Reuters

What could be more peaceful than a night of rest with a little fan gently blowing the air of your bedroom across your body? It sounds harmless -- unless, perhaps, you are from South Korea, where there is a widespread belief in "fan death," the mortal danger of sleeping in a closed room with an electric fan. Many fans in South Korea come equipped with timers so that they will not remain on throughout the night. The Korea Herald called the belief " one of Korea's best-known urban legends."

It's a big enough deal that Korean Consumer Protection Board put out an advisory in 2006:

If bodies are exposed to electric fans or air conditioners for too long, it causes bodies to lose water and hypothermia. If directly in contact with a fan, this could lead to death from increase of carbon dioxide saturation concentration and decrease of oxygen concentration. The risks are higher for the elderly and patients with respiratory problems.

From 2003~2005, a total of 20 cases were reported through the CISS involving asphyxiations caused by leaving electric fans and air conditioners on while sleeping. To prevent asphyxiation, timers should be set, wind direction should be rotated and doors should be left open.

According to Snopes, "There are other, more loony, theories about what causes fan death. One asserts the fan's blades chop up oxygen into carbon dioxide, rendering such mutilated air unbreathable."

No one seems to know why this belief persists, given that its position as a medical condition is dubious. There is some speculation that it has its origins in 1970s efforts by the South Korean government to curb energy use. The natural tendency is to write it off as some kind of crackpot belief.

While it seems likely that the reported cases of fan death have other causes, such as excessive drinking or undiagnosed heart conditions, the relationships between beliefs and physical health are tough to pin down. Alexis Madrigal wrote last year about the case of more than 100 Hmong immigrants killed, in a sense, by night spirits, or, if not by night spirits directly than "by their beliefs in the spirit world, even if the mechanism of their deaths was likely an obscure genetic cardiac arrhythmia that is prevalent in southeast Asia," he wrote. How beliefs shape biology, he concluded, is something "we don't understand ... quite as well as we'd like to think."

A University of California San Francisco medical sociologist who has studied the Hmong, argued for a "local" understanding of biology in her book on night spirits. "Since meaning has biological consequences, and meanings vary across cultures, biology can operate differently in different contexts," Shelly Adler wrote. "In other words, biology is 'local' -- the 'same' biological processes in different places have different 'effects' on people."

That is to say, if you believe hard enough that something might harm you, it actually might. That's the dark side to the placebo effect and squares with the emerging science of the very real mind-body connection.

Regardless of whether Fan Death is "real" -- a belief with real effects -- or a total mirage, it can become an easy tool with which to mock Koreans. As "The Korean" (as the anonymous blogger refers to himself) writes on Ask a Korean:

Fan Death has been the favorite topic of anyone who wished to ridicule Korea. Belief in Fan Death is supposed to show that Koreans lack "critical thinking". There is a whole website devoted to it: www.fandeath.net. The Wikipedia page describing Fan Death is, reading between the lines, dripping with contempt. Even a good-natured Korean blog like Stuff Korean Moms Like uses the Fan Death picture to describe the strangeness of Koreans. Similarly, requests at Mythbusters(best show EVER) asking to debunk Fan Death are interspersed with such bile as: "Do you seriously expect anyone to do a TV program to determine whether untold generations of inbreeding on the Korean Peninsula resulted in a bizarrely maladaptive genetic defect that would cause the carrier to die from a slight breeze on their face and this defect finally manifested itself only after the invention of the Electric Fan?"

And, of course, no country or culture is unique in holding unfounded beliefs. Perhaps the best analog closer to home is the persistent belief that swimming after eating can cause drowning (and for many more examples see "List of Common Misconceptions"). If another culture's strike us as totally unfounded, let it serve only as a reminder that though the ghosts we believe in may be different, they are ghosts just the same.

PROBLEM: Obese people are often the subject of ridicule in society. Will shedding the excess pounds help them get rid of this stigma as well?

• How the Fear of Not Having Enough Food Leads to Obesity
• Most Overweight Mexicans Think Their Weight Is Normal
• Regularly Eating White Rice Raises Diabetes Risk

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METHODOLOGY: Researchers led by Janet D. Latner tasked young men and women to read vignettes describing a woman who had either lost 70 pounds or had kept their weight stable, and who was either currently obese or currently thin. They then asked them about this woman on a number of attributes, including how attractive they found her and their overall dislike for fat people.

RESULTS: Despite having similar height and weight, the women who had a history with obesity were perceived as less attractive than those who had always been thin. The subjects were also more biased against obese people after reading about women who had lost weight than after reading about women who managed to keep their weight stable, regardless of whether the woman was thin or obese.

CONCLUSION: Prejudice against obese people persists even after significant weight loss, and these negative attitudes appear to intensify the more people are led to believe that body weight is easily controllable.

IMPLICATION: Obesity discrimination and the corresponding belief that weight is largely self-determined may need to be addressed on a societal level. "[T]he best science in the obesity field at the moment suggests that one's physiology and genetics, as well as the food environment, are the really big players in one's weight status and weight-loss," says co-author Kerry O'Brien in a statement. "We need to rethink our approaches to, and views of, weight and obesity."

SOURCE: The full study, "'Residual Obesity Stigma: An Experimental Investigation of Bias against Obese and Lean Targets Differing in Weight-Loss History," is published in the journal Obesity.

The benefits of exercise for seniors have been well described. They include improvements in physical, emotional and cognitive health, as well as better quality of life.

We know exercise positively influences the course of cardiovascular disease, diabetes, osteoporosis, depression, and even some cancers. Yet as seniors age, their exercise routines often suffer and they engage in less physical activity. What strategies can be used to motivate seniors to increase rather than decrease the time they spend in exercise? A recent study by Australian researchers offers one answer.

By the end of three months, the pedometer group had increased their exercise time by 63.0 minutes per week compared to the reported time-only group whose exercise time expanded less than half as much, 30.9 minutes.

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• Simple Chores That Keep Seniors Healthy
• Exercise: A Plan and Partner Help
• Tai Chi Improves Parkinson's Symptoms

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The 330 seniors (over the age of 65) recruited were each enrolled in a program which included training, motivational counseling and follow up. Enrollees first met with their primary care doctor who outlined the exercise program, explained its medical benefits and gave a prescription for physical exercise. The researchers then divided the participants into two groups.

In the first group, researchers asked everyone to track and hopefully increase their exercise by simply reporting the actual time they spent. Members of the second group were additionally asked to use a pedometer to count the number of steps they took. Goals were set to increase either steps taken or time spent in exercise incrementally over time.

Over the course of the study, physical exercise counselors made three follow up phone calls to support and encourage the patients' exercise programs, identify barriers and find ways to increase exercise. For example, both groups were encouraged to walk to perform local errands and social visits rather than drive. In addition to total exercise time for each group, researchers compared blood pressure, body mass index (BMI), number of falls and quality of life between the two groups. The period of intervention was three months and the study goals were reassessed 12 months from the onset.

Based on previous research, the investigators expected that the pedometer group would be more motivated to increase their daily steps and therefore spend more time exercising. Indeed, by the end of three months, the pedometer group had increased their exercise time by 63.0 minutes per week compared to the reported time-only group whose exercise time expanded less than half as much, 30.9 minutes.

By the end of a year, the pedometer group was still ahead, though the number of minutes of added exercise had dropped to 49.6 while the results for the reported time-only group, 28.1, was only slightly lower. This was the only significant difference between the two groups but both showed lowered blood pressure, supporting the important role of exercise in the management of hypertension. Neither group showed a difference in BMI and neither group experienced more falls.

The researchers concluded that the pedometer was an effective motivator for increasing the amount of time seniors spend exercising. They speculated that it provided a visual monitor which gave positive feedback as the pedometer clearly showed seniors how simple changes in habits can add up to large changes in total daily/weekly steps. Regardless of the intervention type, the improved exercise regimen persisted for at least one year from the start of the program.

The study was reported in the May 2012 issue of the Annals of Family Practice.

This article originally appeared on TheDoctorWillSeeYouNow.com, an Atlantic partner site.

FoodNavigator-USA.com did a special edition "Where next for natural sweeteners?" Special editions are collections of previously published articles on topics of interest to this newsletter's food industry readers.

Why do this? The holy grail of food technology is to find a no-calorie sweetener that tastes as good as sugar, has no bitter aftertaste, and can be marketed as "natural" because it's extracted from plants. Examples: Stevia extracted from leaves, Monk fruit sweetener.

As with high fructose corn syrup, not everyone considers these sweeteners to be natural since they have to go through chemical processing steps.

Stevia is extracted from leaves with ethanol. Whether this process can be considered natural is currently under debate in Europe. Some European regulators prefer "extracted from a plant source."

Here are some of the articles. For the complete collection, click here.

