Music therapy musicianship: a call for change

The following is offered as a manifesto: a bold assertion of our unique musicianship. We – music therapists – are different from performers and educators. If you are a music therapy student or clinician, consider this an affirmation of who you are. Your musicianship matters much more than you know.

How are we different?

A focus on people

First and foremost, we are musicians of the people. When we engage with participants, we are employing musics that diverse people listen to in their everyday lives. We also use the instruments common to these musics.

An example: I (Bill) am a percussionist who sings and plays thousands of diverse songs, emulating the qualities of different genres. I change these qualities to sound like the original, or to convey a different feel. I improvise using a range of musical frames (e.g., rhythms, progressions, modes). I compose lyrics to songs on the spot while accompanying through an improvised structure. This is only a surface understanding of my unique musicianship, and only one example.

Interactive engagement

Performance is NOT our focus. We focus on musical interaction that can lead to growth or change. We develop shared intentions with participants based on strengths, needs, backgrounds, interests, access to music, and their musicality/musicianship. We navigate with our clients a dynamic balance between structure/safety and creativity/autonomy. Our music-making is not tied to a “score,” but rather to in-the-moment modifications. We are musically vigilant (Ruud, 2020) and musically responsive.

Aesthetic sensitivity

We center our aesthetic sensitivity on people. We listen for more than what is in a song or piece, more so to the qualities of the music that participants and the environment give us: in the sound of a voice faintly singing, in a drum profusely struck, in a breath, in the sound of an ICU machine. We listen as witnesses, and integrate and respond in kind.

We see the values of music in their diverse and connected presentations: as a human right (Clements-Cortės et al., 2024), as a human technology (Patel, 2007), as a tool (Thaut, 2005) or resource (Rolvsjord, 2005) for promoting health, and as a medium for experience (Aigen, 2005; Dewey, 1934).

Why is this difference important?

While affirmation is an imperative of this research, systemic change is our overarching goal. The musics and processes that we employ in our work as music therapists are often peripheral in academic training outside of music therapy-specific courses. Common curricula are greatly informed by classical training and performance, and do not provide our musicianship the amount of space it needs to be truly developed and reinforced.

In many schools of music, music therapy students provide a major portion of student credit hours and funding. Students should not be subsidizing a system that focuses on areas outside of their needs. They should be paying for engaging experiences that clearly prepare them for where they are headed. Students should be taking courses with faculty who create an engaging environment within which these students’ unique music knowledge, music skills, and aesthetic sensitivity are valued.

First steps toward change

We invite you to dig deeper into our two articles (Matney et al., 2024; Meadows et al., 2025) and their supporting analyses. For those of you who are music therapists, students, and educators, we think that you will see parts of yourself and your work authentically represented.

Moving forward, we believe the following offers us the beginning steps toward change:

1. Affirmation: Understand and affirm this uniqueness with those around you (and within you!). Small acts change cultures. For our colleagues in various music and health fields, we hope you may affirm those you work with.
2. Advocacy: Assert the difference, with both objectivity and with pride, in informal and formal conversations.
3. Instigation: Even if shifts begin small, we collectively can find ways to move the curriculum toward greater relevance for music therapy musicianship. We can discuss what content exists in what courses, and how that content does or does not meet the needs of music therapy students. We can instigate change, moving toward classes, content, and timelines that benefit each student’s effort and investment.

The 21^st Century Commission on Music Therapy (2024) has provided concrete and practical recommendations for restructuring curricula. Drafts of new AMTA musicianship competencies seek to provide greater detail, but do not yet go far enough in discussing the nuances of our musicianship: the processes of shared music making and musical responsiveness.

Affirm, advocate, and instigate. Together, we can shift the current culture to foster the future of music therapy as ‘musicians of the people.’

^{Feature image by Andrew K via Unsplash.}

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Think before you tan: why sun awareness matters

Sun Awareness Week (11-17 May 2026) is the British Association of Dermatologists’ (BAD) annual week-long campaign dedicated to raising awareness of the public health risk of sun exposure, from traditional tanning to sunbed use. The week also aims to teach the public about the importance of good sun protection habits, including ways you can check for signs of skin cancer.

Tanning and sunbeds

Sun damage is normally caused by ultraviolet rays from the sun, known as UV rays.

Two types of UV rays can penetrate the Earth’s atmosphere: UVA rays and UVB rays. UVB rays are largely responsible for that perennial summer problem, sunburn. However, both types of UV rays are responsible for potentially more serious issues—specifically skin ageing and skin cancer—the most dangerous version of which is melanoma.

Tanning beds, also known as sunbeds, are well-known for allowing tanning year-round, and are also a source of those UV rays, and can provide an even greater risk for melanoma than their natural counterpart. This is because tanning beds also produce UV rays, but at a much higher concentration than normal, making tanning beds faster, but capable of far more skin damage. That is not to say that traditional tanning is safe; however, sun exposure can be harmful in any amount, to any age group.

Sun protection, prevention campaigns, and public awareness of skin health risks are vital in preventing skin cancers and premature skin ageing.

Recent research from the BAD family of journals—the British Journal of Dermatology, our educational journal Clinical and Experimental Dermatology, and our open-access journal Skin Health and Disease—offers new insights into preventing skin damage and life-threatening skin cancers. Here are some highlights.

Tanning bed trends internationally

In 2009, the International Agency for Research on Cancer classified indoor tanning as a source of Class I carcinogens—the highest level known. As a result, almost 25 countries globally have banned their use for minors—though anyone using a sun bed before their mid-thirties is at a higher risk of developing skin cancer later in life. A study published in BJD showed that Ireland is one of the countries that passed the Public Health (Sunbeds) Act in 2014. Since then, Ireland has seen a dramatic 40% reduction in registered tanning businesses. The key message of the study was that a targeted multi-pronged approach is needed to inform and stop the use of sun beds.

Although the ban on younger people who use sunbeds is helpful in pre-empting later skin cancers, tanning beds are still considered sources of carcinogens, with no safe level of exposure. In the United Kingdom, the regulation of sun beds is poor, as seen in this study, with many beds in sun tanning businesses recorded at settings far higher than the legal limit. This finding also correlates to higher melanoma rates in parts of northern England, with over 50 percent of businesses in some regions over-exposing customers.

Nail lamps and skin damage

Sun beds are not the only indoor source of UV rays. Getting one’s nails done can also pose a surprising risk of UV ray exposure through nail lamps, which help to rapidly dry gel lacquer using similar technology to full-body tanning beds. Individuals using both (ideally not at the same time) can be at risk of skin-damage conditions such as pseudoporphyria.

Sun exposure and athletes

Amongst those who spend much of their time in the sun, student athletes risk over-exposure to UV rays year-round, no matter where in the world they play. Novel research from Stanford has shown that when provided with a short video explaining the risks of sun-exposure, with the free provision of sun-protection in the areas that student athletes frequent, had a positive effect on attitudes towards sun protection usage.

Sun awareness in the medical field

Sun protection awareness campaigns can also benefit healthcare workers. An observational study from Ireland demonstrated that a digitally based sun-awareness campaign targeted at healthcare workers (857 workers completed the survey) in their places of employment raised not only raised the awareness of the importance (79%) of using sun-protection, but also increased the likelihood that healthcare workers would discuss sun protection universally.

Research has shown that clinicians emphasize the use of SPF-containing sunscreens and cosmetics, even though they also do not always meet the standard guidelines themselves. Clarification of sunscreen application guidelines, and further dissemination of the risks of the limits of cosmetics containing SPFs, may be in order—for physicians and the public alike.

Why public health outreach for sun exposure matters

Social media is emerging as an essential tool for raising awareness of the risks of sun exposure and preventing sunbed use among younger generations. Alternatively, social media has also raised interest in sun bed use—especially in the guise of ‘wellness’ and cosmetic applications. Research has shown that individuals who frequently use sun beds are more likely to sunburn as adults and participate in higher risk sun-exposure while using lower-UV ray blocking sun protection.

Acne can be the bane of any teenager—or adult. While some turn to tanning beds for temporary acne relief, adolescents can be unaware of the risks of frequent tanning bed use until the damage may be too late to prevent.

Finally, there is evidence that public health campaigns on skin cancer in both the United Kingdom and Australia have had the positive effect of steadying the rate of melanoma in young adults—especially when those campaigns are based on published research that confirmed the cancer-causing nature of ultraviolet radiation from all types of tanning.

Sun Awareness Week highlights the need for sun protection, education, and awareness about the risks that can contribute to skin cancers—not just from tanning beds. If you notice any changes to skin lesions or moles, then it is best to consult your doctor.

Contribute to the conversation this #SunAwarenessWeek and explore the latest research collection from each of the BAD journals, and check out our Patient Hub for more Sun Awareness resources.

^{Feature image by ClickerHappy via Pexels.}

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Why recovery after a hip fracture is about more than bones

For many older adults, a hip fracture arrives without warning, suddenly changing the course of daily life. Walking becomes difficult, routines are disrupted, and the freedom to live independently can suddenly feel uncertain. Yet when people recovering from hip fractures are asked how they make sense of what has happened, a familiar phrase often emerges: “It’s just part of getting old.”

This widely held belief plays a powerful role in shaping recovery. It influences not only how people understand their injury, but how they imagine what comes next, and whether they believe improvement is possible.

Research published in Age and Ageing, following people from diverse social and cultural backgrounds after hip fracture, suggests that recovery is shaped by far more than the physical aspects of surgery and rehabilitation alone. Beliefs about ageing, cultural norms, family expectations, and the realities of daily life all influence how people approach recovery and whether they take action to prevent another injury.

Even with strong uptake of best-practice acute hospital-based care for hip fractures, a concerning pattern remains. Many patients struggle to stay engaged with rehabilitation or longer-term fracture prevention once they return home. In our research published in Australasian Journal on Ageing, fewer than half of patients followed through with physiotherapy strength and balance exercise after discharge, and even fewer sought related dietary advice or other preventative support. These findings suggest that clinical care does not succeed in isolation. For recovery efforts to be effective, recommendations must make sense within the social and cultural settings of people’s everyday lives.

Recovery after a fracture isn’t just a personal journey; it’s shaped by cultural values and social expectations. For people from collectivist cultures, in which a “we” oriented sense of self is prioritised over an individualistic “I”, recovery is tied to family and community responsibilities. Exercise and rehabilitation were meaningful when they enabled role fulfilment, such as caring for grandchildren, preparing meals for communal gatherings and contributing to household activities, rather than focusing solely on independence. On the other hand, those from individualist cultures often viewed recovery as a path to regaining autonomy, with success defined by walking unaided or avoiding dependence on others. Neither perspective is a one-size-fits-all, but both highlight how aligning recovery with personal and social values can strengthen motivation. When this alignment is missing, even the well-intended advice can feel disconnected or difficult to maintain.

For effective recovery and refracture prevention after a hip fracture, healthcare providers must involve families as partners in care. In cultures where family bonds and collective decision-making are deeply valued, understanding expectations is critical to prevent the risk of well-meaning but limiting advice like “take it easy”. Such reassurance, while comforting, might unintentionally hinder a patient’s full recovery potential. Healthcare providers can help reframe these conversations, empowering families to advocate for progress while respecting cultural values of filial piety.

At the same time, healthcare teams can also inadvertently hinder recovery potential. A focus on acute bone and wound healing, short-term safety, and hospital discharge, while important, may sometimes overshadow conversations about longer-term recovery and potential. When recovery goals are shaped mainly by what feels most safe rather than what feels possible, expectations can narrow, and momentum can stall. Models of care that integrate rehabilitation and prevention into the home environment, such as hospital in the home (HITH) or rehabilitation in the home (RITH), may help bridge the gap between hospital-based care and everyday life, creating continuity across settings rather than a sharp divide at discharge.

As populations age, even with age-specific reductions in some regions, the number of patients with hip fractures will increase, making recovery and the prevention of further injury ever more important. Viewing recovery through a broader lens, one that includes culture, beliefs, relationships, and lived context, helps explain why recovery journeys vary so widely. When care recognises these influences, recovery can become more than bone healing and regaining physical function. It can support people to rebuild confidence, remain connected to what matters in their lives, and reduce the risk of future injuries, including fractures, in ways that are both meaningful and sustainable.

^{Featured image by @daejeung via Pexels}.

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What matters most for children in their family relationships?

Navigating the vast number of opinions about what matters most for children’s healthy development can be a daunting and seemingly endless task. From politicians to journalists to self-styled ‘parenting experts’, everyone has an opinion on what children need in their family relationships and how parents should provide this. These opinions can range from the relatively mundane aspects of everyday parenting, for example, how parents can encourage children to brush their teeth, to larger socio-political and legal questions, such as who is allowed to use fertility treatment to create their families, who is recognised as a parent, and what this means for children.

Too rarely does evidence manage to break through the heat and noise of these debates, yet developmental psychologists have spent decades addressing the questions of how family relationships shape child development and what really matters for children. We draw on classic and cutting-edge research on family relationships to highlight three factors that psychologists have consistently found to shape children’s development across different relationships, transitions, and cultures, which can enable children to thrive within their families.

