Category: 8. Health

Kirsten Smith was 16 when a boy from school injected her with morphine, 18 when she and a date Googled how to crush up and inject themselves with oxycodone, and 19 when she first shot up heroin. Living in Knoxville, Tennessee and modelling herself on Pulp Fiction’s freewheeling Mia Wallace, Smith spent her days experimenting with alcohol, cannabis, ecstasy, mushrooms, LSD and benzodiazepines. She read Kurt Vonnegut and the Beats, and wrote poems on an actual typewriter while listening to the Velvet Underground. For Smith, as for thousands of Americans who came of age in the early 2000s, drug use was a seemingly harmless lifestyle choice.

That is, until she ran out of money. After Smith dropped out of high school and started regularly using heroin, she was caught stealing credit cards and chequebooks from a boyfriend’s wealthy parents, from a family friend at church and from her grandmother. On probation for two years, and forced by her parents into a month-long stay at an addiction treatment facility, Smith felt, for the first time, ashamed.

Returning to school was supposed to be Smith’s lifeline. She went to community college and got a job as a waiter at Charlie’s, a local restaurant chain. Then, in the summer of 2004, she met Brad Renfro, who had starred as a child actor in Hollywood films such as The Client and Sleepers. He introduced her to smoking crack cocaine and the best heroin she had ever known. After three months together, Smith began to wonder whether she would be a junkie for the rest of her life.

One day, standing in the living room of Renfro’s downtown boarding house, Smith watched him struggle to find a vein. Blood ran down his arm as he plugged in the dregs of his cocaine supply, a residue shot that Smith called a “low sad point in an addict’s life”. For her, Renfro had crossed a line into the shadowlands of compulsion. It was over between them. (Smith didn’t hear of Renfro again until he died of an overdose in 2008.)

While waiting on tables at Charlie’s, Smith met a young man named Michael, who had grown up in the same suburb as her. Michael was quiet and kept mostly to himself. His buzz cut and angular features contrasted with his sweet smile and blue eyes. The two clicked when Smith revealed that she had sent a fan letter to the author of Fight Club, Chuck Palahniuk, and had received a written response. Michael didn’t believe her until Smith brought the letter to work, dusty and charred by a house fire Smith had started when she was 15.

In 2005, Smith and Michael rented a one-bedroom apartment in an old building downtown. They also did drugs together, shoplifting to subsidise their lifestyle, which Smith described as a “romanticised junkiedom”. Through their network of white suburban addicts, Michael and Smith became hooked on expensive black tar heroin shipped in by a drug cartel that they referred to as “the Mexicans”. Despite their addictions, Smith and Michael maintained a stable, domestic existence. They wrote stories, paid their bills and owned two cats.

Later that year, Smith and Michael were both admitted to the University of Tennessee. This was Smith’s cue to get sober, but treatments for substance-use disorders and the torturous symptoms of withdrawal were limited. Relatively few medications were approved, and although behavioural and community-based treatments existed, when Smith, 23, tried to return to rehab, her stepfather’s insurance company rebuffed her.

The couple attended meetings at Narcotics Anonymous (NA), a 12-step programme, where they were told that recovery was only possible with total abstinence and strict adherence to a set of rules. To them, it seemed as if they were being made to feel helpless in the grip of their addictions, which were thought of as a lifelong disease. The concept, pervasive in treatment, that addiction is a disease, emphasises the power of compulsions to overwhelm the individual. The problem, Smith told me, was that no one asked or cared about what her desires were. “When I was young and wanted to be a heroin addict, my behaviours were in line with my desires. Was that addiction?”

After she was accepted to university, Smith continued to use heroin. This was less of a personal failure, in her view, and more of a series of decisions she made to try to pursue both drugs and education at the same time. As long as Smith had access to drugs and wanted to use, she was not going to choose abstinence. On one occasion, Smith and Michael flung their unused needles and syringes down a garbage chute, desperate to begin their fresh start. Within hours, they dived into a skip to get them back.

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After she was caught nodding out in front of customers, Smith was fired from her job, and later, so was Michael. Broke and withdrawing, they lay in bed until sunrise, racking their brains for fast money schemes to pay for heroin. Smith remembered hearing about an unsolved bank robbery near her parents’ home. The bank was a small redbrick building in an ideal location, abutting the entrance of the expressway, and it would be open at 8am.

While Michael slept, Smith collected her supplies: an Airsoft gun her stepfather had bought her for Christmas, the bright orange tip painted black; supermarket bags, a scarf to wrap around her head, and a pair of Jackie O sunglasses.

When she walked up to the front desk of the SunTrust bank and pointed her toy gun at the teller, Smith said: “You have 60 seconds to put money in these bags.” When the teller returned the plastic bags, Smith apologised and said: “Thank you.”

As her Volkswagen sped down Northshore Drive, a pack of dye in one of the bags detonated, staining the bills red and filling the car with scarlet smoke. On the expressway, Smith got out, tore the duct tape off her licence plate, and barrelled home. Stumbling into her apartment, Smith woke Michael up. After soaking the bills in their bathtub with water and bleach, they salvaged about $11,000, enough for two months of rent, food, and heroin.

The second robbery was more carefully planned. This time, Smith waited in the car while Michael went inside. But someone saw him leave the bank, and before they could get away, Smith and Michael were arrested.

Awaiting trial under house arrest at the home of her mum and stepfather, Smith handwrote letters to Michael, who was also under house arrest just a couple of blocks away. She told him about the cocktail of medications she was given, which included Xanax and Focalin, a stimulant used to treat ADHD that enabled her to write poetry, a “countdown to prison” journal and a 450-page novel, all in a week.