Monk fruit sweetener firm: 'We hear daily that people are looking for alternatives to stevia'

It might not have garnered as much publicity as stevia, but monk fruit (luo han guo) "has found a niche within the all-natural market but will hit mass market sooner than stevia in this space", according to one leading supplier... Read

Tate & Lyle: Monk fruit sweetener attracting most interest in dairy and beverages

Dairy and beverages are proving the most popular application areas for monk fruit sweetener Purefruit, says Tate & Lyle... Read

Different processes, lower cost, better taste: Is stevia still on track for mainstream success? Taste issues and high cost repeatedly have been raised as possible obstacles to widespread acceptance of stevia-derived sweeteners, but one of the many new suppliers entering the market claims that these are no longer the hurdles they once were... Read

Steviol glycosides are not 'all-natural', says new class action lawsuitA class action lawsuit filed in California this week argues that steviol glycosides should not be considered natural, owing to the "chemical processing" sometimes used to extract them from the stevia leaf... Read

Stevia buyers beware: There are some 'awful' extracts out there...

While traders "jumping in and out of the stevia marketplace" are disrupting prices and standards by peddling some "awful" extracts, high-quality stevia suppliers in it for the long-haul will ultimately prosper, according to one leading player... Read

Stevia in snacks and baked goods - stealth, competition, and potential

While stevia is beginning to take off in a number of baked goods and snack categories in the US, Asian and South American markets, some other emerging 'natural' sweeteners look ready to take it on in the segment, claims Datamonitor... Read

Naturally-positioned sweeteners to lead market growth: Report

The US alternative sweeteners market will grow by 3.3% a year to reach about $1.4bn in 2015 - and naturally positioned sweeteners like stevia and agave nectar will lead the way, claims a new report from market research organization Freedonia... Read

This post originally appeared on Food Politics, an Atlantic partner site.

Remember when you used to go to your grandparents' house and whenever you walked in, your nose detected a change in the air? You're not imagining it -- there really is such a thing as "old person smell," and your ability to detect it may have evolutionary roots.

In a study published today in PLoS One, researchers report that young people aged 20-30 are able to accurately guess when a scent comes from an elderly individual aged 75-95. While study participants were also able to determine when a smell was associated with someone in middle age or in their youth, they were much better at smelling old people than young people.

How did the scientists collect the smell samples in the first place? Scientific American explains, hilariously:

In their new study, Lundström and his colleagues sewed absorbent nursing pads into the armpits of T-shirts and asked volunteers of different ages to sleep in the shirts for five consecutive nights. The researchers divided the 44 volunteers into three groups: eight women and eight men between the ages of 20 and 30 (the young); the same number of men and women between 45 and 55 (middle-aged); and six women and six men between 75 and 95 (elderly). During the day, the volunteers stored the T-shirts in sealed plastic bags; avoided spicy foods, cigarettes and alcohol; and showered with odorless shampoo and soap.

The article goes on to note that many animals are capable of marking out the relative ages of others in their species by smell alone, so it's not implausible that people might be capable of something similar. But humans have a much weaker olfactory system than animals do, so the fact that we can determine anything at all about our peers with our noses is remarkable.

As a physician, I know how frustrating it is to look into the eyes of a young patient and tell her she has Type 2 diabetes and high blood pressure, knowing that these conditions could have been prevented or at least delayed. It's a tragic waste; not only would she be healthier and happier, but her health care would not cost nearly as much.

Unfortunately, this scenario plays out all too often in American medicine. Preventing diseases before they start is one of the most common sense ways to keep people healthy, but this nation continues to focus too narrowly on treating medical conditions after they occur.

Solving the nation's most entrenched problems See full coverage

A disproportionate share of the $2.6 trillion we spend on health care each year goes toward treating the sickest people--covering mostly high-cost hospital care for preventable chronic conditions like heart disease, stroke, Type 2 diabetes, and cancer. Health care spending and lost productivity tied to smoking alone, for example, totals over $193 billion a year. It is estimated that obesity rates are responsible for $34.3 billion and $27.6 billion in additional spending in Medicare and Medicaid respectively, and $74.6 billion in higher spending by private health insurers.

In stark contrast, strategies that can prevent disease and promote health are chronically underfunded. For every dollar spent on health care, less than four cents goes toward public health and prevention--programs and policies that hold the most promise for lowering costs by keeping us from getting sick in the first place.

The solution is simple. With more than half of Americans living with at least one chronic disease, we should be investing more in community-based prevention. A recently released Institute of Medicine (IOM) report concluded that changes in how America invests in health will be critical for the nation to prevent illness and control costs at a level comparable with other rich nations. IOM called for "significant reforms" to refocus the U.S. health system on prevention of the chronic diseases burdening the nation's health and economy.

We know these investments pay off. Spending just $10 per person per year in proven community-based programs to increase physical activity, improve nutrition, and prevent smoking could eventually save more than $16 billion a year, according to Trust for America's Health. That's a nearly $6 return on investment for every dollar invested. This doesn't even count the indirect gains yielded through increased worker productivity, reduced absenteeism at work and school, and improved quality of life.

Health insurance, while critically important to making health care affordable, is only part of the solution. It will take a combination of expanding coverage, delivering better preventive and chronic care, and committing to policies that foster safer, healthier environments and healthier behaviors. Evidence shows that embracing these three strategies collectively are much more effective at both saving lives and money than implementing any one of them alone.

There are economic implications as well. State, city, and local leaders recognize that a community's health affects its ability to attract and retain employers who create jobs. In Nashville, TN leaders are pursuing a range of prevention efforts to make it easier for city residents to make healthier choices. Minnesota is doing something similar. Four years ago, the state launched a Statewide Health Improvement Plan to help save health expenses for both the state and businesses by focusing on improving health and curbing the rise of preventable chronic disease.

And in Wyandotte, Kansas, Major Joe Reardon, seeing how unhealthy his community was--it hadn't seen a new grocery store in 40 years--brought business, public health, education, transportation, and housing leaders together to support efforts to curb smoking, improve rates of physical activity, and promote healthier choices. Under Reardon's leadership, all things relating to community improvement in Wyandotte, even resurfacing streets, now include a prevention inquiry: "How does this affect the health of our residents?" and "What is the economic impact on costs and productivity?"

The good news is that a growing number of policymakers and employers view prevention as critical to both improving worker health and productivity while also lowering soaring health care costs. In 2011, 67 percent of companies with at least three employees that provided health benefits also offered worksite wellness programs; almost all companies with at least 1,000 employees offered one. Companies are encouraging employees to be more physically active, quit smoking, lose weight, and eat healthier.

That's real progress. But if employees and their families live in communities with poor air quality, unsafe areas that limit physical activity and poor access to healthy foods, workplace wellness programs will only get us part way to better health.

Dr. Kristi Egland's working relationship with breast cancer began long before her personal one: She studied the genetics of breast cancer in her laboratory, as she does today. A molecular biologist originally working on leukemia and lymphoma, Egland realized that the same technologies used to study those cancers could be applied to breast cancer. She made the leap and never looked back.

Her personal relationship with breast cancer began five years ago, when her right breast did not return to its normal size after she finished breastfeeding her son. "Since I study breast cancer in the laboratory," she says, "I had wondered what it would be like to have cancer. Would it hurt? Would I know I had it? Would I be able to feel a lump? I figured that if I did acquire breast cancer, I would detect it early because of my awareness."

In fact, her diagnosis did not come particularly early on. She describes the feeling when she first discovered the swelling: "I felt a deep, empty bit in my stomach. Although I was not in pain or feeling sick, I knew something was terribly wrong. I felt like my body was deceiving me." The appointment with the radiologist after her mammogram was even more sobering. "When I watched the image of my breast with the large tumor mass show up on the screen, life stopped. I was not even sure how I should react to the news that I had breast cancer. Should I cry, be brave or identify other possible causes of the mass? My diagnosis was a triple negative invasive breast cancer with lymph node involvement."

This form of cancer is an aggressive one without targeted therapies. Egland and her doctors opted for double mastectomy, and the days leading up to the surgery were some of the scariest of her life: "I wanted the day of my surgery to come so badly. I wanted the tumor out of my body and in my lab so I could conquer it." Once healed from the surgery, she underwent eight rounds of chemotherapy and 33 radiation treatments.

Egland says that dealing with the fact that she of all people had been affected by breast cancer was not easy in the beginning. "I was 37 years old with no history of breast cancer in my family, yet I was diagnosed. During chemotherapy treatments I used to ask, 'Why me?'"

When Egland first began the treatments, she felt self-conscious about the fact that she was suddenly in this role. "When I was undergoing chemotherapy and radiation treatments, I was embarrassed. I felt like I had the words 'breast cancer' written on my forehead." But as treatment wore on, she began to realize that she didn't get cancer because she'd done something wrong: She got it because her breasts were made of cells - and sometimes cells get mutated. "Cells are not perfect," Egland says, "and sometimes processes go wrong at the molecular level. I like to call it bad luck. If the right combination of mistakes is made in the genome of a cell, the cell becomes cancer. I was not being targeted by God or being punished for some misdeed that I had done in the past. I was the unlucky one in the statistic one in eight women in the U.S. will be diagnosed with breast cancer during her lifetime."

Egland ultimately began to realize that the "why me?" question she had asked in the beginning was not the right one to ask: "At the end of treatment I asked 'why not me?' All women are susceptible. No one is exempt from this disease."