1. Relationship quality is more important than family structure

Empirical evidence has consistently shown that the quality of relationships between family members matters far more for children’s healthy development than who lives together and how they are related. Research into the aspects of parent-child relationships that predict outcomes for children has shown that responding in a sensitive (i.e., timely and appropriate) way to a child, consistent provision of support and boundaries, and open communication facilitate positive mental health and social development in children. Similarly, positive, co-operative relationships between parents and siblings also support healthy child development.

Furthermore, studies that have looked at different family structures, whether that be the number, gender, sexual orientation, or gender identity of parents in a family, the way in which families were created, or whether family members share a genetic connection, have provided robust support in this area. What a family looks like matters far less for how children develop within that family than how family members treat each other.

This is not to say that family relationships, whether between parents and children or between siblings, must always be calm and non-conflictual. The presence of appropriate levels of conflict within family relationships, when handled well (i.e., respectfully and flexibly), can actually be beneficial to children and adolescents in helping them learn and practice different communication skills.

2. Connection promotes autonomy

Until recently, it was not uncommon, particularly in Western countries, for parents to be told that the developmental task of childhood and adolescence was to achieve separation from parents. Research has consistently shown, however, that parents can best support children to develop autonomy in age-appropriate ways by maintaining a connection with them. This is the case whether we are looking at research on how parents can encourage their toddlers to explore a new environment, help their children manage the transition to starting school, or support their teens to navigate increasing independence and changing peer relationships. The presence of a consistent, supportive parent-child relationship facilitates rather than hampers the development of autonomy.

3. Supportive policies and communities matter

Finally, research from across different areas of developmental psychology shows us powerfully and consistently that families don’t exist in isolation and that the structures around them matter for children’s (and parents’) wellbeing. This is the case whether we are talking about parents’ access to social support (i.e., the presence or absence of family and friends), the provision or absence of statutory support, for example, in the case of families raising children with disabilities or special educational needs, or the legislative frameworks around families.

We know, for example, that policies around parental leave influence, and in some cases constrain, parents’ decisions about parenting and childcare during infancy, and that satisfaction with these arrangements is related to parents’ relationship quality and mental health, both of which affect children’s development. And discriminatory rhetoric and laws, for example, anti-LGBTQ+ legislation or legislation that negatively targets minoritized ethnic groups, can make children and families feel less safe by legitimising abuse towards the family and adding further burdens on family members to advocate for or defend their family. It should come as no surprise, then, that children and families do better with supportive communities and structures around them.

No two families or two relationships within a family are the same, but there are consistent factors within relationships that can support children’s healthy development. The extent to which families are able to provide these will differ depending on their knowledge, their previous experiences, the resources available to them, the challenges they face, where they live, and the extent to which the structures around them are supportive or obstructive of family life. Children and their families should be supported to thrive in all their diversity, and focusing on what the evidence tells us really matters for children is, surely, the best place to start.

Featured image by Juliane Liebermann via Unsplash.

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Trailblazing paths: iconic women through time [reading list]

In honor of Women’s History Month, we’re celebrating trailblazing paths taken by women whose courage and vision transformed societies. This reading list features five biographies that highlight women who resisted systemic barriers, confronted entrenched hierarchies, and fought for the dignity and safety of others. From activists and reformers to scientists and cultural leaders, these stories reveal how women—often overlooked or silenced—have pushed boundaries, protected the vulnerable, and inspired movements for justice. Together, they remind us that progress toward gender equality has always been driven by those who refused to accept the limits imposed on them.

1. A Slumless America: Mary K. Simkhovitch and the Dream of Affordable Housing by Betty Boyd Caroli

In this biography, Mary K. Simkhovitch emerges as a pioneering force in the settlement house movement and a central architect of American public housing reform. Betty Boyd Caroli traces Simkhovitch’s founding of Greenwich House in 1902 and her influential role in shaping early 20th‑century urban policy, including her leadership in New Deal housing initiatives, the creation of the National Housing Conference, and co‑authoring the landmark 1937 National Housing Act. Balancing an unconventional marriage, family life, and a relentless public mission, Simkhovitch became widely admired—once even depicted as a “Wonder Woman of History”—for her ability to confront urban poverty while advocating fiercely for immigrant communities and affordable housing. This biography, rich with historical insight, positions her as an enduringly relevant figure whose work helped define the federal government’s responsibility to support low‑income families.

Read more.

2. American Infidelity: The Gilded Age Battle Over Freethought, Free Love, and Feminism by Steven K. Green

American Infidelity traces the dramatic late‑19th‑century clash between a dominant evangelical culture and a rising coalition of freethinkers, feminists, and sexual reformers who sought greater personal liberty and challenged religious authority. Historian Steven K. Green follows this struggle through the activists who fought for birth control, divorce reform, and women’s autonomy, as well as the moral crusaders—including Elizabeth Cady Stanton—who worked to suppress them. Revealing how these “infidels” pushed for a more open, rational, and egalitarian society, Green shows how their movements were ultimately stifled but left a powerful legacy that continues to shape today’s debates over reproductive rights, censorship, and the role of religion in public life.

Read more.

3. COMBEE: Harriet Tubman, the Combahee River Raid, and Black Freedom During the Civil War by Edda L. Fields-Black

Winner of the 2025 Pulitzer Prize for History

This book recounts the often‑overlooked story of Harriet Tubman’s 1863 Combahee River Raid, a daring Civil War operation in which she led Union spies, scouts, and two Black regiments up South Carolina’s river to destroy major rice plantations and liberate 730 enslaved people. Drawing on newly examined documents—including Tubman’s pension file and plantation records—historian Edda L. Fields‑Black, a descendant of one of the raiders, brings to life the enslaved families and communities who escaped to freedom that night and later helped shape the Gullah Geechee culture. Through this vivid reconstruction, the book reveals one of Tubman’s most extraordinary military achievements and the enduring legacy of those who fought for liberation.

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4. The Things She Carried: A Cultural History of the Purse in America by Kathleen B. Casey

The Things She Carried reveals how purses, bags, and sacks have long been critical tools for women asserting privacy, autonomy, and political power in America. Kathleen Casey shows how these objects—from 19th‑century reticules to the handbags carried by immigrant workers, civil rights activists, and Rosa Parks herself—became symbolic extensions of women’s rights struggles, allowing them to navigate male‑dominated spaces, protect personal dignity, and challenge discriminatory systems. Drawing on sources ranging from vintage purses to photographs, advertisements, and legal archives, Casey uncovers how women of all backgrounds used the bags they carried to assert agency, cross restrictive social boundaries, and shape pivotal moments in the fight for gender and racial equality.

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5. Frances Oldham Kelsey, the FDA, and the Battle against Thalidomide by Cheryl Krasnick Warsh

This biography tells the remarkable story of Dr. Frances Oldham Kelsey, the FDA medical officer who, in the early 1960s, prevented the dangerous drug thalidomide from being approved in the United States, sparing countless Americans from catastrophic birth defects. A pioneering scientist who earned advanced degrees in an era with few female researchers, Kelsey resisted intense pressure from Merrell Pharmaceutical and spent nineteen months demanding solid evidence of the drug’s safety. Her unwavering stance not only kept thalidomide off the U.S. market but also spurred sweeping reforms in drug regulation through the 1962 Drug Amendment, which established modern clinical trials, informed consent, and stronger FDA oversight. Drawing on archival records and family papers, the book reveals her lifelong commitment to ethical science, her battles against industry hostility and institutional barriers, and her enduring legacy as a vigilant protector of public health.

Read more.

Explore our extended list of titles on Bookshop (UK | US) and Amazon (UK | US).

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The truth about the microbiome: what’s real and what isn’t?

What’s really happening with those microbes inside us? Are we really superorganisms or is it all hype? Dr Berenice Langdon reveals the truth about the microbiome.

Does ‘microbiome’ mean our friendly gut bacteria?

Yes, sort of. Many people are aware that the term ‘microbiome’ refers to ‘friendly gut bacteria’. But ‘microbiome’ also refers to all the microbes or germs inside us. These are mainly bacteria – but they also include fungi, viruses, and many others. The word ‘microbiome’ also refers to where these microbes are: the ‘biome’ part of the word. They couldbe in our gut, or on our skin but a microbiome can also refer to much bigger locations outside the body: the microbiome of a forest, even an ocean.

And going back to the human gut; are these microbes friendly? Well, some are and some aren’t. Like all best buddies, sometimes even the ‘friendly’ ones can be awkward sometimes.

Is it true that our microbiome helps protect us from infections?

We know that if we take antibiotics, they can reduce our gut microbiome, and we can get a diarrhoea infection moving into our gut. On the other hand, we know that the microbiome is mainly made up of bacteria, and bacteria often cause infections. So does our microbiome protect us from infections, or does it cause infections?

The answer is a little bit of both. Our gut microbiome is usually made up of benign bacteria, the sort that don’t cause us harm. These benign bacteria keep the ‘baddy bacteria’, the pathogens, out of the gut. They do this either by outcompeting the bad bacteria, or by making the gut a bit too acidic for the bad bacteria to grow. In this way we can see that the gut microbiome is helping us, just a bit, to avoid gastrointestinal infections.

On the other hand, if our ‘friendly’ gut bacteria happen to get out of our guts and into the wrong place—like our blood stream or our brain—even though these bacteria are generally benign and friendly, they can cause a very serious infection.

Is it true that probiotics are live microorganisms that improve our health?

We know that probiotics are live microorganisms. This is part of their definition, and the idea is that taking them is meant to improve our health in some way. It’s the ‘improve our health’ part that’s difficult to prove.

Scientists have been testing probiotics for decades to determine if they have an effect on our health. They’ve tested their effect on all sorts of medical conditions, including constipation, diarrhoea, ulcerative colitis, and irritable bowel syndrome, as well as other non-gut related conditions such as Parkinson’s and autism. So far, however, there’s no evidence to show that probiotics help any of these conditions. The American Gastroenterological Society mainly does not recommend taking probiotics except as part of a research trial.

Many probiotics currently on the market contain bacteria that are found in our food anyway (in yoghurt, for example), or in fact, are already inside us. Some probiotic packaging even says so itself: contains live microorganisms that naturally exist in the body.

If probiotics don’t do much, are they at least safe? The answer for most people is: yes, probably. The bacteria that make up probiotics are usually fairly benign and don’t usually try and attack us.

But for people who are very ill or in intensive care, probiotics are not recommended. Research shows that probiotics can translocate from the gut to the blood stream. Once in the wrong place—just like the microbes in our gut microbiome—probiotics can cause life threatening infections or even death.

Is it true that a microbiome is essential for survival?

Amazingly, the microbiome is not essential for survival for all sorts of animals including rats, mice, guinea pigs, chickens, flies, and even fish. All of these creatures have been successfully raised without a microbiome. Even more amazingly, this isn’t new. Scientists have been doing this for over a hundred years. It’s absolutely possible for certain animals to survive just fine without a microbiome, and even have babies. This is a fascinating field of research, and these animals are sometimes known as gnotobiotic animals or germ-free animals.

However, it is true that herbivores can’t survive without a microbiome. They are dependent on gut microbes to help them ferment grass or foliage and extract the necessary calories. Herbivores really couldn’t survive without a microbiome.

Is it true that fermented foods and drinks are healthy?

We know that not all fermented foods and drinks are healthy and interestingly, not all fermented foods and drinks have microbes in their final product. Alcohol is an obvious example of this; a fermented drink with known health risks and also one in which the final product contains no microbes whatsoever. Other popular fermented products such as soy sauce are full of salt and are also clearly not universally healthy, while the acid contained in the very popular fermented product cider vinegar can dissolve our teeth and is a known cause of oesophagitis.

However, we still love fermented foods. Fermentation often makes foods taste great and helps us preserve our food. So, while there are certain benefits to fermented food and drink in terms of food production and preservation, overall fermentation doesn’t automatically make foods healthy.

Is it true that we need to pay attention to our diets to improve our microbiomes?

We should of course pay attention to our diet, by not eating too much, having a varied diet and including plenty of fibre, as this is the route to good health. But from a microbiome point of view, the bacteria in our guts don’t need much help.

Our colon typically contains a quadrillion bacteria per ml or 1,000,000,000,000 – a mind-blowingly large number. We also have a wide variety of bacteria inside us, constantly changing minute by minute. We obtain these effortlessly from the bacteria that coat the outside of our foods – even those foods we think of as ‘clean’ like bread and fruit as well as the bacteria naturally found within certain fermented foods mentioned above.

A wide variety of bacteria in our gut is regarded by some as a mark of health and is easily achieved by eating a wide variety of foods and by daily contact with each other, with the outside world, and with nature.

Is it true that together with our microbiomes we are superorganisms?

No, this is not true. Together with our microbiomes we are not superorganisms. While microbes do help us a bit—helping us digest a little bit more food, avoiding certain infections—they also cause us a lot of work, as we have to protect ourselves from them and avoid infections. It is not a universally positive relationship.