Smith also drank heavily during this time. One night, with an ankle monitor on, she drove off drunk in her stepfather’s new car. Within two miles, she crashed into a tree and ended up in an emergency room downtown. With blood all over her face and wires holding her teeth together, Smith looked down and saw that she still had her bag, containing her syringe. She remembers that the first thing she thought was: “I still have time to buy heroin.”

In December 2007, at Smith’s sentencing hearing, her stepfather testified that he hoped she would get the treatment she needed to overcome her problems. “She is a smart person who has made some mistakes,” he said. “Made them willingly.”

Was Smith a patient simply in need of the right medications or a criminal who deserved punishment for actively choosing to harm others – or both? Before the hearing, in a character letter sent to the judge, Thomas Varlan, Smith chose to take responsibility for her crimes. “I wasn’t abused or molested as a child,” she wrote. “I didn’t grow up on the ‘wrong’ side of town. I wasn’t raised by wolves but by a mother and stepfather who love me and gave me countless opportunities to succeed.”

Smith was steadfast in her belief that her actions were volitional from the start. Her drug use and crimes were not the products of an immoral character or a faulty brain incapable of change, but rather of an environment where heroin was accessible and desirable. This outlook determined her experiences in prison and beyond, ultimately leading her to dedicate her life to challenging predominant medical models of addiction with her research. Today, she is an assistant professor of psychiatry and behavioural sciences at Johns Hopkins University in Baltimore, Maryland.

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In light of the non-violent nature of their crimes and their youth, Judge Varlan sentenced Smith to 47 months in custody and Michael to 46 months, the minimum duration for their charges. Smith’s first destination, Blount county jail, was a concrete bunker or, as she put it, a “hell”. She went into drug withdrawal without a doctor to manage her symptoms. Without medical care, she had to remove the wires in her mouth with a fork.

Locked down 23 hours a day for two weeks with a wide-eyed stranger who rocked back and forth while withdrawing from cocaine, Smith, for the first time in her adult life, had no access to drugs or the outside world. The only reading material she had in the tiny room was a pocket-sized copy of the Gospels of the New Testament that community volunteers placed through a slot in the jail cell door. Smith read the words repeatedly to fall asleep; when she woke up, she started reading them again. After nine months, she was shipped to federal prison in Florida.

In Smith’s account of her story, no amount of psychiatric diagnoses or personal reflection helped her quit heroin. The only things that did were incarceration and forced abstinence, followed by her return to education. In prison, it occurred to Smith that there were only two things people could not take away from her: “my tattoos and my education”. After she was released, at the age of 27, she got a job serving sandwiches at a deli that hired former convicts – including Michael, although their romantic relationship was over. Smith stayed sober and was eventually accepted by the University of Kentucky, which – unlike some other institutions – did not require students to disclose past criminal charges. She excelled, and after four years of college went on to graduate school with the hope of becoming an addiction therapist.

Doing shifts at a rehab facility in 2015 while completing her master’s, Smith had a formative encounter with a man in his 20s who was detoxing from opioids. The patient mentioned to her that he had been drinking “a tea from Vietnam” called kratom. He said it soothed his anxiety and helped with his cravings for opioids. Although kratom is described by organisations such as the CDC as a stimulant, the patient said it did not make him feel high. However, the rehab facility enforced an abstinence-only approach to treating addiction, and Smith was required to report the young man. After he was kicked out of rehab, he stayed in contact with her, and told her about his commitment to achieving abstinence through the 12 steps. Two weeks later, he tried heroin and died from an overdose.

In an essay titled Disease and Decision, published in 2022 in the Journal of Substance Abuse Treatment, Smith wrote about how, disillusioned by medical systems with no individualised or evidence-based care, she decided to change careers and turn her ambitions towards research. Often, Smith argued, people with substance-use disorders are actively discouraged from vocalising what they want from the recovery process. “If they try, they are told that they are selfish; that their character defects and thinking were what got them into trouble; and that thinking for themselves is dangerous.”

For Smith, free will is a spectrum, and yet many volitional behaviours get jumbled together under the label “addiction”, as if people with substance-use disorders have permanently lost control over their actions. She believes that although her desires, intentions and choices were constrained by factors that developed from continued drug taking – such as a lack of access to medical care, running out of money, being locked out of the university system – she maintains her behaviour was always the result of conscious decisions. For the same reason, she emphasises that lifelong cravings and relapses are not inevitable. Like everyone else, people who use drugs are “complex systems that can change”, and she believes that they should be held responsible for enacting that change.

Smith is thin and pale, with green eyes and dark curly hair. Her arms are covered in tattoos. On her right forearm, sealing the spot where she used to inject most frequently, are the words “Room 101”, the location in George Orwell’s Nineteen Eighty-Four where Winston Smith betrays his lover to escape his greatest fear. When she was incarcerated, relapsing became Smith’s greatest fear. “That’s the betrayal,” she told me. “I would have broken my mother’s heart, and broken the people who invested love and hope in me.”

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The idea that addiction is a bodily disease was articulated in 1884 by the Scottish physician Norman Kerr. In his inaugural address to the Society for the Study and Cure of Inebriety, he said that addiction to alcohol is “for the most part the issue of certain physical conditions”. He continued: “Whatever else it may be, in a host of cases it is a true disease, as unmistakably a disease as is gout, or epilepsy, or insanity.”

Yet throughout most of the 20th century, a different model of addiction predominated in popular culture. The “moral model” sees addiction not as a disease of the body but of the will. Partly as a result, numerous countries adopted a penal approach to drug use that, particularly in the US, led to vast numbers of people being imprisoned for substance abuse.