Her relationship with her family - a husband and two young children - has only deepened through her experience with cancer. "I remember lying next to my daughter one night after chemotherapy treatment while she was falling asleep, and her soft, quiet presence curled up next to me gave me the strength to keep fighting and helped me get through the brain-numbing therapy. I would think about the milestones that I would miss if I did not win this battle: graduations, weddings and grandchildren. That thought was the saddest one - the thought of not being there. I realized life would continue without me, and those that I loved would be okay. The aching question of 'is my cancer gone?' would not go away."

In the end, Egland's personal relationship with cancer has helped her own research and her feelings about patient care. She says that as a general practice she would love to see a research scientist being included in the team of experts treating a patient, to help direct and personalize therapies as much as possible. She encourages women to donate both cancerous and healthy breast tissue to research, since both are needed to uncover the mechanisms behind breast cell division, normal and diseased.

Egland now keeps her preserved tumor in her desk, partly to feel the power over it that she had so needed while it was still in her body, and partly for research purposes. "When I was handed my tumor, I finally felt like I had control over my cancer. To this day, I still feel empowered when I take my tumor out of my desk drawer. Also, we know a lot about the tumor, so it comes in handy when we need to optimize a certain test in my lab."

Her battle has also altered her feelings about her own road in life in a larger sense. "I do not worry so much about the future anymore," she says. "After fighting for my life against breast cancer, I feel I can face anything that may fall in my path. I have confidence in myself and in my decisions. I know the meaning of family and true friends... I am a wife, mother, scientist and breast cancer survivor."

Obsessive knuckle-crackers are probably familiar with the old warning: keep up the noisy habit, and you'll get arthritis someday. If you're like most, though, the thought of aching joints hasn't stopped you from cracking away, however guiltily.

Can cracking your joints really give you chronic osteoarthritis? Or is it just a myth?

Turns out all that finger-wagging isn't what it's cracked up to be (sorry) -- although there's plenty of speculation about how one could fall victim to the condition. It's sometimes said that the amount of force people apply to their knuckles could strain tendons. Others have noted that the mechanism behind the cracking noise -- brought on by a rapid collapse of gaseous bubbles in between your joints into lots of smaller bubbles -- isn't unlike the cavitation that puts wear and tear on ship propellers.

Fed up with being told by family members about the dangers of joint cracking, one researcher decided to test the supposed link between arthritis and knuckle-cracking -- on himself:

For 50 years, the author cracked the knuckles of his left hand at least twice a day, leaving those on the right as a control. Thus, the knuckles on the left were cracked at least 36,500 times, while those on the right cracked rarely and spontaneously.

The scientist proudly reported that his relatives were spreading crackpot (ugh, sorry) theories  in a paper published in 1998. The "research" won him an Ig Nobel Prize.

Okay, but how about some real science? Studies of knuckle-cracking began in the early 1970s. Some of their methods were a little dubious, to say the least. One of the first papers to be published saw one scientist approach 28 seniors in a Jewish retirement home to see if they could remember cracking their knuckles when they were younger (if they did, they were asked to prove that they could still "demonstrate a KC [knuckle-cracking] maneuver"). In an effort to assess the impact of knuckle-cracking over time, the researcher also surveyed 28 children. Despite the study's strange approach, it concluded that "the chief morbid consequence of knuckle cracking would appear to be its annoying effect on the observer."

Since then, the science has gotten markedly better. A 1990 study surveyed 300 hospital patients, 74 of whom admitted to habitual knuckle-cracking over anywhere from 18 to 60 years. In comparison to non-knuckle crackers, the habitual crackers didn't seem to suffer from arthritis at greater rates, though they did show weaker grip strength and more hand swelling. The authors chalked that up to the fact that those who cracked their knuckles generally did more manual labor.

The researchers concluded that having a history of knuckle-cracking had no correlation with osteoarthritis -- even after accounting for people's cumulative exposure to the habit.

So, compulsive joint-manipulators, rest easy: the only cracks you need worry about now are the ones you step on.

...I'll show myself out.

Performers at the Canaan Baptist Church of Christ sing during a memorial ceremony. (Don Small/Canaan Baptist Church)

The gold reception room in Canaan Baptist Church of Christ in Harlem seemed very large one Saturday afternoon, with about a dozen people sitting inside, praying and recalling those who had died of complications from AIDS.

The few people filled out paperwork to get tested for HIV in a van that waited outside, while a man with HIV lectured the small audience on the virus. When asked the ways in which the virus is spread, a man in the audience incorrectly said "saliva." Others were surprised that people with non-detectable HIV, meaning the virus is under control, can still pass it on to others.

The Vivian L. Potter HIV Ministry, an HIV and AIDS activist group within the Canaan Baptist Church of Christ, usually has as many as 100 guests at its events, says Babette Hudson, the chair of the organization. It was the day of Whitney Houston's funeral, and she says she believes people stayed home to watch. The small turn-out made no difference to her, though.

"If you touch one person, it's good enough for me," Hudson says.

The HIV ministry has been operating since the early 1970s.* When the program first began, the pastor at the time, Reverend Wyatt T. Walker, thought it was important to have an HIV ministry because the epidemic had an impact on the African American community. Today the program organizes prevention-based outreach events to educate the Harlem community.

"We began to do a lot of funerals here at Canaan for people who died of the virus," Hudson says. "We began to lose a lot of members, particularly in our male chorus because a lot of them were MSM's [men who have sex with men]."

Hudson says many of the churches in Harlem are just as active as Canaan, and dismisses the myth that African American churches don't talk about HIV and sex.

"Yes, we do talk about condoms. Yes, we do give out condoms. Yes, we do talk about sex," Hudson says. "I would say that myth goes back to my mother, my mother's generation--and my mother's 80 years old. There was a time when there were things you didn't talk about. Churches were the places you went to worship God and you went home, but as society began to change, as the issues began to change, it was taken for granted they just didn't talk about it."

The adherence rate for taking HIV medicines in Africa is much higher than it is in the U.S., says Dr. Monica Sweeney, the assistant commissioner for the bureau of HIV/AIDS prevention and control at the New York City Department of Health and Mental Hygiene. People with HIV and AIDS in Africa don't have the safety net people have here, she says, and they take the medication to get healthy and to sustain themselves.

"In the U.S., in New York City, if you are HIV positive, the care, support system and medications are available--so why are people coming to get treatment when they already have AIDS?" Sweeney says. "We are going to continue to do primary prevention to keep people from becoming positive with a disease that's almost 100 percent preventable."

She says despite an increase in HIV education, the number of people testing too late is still quite high. One in 4 people already has AIDS when they get tested, she says, and health experts now know the sooner a person gets treatment, the better their health.

On the other hand, when people test negative, they believe it justifies having unsafe sex, Sweeney says.

"It emboldens women to continue having unsafe sex," she says. "Many people know what to do, but they don't put into practice the methods they know."

Rob "Simply Rob" Vassilarakis is currently the outreach specialist and intake coordinator for the day program at El Faro adult daycare center -- an outfit operating under Harlem United, a community-based organization offering support to people living with HIV and AIDS. He reaches out to other organizations and medical providers, in hopes of recruiting new members to enroll in the day program.

Vassilarakis, whose family is from El Salvador, sometimes wonders if all the effort being done in the community to fight HIV and AIDS will actually break through the walls of ignorance and denial about the disease, as well as people's feelings about homosexuality.

"I think there's still a lot of denial about how relevant HIV is. I think people tend to associate HIV as being a gay disease or something that junkies do or this is God's wrath," he says. "In a lot of Latin religious circles, I think people think this is the plague people talk about in revelations. I think there is a lot of stigma and people need to wake up because HIV knows no borders."

Until his mother read his journal and found out he was gay, Vassilarakis lived a double life. He didn't want his family or friends to know about his sexuality because he was afraid of how they would react.

Two years after his mother threw him out of the house, he dated the man who introduced him to crystal meth and gave him HIV--knowing he had the virus.

"I was kind of promiscuous. I dated him, but we weren't in a monogamous relationship, and I knew that he was involved with others as well," Vassilarakis says. "I was feeling invincible I guess. There are some sexual practices that are more risky than others, and in some way I thought I was not really....I wasn't really practicing the riskier types of sex. I thought I was not going to be exposed, but I was."

He tested positive in 1993, just shy of his 23rd birthday. Vassilarakis says the doctor assured him that the test would come back negative, and he could see that the doctor was distraught as he walked into the room to tell him that the results were positive. It was the first time the doctor had to give anyone a positive status, and Vassilarakis says he was upset that he had to give one to someone so young.

The doctor told him that he had approximately seven years to live, but Vassilarakis refused to go on medication, and today he believes it saved his life; he feels that the medications in the early '90s were toxic.

In the years to come, he was homeless and living on the street, high on crystal meth and suffering on a daily basis. Vassilarakis didn't know where he was going to sleep at night, or where his next meal would come from. He says the only purpose of the day was to find out where his next hit and next hookup would come from. The turning point came when he found himself alienated from friends and feeling very alone.

"I thought to myself, 'I can't believe I lived 36 years to live like this, literally stinking with the clothes on my back," Vassilarakis says.

In 2006 he checked into rehab, and then found Harlem United, which gave him the opportunity to speak about his issues. Vassilarakis says he had reached a point in his life where he needed to let everything out.