But ultimately, we are not superorganisms simply because we do not evolve as one unit. Microbes evolve inside us at a vastly faster rate than we do. And we evolve slowly, evolving protective mechanisms against the microbes, but making use of them when we can.

^{Featured image by the National Institute of Allergy and Infectious Diseases via Unsplash.}

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Rethinking nuclear

As someone who has spent decades studying the evolution of nuclear energy, I’ve seen its emergence as a promising transformative technology, its stagnation as a consequence of dramatic accidents and its current re-emergence as a potential solution to the challenges of global warming.

While the issues of global warming and sustainable energy strategies are among the most consequential in today’s society, it is difficult to find objective sources that elucidate these topics. Discourse on this subject is often positioned at one or another polemical extreme. Further complicating the flow of objective information is the involvement of advocates of vested interests as seen in the lobbying efforts of the coal, gas and oil industries. My goal has been to present nuclear energy’s potential role in a sustainable energy future—alongside renewables like wind and solar—without ideological baggage.

An additional hurdle that must be overcome in dealing with the pros and cons of nuclear energy is the psychological context in which fear of nuclear weapons and of radiation impedes rational analysis. The deep antipathy to nuclear phenomena is illustrated by what might be called the “Godzilla Complex” that developed after the crew of the Japanese fishing boat, the Lucky Dragon 5, was exposed to heavy radiation from a nuclear weapons test in 1954. Godzilla was conceived as a monster that emerged from the depths of the ocean due to radiation exposure. It has become an enduring concept that has been portrayed in nearly forty films in the United States and Japan and in numerous video games, novels, comic books and television shows.

It is not surprising that fear of nuclear reactor radiation has been widespread. In spite of the fact that there are no documented deaths due to nuclear reactor waste (in contrast to deaths from accidents), it is widely assumed that nuclear reactor waste is quite dangerous. In contrast, the fact that premature deaths attributable to the fossil-fuel component of air pollution worldwide exceeds more than 5 million annually generates little concern. Similarly, the total waste produced from nuclear energy can be stored on one acre in a building 50 feet high, whereas for every tonne of coal that is mined, 880 pounds of waste material remain. Furthermore, this waste contains toxic components. Yet public concern for nuclear waste clearly overshadows that for coal, despite these contrasting impacts.

After an in-depth review of the most significant nuclear accidents and recognition of the deep psychological antipathy to nuclear energy, I’ve become increasingly interested in the emergence of an international effort to develop safe, cost-effective nuclear energy known as the Generation IV Nuclear Initiative. This began in 2000 with nine participating countries and has since grown substantially.

In the early years, the Generation IV Nuclear Initiative took a systematic approach to identify reactor designs that could meet demanding criteria—including the key characteristic of being “fail safe”. Rather than depending upon add-on safety apparatus, “fail safe” designs rely on the laws of nature—such as gravity and fluid flow—to provide cooling in the event that the reactor overheats. Another high priority design feature is modular construction, allowing multiple units to be constructed in a timely and economical fashion.

After reviewing dozens of options, the Generation IV Nuclear Initiative settled on six designs that it found to be the most attainable and desirable. Since its initial efforts, countries that have embraced the goals of the Generation IV Nuclear Initiative have been pursuing additional designs including reactors that range in size from quite small to about one third the size of the typical one megawatt reactor.

In my book, I’ve focused my attention on four promising designs. These four designs eschew the vulnerabilities of using water as a coolant that proved so devastating at Chernobyl and Fukushima. The explosion at Chernobyl was due to steam and the three explosions at Fukushima were due to hydrogen gas that resulted from oxidation of fuel rods by overheated water. These were not nuclear explosions. Instead, the four designs I’ve highlighted use liquid sodium, liquid lead, molten salts and helium gas as coolants. Liquid sodium and liquid lead cooled reactors are operating successfully in Russia, while China incorporated a gas cooled reactor into its grid in 2023. In the United States, Kairos Power is constructing a molten salt cooled reactor, while the TerraPower company (founded by Bill Gates) has broken ground on construction of a sodium cooled reactor in Kemmerer, Wyoming. These are intended to be models for replacing coal fired power plants with Generation IV nuclear plants. Multiple implementations of this approach are planned through the early 2030s.

Given the world-wide interest in Generation IV reactor development and the many initiatives that are being pursued, it is likely that at least some of these projects will come to fruition in the near future. While success is not guaranteed, there is clearly a need for the general public and students to be kept informed of progress leading up to 2030 and beyond.

To help bridge the knowledge gap in this rapidly evolving domain, I’ve launched a newsletter on Substack called “Nuclear Tomorrow.” It’s written for anyone concerned with the intersection of public policy, energy generation, and its impact on global warming. I hope it serves as a resource for those seeking clarity in a complex and consequential field.

^{Feature image: nuclear power plant via Pixabay.}

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What all parents need to know to support their teens in college

With the semester well underway, your college student is probably juggling a lot—classes, homework, exams, and writing assignments—all while managing friendships, jobs, and other responsibilities. This balancing act can be tough for any young adult, but it’s often especially challenging for students with ADHD. In high school, your teen may have benefitted from built-in structure and support systems (e.g., teachers, parents) that helped them stay on track and meet their goals. In college, those supports tend to fade, leaving students to navigate much more on their own.

As a parent, you can play an important role in helping your student adjust to these new demands. Sometimes this means offering a little extra “scaffolding”—gentle support and guidance—to help them build the skills they need to thrive on their own. That’s exactly why I wrote Mastering the Transition to College: The Ultimate Guidebook for Parents of Teens with ADHD. It’s packed with practical information and strategies to help you and your teen navigate these years successfully. This blog post offers a first look at some of those tips, so you’ll have tools ready if your student starts to struggle, academically or otherwise, this semester.

1. Communication and collaboration are key. You probably know from the high school years that giving unsolicited advice to your teen can backfire. Pushing too hard often leads to resistance. Instead, try to use a calm, collaborative tone. Let your teen know you’re there to support and guide them, but that they are in control of their own decisions. Approaching conversations this way helps your teen feel respected and more open to brainstorming solutions with you.
2. Set goals. Before you can help your teen make changes, it’s important to first understand what they want. Ask about their goals, not just in academics, but in all areas of their life that matter to them. Once you know their priorities, you can work together to map out what steps are needed to get there. This also makes it easier to guide them without feeling like you’re imposing. Some of these steps may be addressed in the tips below.
3. Help your teen establish an organizational system. This may sound obvious, but it’s incredibly powerful: having a clear system to track tasks and deadlines is a game changer. Encourage your teen to choose a system that works for them. It could be a paper planner, a phone app, or a calendar on their laptop. The key is sustainability, so expect some trial and error as they experiment. Whatever they choose, the idea is that the system should be sustainable. The goal is to help them feel in control of their time, not overwhelmed by it.
4. Encourage your teen to develop a system for completing tasks. College life means that the to-do list is rarely empty. Your teen may feel as if their tasks are never-ending… as one is completed, another is added to the list. Therefore, developing a method for triaging what needs to get completed and by when will be crucial. An approach that balances what is important vs. what is urgent is often a good place to start.
5. Discuss all available campus resources with your teen. College campuses offer a lot of support to help your teen succeed. However, students (and parents) often find it difficult to know what resources are available and how to access them. Resources may be academic in nature (e.g., tutoring, office hours, advising, academic accommodations, writing center), mental health related (e.g., student health center, counseling center, skills groups), or logistical (e.g., career services, resident assistants). Knowing what resources to use, when, and how to access them will be essential for ensuring a successful college career. Further, if your teen needs more support than your conversations with them or my book can provide, finding a licensed professional may be a helpful next step. Outside help can be an important part of your teen achieving success.

I hope these tips provide you with a solid starting point in supporting your teen with the transition to and through college. For even more guidance and detailed advice as to how to implement these strategies, check out my book Mastering the Transition to College: The Ultimate Guidebook for Parents of Teens with ADHD.

^{Feature image: photo by Joshua Hoehne via Unsplash.}

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Open Access Week: Nothing about me, without me

In a 2011 speech about shared decision making in healthcare, the UK Secretary of State, Andrew Lansley, coined the phrase “nothing about me, without me”. Used at the time to summarise efforts to empower patients in decisions about their care, the phrase has since been borrowed by advocates and activists on a range of social justice topics.

This year’s Open Access Week poses the question: “How, in a time of disruption, can communities reassert control over the knowledge they produce?” Here at OUP, we were inspired to delve into our open access publishing for examples of research that doesn’t just study communities, but actively involves them. From shaping research questions to guiding implementation, these projects center the voices and experiences of the people at their heart. This commitment to community-led knowledge creation isn’t limited to the articles themselves. It’s reflected in the editorial policies, peer review practices, and team structures that support our journals—ensuring that open access is not just about availability, but about equity and inclusion in research and publishing processes:

• Our Editors and authors publishing with Oxford Open Immunology use the Sex and Gender Equity in Research (SAGER) Guidelines to promote reporting of sex- and gender dimensions in research.
• The European Journal of Public Health is one example of a publication creating space for the promotion of the CARE Principles for Indigenous Data Governance, supporting the ability of Indigenous Peoples to control the use and application of Indigenous Knowledge and data for collective benefit.
• Many of our journals, Nucleic Acids Research included, utilise Early Career Boards to ensure their publications are managed in a way that serves the next generation of researchers and provides those earlier in their careers with experience contributing to journal development.
• Health Promotion International has created a special collection of research on participatory approaches in health promotion.
• Oxford Open Immunology has an open call for papers promoting the use of patient knowledge in research literature.
• JNCI: Journal of the National Cancer Institute and JNCI Cancer Spectrum are committed to supporting and advancing diversity, equity, and inclusion in editorial practices and published content. Recognizing that many populations have been systematically excluded from scholarly publishing, the journals have several initiatives strengthening diversity.

From participatory research approaches to elder care, to self-determination paths for trans and gender diverse people, to rural ownership of businesses in areas of high tourism, and citizen empowerment during energy transitions – our open access publishing is full of examples of the benefits of including people in the process of generating knowledge about them. All articles included here are published with an open access license, ensuring peer-reviewed, trusted knowledge and diverse voices can reach everyone, anywhere in the world:

Diversity in Health Interventions

Self-determination and self-affirmative paths of trans* and gender diverse people in Portugal: Diverse identities and healthcare by C Moleiro et al, European Journal of Public Health

Counting everyone: evidence for inclusive measures of disability in federal surveys by Jean P Hall et al, Health Affairs Scholar

Creating inclusive communities for LGBTQ residents and staff in faith-based assisted living communities by Carey Candrian, Innovation in Aging

Developing a co-designed, culturally responsive physical activity program for Pasifika communities in Western Sydney, Australia by Oscar Lederman et al, Health Promotion International

Co-creating a Mpox Elimination Campaign in the WHO European Region: The Central Role of Affected Communities by Leonardo Palumbo et al, Open Forum Infectious Diseases

Participatory development of a community mental wellbeing support package for people affected by skin neglected tropical diseases in the Kasai province, Democratic Republic of Congo by Motto Nganda et al, International Health

Inclusive Digital Health Strategies

The ATIPAN project: a community-based digital health strategy toward UHC by Pia Regina Fatima C Zamora et al, Oxford Open Digital Health

From disease specific to universal health coverage in Lesotho: successes and challenges encountered in Lesotho’s digital health journey by Monaheng Maoeng et al, Oxford Open Digital Health

Implementing an inclusive digital health ecosystem for healthy aging: a case study on project SingaporeWALK by Edmund Wei Jian Lee PhD et al, JAMIA Open

Developing the BornFyne prenatal management system version 2.0: a mixed method community participatory approach to digital health for reproductive maternal health by Miriam Nkangu et al, Oxford Open Digital Health

Equitable Energy Transitions

Energy communities—lessons learnt, challenges, and policy recommendations by L Neij et al, Oxford Open Energy

Solar-Powered Community Art Workshops for Energy Justice: New Directions for the Public Humanities by Anne Pasek et al, ISLE: Interdisciplinary Studies in Literature and Environment

Community participation and the viability of decentralized renewable energy systems: evidence from a hybrid mini-grid in rural South Africa by Mahali Elizabeth Lesala et al, Oxford Open Energy

Quantifying energy transition vulnerability helps more just and inclusive decarbonization by Yifan Shen et al, PNAS Nexus

Renewable energy and energy justice in the Middle East: international human rights, environmental and climate change law and policy perspectives by A F M Maniruzzaman et al, The Journal of World Energy Law & Business

Protecting Local Cultures

Enriching Cultural Heritage Communities: New Tools and Technologies by Alan Dix et al, Interacting with Computers

A framework for tourism value chain ownership in rural communities by Michael Chambwe et al, Community Development Journal

Local government engagement practices and Indigenous interventions: Learning to listen to Indigenous voices by Christine Helen Elers et al, Human Communication Research

The strengths, gender, and place framework: a new tool for assessing community engagement by Justin See et al, Community Development Journal

^{Featured image by Mareike Mgwelo via Pexels.}

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5 books to master your transition to college [reading list]

As the days get cooler and autumn approaches, it’s the perfect time for a fresh start. Back to school is here. Whether your teen is heading off for another year at college or just beginning the transition, we’ve curated a selection of helpful guides to make the journey smoother. These titles are perfect companions for navigating this exciting new chapter.

