allergies are far more likely to be reported by women
than by men," she said. "An individual often feels that they have control
over their symptoms if they blame food."
Professor Katelaris, speaking at annual scientific meeting of the College of
Dermatologists, said most children grew out of their allergies by adulthood.
"About 97 per cent of those who had an allergy to dairy as children are no
longer allergic as adults, while two-thirds of children grow out of their
egg allergy and 20 per cent grow out of their allergy to peanuts."
A study of 250 doctors in Britain in 2006 found that 63 per cent had
reported an increase in the number of patients claiming they had food
allergies after the singers Geri Halliwell and Victoria Beckham and the
actor Orlando Bloom announced they were sensitive to wheat and dairy
products, while a poll of 1000 adults found more than 20 per cent had learnt
of food intolerances and allergies from celebrity interviews, magazines and
TV shows.
"I get quite frustrated by it," the secretary of the College of
Dermatologists, Stephen Shumack, said. "People want to blame food for
everything that is wrong with them when food allergies are actually very,
very rare."
For those who really are allergic to certain foods, the tiniest amount can
be life-threatening. [SMH]
blaming their meals for everything from acne to headaches - and celebrities
are often at fault, skin specialists said.
More than 10 per cent of adults claimed to suffer from some sort of food
allergy, and most people blamed dairy and wheat for their ills, but less
than 2 per cent had a true allergy, said Connie Katelaris, a professor of
immunology and allergy.
"These imagined food allergies are far more likely to be reported by women
than by men," she said. "An individual often feels that they have control
over their symptoms if they blame food."
Professor Katelaris, speaking at annual scientific meeting of the College of
Dermatologists, said most children grew out of their allergies by adulthood.
"About 97 per cent of those who had an allergy to dairy as children are no
longer allergic as adults, while two-thirds of children grow out of their
egg allergy and 20 per cent grow out of their allergy to peanuts."
A study of 250 doctors in Britain in 2006 found that 63 per cent had
reported an increase in the number of patients claiming they had food
allergies after the singers Geri Halliwell and Victoria Beckham and the
actor Orlando Bloom announced they were sensitive to wheat and dairy
products, while a poll of 1000 adults found more than 20 per cent had learnt
of food intolerances and allergies from celebrity interviews, magazines and
TV shows.
"I get quite frustrated by it," the secretary of the College of
Dermatologists, Stephen Shumack, said. "People want to blame food for
everything that is wrong with them when food allergies are actually very,
very rare."
For those who really are allergic to certain foods, the tiniest amount can
be life-threatening. [SMH]
Taking Multiple Pain Relievers May Cause Complications
People who take more than one nonsteroidal anti-inflammatory drug (NSAID)
may have poorer health-related quality of life, a study suggests.
NSAIDs, which are available in both prescription and over-the-counter (OTC)
forms, are commonly used to treat arthritis.
These drugs are widely available, and patients may take both prescription
and OTC NSAIDs at the same time, either because they need more pain relief
or because they don't realize the products belong to the same class of
drugs, said the study authors, who added that doctors may not know their
patients are taking more than one NSAID.
This study, led by Stacey H. Kovac of Durham VA Medical Center and Duke
University in North Carolina, included 138 patients enrolled in a large
regional managed-care organization. All of the patients had filled at least
one NSAID prescription between February and August 2002.
The researchers found that 26 percent of the patients reported taking at
least two NSAIDs (prescription, OTC or both) during the previous month.
These dual users scored lower than others on the physical component of a
questionnaire designed to evaluate physical and mental health.
Keeping a complete list of a patient's medications would help doctors
identify patients who are taking more than one NSAID, the study authors
said.
"The increased awareness may lead to better communication between the
patient and provider about the appropriate use of NSAIDs," they wrote.
Patients who take more than one NSAID may do so because of inadequate
clinical pain management or because they have higher levels of pain than
other patients, said the researchers. Future research should examine factors
that may lead to dual NSAID use and methods of identifying patients taking
two or more NSAIDs and may be at higher risk of adverse side effects from
the drugs.
"Adequate pain management may have the potential to reduce dual use, improve
patient symptoms, including physical functioning, and reduce patient safety
problems," the researches concluded. [WP]
may have poorer health-related quality of life, a study suggests.
NSAIDs, which are available in both prescription and over-the-counter (OTC)
forms, are commonly used to treat arthritis.
These drugs are widely available, and patients may take both prescription
and OTC NSAIDs at the same time, either because they need more pain relief
or because they don't realize the products belong to the same class of
drugs, said the study authors, who added that doctors may not know their
patients are taking more than one NSAID.
This study, led by Stacey H. Kovac of Durham VA Medical Center and Duke
University in North Carolina, included 138 patients enrolled in a large
regional managed-care organization. All of the patients had filled at least
one NSAID prescription between February and August 2002.
The researchers found that 26 percent of the patients reported taking at
least two NSAIDs (prescription, OTC or both) during the previous month.
These dual users scored lower than others on the physical component of a
questionnaire designed to evaluate physical and mental health.
Keeping a complete list of a patient's medications would help doctors
identify patients who are taking more than one NSAID, the study authors
said.
"The increased awareness may lead to better communication between the
patient and provider about the appropriate use of NSAIDs," they wrote.
Patients who take more than one NSAID may do so because of inadequate
clinical pain management or because they have higher levels of pain than
other patients, said the researchers. Future research should examine factors
that may lead to dual NSAID use and methods of identifying patients taking
two or more NSAIDs and may be at higher risk of adverse side effects from
the drugs.
"Adequate pain management may have the potential to reduce dual use, improve
patient symptoms, including physical functioning, and reduce patient safety
problems," the researches concluded. [WP]
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