Even though he has improved his life, he is still estranged from his family. However, Vassilarakis says he doesn't wish to reunite with them--he now calls his best friends his family.

"You don't choose what family you're born into, but you absolutely choose who you surround yourself with," he says. "I love where I am in my life, and I love the people I have around me and they've accepted me, and most of the people I have in my life are not even gay; they are straight people who accept me regardless."

Vassilarakis' mother has made attempts to reach out to him recently, but he is very hesitant to reach out to her. Even though he has forgiven her, he hasn't forgotten that a lot of his problems were caused by his mother's abandonment. Vassilarakis' life is going well, and it has been a long time since he has had to deal with his issues with his mother.

"I've learned how to live without her and the family," he says. "I've made my peace with it."

* * *

New York City's Sweeney says she believes community outreach is effective because New York used to be 19 percent of the epidemic in the United States, and it's dropped to 14 percent.

But HIV organizations in Harlem say the rate of HIV is still too high, primarily because people have an attitude that they cannot get the virus. However, it's not for a lack of outreach that the rate is so high, they say.

Harlem United focuses on HIV testing, says Kimberleigh Smith, the group's senior director for state and local policy. The organization has spent the past few years amending the public health law in New York State so that more people can get tested as a routine part of their medical care. Now, any time a person between the ages of 13 and 64 visits the doctor, the doctor is required to offer an HIV test.

"Just deciding you should have an HIV test based on, maybe you're gay, or whether you're black, is outdated," Smith says. "To really combat HIV you need to get as many people tested as possible in a routine way, and it needs to be a part of their medical health care."

She says in New York Medicaid is successful at providing people healthcare and there is also an AIDS drug assistance program in the state. While there are waiting lists in other states, Smith says, there aren't any in New York. However, she says there are still many people who don't know how to use the public healthcare system.

"From the onset poverty can shape how you access health care, how you understand your own health," Smith says. "Poor people are less likely to get what they need."

Recently, many faith-based organizations have joined the fight and created outreach programs, some of them funded by the Black Leadership Commission on AIDS.

"Many more houses of worship are involved in this initiative, partly because we created a space for them and we actually help them help themselves develop a curriculum and a language," says Deborah Levine, who has been involved in the public health industry since 1986, and is a part of a program called the New York City Council Faith-Based Initiative. "If people aren't properly trained to understand how the virus is spread that's how you get people spreading misinformation."

Levine says it's important to break down the walls of stigma, engage HIV-positive people in the community and get them the help they need. She says that HIV is becoming more accepted in the faith-based community, but talking about sex and sexuality will always be a challenge.

"Creating safe spaces where people can talk about sexual practices and how they stay safe--and who better than our houses of worship to be the center of good knowledge and good stewardship?" Levine says.

Levine says the HIV rate in Harlem is too high across the board. Activists in Harlem are still struggling to convince people to get tested. She says in some cases people don't want to know their status, either because they don't want others to think they are gay, bisexual or transgender, or that they are promiscuous.

Levine also says many people still don't go to the doctor on a regular basis because it is too expensive. If a person is living paycheck to paycheck, she says, he or she has to strategically figure out when the best time to visit the doctor is, and it's usually when they are very sick.

"As much as things have changed, it's still frustrating that we still have rates of infection in the African American communities that are so high," Levine says. "But to me that's around the social drivers. That's around not having access to clean affordable housing. It's contributed by poverty. Numbers soar because of lack of education."

Smith of Harlem United says a person is more likely to get HIV if they live in an area like Harlem, where the rates are so high.

"If you're an ordinary person and your social or sexual networks are in the neighborhood you're more likely to get HIV," she says. "It doesn't mean you're more promiscuous, it doesn't mean your behavior is any riskier, it just means that you're more likely to get HIV because there's more HIV to get."

Back in March, the New England Journal of Medicine published a study, funded in part by the National Institutes of Health (NIH), on the effectiveness of bariatric surgery to treat and even cure Type 2 diabetes. In early May, for the second time this year, an FDA advisory panel recommended approval for a new anti-obesity drug.

This sounded like progress, and it was. Diabetes is one of the most expensive diseases facing the country today. But there are two paths to managing the challenge of preventable chronic illnesses: treating the disease effectively, and preventing the onset of disease. Today, the balance in our research investments is skewed. For all of the research on drugs and surgery, there is very little attention to building the evidence base for effective disease-prevention programs. There should be. Disease prevention costs much less than disease treatment.

Solving the nation's most entrenched problems See full coverage

So we should be looking to examples that will spare people the many kinds of costs of the disease, and also save the health-care system significant amounts of money. One of the best-researched interventions to prevent diabetes among those at highest risk is the Diabetes Prevention Program. A 2002 study of the program--a big deal, supported by NIH, the Centers for Disease Control and Prevention (CDC), and the Indian Health Service; involving 27 centers and more than 3,000 participants; published in the New England Journal--found that an intensive lifestyle intervention program was effective in preventing or delaying the development of diabetes among people with prediabetes (those who are on a path of developing the disease, based on elevated levels of blood sugar).

The idea behind the intervention was pretty straightforward: helping participants make behavioral changes to eat healthful food and increase physical activity. The goal was for participants to achieve a minimum 5-7 percent weight loss and engage in at least 150 minutes of physical activity per week.

The results were a big deal too. The study found a 58 percent reduction in the incidence of diabetes among those at highest risk. Over the course of the 24-week program, half of the participants lost 7 percent of their weight or more, 38 percent of them sustained that weight loss well beyond the program intervention, and most sustained their 150 minutes of physical activity over time.

The biggest problem, though, was that the program was incredibly expensive: nearly $1,500 per person per year for this one-on-one lifestyle management program, administered by masters-level professionals. (Note that the cost of bariatric surgery ranges from $11,500 to $26,000 per procedure.)

A few years later, researchers at Indiana University looked at a modified version of the program in a group setting, based at the YMCA and led by lifestyle coaches, and found essentially the same effects. Participants in the program lost an average of 6 percent of their body weight, reduced total cholesterol levels, and sustained those changes over time. The cost of the modified program is significantly lower (roughly $500 total per person over three years) and yields a quick return on investment (reducing medical costs more than $900 per person over three years). An article in the January 2012 issue of Health Affairs estimated that the potential cost savings of a nationwide community-based program would be $5.7 billion over 25 years.

The modified program has spread like wildfire, now operating at YMCAs in more than 500 sites across the country. The New York State Health Foundation, which I head, has supported the program's replication in ten regions. The CDC is making a massive push for the program's spread, and payers like UnitedHealth Group are reimbursing for the intervention. All of this is great news.

But this is just one prevention intervention targeting a limited group of people: the 79 million Americans who are at the highest risk of developing diabetes in the near future. What is essential is that we do the same type of careful research to identify a much wider menu of prevention initiatives that can lead to health improvements related to diabetes and a whole range of preventable chronic conditions.

If we consider research investments by NIH, other government agencies, pharmaceutical firms, and other private research funders, the U.S. spends at least $100 billion per year on careful research trials of new interventions that rely on traditional medical care approaches to getting people healthier after they become sick. We spend a tiny, tiny fraction of this amount looking systematically at the potential effectiveness of health prevention programs. Although the Affordable Care Act established a Prevention and Public Health Fund, dedicating $15 billion over ten years to prevention efforts (still a small amount on an annual basis), the fund has already been slashed by one third. And it remains vulnerable to further cuts. Only a small amount of the fund's resources--$49 million in 2011--has been dedicated to prevention research.

This imbalance makes no sense. Are we allowing this inequity because of huge profits that medical care providers and pharmaceutical companies can earn if we keep finding new and expensive medical treatments? Or are we really convinced that it makes economic (and moral) sense to invest so little in prevention and so much in medical treatment?

It's time to take a hard look at why we aren't investing more in prevention research, and move toward a more balanced research agenda.

Nearly 20 years ago, the Dalai Lama asked a biologist why the tools of neuroscience couldn't be used to investigate kindness, compassion and well being.

The answer is that neurobiologists rarely choose to investigate these areas. Even though, then as now, they had tools capable of probing the connections.

Most everyday experiences change the brain, often for the better. And it's impossible to learn any new information without changes occurring in the brain.

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The Dalai Lama's question made a deep impression on neuroscientist Richard Davidson, Ph.D., Professor of Psychology, University of Wisconsin-Madison, who went on to found the Center for Investigating Healthy Minds in 2008. He's also co-author of a recently published review article detailing the progress investigators worldwide have made in understanding the factors that help and harm the mind's development.

As Davidson points out, health research has undergone a major shift in the last few decades, focusing less on illness and more on wellness--staying healthy. We now know that people who sit less live longer. And four simple healthy behaviors - staying trim, exercising, eating a balanced diet and not smoking - can cut the risk of major disease by nearly 80 percent. These are some very practical benefits that have come from shifting the focus from sickness to wellness.

There's no reason brain researchers can't do the same. Most everyday experiences change the brain, often for the better. And it's impossible to learn any new information without changes occurring in the brain. The trick lies in measuring these changes scientifically.