Mastering the Transition to College: The Ultimate Guidebook for Parents of Teens With ADHD

Sending a teen off to college is a thrilling milestone, but for parents and caregivers of teens with ADHD, it can also bring unique challenges. Mastering the Transition to College is designed to ease those concerns by offering expert advice, practical strategies, and proven tools to help teens thrive both academically and emotionally during this transition.

Learn more about Mastering the Transition to College by Michael C. Meinzer

College Mental Health 101: A Guide for Students, Parents, and Professionals 

College Mental Health 101 offers more answers, relief, resources, and research backed information for families, students, and staff already at college or beginning the application process. With simple charts and facts, informal self-assessments, quick tips for students and those who support them, the book includes hundreds of voices addressing common concerns.

Learn more about College Mental Health 101 by Christopher Willard, Blaise Aguirre, and Chelsie Green

Supporting Your Teen’s Mental Health: Science-Based Parenting Strategies for Repairing Relationships and Helping Young People Thrive

Teen mental health issues are rising at an alarming rate, and many families are unsure of how to best help their children. Supporting Your Teen’s Mental Health is an essential resource for parents and caregivers looking to support teenagers who are struggling with mental health concerns. Written in a conversational tone by psychologist and fellow parent Andrea Temkin-Yu, the workbook is a thorough, evidence-based guide to essential parenting strategies that have been proven to help improve relationships and behavior.

Learn more about Supporting Your Teen’s Mental Health by Andrea Temkin-Yu

If Your Adolescent Has Autism: An Essential Resource for Parents 

While adolescence can be a tough time for parents and their teens, autistic teenagers may face specific challenges and need targeted support from the adults in their lives. The road ahead can be difficult for parents and caregivers, too, especially because the teenage years can involve surprising changes in their child and in society’s expectations of them.

Learn more about If Your Adolescent Has Autism by Emily J. Willingham

The Parents’ Guide to Psychological First Aid: Helping Children and Adolescents Cope With Predictable Life Crises 

Just as parents can expect their children to encounter physical bumps, bruises, and injuries along the road to adulthood, emotional distress is also an unavoidable part of growing up. The sources of this distress range from toddlerhood to young adulthood, from the frustration of toilet training to the uncertainty of leaving home for the first time. 

Learn more about The Parents’ Guide to Psychological First Aid edited by Gerald P. Koocher, Annette M. La Greca, Olivia Moorehead-Slaughter, and Nadja N. Lopez 

Check out these books and more on Bookshop and Amazon.

_{Featured image by Tanja Tepavac via Unsplash.}

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Back to school for happy and healthy kids

Every September, caregivers and kids alike prepare for one big change: the start of a new school year. As the weeks of summer draw to a close, families are cramming in the last moments of summer fun while simultaneously gearing up for school drops offs and new classroom schedules. While it can be an incredibly exciting time, filled with first day of school outfits and new school gear, it can also be incredibly stressful. This can be particularly true for teenagers who, compared to younger kids, are facing higher academic demands and social pressure while experiencing the major physical and developmental changes that come during adolescence. On top of that, a 2023 Center of Disease Control report showed that teens of today have higher rates of mental health concerns, such as anxiety and depression, and that suicidal thoughts and behaviors are increasing. This can make the return to school daunting for teens, as well as parents who are worried about how their child will manage the transition and demands of the year. 

Fortunately, there are several tools that parents and caregivers can use to prepare kids and teens for the first few weeks in September. This includes setting clear expectations, skills to encourage helpful behavior, and strategies that help kids feel supported by their parents.  

Setting expectations 

While many kids prefer to keep their heads in the sand when it comes to a new academic cycle, it can be incredibly helpful to set expectations for the school year a few weeks in advance. The most basic version of this includes outlining differences between summer versus school schedules, such as changes to sleep and wake times, limits to screens, or daily responsibilities. This preview can help kids’ brains prepare for the upcoming shifts in their daily lives and make the transition a little smoother. It’s also a great idea to talk to kids about how the upcoming school year might be different than the last one. This could include providing information on class size, the structure of the day, or increased expectations. The goal is not to scare your kids about everything coming their way, but rather to provide them with simple clear information in a manner that builds excitement. For example, “It’s so fun that you get to go to go off-campus for lunch this year. I bet it will make the day feel way more interesting!” Or, “I know high school is bigger than middle school. It may feel a little overwhelming, but it’s also such a great time for you to see how capable you are.”  

Encouraging positive behaviors 

Once expectations have been set, parents can also work to encourage brave or skillful behavior. This may include things like taking more responsibility (e.g., managing their own communication with teachers and coaches), growing outside of their comfort zone (e.g., joining a new club or social circle), or challenging themselves with new opportunities or roles (e.g., a first job or harder courseload). This most effective way to do this is through a skill called “labeled praise.”  

Labeled praise is when you show appreciation for a specific behavior or characteristic your child is demonstrating. When it comes to a new school year, parents can look for opportunities to praise preparation, flexibility, and bravery. For example, “I know you really loved your teachers last year, and I appreciate how openminded you are about your new schedule.” Another parent may say, “Great call on getting to bed a little earlier this week. It’ll make the start of school so much easier!” For teens who haven’t mastered brave or skillful choices, parents can offer cheerleading and encouragement. Phrases like “I know you’re going to do a beautiful job making friends because you’ve done it before!” or “10^th grade is tough, and I have total confidence that you’re going to find a way to balance everything” send a message that they really believe in their kid. This can go a long way towards encouraging positive behaviors.   

Providing validation 

When you do notice your child having a hard time, whether it’s nerves, low mood, or difficulty organizing themselves for a new semester, it’s always a great idea to offer validation. Validation is a skill used to show somebody that you can see their perspective or understand where they are coming from. Validation can be a tricky skill to master for caregivers because it is sometimes hard to put yourself in your child’s shoes, or you are eager to get them to see a new perspective. For example, when your child complains about their new math teacher who they have heard is a hard grader, it’s tempting to say “Nah! I’m sure it’ll be fine!” This may work for some kids. However, it can come off as dismissive and hard to believe for a teen whose anxiety or stress is high. Instead, try validation: “It makes sense that you’re nervous based on what you’ve heard!” While you aren’t agreeing with your child’s worries, you are acknowledging them, and that can help increase a sense of connection and communication. Once your child feels understood, they’ll be better able to think clearly about the situation and problem solve as needed.  

As you navigate another year of permission slips, homework, and extracurricular activities, remember that you have a handful of tools in your pocket to help ease the way. With a little bit of preparation, encouragement, and support, you and child can start the school year off on a great foot.  

^{Feature image: Photo by Wajih Ghali on Unsplash.}

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Caring fish dads evolved prostates faster

Animals caring for their young, such as a lioness carrying her cub by their scruff or a matriarchal elephant herd nursing young calves, are the kinds of behavior that many would pay good money to watch on a safari. However, fish, especially father fish, caring for their young has received limited popular attention, except maybe for the clownfish father-son duo featured in Finding Nemo. Findings published in the recent article “Parental care drives the evolution of male reproductive accessory glands across ray-finned fishes” in the journal Evolution by a group of scientists in Canada shed new light on the evolution of fish paternal care. Lucas Eckert (McGill University), along with his co-advisors Ben Bolker and Sigal Balshine (both at McMaster University) and their co-authors Jessica Miller and John Fitzpatrick, show that, among ray-finned fish, species in which fathers look after young evolved reproductive accessory organs six times faster than those without male care.

Ray-finned fish, bony fish with webbed fins supported by thin, long rays of bone, represent the vast majority of known fish species. Some of these species have reproductive accessory organs, which are parts analogous to prostate glands in humans. These organs are not directly involved in producing gametes, but they optimize reproductive potential through functions such as sperm storage and nourishment. They also produce fluids that increase the ability of sperm to move and fertilize eggs. Research on how these glands evolved has focused mostly on mammals and insects, with little known about their evolution in fish.

“Accessory reproductive glands are a bit of a ‘mystery organ’ when it comes to fish”, says Dr. Sigal Balshine, fish behavioral ecologist and co-principal investigator of this study. “Some fish have them while some don’t have them at all. We know of their existence only in a very few species out of nearly 30,000 fish species in the world. Even when they are present, accessory reproductive glands show bizarre diversity which has always made me think that there must be interesting evolutionary drivers shaping them. There was a lot we didn’t know regarding how or when they evolved, which is why we started collecting data on them”.

In certain groups of animals, sperms of multiple males compete to fertilize the eggs of a single female, a scenario known as sperm competition. Accessory glands produce secretions that enhance sperm performance, and scientists have long believed that they evolved as a weapon to aid in this post-copulatory war in organisms such as rodents and insects. Most fish biologists assumed fish reproductive accessory glands followed the same evolutionary trend. However, in their study, Eckert and colleagues shift the focus away from sperm competition towards parental care. These authors reconstruct the evolutionary history of reproductive accessory organs, testing whether parental care and/or mate competition among males contributed to their evolution.

“There was evidence that these organs were super important in the species that have them, in securing reproductive success and fitness through a variety of functions. In that context, when some species have them and some don’t, the most obvious question was what were the drivers that selected for their evolution in the first place.” says Lucas Eckert, PhD student and lead author of the study, and one of the many students who have been collecting these data since 2017.

The team approaches this question using a quantitative synthesis of phylogenetic, morphological, and behavioral trait data of ray-finned fish collected from published databases. A plethora of published research data is available on reproductive traits of fishes, owing to their remarkable diversity in reproductive organs and behaviors. However, previous studies mostly only describe these traits, without formally testing any hypotheses regarding their evolution. In this study, the authors compile reproductive trait data for over 600 fish species from research conducted over many decades, to quantify the influence that sperm competition and parental care have had in shaping the accessory glands.

In this study, we have been able to put existing data and methods together in ways that they have not been connected before”, says Dr. Ben Bolker, mathematical biologist and co-principal investigator of the study. “This study has been able to find ways to ask the question and find, how much sperm competition and parental care contribute to the evolution of accessory reproductive organs of ray-finned fish, rather than ask what exactly caused accessory glands to evolve, because in biology everything does everything”.

The special benefits accessory glands provide male fish for improving their reproductive success explains why they evolved faster in species with paternal care. Unlike in many other animal groups where mothers take care of their young, when it comes to fish, that duty was most commonly delegated to fathers by evolution: they had the resources to maximize the survival of fertilized eggs, such as territory, security and nutrition. Accessory glands produce secretions that protect fertilized eggs against microbial infections and increase sperm adhesiveness and the viable period of sperm after release. These secretions allow these stay-at-home fish dads to multi-task in keeping their sperm viable for newly spawning females even while taking care of their young and defending their nests.

Though the evolution of accessory glands is traditionally thought to be driven by sperm competition, this study uncovers a new angle on drivers of fish accessory gland evolution by considering parental care behaviors. The authors hope that these results will encourage researchers to take a closer look at these mysterious glands and consider their potential importance in the species that possess them.

^{Featured image: Goby eggs by Olivier Dugornay, via Wikimedia Commons (CC BY 4.0).}

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A snapshot of genomics and bioinformatics in modern biology research

I often tell my students that biology has become a data-driven field. Certainly, there’s a general sense that methods related to biological sequences (that is methods in genomics and bioinformatics) have become very widespread. But what does that really mean?

To put a little flesh on those bones, I decided to look in detail at all the biology-related articles in a single issue of the journal Nature (issue 8069, the one that was current when I started). I’m focusing here on articles, representing novel peer reviewed research. By my count, 16 of the 26 papers in this issue are related to biology in one way or another. (Those 16 also include neuroscience and bio-engineering related papers).

For each of these articles I went through the methods looking for genomics and bioinformatics related approaches. I sorted what I found into a few categories. Here’s a short summary:

• Four of the papers (25%) used high throughput DNA sequencing.
• Four were doing phylogenetic reconstruction. (Two of these were doing both phylogenetic reconstruction and sequencing).
• Four were doing RNA seq, that is high throughput sequencing of RNA to study gene expression.
• Five used computational methods of sequence analysis (e.g. alignment or its derivatives).
• My “other high throughput methods” category also contained five papers.

Considering all high throughput sequence-related methods together, I found that 10/16 papers fell into at least one of these categories. That is, just over 60% of biology papers in this issue were using one or another such method. Which is to say, these methods really are very common in modern research.

The papers in issue 8069 used these methods to study a huge diversity of questions. One paper used sequencing based approaches to better characterize variation in the pea plant studied by Gregor Mendel, using this to get insights into the basis of several of his traits (which had not previously been known). Another looked at deep phylogenetic relationships among eukaryotes. Still another compared patterns of methylation during development between eutherian and marsupial mammals. I could go on, but the message is that genomics and bioinformatics are used to answer many different kinds of questions.