A turning point came in 1997, when the then-director of the National Institute on Drug Abuse (Nida), psychologist Alan Leshner, published an article in the respected journal Science, in which he argued that addiction should be treated not as a moral failing but primarily as a chronic, relapsing disease of the brain. Addiction, according to Leshner, starts with voluntary consumption of drugs but over time the addictive qualities of the drug hijack the individual’s decision-making with uncontrollable cravings and compulsions.

When I spoke to Leshner earlier this year, he explained how he sought to change addiction from a criminal issue into a public health problem that could be treated with medication instead of incarceration. He had been inspired by how advances in neuroscience had shifted cultural assumptions about people with schizophrenia, who had come to be viewed in a far more humane manner: as people with neurological diseases who deserved medical care. “It became clear to me,” Leshner said, “that a core difference between addicted and non-addicted people was the same as the core difference between individuals with and without schizophrenia – which is that they have changes in their brains.”

Leshner stands by his 1997 article, in which he recognised the importance of environmental and socioeconomic factors on persistent drug use but argued that over-emphasising social and spiritual solutions to addiction only worsened “the tremendous stigma attached to being a drug user or, worse, an addict”. (By overturning the moralistic attitude towards drug use, Leshner also sought to justify putting medications such as buprenorphine – a weak opioid restricted because of its potential for abuse – into doctors’ offices and prisons.)

Leshner’s approach, known as the brain disease model of addiction or BDMA, became the model for teaching addiction in medical schools in the US and beyond, as well as shaping drug education campaigns in schools. However, this approach has itself come under attack. Critics of BDMA, such as Smith, believe that downplaying the role of free will in addiction can dampen the belief that full recovery is possible. Smith does not deny that brains change from drug use – the impact of addictive substances on the brain’s reward pathways is well established – but claims that a perception of people with substance-use disorders as “recovering” but never “recovered” does little to improve the general understanding of addiction and can destroy any shred of hope that they may hold. Smith argues that terms such as “chronic” and even “disease” can push people with substance-use disorders and the people around them to see relapse as “an inevitable outcome”.

Similarly, Eric Strain, an addiction psychiatrist who has helped mentor Smith at Johns Hopkins University, argues that the BDMA oversimplifies our understanding of addiction. The BDMA, according to Strain, says doctors know what people with substance-use disorders need. “It implies: ‘Just take Suboxone, everything will get better’,” Strain explained to me, referring to a commonly prescribed medication. But things are not always so simple. “Look at the treatment dropout rates,” he said. “They’re abysmally high.”

The label of “disease” has trailed Smith for most of her adult life. After she obtained her PhD, which studied the treatment of substance-use disorders in incarcerated women, Smith went on to complete a four-year research fellowship at Nida, the centre of American addiction research. But her postdoctoral position came with conditions: she was forbidden from handling any of the money used to pay research participants or the drugs being tested in the labs. The issue of trust, and the assumptions people made about her capacity to function and resist relapsing, would not go away.

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Smith belongs to a new generation of addiction scientists who are using their personal experiences to inform their research. Their focus is on helping people with substance-use disorders to identify the environmental factors that lead them to use drugs, and encouraging them to take action to change those factors.

In Smith’s own research at Johns Hopkins, which includes clinical trials and lab-based pharmacological studies, she interviews people with substance-use disorders about their experience of self-medication with unregulated substances like kratom. Instead of asking how the medical system can best force people into sobriety, Smith’s research asks how people with substance-use disorders have learned to manage their addictions themselves.

Justin Strickland, a behavioural pharmacologist who worked with Smith on models of addiction that emphasise environmental triggers, told me that there is actually more agreement than disagreement between supporters and detractors of the BDMA. “We all know that addiction is affected by neurobiology, genetics and childhood trauma,” he said. “The differences are in what is emphasised.” As the psychiatrist Carl Erik Fisher, who had an alcohol-use disorder during his medical training, wrote in his recent book about addiction, The Urge: “It is not that addiction is or is not a brain disease, or a social malady, or a universal response to suffering – it’s all of these things and none of them at the same time, because each level has something to add but cannot possibly tell the whole story.”

In the past five years, organisations such as Nida and the National Institutes of Health (NIH) have increasingly supported research into psychosocial approaches to addiction, harm reduction and methadone clinics, as well as community-based services that emphasise continuity of care. Meanwhile, some addiction scientists with histories of substance-use disorders think that the BDMA debate is still worth having. Noel Vest, a friend of Smith’s who is now an academic, began to use methamphetamines at the age of 21 and became addicted to alcohol. By 25, he had lost his business, his car and his house. After seven years in prison for multiple offences including identity theft, Vest became a drug and alcohol counsellor, which he abandoned when he realised his work was merely an extension of the criminal justice system he had just left. Treatment failure and missed appointments were an inherent part of recovery, and he refused to punish people for what he saw as the natural course of addiction. While on parole, Vest attended a local university and went on to complete a PhD in experimental psychology.

For Vest, the problem is not the BDMA itself but how early the concept of disease and the necessity of treatment is forced on to people with substance-use disorders. “If you tell someone early on in addiction – someone who can’t even tie their shoes because they can’t put a thought together – that they have this lifelong condition that will never get better, that’s a huge leap most are not ready for.”

In many of my conversations with scientists both for and against the BDMA, one idea kept coming up: indeterminism. In an indeterministic model of addiction, any outcome, whether that be relapse or recovery, is neither predestined, nor fully within our control. The structure of the brain and one’s environment, as well as the influence of one’s past, are dynamic processes that we can study and attempt to shape, either through policy, treatments or personal choices. Hope and courage can coexist with chaos and chance.