Throughout the ages, many behaviors have been said to promote well being and lead to a happier life. These range from playing a musical instrument to community service to practicing yoga. But it's only recently that science has begun to test these claims.

Davidson's review, written with Bruce McEwen of Rockefeller University, points out that most of what has been learned comes from changes that harmed the brain, which was more or less the Dalai Lama's point. Brain researchers have observed the bad effects of repeated exposure to stress in early life, harm that's accompanied by an increase in the size of the amygdala and decreases in the size of the brain's prefrontal cortex, the area responsible for coordinating thoughts.

Scientists have learned about beneficial changes in the brain mostly from special situations. For example, patients with chronic fatigue syndrome who have been helped by cognitive behavioral therapy show an enlargement in their prefrontal cortex. And Zen meditators have an increased tolerance to pain, a change that's accompanied by the enlargement of several areas of the brain, particularly the anterior cingulate region of the cortex.

These findings may seem esoteric, but they're the first steps in charting the physical changes that occur in a healthy brain.

It's possible that the human mind is too complex for us to learn its secrets by studying gross anatomical changes. But maybe, many years from now, after checking your blood sugar to make sure that you're not diabetic, your doctor will be able to look at your brain scan and ask: "Hmm. Your basal ganglia have shrunk a bit. Have you been acting more self-centered lately?"

We'll never know, unless more researchers start asking the right questions.

The review article appears in the May issue of Nature Neuroscience.

This article originally appeared on TheDoctorWillSeeYouNow.com, an Atlantic partner site.

Welcome to the largely unregulated universe of dietary supplement marketing, in this case of DMAA, a.k.a. 1,3-dimethylamylamine, methylhexanamine, or geranium extract (from which it is supposedly isolated).

DMAA is supposed to stimulate athletic performance.

In April, the FDA sent letters warning ten DMAA distributors that it considered their products adulterated because:

• DMAA does not naturally come from a food.
• Most of it is produced synthetically
• It might not be safe.

The research has been published in Nature, and there is more information about the study on the University of Pennsylvania's site: 

The research involved a unique collaboration between the laboratories of senior authors Christopher Hunter, professor and chair of the Pathobiology Department in Penn’s School of Veterinary Medicine, and Andrea Liu, the Hepburn Professor of Physics in the Department of Physics and Astronomy. Penn Vet postdoctoral researcher Tajie Harris and physics graduate student Edward Banigan also played leading roles in the research ...

This parallel with animal predators also makes sense because parasites, like prey species, have evolved to evade detection.

“Many pathogens know how to hide, so T cells are not able to move directly to their target,” Hunter said. “The T cell actually needs to go into an area and then see if there’s anything there.”

The model is also relevant to cancer and other immune-mediated diseases, Hunter noted.

“Instead of looking for a parasite, these T cells could be looking for a cancer cell,” he said. By knowing what controls T cell movement, “you might be able to devise strategies to make the T cells more efficient at finding those cells.”

Don't miss Sensenig's incredible video of drones performing the James Bond theme for another lab at the University.

Over at The Guardian, Vaughn Bell argues that our belief in the inherent neutrality of science drawn from magnetic resonance imaging (MRI) may be unwarranted:

Imagine you are playing two roulette wheels. Clearly, the result of one doesn't affect the outcome of the other but sometimes they'll both come up with the same number just due to chance. Now imagine you have a roulette wheel for every point or voxel in the brain. A comparison of any two scans could look like some areas show linked activity when really there is no relationship. Ideally, the analysis should separate roulette wheels from genuine activity, but you may be surprised that hundreds if not thousands of studies have been conducted without such corrections.

Researchers could be discovering patterns where there are none, in other words -- not just between regions of the brain, but also across brain scans and even among multitudes of studies that all build upon one another. It's a worrying thought.

The problem recalls an old Malcolm Gladwell essay explaining that as technology has improved, our abject inability to sort signal from noise has grown ever more apparent. Despite radical advances in imaging technology, the limitations of our own brains are keeping us from producing completely accurate scientific research.

For those who have seen the Stanley Kubrick film A Clockwork Orange, the words "behavior modification" may conjure up images of the creepy protagonist with his eyelids propped open, forced to watch brutal films under the influence of nausea-inducing drugs. But as David H. Freedman explains in his June Atlantic cover story, the theories of psychologist B.F. Skinner have long been misunderstood. And they're now finding all new acceptance, thanks to smartphone apps that help people become perfected versions of themselves.

Freedman came online on Tuesday, May 29, at 3 p.m. to talk to readers about his story. The transcript appears below.
   
David H. Freedman:
Hi All, ready to begin in 2 minutes
   
doctorawed: 
Nowhere in Chomsky's critique of Skinner did I ever see a suggestion human beings were too smart to have any aspects of their behavior shaped by Skinnerean conditioning. Chomsky did argue that Skinner couldn't account for all aspects of language learning/acquisition, but that's quite a different claim.
   
Freedman:
Glad to be here, thanks for a good, tough first question!

Saying "we're too smart" is indeed a gross oversimplification--hey, space was tight. Chomsky made 2 big points re: Skinner. First, he said that humans have speech circuits in their brains that animals don't have, so Skinners' theories on how humans acquire speech can't be right.

Second, he noted that Skinner only did work on animals, so didn't really present any science on humans, and therefore his ideas about humans shouldn't be taken as serious scientific claims. I very roughly boil this down to, "It works on animals, maybe, but humans probably have too much special stuff going on in their big brains to succumb to training this way." The evidence shows overwhelmingly that Chomsky was dead wrong.
   
Rochelle: 
In working with adolescents who abuse marijuana, is behavior work best or education, and does the token economy work well with this age?
   
Freedman:
Behavior work can be seen as a form of education, it's not either or. If you mean just providing information, without any reinforcement, behavior analysts would say (and studies seem to show) that's not likely to be very effective. The token economy is a form of reinforcement-based behavioral modification that in some situations, for some people, works well to some extent. But there are many other ways to carry out effective reinforcement.
   
Joseph Jay Williams: 
I enjoyed the article a lot, it's very timely, and encouraging for people who struggle with health issues.
   
Freedman:
I'm glad you think so. The medical community for the most part is pretty much in agreement that health-related behavior change is the most important thing that needs to happen. People who do health-promoting things (eat healthy foods, exercise, don't smoke, etc.) are doing a lot more for themselves than anything modern medicine is likely to do for them.
   
Joseph Jay Williams: 
I do research on behavior change - I'm in cognitive science - and I'm curious whether you came across current researchers who you thought were advocating particularly effective principles, and whether there were particular apps or web-based programs you were impressed by. There's been discussion in the news about the potential (and concerns) about internet-based interventions. But I haven't seen articles that tried to synthesize some of the most important principles - it seems readers would be interested in that, but is that style of journalism just less appropriate for a magazine or newspaper?
   
Freedman:
I've been paying more attention to those researchers who are employing online and phone apps for reinforcement-oriented behavior change. There is also work that tries to directly address thought and feelings online, rather than behavior. Right now the studies are all over the place on whether these sorts of interventions are effective--and a lot of it depends on what's being measured. Self-reported changes in feelings? Self-reported changes in behavior? These are harder studies to get reliable, meaningful answers for--one big advantage to the strictly behavioral approach.
   
Freedman:
I've seen articles that try to synthesize some of the principles of online behavioral interventions (I quote a few in the article), but trying to say something smart about internet-based interventions in general would be tricky right now--the studies are still pouring in.
   
Luis De Avila: 
I'm a student of behavior change that's learned via the school of life. It seems to me that it may be too late for most people to change their health behavior... Are there any attempts to change the behavior of children that you find to be compelling or interesting in their approach?
   
Freedman:
I hope you're wrong about us adults not being able to change our behavior! I think I've seen quite a few do so. But I agree that we really ought to focus a lot of special attention on children. And yes, absolutely, there is a huge amount of work going on in that regard in behavior analysis. Although behavior analysis is best known for working with children with autism, it actually works in all facets of education with all children. Skinner himself was interested in general education, not special education.
   
Freedman:
I think just about any good teacher of students of any age (and parents!) intuitively use Skinnerian approaches of praising and otherwise rewarding students for doing some good, and ignoring (as much as possible) undesirable behavior.
   
Freedman:
Anyone here have experience with different sorts of diet approaches? I'm always curious to hear how people fare with different techniques.

I became interested in this whole subject when my doctor told me to lose 25 pounds. I tried Atkins, I tried cutting portions, I tried upping my exercise. I kept losing weight, and then falling off the wagon and putting it back on.

It wasn't until I started carefully tracking what I ate, establishing rigid habits, making small changes to them, and building in all sorts of rewards that I finally managed to slowly but surely shed the extra weight. That got me curious about why that worked so well...and to rediscovering Skinner.
   
Joseph Jay Williams: 
Here's a review article of behavior modification as applied to children: http://www.sciencedirect.com/science/article/pii/0273229781900058, if it's behind a pay-wall you can look on scholar.google.com to see if the author's posted a PDF online, or just ask any undergraduate at a university to access it through their library. This is a simpler explanation of applying the approach: http://www.ldonline.org/article/6030

Freedman:
Thanks for that.
   