The take-away is that these are foundational methods for modern biology. As such they should be basic training for any student interested in continuing with research in the biological sciences. This is not only so students can conduct research on their own, but also so they can understand papers they read in a deeper and more sophisticated way.

In our recent second edition of the book Concepts in Bioinformatics and Genomics, we try to balance biology, mathematics and programming, as well as build knowledge from the ground up. Topics range from RNA-Seq and genome-wide association studies to alignment and phylogenetic reconstruction. Our hope is that this approach will help students understand the research they encounter on a deeper level and prepare them to potentially participate in that enterprise.

^{Featured image: by CI Photos via ShutterStock.}

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Knowledge and teaching in the age of information

The advent of the World Wide Web in the turn of the last century completely transformed the way most people find and absorb information. Rather than a world in which information is stored in books or housed in libraries, we have a world where all of the information in the world is accessible to everyone via computers, and in the last decade or so, via their handheld mobile device. The young people currently in university or in school grew up in a world where information is not privileged and immediate access to all of it is taken for granted. In this age of immediate and readily accessible information on any subject, we must ask: What is the role of academic institutions in teaching? If anyone can find out anything at any time, why learn anything? Is there any value to knowledge in its own right?

The answer is that of course teaching and learning are still important, but they must change to reflect the way information is accessed. The fact is that information on its own is useless without a contextual framework. It may be possible to easily find a detailed account of all of the units and commanders that participated in the Battle of Regensburg in 1809, but if the reader has no understanding of military history, and no background on the politics leading to the Napoleonic wars, this information is no different from a shopping list. Similarly, it may be possible to find detailed information on the excretory system of annelid worms, but without an understanding of what excretory systems are and what their role is in the organism, and without a knowledge of the biology and evolution of annelid worms, this information is no more than a list of incoherent technical terms.

These two very different examples serve to highlight the difference between information and knowledge. Possessing knowledge about a subject means being able to place information into a broad framework and context. People who are knowledgeable about the Napoleonic wars do not necessarily know the names of every commander of every unit in the Battle of Regensburg, but if they need this information, they can access it and use it better than someone with no knowledge. A comparative zoologist may not know all the details about annelid excretory systems, but when needed, they will know what to look for.

With this distinction in mind, I suggest that teaching and textbooks need to shift their focus from transferring information to transferring knowledge. No textbook can compete with the wealth of information available at the students’ fingertips. No course can ever impart all that there is to know about a subject. However, a good teacher and a well-written textbook can provide a much better framework for knowledge and understanding than a search engine will ever be able to. Indeed, a course or module that overburdens the students with numerous bits of information is not only a misuse of resources, it is ultimately counter-productive, as the student will always be able to challenge the teacher with a new bit of information not included in the course.

Teaching in the age of information should focus on providing a working vocabulary of a subject and on building a robust framework of knowledge. Detailed examples can be used to demonstrate principles, but this should be done sparingly. The curious students can then fill in the details on their own, taking advantage of the information at their fingertips.

I have been following these principles in my teaching of evolution and organismic biology for as long as I have been a university professor. My frustration at the details-heavy zoology textbooks led me to write a new textbook, focusing on principles and on providing a conceptual framework to organismic biology, rather than on details. For example, I have written a chapter on excretory systems that outlines what the roles and functions of this system are, and gives a few demonstrative examples of how these functions are manifested in a small number of organisms. I have included similar chapters on other systems interspersed with chapters on individual animal phyla, which give an overview of the phylum and its diversity, and present the specific variations within each of the organ systems, and how these are adapted to the life history of members of the phylum.

As we and our students continue to have easier and more readily available access to information, this new approach will provide a more successful framework for students to continue to grow and learn as they step out into the world. Hopefully this approach will be picked up by authors of additional textbooks to provide a new generation of teaching resources, more suitable for the age of information.

^{Feature image credit: Ilya Lukichev via iStock.}

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Quantum information theorists use Einstein’s Principle to solve “Einstein’s quantum riddle”

Albert Einstein, Boris Podolsky, and Nathan Rosen introduced the mystery of quantum entanglement (entanglement) in 1935 and it has been called “Einstein’s quantum riddle.” Many physicists and philosophers in foundations of quantum mechanics (foundations) have proposed solutions to Einstein’s quantum riddle, but no solution has received consensus support, which has led some to call entanglement “the greatest mystery in physics.” There is good reason for this 90-year morass, but there is also good reason to believe that a recent solution using quantum information theory will end it in ironic fashion.

Simply put, entanglement is one way that quantum particles produce correlated measurement outcomes. For example, when you measure an electron’s spin in any direction of space you get one of two outcomes, i.e. spin “up” or spin “down” relative to that direction. When two electrons are entangled with respect to spin and you measure those spins in the same direction, you get correlated outcomes, e.g. if one electron has spin “up” in that direction, then the other electron will have spin “down” in that direction. Einstein believed this was simply the result of the electrons having opposite spins when they were emitted from the same source, so this was not mysterious. For example, if I put two gloves from the same pair into two boxes and have two different people open the boxes to “measure” their handedness, one person will find a left-hand glove and the other person will find a right-hand glove. No mystery there. The alternative (which some in foundations believe) is that the electron spin is not determined until it is measured. That would be like saying each glove isn’t a right-hand or left-hand glove until its box is opened. No one believes that about gloves! So, Einstein argued, if you believe that about electron spin, then explain how each electron of the entangled pair produces a spin outcome at measurement such that the electrons always give opposite results in the same direction. What if those electrons were millions of miles apart? How would they signal each other instantly over such a great distance to coordinate their outcomes? Einstein derided that as “spooky actions at a distance” and instead believed the spin of an electron is an objective fact like the handedness of a glove. No one knew how to test Einstein’s belief until nine years after his death, when John Bell showed how it could be done.

In 1964, Bell published a paper that tells us if you measure the entangled electron spins in the same direction, you can’t discern if Einstein was right or “spooky actions” was right. But if you measure the spins in certain different directions, then quantum mechanics predicts correlation rates that differ from Einstein’s prediction. In 1972, John Clauser (with Stuart Freedman) carried out Bell’s proposed experiment and discovered that quantum mechanics was right. Apparently, “spooky actions at a distance” is a fact about reality. Later, Alain Aspect and Anton Zeilinger produced improved versions of the experiment and, in 2022, the three shared the Nobel Prize in Physics for their work.

Given these facts, you might think that the issue is settled—quantum mechanics is simply telling us that reality is “nonlocal” (contains “spooky actions at a distance”), so what’s the problem? The problem is that if instantaneous signaling (nonlocality) exists, then you can show that reality harbors a preferred reference frame. This is at odds with the relativity principle, i.e. the laws of physics are the same in all inertial reference frames (no preferred reference frame), which lies at the heart of Einstein’s theory of special relativity. In 1600, Galileo used the relativity principle to argue against the reigning belief that Earth is the center of the universe, thereby occupying a preferred reference frame, and, in 1687, Newton used Galileo’s argument to produce his laws of motion.

Physicists loathe the idea of abandoning the relativity principle and returning to a view of reality like that of geocentricism. So in order to save locality, some in foundations have proposed violations of statistical independence instead, e.g. causes from the future with effects in the present (retrocausality) or causal mechanisms that control how experimentalists choose measurement settings (superdeterminism). But most physicists believe that giving up statistical independence means giving up empirical science as we know it; consequently, there is no consensus solution to Einstein’s quantum riddle. Do we simply have to accept that reality is nonlocal or retrocausal or superdeterministic? Contrary to what appears to be the case, the answer is “no” and the alternative is quite ironic.

The solutions that violate locality or statistical independence assume that reality must be understood via causal mechanisms (“constructive efforts,” per Einstein). This is the exact same bias that led physicists to propose the preferred reference frame of the luminiferous ether in the late nineteenth century to explain the shocking fact that everyone measures the same value for the speed of light c, regardless of their different motions relative to the source. Trying to explain that experimental fact constructively led to a morass, much like today, in foundations and here is where the irony begins—Einstein abandoned his “constructive efforts” to solve that mystery in “principle” fashion. That is, instead of abandoning the relativity principle to explain the observer-independence of c constructively with the ether, he doubled down on the relativity principle. He said the observer-independence of c must be true because of the relativity principle! The argument is simple: Maxwell’s equations predict the value of c, so the relativity principle says c must have the same value in all inertial reference frames to include those in uniform relative motion. He then used the observer-independence of c to derive his theory of special relativity. Today, we still have no constructive alternative to this principle solution to the mystery of the observer-independence of c.

The next step in the ironic solution occurred when quantum information theorists abandoned “constructive efforts” in the exact same way to produce a principle account of quantum mechanics. In the quantum reconstruction program, quantum information theorists showed how quantum mechanics can be derived from an empirical fact called Information Invariance and Continuity, just like Einstein showed that special relativity can be derived from the empirical fact of the observer-independence of c. The ironic solution was completed when we showed how Information Invariance and Continuity entails the observer-independence of h (another constant of nature called Planck’s constant), regardless of the measurement direction relative to the source. Since h is a constant of nature per Planck’s radiation law, the relativity principle says it must be the same in all inertial reference frames to include those related by rotations in space. So, quantum information theorists have solved Einstein’s quantum riddle without invoking nonlocality, retrocausality, or superdeterminism by using Einstein’s beloved relativity principle to justify the observer-independence of h, just as Einstein did for the observer-independence of c.

^{Feature image credit: Jian Fan on iStock.}

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Shining light on sun safety for Sun Awareness Week 2025

Kicking off today, Sun Awareness Week (12-18 May) is the start of the British Association of Dermatologists’ (BAD) summer-long campaign to encourage everyone to protect their skin from sun damage and skin cancer, the most common cancer in the UK.

There are several types of skin cancer, with melanoma and non-melanoma skin cancers being the most common. Melanoma develops from melanocytes, cells in deeper layers of the skin that give skin its colour. Non-melanoma skin cancers, such as basal and squamous cell carcinoma, develop from cells known as keratinocytes found in the outer layer of the skin. Simple steps like using sunscreen, avoiding sun in the middle of the day, wearing sun hats, and reducing the amount of direct sun exposure can lower your risk of both.

Recent research from the BAD journals—British Journal of Dermatology, Clinical and Experimental Dermatology, and Skin Health and Disease—offers new insights into preventing, diagnosing, and treating melanoma and non-melanoma skin cancers. Here are some highlights:

Why sunscreen matters

Using sunscreen every day is one of the best ways to stay safe. The sun gives off ultraviolet (UV) rays that harm your skin and raise skin cancer risk, and regular use of high-SPF sunscreen can protect you. Sunscreen comes in many forms, like creams, lotions, sprays, and sticks. Apply it 15-30 minutes before going outside. Reapply every 2 hours, or after swimming or intense physical activity.

Sunscreen prevents skin cancer and premature ageing (called photoageing), but it’s good to know the facts. A recent narrative review found possible downsides of using sunscreen, like allergic skin reactions and concerns about endocrine disruption. Some ingredients, like preservatives and fragrances, may cause allergic skin reactions, though evidence suggests these reactions are rare. Concerns about hormone effects are low, as sunscreen stays mostly on the skin’s surface.

Photoageing: a key concern

UV rays don’t just increase skin cancer risk—they also age your skin early, causing wrinkles and spots. A recent survey across 17 countries found that people often worry more about photoageing than skin cancer. So, talking about photoageing in sun awareness campaigns could motivate more people to engage in sun protective behaviours.

A digital sun protection campaign for healthcare workers

Researchers from University of Limerick Hospital Group in Ireland tried a new digital campaign to promote skin cancer awareness among hospital staff. Their study found that staff became more positive about sun protective behaviours after the campaign, showing that digital tools could work for everyone in encouraging sun protection.

Better sun habits, better outcomes

Campaigns like Sun Awareness Week make a real difference. A study from Austria found that people who improved their sun protection habits after being diagnosed with melanoma lived longer, showing that these behavioural changes can save lives.

Global melanoma trends

A population-level study across 162 countries found that melanoma diagnoses are rising over time, but death rates are steady or growing slowly. This may be related to improved screening and awareness programs for melanoma. However, this may be compounded by melanoma overdiagnosis, with some cases caught early that may not have been deadly. Researchers are still exploring this complex phenomenon.

Melanoma and gender

Men and women face different melanoma risks. This study from Australia found that, on average, women are often diagnosed with melanoma years earlier than men, especially on the torso and for thinner melanomas. Their findings suggest that sex-tailored approaches to melanoma control could improve prevention and care.

Sun safety policy in primary schools

As per the World Health Organization, school sun protection programmes may be the key to skin cancer prevention. This study carried out an online survey of primary schools in Wales to understand their sun safety policies and practices. Of 471 schools that responded, only 183 enforced their policy. Those who did not have a policy were ‘not aware of the need’ (34.6%); ‘need assistance with policy or procedure development’ (30.3%); or ‘not got around to it just yet’ (26.8%).

Skin cancer and blood cancers

This study in the Netherlands found that patients with blood cancers have a higher risk of developing skin cancers across their lifetime. This means that targeted awareness campaigns for sun protection are vital for this patient population.

