- You Asked: What’s the Best Sleeping Pill?
- Your Appendix May Not Be Useless After All
- Russia Might Ban Cigarettes for Everyone Born After 2014
- Why Donald Trump’s Choice of RFK Jr. as Vaccine Czar Is a Terrible Idea
Posted: 11 Jan 2017 07:37 AM PST
Something is keeping Americans up at night. More than one third of adults regularly don’t get enough sleep, and 25% percent of kids have difficulty sleeping. The causes of those sleep issues vary—from the sleep-suppressing blue light of a smartphone to the effects of booze—and they’re hard to pin down. But whatever the cause, more and more of us, particularly women and seniors, are turning to sleeping pills for relief.
But which one is best? The one you only take for a week or two, experts say.
Pills are a bandage, not a cure, says Dr. Phyllis Zee, professor of neurology and sleep medicine at Northwestern University’s Feinberg School of Medicine. “It’s like taking Tylenol every day for a fever without ever figuring out what’s causing the fever,” Zee says. Depression, too little exercise, runaway stress and a hundred other major or minor health issues could be causing or contributing to your sleeping woes. When you attack your problem with pills, you do nothing to resolve those underlying problems, she explains.
What does work, says Zee and the six sleep experts I contacted for this story, is cognitive behavioral therapy for insomnia, or CBT-I. It’s the most effective long-term treatment for sleep woes. “By far the best evidence we have when it comes to resolution of insomnia is associated with CBT-I, which is why every major medical authority advocates CBT-I as the first-line treatment for insomnia,” says Michael Grandner, director of the Sleep and Health Research Program at the University of Arizona College of Medicine.
CBT-I interventions can range from cutting out all screen time an hour before bed to visiting a sleep clinic every week. “But basically, it advocates having a regularized time and routine surrounding bedtime,” says Dr. Namni Goel, a sleep researcher at the University of Pennsylvania School of Medicine.
While every person with sleep issues should be employing CBT-I, Goel and others agree there’s a time and place for sleeping pills.
For short stints—a few nights for a week or two—a prescription hypnotic like Ambien or Lunesta can help you get some rest if you’re stressing about a big event, like your upcoming wedding or some especially hectic period at work, Grandner says. He also says keeping some on hand and taking a pill once every couple months if you’re really desperate isn’t too problematic. “The real concern,” he says, “is taking these pills on a weekly or monthly basis for an extended period of time.”
He mentions research linking these drugs to higher risks of death. That research is preliminary and incomplete, he says. “But it’s pretty well established that the kind of sleep you get on a drug like Ambien or is not as deep or restorative as natural sleep,” he adds. “I think it’s safe to say anything that drags you kicking and screaming into unconsciousness is not without risks.” Goel says these types of drugs have also been linked with memory and mood problems. Use them too much, and they may be habit-forming—meaning you can’t get to sleep without them, she adds.
Apart from hypnotics, more and more doctors are prescribing mild antidepressant drugs for sleep disorders. “The most common one is trazodone, which is considered quite safe and has a mild sedative effect,” Grandner says. “But at the same time, it’s not approved by the FDA to treat insomnia, and I don’t think a lot of doctors writing these trazodone prescriptions realize we have almost no good evidence to support its use as a sleep aid.” Another newer class of sleep drug—a type called “orexin receptor agonists” that block a brain chemical that keeps you awake—could turn out to be a game-changer. But these drugs are so new that their long-term benefits and risks aren’t well understood, Grandner says.
Melatonin is another, mellower option. But while many people think of the hormone as natural and “something my body makes anyway,” it’s still something that should only be used for temporary relief, says Dr. Andrew Weil, founder and director of the Arizona Center for Integrative Medicine at the University of Arizona. “Short-term use of melatonin has a good safety profile in adults,” Weil says. But the side effects of long-term or heavy usage aren’t well known, he adds.
The effect melatonin may have on kids is even murkier. “I’ve been treating kids in sleep clinics for 25 years, and I’ve just seen an explosion in melatonin use the last five years,” says Dr. Judith Owens, director of the Center for Pediatric Sleep Disorders at Boston Children’s Hospital. “It seems like it’s become the real go-to for parents and pediatricians, but we really don’t have any research on its use for periods longer than three months.” She mentions early onset puberty as one theoretical risk.
“Now, I use it in my patients, and of all the pills you could give a child, it’s probably the safest,” she adds. “But a lot of people think of melatonin almost like it’s a vitamin, and it’s not.” She says parents shouldn’t consider giving their kids any sleep aid unless they’ve been to a specialist or clinic and are using the pill under professional supervision.