Freedman:
The term "behavior modification" still sounds a little scary to many people. There's no clear definition to it, but somehow it seems like a form of controlling people against their will. Actual Skinnerian behavior change generally gently guides people toward behaviors they find more satisfying and helpful to their goals.
   
Joseph Jay Williams: 
One interesting point the CEO of Weight Watchers has made is that diets may sometimes be a bit off the mark. They represent the biological or medical approach that's often been taken to weight loss, where all the effort is spent trying to figure out the best and worst ways to consume calories. Instead, taking a psychological approach focuses primarily on the best and worst ways to build habits and help people change their environment so they start eating less. I think it's fascinating how we all acknowledge the important of what we think and feel, but analysis and creativity in changing that "psychological level" just doesn't jump out at people the same way the "biological level" does.
   
Freedman:
I agree that the concept of diets is problematic. Most people who adopt diets end up with diets that can't realistically stick with forever. It's not really about eating particular foods--it should be more about altering behaviors via small, easy, satisfying and rewarding changes. These are much, much easier to adopt, and more importantly to stick with
   
Natalie: 
Thanks for all this information. I heard your interview this morning on NPR, then got on The Atlantic's website to read more about it. I'm hoping that my husband and, each with our smartphones, can work together to increase our health and fitness ... and hey, strengthen our relationship, too!
   
Freedman:
I love the idea of losing weight together, and making it a way to reinforce your relationship!
   
Weight loss works much better when there's a social element of some sort. Humans are very wired to do things in concert with others. We need that support and validation!
   
Natalie: 
Also, I use behavior modification, a.k.a. positive reinforcement, with my pets all the time. It works beautifully for them. It's time I apply it to myself and my human relationships, too.
   
Freedman:
It sure does work great on pets. And this turns out to raise objections to using the same principles on humans--we shouldn't be "trained" like animals. Guess what? We're animals. We respond really, really well to training when it's done right--that is, with lots of well-chosen reinforcement and support. Why shouldn't we train ourselves, or allow ourselves to be "trained" if it has great benefits for our health and lives?
   
Luis De Avila: 
Yes. I would agree that the challenge for most of us is psychological. We know we need to exercise and eat healthily. We eat poorly for other reasons... like the ones I listed previously.
   
Freedman:
It seems to us that our thoughts and feelings are super-important, and are calling all the shots. And yet behavior analysis manages to get good results without really paying much attention to thoughts and feelings. It's hard to say why that is (though there are many theories), but it's pretty well established. The record isn't really strong for getting people to change behaviors long term by focusing on thoughts and feelings
   
Joseph Jay Williams: 
I'm not sure if this is problematic for you as it might count as an endorsement, but which apps or web-based programs might you suggest people check out? I think seeing examples of good ones would be a great way to internalize these ideas.
   
Freedman:
I mention some in the article. A few I don't mention there, but think are very good: SparkPeople for weight loss, and Joe's Goals for doing almost anything. I've played around with Joe's Goals myself, and found it very effective for getting myself to do a bunch of work-related, financial and home-chore tasks that I habitually neglected.
   
Alison: 
Hi there. I'm interested in your implication, toward the end of your story, that people aren't as paranoid anymore about Big Brother watching us and controlling our lives. I think most people just don't care that much if these apps are gathering consumer information, just like they don't really care that Google is targeting ads based on their private emails. Do you think we're being naive nowadays? Or do you think people were overly paranoid in the past?
   
Freedman:
Both! I think we used to be overly paranoid about government intrusion (not that there wasn't some historical reason to react that way), and today we're a little too loose with our personal info. I know I am. I'm amazed at what I'm willing to share with companies these days.
   
Natalie: 
Very, very interesting what you've written about reducing focus on thoughts and feelings. Can you point us to some articles about this concept?
   
Freedman:
This is a huge topic! How about emailing me at dhfreedman@gmail afterwards, and I'll point you to a few that would at least get you started. And certainly reading Skinner himself would be a good intro to the subject. I recommend the book, About Behaviorism.
   
Elizabeth: 
I recommend poverty and heartache. I lost sixty pounds in a year, with no other deliberate behavior modification, and I've never looked better. It seems to me that this question is usually posed by those whose primary goals are to be rich and successful. That's different.
   
Freedman:
I have heard that sort of thing before--clearly, some people are naturally led to weight loss when the world around them turns harsh from their point of view. And yet many others have exactly the opposite reaction--they overeat when they're miserable.
   
Laurie: 
Are there smartphone apps that could help teenagers take control of their own lives, helping them get better grades or develop better lifestyle habits? Or would these not work, because they'd have to WANT to want to be better? (I.e., if they're in a rebellious phase of life, maybe there isn't much that can be done about it, even a cool iPhone app.)
   
Freedman:
Teenagers can always be tricky to work with, regardless of the approach, because so many changes are going on in their lives. But absolutely, reinforcement techniques via Smartphone should be able to help. I've seen studies of apps that address certain dangerous behaviors, with some success, but these are still a work in progress. We can certainly see teenagers are way into social apps, though, suggesting there's a lot of potential there.

Freedman:
The notion of "wanting" to change is a complicated one. Many people seem to very badly want to lose weight, but can't (at least using most approaches). Others seem to shed weight when they're not particularly interested in doing so. So it's not necessarily a critical factor. But there's no question some people need more help than others, and some people are more willing to get and accept that help than others.
   
Freedman:
Surveys suggest that a huge percentage of the obese population either doesn't acknowledge their obesity, or don't seem particularly concerned by it. So as a public health matter, giving people an effective means for losing weight and keep it off won't by itself solve obesity. We either need to find a way to motivate the others to jump on board, or else change the environment on their behalf so that the weight loss happens easily and naturally without their having committed to a weight loss effort.
   
Elizabeth: 
I live in what many people would call a ghetto, and I can attest to that. Healthy food is hard to come by and expensive. In addition, for women in particular, some extra weight is a security blanket. The constant attention can be grueling. It can be dangerous.
   
Freedman:
Access to healthy food choices is a problem that needs to be solved--here in the US, and all over the world. It won't necessarily fix obesity--plenty of people are obese where healthy food abounds--but it will be a big and necessary step in the right direction. I think a lot of people are thinking about how to solve this problem--I'm working with a big group at McGill University that's looking at all kinds of potential solutions.
   
Natalie: 
When it comes to my behaviors regarding food, what has seemed to help most is to view the behaviors as addictive, and then act accordingly. I'm wondering about your views on working with addictive behaviors combined with positive reinforcement.
   
Freedman:
I think there are certain advantages to treating eating behaviors as addictions--they have much in common with alcoholism, smoking and narcotics abuse. But there are significant differences, too--we all need to eat to live, but we don't need to smoke to live, for example. But in the end, I recommend sticking with whatever works. Overeaters anonymous takes a 12-step approach to eating, and I think it's a good program. Many other programs stay away from addiction metaphors, and yet work well also.
   
Alison: 
Do you think people could become too dependent on apps like these? If you have a tendency toward addictive behavior, I can see how using these apps and micromanaging your every move could become addictive in itself.
   
Freedman:
A great question. I guess it could become obsessive and get out of hand at some point. But so far I haven't seen much evidence or even many anecdotes to suggest that these tools are likely to become anywhere near as big a problem as the problems they're designed to solve
   
Jacquie: 
I am someone who's maintained a 65lb weight loss for 5+ years, so I have some experience in this area.
   
Freedman:
One thing that worries me (and much of the weight-loss community) is that pushing these great tools for weight loss will increase the number of people who are underweight. I don't know how to address that risk. I think there's general agreement that obesity is a much, much wider and costly problem than (for example) anorexia, but that doesn't mean that it's OK to raise the risks of the latter.
   
Jacquie: 
Sorry, sent permaturely! To continue my point...I personally don't like rigid food tracking and measuring. It's too easy to fall off the bandwagon because these requirements feel confining and time-consuming. For me it was much better to learn how to make better choices: eat dark chocolate instead of cake, eat veggies with dinner instead of pasta, etc. If you make better food choices you will naturally eat fewer calories and lose weight. Personally I am a big proponent of reduced-carb diets because they reduce cravings, but that doesn't work for everyone. My main point is that I think a lot of people will eventually fail using the food diary system.
   
Freedman:
I'm actually with you on that one, for me personally. I lost the weight using Skinnerian principles, but I didn't and still don't track calories. Instead, I learned to stick to certain foods and eat with certain bowls so I could judge how much I was taking in at a glance. That makes it harder for me when I eat out, though. For most people, tracking seems to be the way to go--especially given how easy the smartphone apps make it. And it's going to get easier and easier as the apps get better.
   
Freedman:
Well, folks, looks like my hour is up--and a bit more. Thanks for these great questions! Feel free to email me at dhfreedman@gmail.com. For those of you trying to lose weight or otherwise change problematic behaviors--good luck, you can do it!

Take a minute and do a little self-diagnostic on your body. Chances are, you've got at least one cut, ache, sprain or other minor ailment bothering you. If not, great news: something will probably happen to you in the next three days.

That's according to a recent year-long survey of 2,000 Britons who are either exceptionally clumsy or a good predictor of how often the rest of us are likely to suffer bumps and bruises over the course of a lifetime.