Diabetes drugs and skin cancer

In this systematic review, the authors found that drugs for type 2 diabetes, especially metformin, may lower risk of non-melanoma skin cancer. This is good news for people with type 2 diabetes who are worried about developing skin cancer.

This Sun Awareness Week, we are urging everyone to prioritise sun protection to prevent skin cancer and premature skin ageing. Check your skin regularly and see a doctor if you notice any new or changing moles or other skin lesions.

Join the #SunAwarenessWeek conversation and share your sun safety tips! You can explore the latest research from the BAD journals here.

_{Featured image by Kaboompics.com via Pexels.}

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Ultra-processed foods are making us old beyond our years

In recent years, ultra-processed food (UPFs) consumption has surged globally, raising concerns about its impact on health.

Ultra-processed foods are industrial formulations typically containing ingredients not commonly used in home cooking, such as hydrogenated oils, high-fructose corn syrup, flavour enhancers, and emulsifiers. Examples of these types of foods include chips, soft drinks, instant noodles, ice cream, chocolate, biscuits, ready-to-eat meals, sausages, burgers, chicken and fish nuggets, sweet or savoury packaged snacks, and energy bars.

These foods, and the ingredients they contain, are designed for convenience and long shelf life, and to enhance palatability, but often come at the cost of nutritional value.

Now, a groundbreaking study, led by Monash University, has shed light on a particularly alarming consequence – the acceleration of biological ageing.

Biological age refers to how old a person seems based on various molecular biomarkers, compared to chronological age, which is the number of years a person has lived.

A person’s biological age is a relatively new way of measuring a person’s health, and can be traced back to 2013, when geneticist Steve Horvath developed the epigenetic clock, which measures DNA methylation levels. DNA methylation is a process that modifies the function of genes.

A second generation of epigenetic clocks was developed a few years later that incorporated environmental variants such as smoking or chronological age. Among these was the PhenoAge and GrimAge clocks.

As well as diet, biological age can be influenced by genetics, general lifestyle, and environmental factors, and it can differ significantly from chronological age.

A person with a healthy lifestyle may have a biological age younger than their chronological age, while poor lifestyle choices, such as a diet high in UPFs, can accelerate biological ageing.

The Monash University study, published in the journal Age and Ageing, was led by nutritional biochemist Dr Barbara Cardoso, a senior lecturer in the University’s Department of Nutrition, Dietetics and Food. It involved 16,055 participants from the United States aged 20-79, whose health and lifestyles were comparable to those in other Western countries such as Australia. The study used the PhenoAge clock to assess biological ageing.

It found a significant association between increased UPF consumption and accelerated biological ageing. For every 10% increase in UPF consumption, the gap between biological and chronological age widened by approximately 2.4 months.

Participants in the highest UPF consumption quintile (68-100% of energy intake in their diet) were biologically 0.86 years older than those in the lowest quintile (39% or less of energy intake in their diet).

Dr Cardoso said the findings underlined the importance of eating as many unprocessed and minimally-processed foods as possible.

“The significance of our findings is tremendous, as our predictions show that for every 10% increase in total energy intake from ultra-processed food consumption there is a nearly 2% increased risk of mortality and 0.5% risk of chronic disease over two years,” she said.

“Assuming a standard diet of 2000 calories [8500 kilojoules] per day, adding an extra 200 calories of ultra-processed food, which roughly equals an 80-gram serving of chicken bites or a small chocolate bar, could lead to the biological ageing process advancing by more than two months compared to chronological ageing.”

The study used data from the US National Health and Nutrition Examination Survey (NHANES) 2003-2010. Diet quality was assessed with the American Heart Association (AHA) 2020 and the Healthy Eating Index 2015 (HEI-15).

The association between UPF intake and biological ageing remained significant after adjusting for diet quality and total energy intake, using the above data as a baseline.

This suggested the association could be due to other factors such as lower intake of flavonoids or phytoestrogens, which occur in natural foods such as fresh fruit and vegetables, or higher exposure to packaging chemicals and compounds formed during food processing.

“Adults with higher UPF tended to be biologically older,” the study found. “This association is partly independent of diet quality, suggesting that food processing may contribute to biological ageing acceleration. Our findings point to a compelling reason to target UPF consumption to promote healthier ageing.”

The results also support earlier research linking UPF consumption to ageing markers such as telomere length (a shorter telomere length is a sign of cell ageing), frailty, cognitive decline, and dementia. 

Dr Cardoso said while the study participants were from the US, the relevance of the findings apply to Australians too – on average, ultra-processed foods represented almost 40% of total energy intake among Australian adults.

She said given the global population continued to age, demonstrating the adverse effects of UPFs reinforced the need for dietary-focused public health strategies to prolong a healthy lifespan.

“Our findings indicate that reducing ultra-processed foods in the diet may help slow the biological ageing trajectory, bringing another reason to target ultra-processed foods when considering strategies to promote healthy ageing,” she said.

Mechanisms behind UPFs and ageing

Mechanisms by which UPFs may accelerate biological ageing include:

1. Nutrient deficiency: UPFs are often low in essential nutrients such as vitamins, minerals, and antioxidants, which are crucial for maintaining cellular health and preventing oxidative stress.
2. Chemical additives: Many UPFs contain artificial additives and preservatives that may have adverse effects on health, including promoting inflammation and disrupting metabolic processes.
3. Packaging chemicals: Exposure to chemicals from food packaging, such as bisphenol A (BPA), has been linked to various health issues, including accelerated ageing.

Practical steps to reduce UPF intake

To mitigate the adverse effects of UPFs, individuals can take several practical steps:

1. Increase whole foods: Emphasise whole, minimally processed foods such as fruits, vegetables, whole grains, nuts, and seeds in your diet.
2. Read labels: Be mindful of food labels and avoid products with long lists of unfamiliar ingredients.
3. Cook at home: Preparing meals at home allows for greater control over ingredients and cooking methods.
4. Limit convenience foods: Reduce reliance on ready-to-eat meals and snacks, opting instead for healthier alternatives.

This work was carried out in collaboration with senior author Euridice Martinez Steele, from the University of Sao Paulo (Brazil), Daniel Belsky, from Columbia University (US), Dayoon Kwon, from the University of California at Los Angeles, Priscila Machado, from Deakin University, and Junxiu Liu, from Icahn School of Medicine at Mount Sinai (US).

This article was first published on Monash Lens. Read the original article.

_{Featured image credit by Fabricio_Macedo_Photo via pixabay.}

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Searching DNA databases: cold hits and hot-button issues

Many criminal investigations, including “cold cases,” do not have a suspect but do have DNA evidence. In these cases, a genetic profile can be obtained from the forensic specimens at the crime scene and electronically compared to profiles listed in criminal DNA databases. If the genetic profile of a forensic specimen matches the profile of someone in the database, depending on other kinds of evidence, that individual may become the prime suspect in what was heretofore a suspect-less crime.

Searching DNA databases to identify potential suspects has become a critical part of criminal investigations ever since the FBI reported its first “cold hit” in July 1999, linking six sexual assault cases in Washington, D.C., with three sexual assault cases in Jacksonville, Florida. The match of the genetic profiles from the evidence samples with an individual in the national criminal database ultimately led to the identification and conviction of Leon Dundas.

How the statistical significance of a match obtained with a database search is presented to the jury should, in my view, be straightforward but, given the adversarial nature of our criminal justice system, remains contentious. One view is that if the profiles of the evidence and a suspect who had been identified by the database search match, then the estimated population frequency of that particular genetic profile (equivalent to the Random Match Probability in a non-database search case) is still the relevant statistic to be presented to the jury. The Random Match Probability (RMP) is an estimate of the probability that a randomly chosen individual in a given population would also match the evidence profile. The RMP is estimated as the population frequency of the specific genetic profile, which is calculated by multiplying the probabilities of a match at each individual genetic marker (the “Product Rule”).

An alternative view, often invoked by the defense, is that the size of the database should be multiplied by the RMP. For example, if the RMP is 1/100 million and the database that was searched is 1 million, this perspective argues that the number 1/100 is the one that should be presented to the jury. This calculation, however, represents the probability of getting a “hit” (match) with the database and not the probability of a coincidental match between the evidence and suspect (1/100 million), the more relevant metric for interpreting the probative significance of a DNA match. Although these arguments may seem arcane, the estimates that result from these different statistical metrics could be the difference between conviction and acquittal.

There are many different kinds of DNA databases. Ethnically defined population databases are used to calculate genotype frequencies and, thus, to estimate RMPs but are not useful for searching. The first DNA searches were of databases of convicted felons. In some jurisdictions, databases of arrestees have also been established and searched. These searches have recently been expanded to include “partial matches,” potentially implicating relatives of the individuals in the database. This strategy, known as “familial searching,” has been very effective but contentious, with discussions typically focused on the “trade-offs” between civil liberties and law enforcement. In some jurisdictions, the “trade-off” has been between two different controversial criminal database programs. In Maryland, for example, an arrestee database (albeit one specifying arraignment) was allowed but familial searching was outlawed. Familial searching has been critiqued as turning relatives of people in the database into “suspects.” A more accurate description is that these partial matches revealed by familial searching identify “persons of interest” and that they provide potential leads for investigation.

Recently, searching for partial matches in the investigation of suspect-less crimes has expanded from criminal databases to genealogy databases, as applied in the Golden State Killer case in 2018. These databases consist of genetic profiles from people seeking information about their ancestry or trying to find relatives. Genetic genealogy involves constructing a large family tree going back several generations based on the individuals identified in the database search and on genealogical records. Identifying several different individuals in the database whose profile shares a region of DNA with the evidence profile allows a family tree to be constructed. The shorter the shared region between two individuals or between the evidence and someone in the database, the more distant the relationship. This is because genetic recombination, the shuffling of DNA regions that occurs in each generation, reduces the length of shared DNA segments over time. So, in the construction of a family tree, the length of the shared region indicates how far back in time you have to go to locate the common ancestor. Tracing the descendants in this family tree who were in the area when the crime was committed identifies a set of potential suspects.

The DNA technologies used in investigative genetic genealogy (IGG) are different from those typically used in analyzing the evidence samples or the criminal database samples, which are based on around 25 short tandem repeat markers (STRs). The genotyping technology used to generate profiles in genealogy databases is based on analyzing thousands of single nucleotide polymorphisms (SNPs). With the recent implementation of Next Generation Sequencing technology to sequence the whole genome, even more informative searching for shared DNA regions can be accomplished. (Next Generation Sequencing of the whole genome is so powerful that it can now distinguish identical (monozygotic) twins!)

Investigative genetic genealogy (IGG) has completely upended the trade-offs and guidelines proposed for familial searching as well as many of the arguments. Many of the rationales justifying familial searching of criminal databases, such as the recidivism rate, and the presumed relinquishing by convicts of certain rights do not apply to genealogical databases. Also, the concerns about racial disparities in criminal databases don’t apply to these non-criminal databases either. In general, it’s very hard to draw lines in the sand when the sands are shifting so rapidly and the technology is evolving so quickly. And it is particularly difficult when dramatic successes in identifying the perpetrators of truly heinous unsolved crimes are lauded in the media, making celebrities of the forensic scientists who carried out the complex genealogical analyses that finally led to the arrest of the Golden State Killer and, shortly thereafter, to many others.

It’s still possible and desirable to set some guidelines for IGG, a complex and expensive procedure. It should be restricted to serious crimes. The profiles in the database should be restricted to those individuals who have consented to have their personal genomic data searched for law enforcement purposes. With the appropriate guidelines, the promise of DNA database searching to solve suspect-less crimes can truly transform our criminal justice system.

_{Featured image by TanyaJoy via iStock.}

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Nature’s landscape artists

Claude Monet once said, “I perhaps owe having become a painter to flowers.” Perhaps he should have given bees equal credit for his occupation. Without them, the dialectical coevolutionary dance with flowers that has lasted 125 million years would not have produced the colorful landscapes he so cherished. For Darwin, it was an abominable mystery; for Monet, an endless inspiration.

Bees, like Monet, paint the landscape. Their tool kit, however, is not one of canvas, paint pigments, and brushes, but consists of special body parts and behavior. Their bodies, covered with branched hairs, trap pollen when they rub against floral anthers and transfer it to the stigma—pollination. Their visual spectrum is tuned to the color spectrum of flowers, not an adaptation of the bees to flowers but an adaptation of flowers to attract the pollinators. Insects evolved their color sensitivities long before flowering plants exploited them.

The behavioral toolkit of honey bees is expansive. Bees learn the diurnal nectar delivery rhythms of the flowers; they also learn their colors, shapes, odors, and where they are located. Honey bees are central-place foragers, meaning they have a stationary nest from which they explore their surroundings. They can travel more than 300 km² in search of rewarding patches of flowers. To do this, they have a navigational tool kit. First, they need to know how far they have flown: an odometer. This they accomplish by measuring the optical flow that traverses the nearly 14,000 individual facets that make up their compound eyes, similar to us driving through a city and noting how much city flows by in our periphery. They calculate how far they have flown and the angle of their trajectory relative to the sun, requiring a knowledge of the sun’s location and a compass. Then they integrate the individual paths they took and determine a straight-line direction and distance from the nest. Equipped with this information, they return to the nest and tell their sisters the location of the bonanza they discovered.