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In our conversations, Smith always maintained that her drug taking was a choice, and that she was saved from hitting rock bottom by her upbringing, which she frequently described as perfect. “I wasn’t abused,” she told me. “I practised violin. I had a lot of protective factors. A lot of people in prison do not have those things.”

Still, Smith’s childhood was not always straightforward. She describes her mother as a “good stay-at-home mother”, but she was also eccentric and volatile. When she divorced Smith’s father after 12 years of marriage, she plunged into a depression that she never fully rose out of. (“I had two people, whom I trusted and loved, telling me that the other person was evil,” said Smith, who was six when their drawn-out custody battle began.) While Smith was under house arrest, her mother attempted suicide for the first time. Returning home from prison years later, Smith found that her mother’s place was now packed with clutter. Her mother slept in the middle of the day, heavily medicated and not able to leave the house. In 2024, her mother died from complications with her medication regimen after a long struggle with mental illness. Months later, Smith’s stepfather also died.

It was in the period after her mother and stepfather’s deaths that Smith was hired as an assistant professor at Johns Hopkins. Last year, the district court in Knoxville invited Smith to speak at a graduation ceremony for a programme called Full Circle that allowed people in prison with substance-use disorders to leave federal probation early after a year of working with a mentor.

At the ceremony, Smith met the judge who had sentenced her all those years ago. The memory of that day, probably the bleakest of her existence, was a blur. “I remember looking up at this thing that was clearly a judge,” she recalled. “But I was crying so hard when I addressed him that I only remember sobbing.”

It was difficult to look him in the eyes. Judge Varlan was a head taller than Smith, with a wiry frame and a clean-shaven face. She was surprised how quiet he was. His cadence was slow, his demeanour laconic, but his smile was warm and fatherly. To the judge’s wife, Smith expressed how nervous she was to meet them. Mrs Varlan smiled with tears in her eyes, and reassured Smith that the judge had been looking forward to her visit.

In her speech, Smith told the graduates: “Most of us in this room are likely hard-headed and stubborn. Turning that stubbornness in the right direction can be a powerful thing.”

Shoulder to shoulder with Judge Varlan, Smith watched a dozen or so ex-inmates walk across the stage, many starting over at an older age than she had. It sank in how rare “full circle” moments were for people like her. She had willed it into existence by remaining, as the judge and his wife, and Smith’s mother and stepfather had been, stubborn about her ability to change.

A new study reveals the profound emotional and physical toll of extreme morning sickness, with more than half of affected women reporting they considered terminating their pregnancy, and 9 in 10 saying they had thought about not having more children.

The national survey, published in PLOS ONE, is one of the most comprehensive investigations into the lived experience of hyperemesis gravidarum (HG)-a severe form of nausea and vomiting in pregnancy – in Australia.

It highlights not only the debilitating nature of the condition but also the inconsistent effectiveness of commonly prescribed treatments.

Lead author Associate Professor Luke Grzeskowiak, a pharmacist and researcher from Flinders University, says that the findings underscore the urgent need for more compassionate, evidence-based care for pregnant women experiencing HG.

“Hyperemesis gravidarum is not just morning sickness-it’s a serious condition that can have devastating consequences for women’s mental health, relationships, and decisions about future pregnancies,” says Associate Professor Grzeskowiak.

“Our study shows that many women are not getting the support or relief they need, and that’s something we must urgently address.”

The survey of 289 Australian women found that 54% had considered terminating a pregnancy due to HG symptoms, while 90% had considered not having more children.

The condition was also linked to high rates of anxiety and depression, with 62% of respondents reporting they ‘often’ or ‘always’ experienced these feelings during pregnancy.

Despite the severity of symptoms, only half of the women surveyed rated commonly used treatments as effective.

Ondansetron, doxylamine and corticosteroids were perceived as the most effective medications, yet many women reported significant side effects, including constipation, sedation, and impaired cognition.

Metoclopramide, another frequently used drug, was discontinued by nearly one-third of users due to adverse effects.

“Women are often prescribed multiple medications in an attempt to manage their symptoms, but the reality is that many of these treatments come with their own burdens,” says Associate Professor Grzeskowiak.

“We need better evidence to guide treatment decisions and ensure women are supported to make informed choices.”

Beyond the physical symptoms, the study paints a dismal picture of the broader impact of HG on women’s lives.

More than half of respondents reported major disruptions to their ability to work, care for children, maintain relationships, and perform daily tasks. Thirty-seven per cent requested early induction of labour to end their pregnancy sooner due to the severity of their symptoms.

Caitlin Kay-Smith, founder of consumer organisation Hyperemesis Australia and co-author on the study, says the findings should prompt a shift in how HG is understood and managed in clinical settings.

“Too often, women’s symptoms are dismissed as a normal part of pregnancy, when in fact they are experiencing a condition that can be life-altering,” she says.

“We need to move away from a one-size-fits-all approach and toward personalised care that recognises the full impact of HG.”

The study was co-designed with Hyperemesis Australia and supported by the Robinson Research Institute at the University of Adelaide. It calls for further research into the long-term effects of HG and its treatments, as well as greater investment in support services for affected women.

Associate Professor Luke Grzeskowiak says the message from women was clear: “They want to be heard, believed, and treated with dignity.”

Researchers funded by the National Institutes of Health (NIH) have found that a single injection of the antibiotic benzathine penicillin G (BPG) successfully treated early syphilis just as well as the three-injection regimen used by many clinicians in the United States and elsewhere. These findings from a late-stage clinical trial suggest the second and third doses of conventional BPG therapy do not provide a health benefit. The results were published today in The New England Journal of Medicine.