In a single year, the average British citizen cuts herself twice while shaving, gets one electric shock, and three papercuts. She'll lose her voice at least once and accidentally bite her tongue three times. Throw in your garden-variety headaches, cramps, blisters, trips and falls and other injuries, and you get 124 such incidents annually.

In case you're counting, that's 9,672 ailments over the course of a 78-year lifespan.

The study, conducted by the health non-profit Beneden Healthcare Society, also revealed that a quarter of Britons have gone to sit down and missed their chairs. Half of them have knocked their heads while getting out of a car. And 1 in 20 admitted to having slipped on a banana peel at least once, which suggests there might be some truth to the classic mishap, after all.

PROBLEM: The average American consumes roughly 47 pounds of cane sugar and 35 pounds of high-fructose corn syrup per year, mostly through processed foods like soft drinks, condiments, and desserts. Though previous studies have shown how these sweeteners harm the body through its role in diabetes, obesity, and fatty liver, it was unclear if they had impact on mental processes.

• Kids Will Eat More Veggies If They Drink Water Instead of Soda
• Eating Chocolate for Breakfast Is Good for Your Diet
• Kids in Families That Eat at Home Are Healthier

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METHODOLOGY: University of California, Los Angeles, researchers Rahul Agrawal and Fernando Gomez-Pinilla trained two groups of rats on a maze twice daily for five days before serving them a fructose solution as drinking water for six weeks. The second group also received omega-3 fatty acids, which protect against damage to the synapses or the chemical connections between brain cells that enable memory and learning. After this experimental diet period, the researchers tested the rats' ability to recall the visual landmarks the scientists installed to help them escape the maze.

RESULTS: The second group of rats remembered the correct route and were able to exit much faster than the rats that did not receive omega-3 fatty acids in the form of docosahexaenoic acid (DHA) and flaxseed oil. A closer look at the brains of the DHA-deprived mammals showed a decline in synaptic activity and signs of resistance to insulin, a hormone that controls blood sugar and regulates synaptic function.

CONCLUSION: A high-fructose diet sabotages learning and memory, but omega-3 fatty acids can partially offset the damage.

IMPLICATION: Gomez-Pinilla says consuming one gram of DHA per day through foods rich in omega-3 fatty acids like salmon, walnuts, and flaxseeds can protect the brain against fructose's dumbing effects. "It's like saving money in the bank," he says in a statement. "You want to build a reserve for your brain to tap when it requires extra fuel to fight off future diseases."

SOURCE: The full study, "Metabolic Syndrome' in the Brain: Deficiency in Omega-3 Fatty Acid Exacerbates Dysfunctions in Insulin Receptor Signalling and Cognition," is published in the Journal of Physiology.

Half of Americans with individual health insurance (that is, those who are not insured through their employers) have coverage that's categorically worse than what will be allowed under the reforms of the Affordable Care Act, according to a new study. New changes, which will go into effect in 2014, will help more Americans gain access to better care, covering more conditions for less out-of-pocket cost.

The new analysis, supported by the Commonwealth Fund, evaluated current individual coverage and group coverage, looking at how much people were paying for medical bills every year, and the kinds of conditions that were covered.

People in this 'tin' category did not have benefits like mental health coverage or even maternity care.

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Under the new program, people will have the option of buying coverage that falls into one of four categories of cost-sharing - platinum (which covers an average of 90 percent of medical expenses), gold, silver, and bronze (which cover about 60 percent). So the authors of the study wanted to see how people's current coverage stacks up to what will be mandated in the near future.

They found that for people who have individual plans today, 51 percent had health coverage that was worse than the new bronze coverage. The authors dubbed this category "tin" coverage, and people who fell into this group paid an average of $4,127 in out-of-pocket expenses each year, but people with the most health problems paid over $27,000 every year. People in this "tin" category did not have benefits like mental health coverage or even maternity care.

People with group health insurance were better off, with 60 percent falling into either gold or platinum categories. About 80 percent of their medical expenses were covered, and they generally had preventive care and screening tests, maternity coverage, and mental health coverage. Their out-of-pocket expenses were $1,765 per year, and even people with the most health problems spent only $7,513 annually. Both of these costs are considerably less than those of people who have individual coverage.

The good news is that things will continue to change. Insurance companies can no longer deny people coverage because they have pre-existing conditions, or set rates depending on a person's health. State exchanges and small-group and individual plans will offer people much more extensive coverage and protections than we have today, according to the authors.

"This study shows that millions of Americans currently have coverage that does not accord them access to timely care and potentially leaves them exposed to catastrophic medical bills," said Sara Collins, Vice President of the Commonwealth Fund. "The provisions of the Affordable Care Act will not only extend new coverage to millions of uninsured Americans, but vastly improve the coverage of many who are insured but poorly protected by their health plans."

The study was carried out by a team at the University of Chicago and published in Health Affairs.

This article originally appeared on TheDoctorWillSeeYouNow.com, an Atlantic partner site.

As a physician, I know how frustrating it is to look into the eyes of a young patient and tell her she has Type 2 diabetes and high blood pressure, knowing that these conditions could have been prevented or at least delayed. It's a tragic waste; not only would she be healthier and happier, but her health care would not cost nearly as much.

Unfortunately, this scenario plays out all too often in American medicine. Preventing diseases before they start is one of the most common sense ways to keep people healthy, but this nation continues to focus too narrowly on treating medical conditions after they occur.

Solving the nation's most entrenched problems See full coverage

A disproportionate share of the $2.6 trillion we spend on health care each year goes toward treating the sickest people--covering mostly high-cost hospital care for preventable chronic conditions like heart disease, stroke, Type 2 diabetes, and cancer. Health care spending and lost productivity tied to smoking alone, for example, totals over $193 billion a year. It is estimated that obesity rates are responsible for $34.3 billion and $27.6 billion in additional spending in Medicare and Medicaid respectively, and $74.6 billion in higher spending by private health insurers.

In stark contrast, strategies that can prevent disease and promote health are chronically underfunded. For every dollar spent on health care, less that four cents goes toward public health and prevention--programs and policies that hold the most promise for lowering costs by keeping us from getting sick in the first place.

The solution is simple. With more than half of Americans living with at least one chronic disease, we should be investing more in community-based prevention. A recently released Institute of Medicine (IOM) report concluded that changes in how America invests in health will be critical for the nation to prevent illness and control costs at a level comparable with other rich nations. IOM called for "significant reforms" to refocus the U.S. health system on prevention of the chronic diseases burdening the nation's health and economy.

We know these investments pay off. Spending just $10 per person per year in proven community-based programs to increase physical activity, improve nutrition, and prevent smoking could eventually save more than $16 billion a year, according to Trust for America's Health. That's a nearly $6 return on investment for every dollar invested. This doesn't even count the indirect gains yielded through increased worker productivity, reduced absenteeism at work and school, and improved quality of life.

Health insurance, while critically important to making health care affordable, is only part of the solution. It will take a combination of expanding coverage, delivering better preventive and chronic care, and committing to policies that foster safer, healthier environments and healthier behaviors. Evidence shows that embracing these three strategies collectively are much more effective at both saving lives and money than implementing any one of them alone.

There are economic implications as well. State, city, and local leaders recognize that a community's health affects its ability to attract and retain employers who create jobs. In Nashville, TN leaders are pursuing a range of prevention efforts to make it easier for city residents to make healthier choices. Minnesota is doing something similar. Four years ago, the state launched a Statewide Health Improvement Plan to help save health expenses for both the state and businesses by focusing on improving health and curbing the rise of preventable chronic disease.

And in Wyandotte, Kansas, Major Joe Reardon, seeing how unhealthy his community was--it hadn't seen a new grocery store in 40 years--brought business, public health, education, transportation, and housing leaders together to support efforts to curb smoking, improve rates of physical activity, and promote healthier choices. Under Reardon's leadership, all things relating to community improvement in Wyandotte, even resurfacing streets, now include a prevention inquiry: "How does this affect the health of our residents?" and "What is the economic impact on costs and productivity?"

The good news is that a growing number of policymakers and employers view prevention as critical to both improving worker health and productivity while also lowering soaring health care costs. In 2011, 67 percent of companies with at least three employees that provided health benefits also offered worksite wellness programs; almost all companies with at least 1,000 employees offered one. Companies are encouraging employees to be more physically active, quit smoking, lose weight, and eat healthier.

That's real progress. But if employees and their families live in communities with poor air quality, unsafe areas that limit physical activity and poor access to healthy foods, workplace wellness programs will only get us part way to better health.

PROBLEM: Even though people make mistakes in the workplace all the time, few studies have looked into the effect of errors on employees' impressions of their bosses. More precisely, are male and female supervisors held to the same standards?

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METHODOLOGY: Researchers led by Pennsylvania State University's Christian Thoroughgood asked 284 subjects to read a series of emails describing a boss' unflattering behavior as they did their job or as they related with others. Then they were supposed to envision themselves as subordinates of the leader, who was either a man or a woman. The subjects then answered a survey measuring their desire to work for that leader and their perception of his or her competence.