Communication among honey bees is not done with airborne sounds, as they have no organs for detecting them. Information is conveyed through a dance performed by returning foragers on the vertical surface of a comb in a dark nest. New recruits gather on the comb dance floor, attend the dances, and learn the direction and distance to the patch of flowers. How they perceive the information in the dance is not known, but to us as observers, we can decipher the direction by the orientation of the dance, and the distance by timing one part of it. Because the dance is done on a vertical comb inside a dark cavity, perhaps a hollow tree or a box hive provided by a beekeeper, the forager has two challenges. First, she must perform a bit of analytical geometry and translate the angle of the food source relative to the location of the sun from a horizontal to a vertical plane, then she must represent the direction of the sun at the top of comb. This is a constant like north at the top of our topographical maps.

Equipped with this information, recruits fly out of the nest in the direction of the resource for the distance indicated by the dance and seek the flowers. The flowers lure them in with attractive colors, shapes, odors, and sweet nectar that the bees imbibe and in the process transfer pollen onto the stigma, fertilizing the ova. The seeds develop, drop to the ground and wait until the following spring when the plants emerge and paint the fresh landscape with a kaleidoscope of colors that rivals Claude Monet.

_{Featured image by JLGutierrez on iStock.}

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Frances Oldham Kelsey: fame, gender, and science

Frances Oldham Kelsey, pharmacologist, physician, and professor, found fame soon after she finally, well into her forties, landed a permanent position as medical reviewer for the Food and Drug Administration in 1961. One of the first files to cross her desk was for the sedative thalidomide (tradename Kevadon), which was very popular in Europe and other nations for treating morning sickness.

But Kelsey, along with the other pharmacologist and chemist on her team, found the New Drug Application (NDA) submitted by Merrill Pharmaceuticals to include incomplete, shoddy research, and she put off approving the drug until studies came out of Europe about thalidomide’s extreme toxicity to fetuses. Thousands of babies were born with no arms or legs, malformed hearts, and other defects.

By August 1962, Kelsey was feted in the national and international press for preventing the drug from general use in the United States, and added award dinners, interviews, speeches, and receptions to her already busy work schedule.

Yet behind the scenes, she had to gingerly negotiate around aggrieved colleagues who were overlooked for their efforts (as she was the first to admit). Worse yet, there were a series of FDA Commissioners and senior executives whose power and lofty titles didn’t translate to as much publicity as America’s Good Mother of Science. James (Go Go) Goddard, for instance, was highly miffed when the announcement of his nomination as FDA Commissioner was accompanied by a photo of Kelsey.

The fact that Kelsey was a woman certainly did not help. She had bumped her head on glass ceilings right through graduate school and beyond, when her fellow students attained university appointments and she did not. A career in science was a man’s game, as was the drug industry. A photograph of Kelsey and FDA colleagues explaining amended drug policies to pharmaceutical executives portrayed a sole woman facing down a sea of hostile men. But she persisted, confident in her training and knowledge, and true to her moral compass.

What was unique about Frances Kelsey in the 1960s was the seamless way she integrated all her roles. The stereotypical female physician or scientist of the time (and they were a minority) was unmarried, abrasive, and dispassionate. Dr. Kelsey was happily married to a fellow pharmacologist and was raising two teenaged girls.

She had lots of friends, entertained, played golf and tennis, gardened, and generally enjoyed life. Kelsey was also a resident physician at her daughters’ Girl Scout Camp in South Dakota. And she loved doing science—dissecting whale glands, studying rabbit embryos under the microscope, and reading up on all the latest research.

When she postponed approval of the Kevadon NDA, it was not based on her husband’s advice, or being too nitpicky, or even procrastination and the messiness of her desk, as some opponents and journalists charged, but due to her careful application of scientific methods.

Dr. Kelsey did not shy away from the Good Mother of Science label. She gave speeches to female students and interviews in women’s magazines about the potential dangers of using drugs in pregnancy, and also its necessity in some cases. She headed another FDA file relating to foetal health—the consequences of the administration of the estrogen diethylstilbestrol (DES) to pregnant women in clinical trials, which resulted in serious injuries for many mothers and their children.

The American public appreciated all of these efforts, as they made evident in the thousands of pieces of fan mail they sent to Dr. Kelsey’s home and office. One theme ran throughout these letters, post cards, poems, and songs. It was not how can a woman be a scientist? It was why aren’t there more women in science doing great things for the benefit of all?

_{Featured image by National Cancer Institute via Unsplash.}

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Discussing your research findings

Most research articles in journals have a standard structure with sections entitled “Introduction,” “Methods,” “Results,” and “Discussion.” Each has a clear remit except for the Discussion, which, if you’re a less experienced writer, may seem a hopelessly vague description. The occasional alternative of “Conclusion” or “General Discussion” isn’t much better.

Uncertain what’s needed, some authors offer a summary of their results, or even of the whole work, though both are really covered by the abstract.

What, then, should you include?

Basic elements

The following can all help the reader get more from your Discussion—and more from your article:

• a reminder of the research problem
• an objective review of the results
• the immediate implications of the results
• the relevance to the field of the results
• the limitations of the results
• a succinct conclusion

But not new results or methodological detail, which would be out of place here.

Research problem

Opening with a reminder of the research problem sets the context for the Discussion and accommodates the different ways readers approach a research article, as explained shortly. But don’t repeat the wording from the Introduction. You’ve made progress since then, and it should be reflected in the way the problem is described.

Here’s an example from a civil-engineering article. First, in the Introduction, a simple statement:

Chloride-induced rebar corrosion is one of the major forms of environmental attack [on] reinforced concrete.

And then, in the Discussion (actually the Conclusion in this example), an elaboration:

Chloride ingress into concrete is a complex process, which in many environments is further complicated by the temperature cycles and wet-dry cycles experienced by the reinforced concrete structures. While there are numerous existing experimental or modeling studies …

This opening makes sense whether the reader works linearly through the report, jumps straight to the Discussion to decide if it’s worth reading the earlier sections, or moves from one section to another according to their interests at the time.

Review and implications

Examine the Results section as if you were a neutral observer. Focus on the main findings, noting strengths and weaknesses, and any immediate implications. You don’t need to be exhaustive: some results will already have been routinely processed, for example, in control measurements; others may have been placed in an appendix or supplement, as required by the journal.

In considering the implications, strike a balance between claiming too much, which looks like boosterism (and alienates readers), and overprotecting what you do claim with too many instances of “may,” “might,” “can,” “could,” and so on, leaving readers with little sense of substance.

Depending on your research discipline, you may have applied statistical tests to decide the reliability of your results. If so, give the same prominence to the tests that didn’t reach statistical significance as those that did, not least to counter the historical bias in the literature.

You may also have listed specific research objectives in the Introduction. If so, identify those that were realized and explain any that weren’t. That knowledge could encourage others to build on your work.

Relevance to the literature

Along with any comparisons you’ve already made between your results and those of other researchers, it’s useful to stand back and relate your findings to the field as a whole. Here’s an example from a cell biology article published in 2012:

Regional clusters of mutations in cancer have occasionally been observed in experimental models, although not at the mutation density observed here (Wang et al., 2007). … Furthermore, they are closely associated with regions of rearrangement and occur on the same chromosome and chromosomal strand over long genomic distances, suggesting that they occur simultaneously or … over a short time span (Chen et al., 2011).

By making connections of this kind, you recognize the priority of other studies, albeit sometimes with caveats, but also show how your own work advances those studies in a coherent way.

Limitations

Having pointed to the strengths of your work, you should also note its limitations and possible failings. Make it clear when the reader can safely apply your findings—and when they can’t. Being open about their applicability increases the authority of your work and its potential impact.

When deciding what limitations to mention, concentrate less on the obvious ones, the finite sample size, say, which the reader already knows from the Methods, and more on the subtle ones, for example factors you couldn’t control for some alternative explanation.

In practice, it may not be enough to state the limitations for the reader to appreciate their consequences. Here’s an example from a computer-science article, edited to reduce its identifiability:

We specified default values for the tools based on pretesting. It is possible that different values for these tools could affect the results.

It would help to know, for example, how representative the default values are and what happens when other values are used instead. In this way, your findings might be applied in areas you hadn’t considered.

Concluding statement

The closing paragraph of the Discussion—or a separate short Conclusion—should complement the opening of the Introduction. Keep it short, simple, and relevant. You could mention the new understanding that’s been achieved or the discovery of longer-term implications or new research directions.

There’s no need, however, to share your own research plans. They’re important to you but not necessarily to other researchers, who might misinterpret them as signalling your claim to the research area.

Finally, if you can, end with a brief take-home message, something to remember your findings by. But not “More research is needed”—which may have the opposite effect.

_{Photo by Unseen Studio on Unsplash}

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The best of <i>Health Affairs Scholar</i> 2024

As we welcome 2025, we reflect on the milestones and achievements that shaped Health Affairs Scholar in 2024. Among the highlights, we introduced our first Calls for Papers, focusing on the critical topics of: Global Aging, Intersections of Social Policies and Health, and Policy Options for the 340B Discount Program. These ongoing series continue to invite submissions, fostering meaningful discourse on pressing policy issues.

The journal also launched its inaugural Featured Paper Series, Health Workforce Issues and Challenges in the Post-Pandemic Era, with contributions from each of the nine federally funded Health Workforce Research Centers. Building on this momentum, three additional Featured Paper Series are set to publish in 2025, each exploring distinct, timely topics and supported by different sponsoring organizations. The papers below kick-off two of these series, with the introduction to the third series on Emergency Room Care coming soon.

• Health And Political Economy: Building A New Common Sense In The United States by Victor Roy, Darrick Hamilton, and Dave Chokshi
• Evidence To Inform Biopharmaceutical Policy: Call For Research On The Impact Of Public Policies On Investment In Drug Development by Sandra Barbosu, Kirsten Axelsen, and Stephen Ezell

In addition to these exciting new initiatives, we’re pleased to share that the journal is now indexed in the Web of Science, as well as PubMed Central, The Directory of Open Access Journals, and Google Scholar.

As we look back on a successful year, we also want to highlight the top ten most read papers published in 2024. These papers reflect some of the timeliest issues of 2024, including contraceptive access and use in the post-Dobbs era, mapping pharmacy deserts across the country, prior authorization burdens and solutions, and much more.

1. Has the Fall of Roe Changed Contraceptive Access and Use? New Research from Four US States Offers Critical Insights by Megan L Kavanaugh and Amy Friedrich-Karnik

In this brief report, Megan Kavanaugh and Amy Friedrich-Karnik examine the broad impact the overturning of Roe v. Wade has had on contraceptive access and use. The report highlights decreased access to quality contraceptive care across four states and emphasizes the need for evidence-based policies and programs to better support people’s contraceptive needs in the post-Dobbs era.

2. The Evolution and Scope of Medicaid Section 1115 demonstrations to address nutrition: a US survey by Erika Hanson and others

Medicaid Section 1115 demonstration waivers offer states the opportunity to pilot coverage for nutrition-based services to address health disparities. Erika Hanson and coauthors provide insight into the evolution and current landscape of food-based initiatives supported by these demonstrations across 19 states.

3. Return On Investments In Social Determinants Of Health Interventions: What Is The Evidence? by Sayeh Nikpay, Zhanji Zhang, Pinar Karaca-Mandic

Sayeh Nikpay and coauthors quantify the return on investment for interventions focused on combating food and housing insecurity, emphasizing the role these estimates play in encouraging future investment by health plans and other private actors in the health care space.

4. Why Does The Cost Of Employer-Sponsored Coverage Keep Rising? Salpy Kanimian, Vivian Ho

Salpy Kanimian and Vivian Ho explore the rising gap between health insurance costs and wages, highlighting the role hospitals play in driving premiums. Between 2006 and 2023, hospital price index rose faster than insurance premiums, and hospitals consistently maintained high profit margins than insurers.

5. Life Cycle Of Private Equity Investments In Physician Practices: An Overview Of Private Equity Exits by Yashaswini Singh, Megha Reddy, Jane M Zhu

Yashaswini Singh and colleagues explore the often rapid turnover of private equity investments in physician practices. Their analysis reveals that private equity firms increase affiliated practices by 595% on average in just three years, raising concerns about the long-term sustainability of care and workforce investments.

6. Locations and Characteristics of Pharmacy Deserts in the United States: A Geospatial Study by Rachel Wittenauer and coauthors

Rachel Wittenauer and coauthors use pharmacy address data and Census Bureau surveys to map pharmacy deserts across the United States. Their findings show that 4.7% of Americans in both rural and urban communities live in these deserts, demonstrating an urgent need to improve access to pharmaceutical services.

7. Perceptions Of Prior Authorization Burdens And Solutions by Nikhil R Sahni and coauthors

Nikhil R. Sahni and colleagues examine the perceived challenges related to prior authorization processes and the barriers that impede the adoption of automated solutions including the use of artificial intelligence.