Benzathine penicillin G is highly effective against syphilis, but the three-dose regimen can be burdensome and deter people from attending follow-up visits with their healthcare providers. The new findings offer welcome evidence for potentially simplifying treatment with an equally effective one-dose regimen, particularly while syphilis rates remain alarmingly high.”

Carolyn Deal, Ph.D., chief of the enteric and sexually transmitted infections branch of NIH’s National Institute of Allergy and Infectious Diseases (NIAID)

Syphilis is a common sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. The United States reported 209,253 total syphilis cases and 3,882 congenital syphilis cases in 2023, representing 61% and 108% increases over 2019 numbers, respectively. Without treatment, syphilis can result in neurological and organ damage as well as severe pregnancy complications and congenital abnormalities. Syphilis can also increase a person’s likelihood of acquiring or transmitting HIV.

BPG is one of the few antibiotics known to effectively treat syphilis, and stockouts are common worldwide. The antibiotic is currently being imported to the United States to resolve a nationwide shortage.

The study was conducted at ten U.S. sites and enrolled 249 participants with early syphilis, which encompasses the primary, secondary, and early latent stages of disease. Sixty-one percent of participants were living with HIV and 97% were men. The participants were randomly assigned to receive either a single intramuscular (IM) injection of BPG 2.4 million units (MU) or a series of three IM injections of BPG 2.4 MU at weekly intervals. All participants were monitored for safety. Biological markers of successful treatment in the blood-known as the serologic response to therapy-were examined at six months following treatment.

Seventy-six percent of participants in the single-dose group had a serologic response to treatment compared to 70% of participants in the three-dose group. The difference between groups was not statistically significant, even when participants were stratified by HIV status. One participant developed signs of neurosyphilis three days after starting BPG therapy and was excluded from the analysis. Three serious adverse events were reported but were not related to BPG.

“Syphilis has been studied and treated for more than a century, and BPG has been in use for more than 50 years, yet we are still acquiring knowledge to help us optimize treatment,” said Principal Investigator Edward W. Hook III, M.D., emeritus professor of medicine and epidemiology at the University of Alabama at Birmingham. “We hope these promising results will be complemented by scientific advances in syphilis prevention and diagnosis.”

According to the study authors, the results from this trial provide substantial evidence that single-dose BPG 2.4 MU is as effective as three doses in treating early syphilis. More research is needed to understand the full potential of this abbreviated treatment strategy and to evaluate therapeutic approaches for all stages of syphilis, including late syphilis, latent syphilis of unknown duration, and clinical neurosyphilis.

The study was conducted through the NIAID-funded Sexually Transmitted Infections Clinical Trials Group.

Patients with atrial fibrillation who live in neighborhoods with poor access to full-service grocery stores face sharply higher odds of stroke and death, according to a new study from Tulane University.

Researchers at Tulane University School of Medicine found that, compared with similar patients in better-served areas, those in food deserts had more than double the risk of ischemic stroke and nearly four times the risk of death.

The study, published in the journal JACC: Advances, analyzed electronic health records for 1,553 patients treated for atrial fibrillation (an irregular heartbeat) in the New Orleans area between 2010 and 2019. Using federal maps that flag “food deserts,” defined as places where many residents live more than a mile from a supermarket, the team sorted patients by ZIP code into two groups: 1,115 living inside food deserts and 438 living outside them.

Researchers then compared patients with similar medical profiles but different levels of neighborhood food access. They tracked who was hospitalized, suffered stroke or died and adjusted for age, sex, body mass index, common health conditions (such as hypertension and diabetes) and medications, including blood thinners.

The differences were stark. After accounting for other risks, food-desert residence was linked to a 2.21-times higher risk of ischemic stroke and a 3.84-times higher risk of death over five years. A combined measure of “any bad outcome” (hospitalization, stroke or death) was 42% higher. Researchers believe it is likely that residents living in food deserts nationwide experience similar increased risks.

The findings demonstrate an urgent need to increase cardiovascular screenings for conditions such as atrial fibrillation, particularly in New Orleans and communities with similar socioeconomic profiles, said corresponding author Dr. Nassir Marrouche, director of the Tulane University Heart and Vascular Institute.

“This research shows that for patients with AF, the environment they live in, the basic infrastructure of their neighborhood, can be just as important as the care they receive in the clinic,” Dr. Marrouche said. “Something as fundamental as access to healthy food could literally save lives.”

Researchers used the REACHnet clinical research database to identify local patients and matched their ZIP codes to the U.S. Department of Agriculture’s Food Access Research Atlas. They then used standard survival curves and risk models to compare outcomes while controlling for other factors.

To help reduce risks for patients, the authors suggest clinicians ask simple screening questions about food access and connect at-risk patients to nutrition programs or social services. Policymakers and health systems could target nutrition support and grocery access in neighborhoods where medically vulnerable residents live.

At the Tulane Research Innovation for Arrhythmia Discovery (TRIAD) Center, our research team is committed to addressing the specific needs of the New Orleans community. Early detection through expanded screening efforts can save lives in these vulnerable communities where we’ve unearthed these striking disparities. By focusing on local data and real-world health disparities, we’re working to create more inclusive models of care and improve cardiovascular outcomes where it’s needed most.”

Dr. Nassir Marrouche, Director, Tulane University Heart and Vascular Institute

Deep in the Bolivian Amazon exists a forager-horticultural community called the Tsimane. Researchers look to them for insights on how the human body functioned prior to modern technologies, as their lifestyles remain the closest to that of our ancestors. Oftentimes researchers find how we have navigated away from our evolutionary path, such as the Tsimane having the lowest rates of dementia, the healthiest hearts, and low late-age inflammation than those living in industrialized nations. But, new research from Arizona State University, has discovered a universal experience – post-menopausal women experiencing increased blood lipid levels, such as cholesterol. 