For adults, Grandner says the best evidence suggests taking 0.5 to 1 mg of melatonin a few hours before bedtime. “The idea is you want to take it right around the time your system should naturally start producing the hormone,” he says. Especially in older adults, whose bodies may no longer make enough melatonin, taking the supplement in the evening may be helpful “if they’re not getting a good night’s sleep,” he says. But in higher doses taken right before bed, both he and Weil say taking melatonin may actually disrupt sleep.
The kind of deep, restful, rejuvenating sleep we all want isn’t going to come from a pill. You’ll have to make some changes if you want to catch some ZZZs.
Posted: 11 Jan 2017 06:57 AM PST
The appendix, notorious for its tendency to become inflamed or even rupture, has historically been viewed as a vestigial organ with no real function. But new research supports the idea that the appendix may indeed serve a purpose: to protect beneficial bacteria living in the gut.
Heather F. Smith, PhD, associate professor at Midwestern University Arizona College of Osteopathic Medicine, has studied the evolution of gastrointestinal traits across different animal species. Her new research, published in the journal Comptes Rendus Palevol, analyzed the presence or absence of an appendix in 533 different mammals.
She found that the appendix evolved independently in different genetic “trees,” more than 30 separate times. Furthermore, the appendix almost never disappeared from a lineage once it appeared. This suggests that the organ remains for a reason, she says—an adaptive purpose.
Smith and her co-authors—from Duke University Medical Center, the University of Stellenbosch in South Africa and the Muséum National d’Histoire Naturelle in France—were able to reject several previous hypotheses that the appendix may be linked to dietary or environmental factors. But they did make one interesting discovery: Species who had an appendix tend to have higher concentrations of lymphoid tissue in their cecum, a pouch that connects the small and large intestine.
This type of tissue can play a role in immunity, and can also stimulate growth of healthy gut bacteria. So it makes sense, Smith says, that the appendix actually serves as a “safe house” for these beneficial bugs.
This study isn’t the first to suggest that the appendix may play this type of role. The “safe house” idea was first raised by a 2007 study, which inspired Smith to question whether the appendix had evolved to serve this function in humans and other mammals—a theory that now appears quite likely.
So what does this mean for people who have had their appendix removed? Luckily, not much. “In general, people who have had an appendectomy tend to be relatively healthy and not have any major detrimental effects,” Smith says. (She herself had hers out at age 12.)
Some studies have shown, however, that people without an appendix may have slightly higher rates of infection than those with a functioning organ. “It may also take them slightly longer to recover from illness, especially those in which the beneficial gut bacteria has been flushed out of the body,” Smith added.
In a broader sense, Smith says that research on the appendix has provided “another line of evidence against over-sanitizing and excessive hygiene.” Because this organ is full of immune tissue, she says, one of the leading causes of appendicitis has to do with poorly developed immunity.
“Exposure to pathogens and infectious agents, like bacteria and viruses, is important for the normal development processes of the immune system,” Smith says. Without this exposure, development can be suppressed and the immune system can become hypersensitive—a hypothesis often used to explain illnesses like asthma and allergies.
More research in this area may help doctors address the organ’s most well known problem. “As treatments are developed for other autoimmune disorders and responses, it’s certainly possible that something similar may be developed for treating appendicitis,” she says.
Posted: 11 Jan 2017 05:44 AM PST
Russia is considering major steps to make sure its citizens do not become smokers.
The Russian Health Ministry this week proposed a ban on selling cigarettes to people born after 2014, Radio Free Europe/Radio Liberty reports, even after they are 18, which is currently the legal smoking age in the country. That means a full prohibition of cigarettes would not go into effect until 2033.
The proposal is part of a document that details government efforts to curtail smoking in the country. Russia has already banned smoking in restaurants since 2013.
Some experts warn that the ban could give rise to a black market for illegal cigarettes. But the Health Ministry defended its proposal, citing the 300,000 to 400,000 Russian citizens who die from smoking-related diseases each year.
“By 2033, the ban on the sale of tobacco products to people born after 2014 will not seem an extreme measure, but an entirely logical development of events,” Marina Gambaryan, an expert at the Health Ministry, told TASS.