RESULTS: The respondents saw bosses who who made mistakes as less desirable to work for and less competent overall as well as in both task and relationship areas. Interestingly, male leaders were evaluated more negatively than female leaders for errors made in traditionally male industries, such as construction.

CONCLUSION: Errors damage the reputations of leaders who commit them. Men are judged more harshly than women making the same mistake in traditionally male work domains.

IMPLICATION: Gender expectations affect how leaders' errors are evaluated. Men may be severely penalized when they underwhelm in typically male contexts, while women are given a pass.

SOURCE: The full study, "Real Men Don't Make Mistakes: Investigating the Effects of Leader Gender, Error Type and the Occupational Context on Leader Error Perceptions," is published in the Journal of Business and Psychology.

After graduating from Rutgers in 1982, Mario Batali began a new course of studies at Le Cordon Bleu in London--only to withdraw almost immediately. In Batali's own words, he was a culinary upstart who "felt kinda important" because he had been working on the side for the acclaimed chef Marco Pierre White (a notoriously unforgiving boss who chucked a pan of hot risotto that he deemed substandard into the chest of an unsuspecting young Batali). Three decades later, speaking to Corby Kummer at The Atlantic Food Summit (he wrote about his interviews with Martha Stewart and Batali here), Batali called himself "foolish," "young," "impatient" for failing to finish culinary school, and he offered some advice: "I would recommend that whatever you do, whatever you start, you should finish it." But some would say that Batali--now an award-winning restaurateur and television personality whose Italian cuisine is almost as famous as his penchant for Crocs and shorts--has done rather well for himself, despite what he sees as the impetuous decisions of his youth.

If Batali made one thing clear on Thursday, it's that there is no clear, predictable path toward celebrity chef-dom. The concept itself is a relatively new phenomenon. "Keep in mind that in 1975, when you became a cook, it was because you were between two things: you were between getting out of the military and ... going to jail," Batali said. "Anybody could be a cook, just like anybody could mow the lawn." But then came a cultural shift toward the restaurant as the setting of an anticipated evening out, where the food is enjoyed for more than its nutritional utility and chefs are artists to be revered. Batali, of course, was lucky enough to be swept up in this wave. But he aired the concern that many culinary schools make the mistake of convincing students that they can touch the ceiling within months of graduation--that they can have their own show on the Food Network, or snag that executive chef position. "We don't even hire sous chefs. We hire linemen," Batali said of his own restaurants. "No one is ever hired to be the boss."

The proliferation of competition shows on the Food Network has had a sort of democratizing effect (Cupcake Wars routinely invites owners of small, little-known bakeries, and Chopped once convened a group of cafeteria cooks for an episode), making television seem more accessible than ever, a quick way to draw eyes to your food. But Batali--one of the Food Network's early recruits in the 1990s--said that he believes talented young chefs can gain traction without television exposure: "You don't need TV," he said. Certainly, television can help chefs to meet new customers and to "espouse your personality and the ideology of your restaurant"--to build a brand, essentially--but the medium alone does not ensure a successful career in food. "All the people who lose in the first three or four rounds of all of these sadistic shows don't go home to a crowded restaurant," he said. "TV isn't necessarily the guarantee." For Batali, however, his knowledge of Italian cuisine "propelled him a little forward because people saw me as someone who truly understood this stuff" (on Molto Mario, Batali was a congenial conversationalist, whipping up platters of pasta as he held court with three guests). Batali, whose career undeniably benefited from his television experience, had only one real complaint about his participation on competition shows: the "skinny little actresses from a show called The O.C." who were invited--instead of the chef-judges he respects--to critique "something I spent an hour humping to get done."

Batali said that he strives for consistency, to make it possible for customers to enjoy their favorite dish again years down the line--but it's an ambition made precarious when most other chefs are using "jello and some seaweed extract," or trying to incorporate a "test tube to squirt you with something." Above all things--creativity, technique, encyclopedic knowledge--the quality essential to being a chef, the "fundamental, most important building block," is generosity. "You have to be generous if you want to spend your time making someone else dinner," he said. "Even if you're charging, you're still giving."

Most people can pick up the basic techniques of working in a kitchen, but the more abstract elements of passion, service, and engagement are not as easy to learn: "I can teach a chimp how to make linguini and clams. I can't teach a chimp to dream about it and think about how great it is," Batali said. "Although the skills aren't hard to learn, finding the happiness and finding the satisfaction and finding fulfillment in continuously serving somebody else something good to eat, is what makes a really good restaurant."

Antidepressant medications may provide as much pain relief for people with arthritis as the more commonly prescribed anti-inflammatory medications (NSAIDs) do. That's the conclusion of a recently published review.

The antidepressant duloxetine (better known as Cymbalta) was approved by the FDA for treating chronic pain in 2010 based on two studies showing that it was about as effective a pain treatment as NSAIDs are. But so far, few patients are receiving it as a treatment for pain.

Based on self-reported pain relief, about one patient out of six benefited from duloxetine treatment.

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The review authors focused on these two studies of duloxetine as sole treatment for pain from osteoarthritis and a third that looked at duloxetine as an add-on treatment for people already taking an NSAID for knee osteoarthritis.

The two studies of duloxetine as stand-alone pain reliever for arthritis were 13-week randomized studies comparing pain relief of duloxetine to placebo. Based on self-reported pain relief, about one patient out of six benefited from duloxetine treatment.

This is similar to the treatment benefits found in previous reviews of two NSAIDs, etodolac (one in five patients) and tenoxicam (one in four patients), indicating that duloxetine is roughly as effective at treating pain as these other two medications.

That duloxetine isn't a magic bullet is shown by the number of people in these two studies who suffered from side effects: 16.3 percent of the subjects taking it discontinued treatment due to an adverse reaction. The three most common were nausea, fatigue and constipation. Only 5.6 percent of those taking placebo discontinued the study due to side effects.

Overall, after subtracting out the effects from placebo, one in six patients benefited and one in ten experienced significant side effects from duloxetine.

The reviewers also looked at a more recent study, a randomized trial of 524 people with knee arthritis whose pain had persisted despite taking an NSAID for it. All continued to take an NSAID, mainly ibuprofen or naproxen, while half also began to take duloxetine and the other half took a placebo.

After eight weeks, 35 percent who took duloxetine reported pain reduction of 50 percent or greater compared to 16 percent in the group taking placebo. Subtracting out the results from the placebo, these numbers indicate that nearly one in five patients (19 percent) experienced 50 percent or better pain relief from duloxetine.

Once again, discontinuation due to side effects was roughly one in six in the duloxetine group (15.2 percent), compared to 8.8 percent in the placebo group. Subtracting out side effects from placebo, this suggests that about one in sixteen patients experienced significant side effects from duloxetine.

Taken together, all three studies suggest that about one in six people with arthritis would benefit from taking duloxetine, alone or in combination with other medication. Considering how hard it is to effectively treat arthritis pain, the authors conclude that doctors treating patients with arthritis pain should consider prescribing antidepressants to them.

The review was published online before print by the International Journal of Clinical Practice.

This article originally appeared on TheDoctorWillSeeYouNow.com, an Atlantic partner site.

The grocery store can be a confusing place when you are trying to choose healthy foods. Though nearly all foods have a Nutrition Facts label, not everyone knows how to read or interpret the label correctly. Some food packages have health claims printed on them, and some stores provide indicators that certain foods are good for you. But it can get to be a bit confusing unless you have a degree in nutrition.

Researchers at the University of Arizona College of Medicine and Arizona State University set out to determine if providing in-store nutrition counseling could make a difference in the foods shoppers chose. A supermarket chain offered a packaged EatSmart program created by a registered dietitian chosen for the study.

The foods people purchase are indicative of their dietary intake so education and information can have a long lasting impact on the diets and health of individuals and families.

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The program includes colorful nutrition shelf tags placed under items using recommendations from the American Heart Association: "healthier option," "hearthealthy," "calcium rich, "immune booster," or "low sodium." In all, each store had about 600 shelf tags. EatSmart educational materials were also available in the stores.

Shoppers were recruited onsite. Half of the 153 participants shopped using only the store labels and had no other nutrition education. The other half of the shoppers had a 10-minute face-to-face session with a nutrition educator that focused on better understanding of two of the labels, "heart healthy" and "immune booster," before they shopped.

For the purposes of the EatSmart program, "heart healthy" foods include those that are low in total fat, saturated fat, and trans fats. All fruits and vegetables, and particularly the dark green and bright yellow, orange, and red produce, are considered "immune boosters."

After the participants completed their shopping, researchers analyzed each grocery cart to determine the fat content and the amount and color of the fruits and vegetables purchased. Those who received the face-to-face intervention purchased more servings of whole fruit and dark green and bright yellow vegetables compared to the group who received no nutrition education. There was no difference in the fat content of the carts between the two groups.

The foods people purchase are indicative of their dietary intake so education and information can have a long lasting impact on the diets and health of individuals and families. The value of face-to-face nutrition education by a registered dietitian at the point of purchase (the grocery store) may be a service grocery store merchants (or public health officials) should consider offering.

The study was published in the May issue of the Journal of Nutrition Education and Behavior.

This article originally appeared on TheDoctorWillSeeYouNow.com, an Atlantic partner site.