Published today in the Evolution, Medicine, and Public Health, “Higher blood lipid levels after transition to menopause in two forager-horticulturalist populations,” looked at several blood lipids, like cholesterol, that are major contributing factors to heart disease. In industrialized nations, such as the United States and the United Kingdom, women notably experience an increased risk of heart disease post-menopause, including an increase in those blood lipids. 

While we have good data from industrialized populations, to our knowledge, nobody had looked at this relationship in a non-industrial, highly active population like the Tsimane before.”

Madeleine Getz, PhD student studying global health in ASU’s School of Human Evolution and Social Change, and lead author on the study

The results of the study found that for the Tsimane, five of the six factors – including triglycerides, total cholesterol and low-density lipoprotein (LDL) cholesterol – were higher after menopause.

“While the difference varied by marker, they were between 1.5 to 11% higher after menopause. To see these risk factors increase after menopause in this population, despite their incredibly low levels of heart disease, was unexpected,” Getz said, who is also an affiliated graduate student with ASU’s Center for Evolution and Medicine and the Institute of Human Origins. 

Despite this increase being two to seven times lower than those documented in populations in the U.S and the U.K., the marked increase in post-menopausal lipid biomarkers for the Tsimane makes for a similar pattern despite vastly different lifestyles and diets. 

“This suggests that these increases in cholesterol around menopause may be a human universal, no matter how or where we live,” Getz said.

Living a traditional hunter-farmer lifestyle, the Tsimane follow a diet free of processed foods and maintain high levels of physical activity, averaging around 15-20,000 steps per day. Their way of life closely mirrors that of early human societies, providing valuable insights into how modern environments influence disease and aging. 

Benjamin Trumble, senior author on the study and professor in ASU’s School of Human Evolution and Social Change, serves as the co-director of the Tsimane Health and Life History Project. The group has a longstanding relationship with the Tsimane to collect demographic and biomedical data, as well as helps to provide medical care for the community – a relationship that has been in effect for more than 20 years. 

“Working with populations like the Tsimane allows us to global variation in both menopause, as well as human health and disease” said Trumble. “The findings here suggest that menopause is associated with increased risk factors for heart disease, even in the population with the healthiest hearts in the world. That suggests that post-menopausal increases in heart disease may be a human universal, and part of our underlying physiology regardless of lifestyle choices.” 

Some sugar substitutes may come with unexpected consequences for long-term brain health, according to a study published in the September 3, 2025, issue of Neurology^®, the medical journal of the American Academy of Neurology. The study examined seven low- and no-calorie sweeteners and found that people who consumed the highest amounts experienced faster declines in thinking and memory skills compared to those who consumed the lowest amounts. The link was even stronger in people with diabetes. While the study showed a link between the use of some artificial sweeteners and cognitive decline, it did not prove that they were a cause.

The artificial sweeteners examined in the study were aspartame, saccharin, acesulfame-K, erythritol, xylitol, sorbitol and tagatose. These are mainly found in ultra-processed foods like flavored water, soda, energy drinks, yogurt and low-calorie desserts. Some are also used as a standalone sweetener.

Low- and no-calorie sweeteners are often seen as a healthy alternative to sugar, however our findings suggest certain sweeteners may have negative effects on brain health over time.”

Claudia Kimie Suemoto, MD, PhD, study author, University of São Paulo, Brazil

The study included 12,772 adults from across Brazil. The average age was 52, and participants were followed for an average of eight years.

Participants completed questionnaires about diet at the start of the study, detailing what they ate and drank over the past year. Researchers divided them into three groups based on the total amount of artificial sweeteners they consumed. The lowest group consumed an average of 20 milligrams per day (mg/day) and the highest group consumed an average of 191 mg/day. For aspartame, this amount is equivalent to one can of diet soda. Sorbitol had the highest consumption, with an average of 64 mg/day.

Participants were given cognitive tests at the start, middle and end of the study to track memory, language and thinking skills over time. The tests assessed areas such as verbal fluency, working memory, word recall and processing speed.

After adjusting for factors such as age, sex, high blood pressure and cardiovascular disease, researchers found people who consumed the highest amount of sweeteners showed faster declines in overall thinking and memory skills than those who consumed the lowest amount, with a decline that was 62% faster. This is the equivalent of about 1.6 years of aging. Those in the middle group had a decline that was 35% faster than the lowest group, equivalent to about 1.3 years of aging.

When researchers broke the results down by age, they found that people under the age of 60 who consumed the highest amounts of sweeteners showed faster declines in verbal fluency and overall cognition when compared to those who consumed the lowest amounts. They did not find links in people over 60. They also found that the link to faster cognitive decline was stronger in participants with diabetes than in those without diabetes.

When looking at individual sweeteners, consuming aspartame, saccharin, acesulfame-k, erythritol, sorbitol and xylitol was associated with a faster decline in overall cognition, particularly in memory.

They found no link between the consumption of tagatose and cognitive decline.

“While we found links to cognitive decline for middle-aged people both with and without diabetes, people with diabetes are more likely to use artificial sweeteners as sugar substitutes,” Suemoto said. “More research is needed to confirm our findings and to investigate if other refined sugar alternatives, such as applesauce, honey, maple syrup or coconut sugar, may be effective alternatives.”

A limitation of the study was that not all artificial sweeteners were included. Also, diet information was reported by the participants, who may not have remembered accurately everything they ate.

The study was supported by the Brazilian Ministry of Health, the Ministry of Science, Technology, and Innovation, and the National Council for Scientific and Technological Development.

A new study led by the University of Portsmouth suggests our saliva is stronger than we thought. 