Posted: 10 Jan 2017 02:29 PM PST
There’s been a mesmerizing kind of destructive physics at play in the appointments Donald Trump has made since winning the White House. Just as a particle of matter and a particle of antimatter will destroy each other instantly on contact, so too can precisely the wrong person appointed to precisely the wrong position blow up the very purpose of the job that’s supposed to be getting done.
Department of Energy, meet former Governor Rick Perry, the man who once said he wanted to eliminate you entirely. Boom. Department of Health and Human services, meet Rep. Tom Price, who wants to throw out the Affordable Care Act, allow insurers to quit covering patients with pre-existing conditions and make Medicare less available to the people who need it most. Boom.
Now comes the Trump team’s latest planned explosion: the appointment of celebrated anti-vaccine crusader Robert F. Kennedy, Jr. to chair a commission on, yes, vaccine safety and integrity.
The through-the-looking-glass news broke today in the lobby of Trump Tower, when Kennedy descended from the presidential aerie and told the gaggle of reporters camped around the elevators that Trump had called and offered him the job and he had accepted. His new responsibilities, Kennedy said, included making sure “we have scientific integrity in the vaccine process for efficacy and safety effects.” He also stressed that “everybody ought to be able to be assured that the vaccines we have [are] as safe as they can possibly be.” Finally, he added that Trump “is very pro-vaccine, as am I.”
Later in the afternoon, a Trump spokesperson said in a statement that the president-elect “is exploring the possibility of forming a committee on Autism, which affects so many families; however no decisions have been made at this time. The president-elect looks forward to continuing the discussion about all aspects of Autism with many groups and individuals.”
Trump first weighed in on the topic of vaccines in 2014, repeating the universally debunked claim that vaccines are somehow linked to autism. He published this finding in a non-peer-reviewed Tweet, saying:
In a 2015 presidential debate, Trump doubled-down on this nonsensical non-science, even offering a personal testimonial to give it weight. “You take this little beautiful baby, and you pump — I mean, it looks like just it’s meant for a horse and not for a child,” Trump said. “We had so many instances [in which] a child had a vaccine, and came back and a week back had a tremendous fever, got very very sick, and now is autistic.”
The vaccine-autism fable, as most people know by now, began with a fraudulent study by British physician Andrew Wakefield, published in The Lancet, claiming that the measles-mumps-rubella vaccine had been provably linked to autism in children. In 2010, the journal summarily retracted the paper, finding multiple instances fraud and other unethical behavior, and concluding that Wakefield had acted with “callous disregard” for the welfare of the children in his study. He was later stripped of his license to practice medicine. So, done and done, right?
Not quite. Despite the tidal wave of studies showing that vaccines are safe and effective and that there is far greater risk—both to individual children and to the community as a whole—in leaving kids unvaccinated, the rumor has persisted. That’s partly thanks to the boldface names in Hollywood—Jenny McCarthy, Jim Carrey and Rob Schneider, we’re looking at you—who have continued to peddle the rubbish, and partly due to ostensibly more serious thinkers who have echoed them. That’s where Kennedy has played his dangerous role.
In 2014, he published a book making the familiar autism argument and laying the blame at the familiar chemical boogeyman: thimerosal, a form of mercury that has been used in vaccines as a preservative and that he claims is poisoning children. As I reported at the time—and as scientists have been saying and saying and saying until they’re hoarse—his thinking is wrong on the chemistry, wrong on the epidemiology and wrong on the basic facts of the case.
First: for all practical purposes, the thimerosal just isn’t there. It has long since been removed from all vaccines except some formulations of the flu vaccine where it’s used in vanishingly small trace doses. What’s more, thimerosal is an ethylmercury product; the type of mercury that is harmful—and only in higher concentrations—is methylmercury. Finally, while it’s true that autism cases have gone up in the the U.S. in recent years, that has happened at the precise time thimerosal levels in vaccines have fallen. Epidemiologists attribute the increased autism incidence almost entirely to better diagnoses and an expanded definition of conditions that fall onto the autism spectrum.
Kennedy has remained stubbornly unmoved by all that, continuing to scare the daylights out of parents by warning that vaccines, which have saved tens of millions of lives over the decades, are somehow a menace. Well, now he’s got a president’s ear and a president’s support, and a much bigger megaphone than he ever had before.
If there is anything Kennedy said in his impromptu press conference today that was inarguably true, it came when he commented on Trump’s beliefs about vaccines. “His opinion doesn’t matter but the science does matter, and we ought to be reading the science,” he said.
Yes, we should—because it proves that the newly chosen vaccine czar does not know what he’s talking about.
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