The research, published in PLOS One, is the first to examine how drinking apple juice affects saliva’s lubricating properties using advanced scientific techniques. 

Saliva plays an important role in preventing friction and bacteria in our mouths by creating a slippery film on teeth. It also helps repair early damage to tooth enamel. We know this protective layer is affected by different drinks, but until now it wasn’t clear exactly in what way and for how long.

Using 32 healthy participants, scientists analysed how rinsing with apple juice for one minute impacts saliva, before doing the same test using water. They found the mouth’s natural defences bounce back remarkably quickly when exposed for a short period of time.

While apple juice temporarily disrupted saliva, the effects began to wear off within just 10 minutes. Even more surprisingly, the team discovered that water actually caused greater initial disruption to saliva’s protective properties – but the recovery time was much faster.

We were genuinely surprised by these results. 

It’s long been believed that apple juice, like other acidic drinks, immediately harms our oral health, including the teeth. However, our research shows that saliva plays a vital role in protecting and quickly repairing the mouth to prevent lasting damage.

But it’s important to point out that long-exposure to apple juice – by repeatedly drinking it or not washing your mouth out with water after taking a sip – can have a long-term negative effect on our oral hygiene.”

Dr. Mahdi Mutahar, lead author from the University of Portsmouth’s School of Dental, Health and Care Professions

The team used cutting-edge laboratory techniques – normally used in engineering – to measure exactly how slippery and protective saliva is before and after drinking apple juice and water. These included tribology, protein analysis, and real-time monitoring of salivary films.

Protein players 

The study revealed which specific proteins in spit are affected when you drink apple juice; immunoglobulins, cystatins and carbonic anhydrase decrease significantly, while mucins – the main lubricating proteins that keep everything slippery – remain stable.

Understanding these proteins could lead to new toothpastes and mouthwashes designed to boost the mouth’s natural defenses.

Dr Mutahar explained: “The key finding is that one brief drink of apple juice isn’t harmful – the lubrication comes back to normal and the proteins in saliva do their protective work. 

“The biggest shock though was discovering that rinsing mouths with tap water actually caused more friction and disruption than apple juice. The Portsmouth water we used contains minerals that seem to interfere with saliva’s lubricating proteins, more than the fruit juice did.”

The Portsmouth tap water contains high concentrations of ions including sodium, potassium, and magnesium, which interfere with saliva’s main lubricating protein, mucin. 

The research also uncovered an unexpected link between fruit juice consumption and the mouth’s immune system. The decrease in immune-related proteins suggests that what we drink or eat may influence our oral immune defenses, which in turn may affect the general immune system. 

“What’s new is discovering that what we drink can actually change how our mouth’s immune system works,” explained Dr Mutahar. “The ingredients in apple juice may be influencing oral immune defences, possibly affecting overall immune response in ways we’re only just beginning to understand.”

Changing your hygiene habits 

The research suggests that moderate consumption of fruit juice may not be as immediately damaging as once thought, thanks to saliva’s rapid recovery abilities. 

However, the team cautions this doesn’t mean fruit juice is harmless – repeated exposure throughout the day could overwhelm the mouth’s natural repair mechanisms.

“Think of it like a cut on your skin,” said Dr. Mutahar. “Your body can heal small, occasional damage quite well, but if you keep reopening the wound, it becomes a problem. The same principle applies here.”

A few simple behaviour changes could minimise any negative effects of drinking apple juice:

Drink quickly, don’t sip: “Don’t expose your teeth for long periods of time,” advises Dr Mutahar. “Have your apple juice fairly quickly rather than sipping it constantly throughout the day.”

Rinse immediately: Rinse your mouth with water immediately after drinking apple juice. This helps remove lingering acids, which is especially important for sugary drinks like apple juice, as sugar is a major contributor to tooth decay too.

Use a straw: This reduces contact between the acidic drink and your teeth.

Allow recovery time: If you want a second drink, have a short drink of water, wait, and then have your second one. This allows saliva to work and those important proteins to buffer and protect.

The research team is now exploring the effects of repeated exposure – specifically, what happens when people consume acidic drinks several times a day. Most importantly, they aim to investigate how apple juice impacts the teeth directly, rather than just saliva, and how it compares to the effects of pure acid. They are also planning to test deionized water (with minerals removed) to confirm whether Portsmouth’s hard water findings apply to all water types. 

Future research could look into adding protective proteins to everyday drinks – a move that might not only neutralize harmful acids but also strengthen the mouth’s natural defences by supporting saliva’s ability to repair and protect teeth.

The research was conducted in collaboration with Professor Anwesha Sarkar from the University of Leeds, a leading international expert in food-saliva interactions, and involved participants aged 18-56 from the Portsmouth area.

Professor Sarkar, a professor of colloids and surfaces in the University of Leeds School of Food Science and Nutrition, said: “This is fascinating research which shows how open collaboration can improve our understanding of food and drink, and its effects on our oral health. 

“By combining the knowledge and expertise of Dr. Mutahar and the dental team in Portsmouth with my expertise in material science, specifically friction and real-time adsorption measurements, we have opened up new areas of possibility when it comes to dental health and protecting our teeth with our very own, highly potent saliva. In time I hope this collaboration leads to more improvements in dental care and development of oral devices.”

Colorectal cancer is unique in having its own microbial ‘fingerprint’ – according to new research from the University of East Anglia.

Colorectal cancer is the fourth most common cancer in the UK and the second deadliest.

The research could help doctors better understand how this cancer develops, how aggressive it might be, and even how a patient might respond to treatment.

The team studied whole genome sequencing (WGS) data from more than 9,000 cancer patients.

The analysis, published today, also challenges scientific claims that all cancers are associated with a unique microbial fingerprint.

This study changes how we think about the role of microbes in cancer.”

Dr. Abraham Gihawi, lead researcher from UEA’s Norwich Medical School

How the research happened

The research team studied Genomics England DNA sequence information from 11,735 cancer samples representing 22 different types of cancer.

“When you collect cancer DNA sequences, you also gain information from the DNA of microbes contained within the samples,” said Dr. Gihawi. 

“We wanted to determine the precise DNA composition of microbes present in each sample. So, we developed computer programs to remove human DNA and analyse the remaining microbe DNA.

“We then correlated this information with clinical data from the patients about their cancer type and clinical outcome.

“What we found challenges previous claims that each cancer type has a distinct microbiological signature or fingerprint.

“But importantly, as whole genome sequencing becomes more common in hospitals, we show that looking at the microbes in tumor samples could become a powerful tool for improving cancer care at little extra cost.

A breakthrough for colorectal and oral cancers

“Our results show that only colorectal tumors possess distinctly identifiable microbial communities.

“We found that these microbial signatures were so specific that they could accurately distinguish colorectal tumors from other tumors. We hope that this could help doctors diagnose the disease more precisely and researchers to study the microbes found in colorectal cancer.”

The study also uncovered promising clinical applications.

For example, in oral cancers, the study found that certain viruses like HPV (human papillomavirus) could be detected accurately compared with current medical tests.

The team also found rare but dangerous viruses, such as Human T-Lymphotropic Virus-1 (HTLV-1), which can be dormant infections capable of causing cancer.

Better survival rates

“We found that certain types of bacteria were associated with poorer survival rates in some cases of sarcoma. This might lead to additional research and treatment options for these types of cancer,” said Dr. Gihawi.

“One of the most exciting things we found was that in some sarcoma cases, the presence of specific bacteria was linked to better survival rates.

“This suggests that microbes might one day help doctors predict how well a patient will respond to treatment and open up new approaches to treatment,” he added.

An indispensable tool

Prof Daniel Brewer, from UEA’s Norwich Medical School, said: “This study highlights the growing clinical value of whole genome sequencing in identifying pathogenic organisms such as HTLV-1 and papillomavirus, which may otherwise go undetected.

“By revealing these hidden infections and providing insight into cancer prognosis – particularly in sarcomas – it demonstrates how genomic analysis is becoming an indispensable tool in precision medicine.

“The findings also suggest that oral cancer, in some cases, may be a close diagnostic consideration, further emphasizing the importance of comprehensive genomic profiling in clinical decision-making.”

This research was led by UEA in collaboration with the University of Leeds, the Quadram Institute, Oxford Nanopore Technologies, the Institute of Cancer Research, London, the University of Manchester, NIHR Manchester Biomedical Research Centre, the University of Athens (Greece) the University of Liverpool, Cambridge University Hospitals NHS Foundation Trust, University College London, the University of Southampton, the University of North Carolina (US) and the Earlham Institute.

This work was funded by the Big C Cancer Charity and Prostate Cancer UK, with further support from The Bob Champion Cancer Trust, The Alan Boswell Group, Masonic Charitable Foundation Successor to the Grand Charity, Movember, Prostate Cancer Research, the King Family, the Hargrave Foundation, NIHR Manchester Biomedical Research Centre and Sarcoma UK.

‘Microbial Clues in Cancer: New Study Challenges Old Assumptions and Reveals Clinical Potential’ is published in the journal Science Translational Medicine.

PESHAWAR: The health department has announced a province-wide measles and rubella vaccination campaign scheduled for late November this year.

The initiative is part of a national effort aimed at curbing the spread of these contagious diseases and protecting children across the province.

In this regard, the first steering committee meeting chaired by the special secretary health, Mansoor Arshad, was held on Wednesday. The meeting was attended by the additional director general health services, Dr Naeem Awan, the director expanded programme on immunization (EPI), Dr Asghar Ali, representatives of Unicef, WHO and other partner organisations, a statement said.

The meeting focused on preparations for the upcoming Measles-Rubella (MR) campaign, including coordination strategies, stakeholder engagement, and public awareness efforts.

6m children to be inoculated from Nov 17 to 29

The participants also reviewed the current coverage of MR1 and MR2 vaccinations and discussed ways to enhance outreach.

Briefing the committee, the director EPI revealed that over 10,000 suspected measles cases had been reported so far this year, of which only 3,890 — approximately 39 percent — were confirmed. He added that 48 percent of the suspected cases involved children who had not received any measles vaccination.

He further stated that in 2024, more than 15,000 suspected cases were reported, with 7,354 confirmed.

According to officials, the upcoming campaign aims to vaccinate six million children across the province.

The 12-day drive will run from November 17 to 29 and will be conducted during official working hours. The goal is to achieve 95 percent coverage among targeted children to prevent future outbreaks and reduce transmission risks.

Children aged six to 59 months will receive a single dose of the measles vaccine, while those under five years will also be administered two doses of the Oral Polio Vaccine (OPV). Eligible children will be provided with other essential vaccines through fixed centres and regular vaccinators.

The committee also decided to re-engage the education department to facilitate access to children in schools and madrassas. Outreach and mobile teams will be deployed at vaccination centres, educational institutions, and busy public locations to ensure maximum coverage.

To implement the campaign, the health department will mobilise 1,753 fixed teams, 4,918 outreach teams, and 300 mobile teams across 37 districts, 146 tehsils, and 1,403 union councils.

The department has urged parents to cooperate with vaccination teams and ensure their children are immunized against measles during the campaign.

Published in Dawn, September 4th, 2025