8. Balancing Innovation And Affordability In Anti-Obesity Medications: The Role Of An Alternative Weight-Maintenance Program by David D Kim, Jennifer H Hwang, Mark Fendrick

Anti-obesity medications have garnered significant attention for their effectiveness, but their high price poses a major challenge to accessibility. Using a policy simulation model, David Kim, Jennifer Hwang, and Mark Fendrick evaluate the impact of an economical weight-maintenance program after weight loss plateau as an alternative to continuous medication use.

9. Infant Mortality In Ghana: Investing In Health Care Infrastructure And Systems by Danielle Poulin and coauthors

A policy inquiry by Danielle Poulin and coauthors provides recommendations for policymakers to address the persistently high rates of infant and neonatal mortality in Ghana, despite efforts to improve financial accessibility to care. The authors suggest that a systems approach is needed to minimize barriers to pre- and post-natal care, including investment in medical facility and transportation infrastructure, increased workforce development, and improvement in claims reimbursement.

10. Physicians Working With Physician Assistants And Nurse Practitioners: Perceived Effects On Clinical Practice by Xiaochu Hu and coauthors

A national survey of US physicians reveals that most view working with physician assistants and nurse practitioners as positively impacting their clinical practice. Physicians in medical schools and with higher incomes were particularly likely to report benefits, while those in specialties with higher women’s representation had lower ratings.

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OUPblog - Academic insights for the thinking world.

The concept of emotional disorder

In August 2024, a special report on ‘ecological medicine’ was published in Psychiatry Online. The authors of the report describe ecological medicine as “the structured and deliberate use of connectedness and interaction with plants, animals, and other species to generate a therapeutic effect for individuals.” While few would doubt the value of spending time in the natural world, the suggestion that we need medicine to mediate our connection to nature is a striking one. Surely nothing could be more direct and immediate than the sense of awe we feel when we gaze upon the vast night sky, or the sense of renewal we feel when wandering in a spring meadow? And surely, too, it is more than just our health that is affected by this engagement; we are affected.

That the concept of ecological medicine seems to be pointing at something so familiar, and yet seems to be expressing it in such a striking and novel manner, gives us pause to reflect. How have we arrived at a point in our civilisation where it seems sensible to describe as a medical discovery the idea that “other species are worthy of respect”, and that the recognition of inter-species reciprocity that is enabled by participating in ecological medicine “serves to counteract some of the societal elements contributing to society’s epidemic of mental health problems”?

This manner of approaching our sense of connection with nature is, arguably, emblematic of a sweeping cultural trend:

Today, we speak of ‘mental health’, often treating this as synonymous with the notion of flourishing itself. To accept the notions of ‘mental health’ and ‘flourishing’ as synonymous with each other involves a commitment to the conjunction of the following two claims:

C1 takes mental health to be sufficient for flourishing, whilst C2 takes it to be a necessary condition. C1 is the stronger of the two claims insofar as it asserts that nothing else—apart from being mentally healthy—is required for human flourishing. C2, unlike C1, allows for the possibility that there may be other conditions besides that of mental health that are also necessary for human flourishing—conditions pertaining to other domains of value such as ethics or aesthetics (domains that are of course salient in our connection with nature). But even the weaker claim, C2, imports a medical connotation into our conception of human flourishing that would have once seemed novel, perhaps even puzzling. Aristotle in the Eudaimian Ethics, for instance, takes health (like wealth or honour) to be a means by which we might come to flourish, rather than as tantamount to flourishing itself. How did this connotation appear, signalling the shift towards the medicalisation of our understanding of what it means to flourish?

Here is one story of the origin of this connotation (told by Martin Seligman, a founding father of the positive psychology movement): if (severely) distressing emotional experiences are cast as states of pathology, as contemporary psychiatry does, then it isn’t a huge leap (although it is a substantive one) from this claim to the idea that being in a state opposite to this—that is, enjoying a preponderance of pleasant emotional experiences—amounts to a state of wellness, a state of wellbeing, indeed a state of flourishing. This chain of inference is one of the major paths we have taken that has led us towards the medicalisation of our conception of flourishing. If this is right, then recovering alternate, non-medicalised conceptions of human flourishing, conceptions that might well return to us the expressive power to capture (amongst other things) our immediate connection with nature that we intuit, will involve a dissection of the concept of emotional disorder.

What, then, is the basis of the claim that (severely) distressing emotional states constitute states of pathology? From what general concept of disorder is this identification derived, and in light of what conception of our emotional lives might this identification be motivated? Surprising lines of inquiry emerge in the course of this exploration, all of which point to the pivotal role that our emotions play in the myriad ways we appraise our lives and make sense of ourselves. One particular line is worth mentioning here: it is often assumed that the medicalisation of our understanding of human flourishing signifies progress, at least in the sense that it yields an understanding that is informed by scientific knowledge. But this line of inquiry invites us to consider whether human flourishing is something we should seek to understand exclusively in scientific terms (as the invocation of the idea of progress implies). Indeed, is it something we should seek to understand in scientific terms at all? A systematic investigation of the value of emotions in human life suggests that there are visions of human flourishing that invite, indeed compel, not the detachment of the scientific gaze, but our immersion in life through the exercise of our rational agency. It is in appreciating the trade-offs between these alternative conceptions of human flourishing, and the appraisals they lead us to make of our emotional experiences, that we arrive at a clearer reflective understanding of our current predicament. It is in so doing that we may recover our power to express the immediate connection we feel with nature when we plant an acorn and tend its growth.

My aim is not to argue in favour of any particular conception of flourishing—and so I do not, for instance, claim that it is a mistake to medicalise our sense of connection with nature. It is rather to display as perspicuously as possible some of the conceptual structures that guide our ongoing quest to live happier and more enlightened lives. This quest has, for the most part, taken a very distinctive shape over the past half century: we pour billions of dollars each year into the enterprise of improving our ‘mental health’. It is ultimately for us to decide, individually and collectively, whether thinking of our flourishing in terms of the notion of ‘mental health’ is a good thing to do—rather than being, merely, something we’ve simply ended up doing.

_{Featured Image by Sébastien Bourguet on Unsplash.}

OUPblog - Academic insights for the thinking world.

The risks of dopamine agonists for the treatment of restless legs syndrome

An extraordinary breakthrough of modern medicine occurred in 2005 when the FDA approved ropinirole for the treatment of restless legs syndrome (RLS). With the first drug ever approved for this misery-inducing condition, patients finally had a highly effective treatment with relatively few side effects. Nearly 20 years later, ropinirole and its cousin pramipexole are among the most prescribed treatments for RLS, and they have been considered first-line therapy for over a decade.

Restless legs syndrome is an unpleasant sensation, typically described as an intense urge to move, that worsens later in the day, is provoked by holding still, and improves while moving. It can affect people of all ages, but it gets more common around middle age. For people with this condition, life can become unbearable. They are unable to sit long enough to enjoy a meal or watch a movie. Taking a flight or a long car ride is torture. Having an effective treatment like ropinirole and pramipexole was beyond a miracle for patients with severe symptoms.

Ropinirole and pramipexole fall under the drug category of dopamine agonists. This means that these drugs stimulate dopamine receptors in the brain. While it was known long before 2005 that dopamine-related drugs could improve RLS symptoms, those drugs had unacceptable risks. The two new dopamine agonists—which were joined in 2008 by a third drug, rotigotine—were considered much safer, and doctors who treated RLS flocked to them. Dopamine agonists were how RLS was treated. Problem solved, apparently.

Another extraordinary event is taking place in 2024, though. Dopamine agonists are not only being removed as first-line treatment for RLS, new guidelines by the American Academy of Sleep Medicine place dopamine agonists on the “do not use” list. This complete about-face is a result of years of observing that dopamine agonists are not the RLS saviors they were once thought to be. In fact, they have almost certainly caused even more suffering.

Dopamine agonists have two major problems: augmentation and impulse control disorders. Augmentation occurs when consistent use of a dopamine agonist starts to make RLS symptoms worse. This might manifest as patients having symptoms earlier in the day or having symptoms in other body parts, such as the arms.

Augmentation is thought to be the result of the brain shutting down its own natural dopamine production to rely more and more on the pills to stimulate dopamine receptors. As a result, patients require higher or more frequent doses to achieve the same degree of relief. Eventually, even those doses don’t provide relief, and the suffering starts to spread throughout the day. These drugs are particularly insidious because each time the dose is increased, patients feel better. Temporarily. If they try to decrease their dose, they feel worse. Essentially, patients become dependent on these drugs; they’re addictive.

The only treatment for augmentation is to stop the offending medication. Dopamine agonists must be weaned off, and the process can be brutal: insomnia, severe pain, anxiety, depression, thoughts of suicide, and more. When it’s over, though, the RLS symptoms are inexorably better.

The elevated doses of dopamine agonists that patients with augmentation often take can also cause a highly destructive condition called impulse control disorders (ICDs). ICDs are a form of compulsive behavior in which patients find it difficult or impossible to stop doing things that are harmful to them. The most common ICDs related to dopamine agonists are eating, shopping, gambling, and pornography consumption. Patients with a gambling ICD, for example, might spend 24 straight hours at a blackjack table. Those with a shopping ICD might start buying gifts they can’t afford for all their friends and family members just because an advertisement came on TV. The financial and social losses incurred by these patients can be massive, and many of them have no idea that their RLS medication is the cause.

With decades of experience, it became clear to physicians treating RLS that dopamine agonists were a seductive enemy to RLS patients. Exposing patients to the risks of augmentation and ICDs could no longer be justified, and they are no longer recommended for daily use. If patients do take dopamine agonists, the doses must be kept low, and ideally, used only sparingly for situations likely to trigger the RLS, like a long flight.

Fortunately, there are highly effective alternatives to dopamine agonists now. The most important treatment, bar none, is iron. A low level of iron in the brain is a very common cause of RLS and a very treatable one. Successful treatment of RLS begins with ensuring adequate levels of brain iron. After that, first-line drug therapy is now gabapentin, a drug originally approved for seizures that is highly effective for RLS, along with its related drug gabapentin enacarbil and their counterpart pregabalin. The other highly effective class of medications for RLS is opioids, including methadone and buprenorphine. Dipyridamole, a drug that used to be used to help prevent strokes, is starting to be used for RLS now. And earlier this year, a nerve stimulator band worn below the knees entered the American market for a drug-free treatment option. Each of these therapies can be considered for the treatment of RLS.

It is crucial for doctors and patients to understand the risks of dopamine agonists, including augmentation and ICDs. There are many alternatives to help this long-suffering group of people without the threat of making them worse over time. Patients who suffer with RLS should know they need not suffer forever.

_{Featured image by corelens via Canva}

OUPblog - Academic insights for the thinking world.

We need to support our health and social care system

Do you remember when we Clapped for Carers?

UK health and social care systems are world leaders in so many ways. Whether it’s leading in medicine and treatments, to providing a social justice-based social care, the system does a great job in supporting the health and additional needs of some of the most vulnerable individuals in society. However, there is no doubt that UK health and social care systems are experiencing significant stress. Virtually every week we are hearing new initiatives from political parties about how they will save the system, or how record amounts of money are being put into the NHS.

The health and social care workforce face difficulties at almost every turn. They are often blamed when serious and distressing events occur, despite doing everything in their power to support those experiencing distress. They have difficulties in workload, satisfaction, looking after extreme events … all of which is against the backdrop of UK Covid lockdowns, where we were implored to stand on our doorstep and ‘Clap for Carers’ all while they were being disproportionately affected by Covid.

The Political Blame Game

In late 2023, the former UK prime minister stated that “we were making progress on bringing the overall numbers [of those on NHS waiting lists] down—what happened? We had industrial action and we got strikes”. Despite NHS waiting lists increasing steadily since 2012, with obvious increases during and following the end of Covid lockdowns, and December 2023 having some of the longest waiting lists ever (although there had been a small decline in that month), the blame is on the workforce for waiting lists that had been increasing year on year since 2012.

Far too often health and social care workers are blamed. The decision of the Conservative government to prevent social care workers from bringing their families to this country from abroad, for example, suggests that the immigration which is needed to keep the care system afloat is a problem. Indeed, nearly one in five of the social care sector are international, and The King’s Fund suggests that without them the sector will struggle to function. As such, governmental actions have inevitably had knock-on effects on the availability of care provision in this country.

We need a political system that supports and guides health and social care workers—not one which demonises and detracts from them.

The Organisational Effects on the Workforce

When health and social care professions go on strike, evidence from studies across the health and social care (and wider public services) sectors suggest that pay is only one of the myriad issues fuelling their discontent—even though we have seen teachers and social workers face amongst the worst fall in wages of all professions in the UK.

Perhaps amongst the most damning evidence comes from national surveys and research which look at the impacts of organisational working conditions on the health and social care workforce. For example, since 2018/19 we have seen that social workers have among the worst working conditions of any occupation and profession in the country. These conditions have been consistently poor, and are undoubtedly contributing to the continually high levels of sickness absence and high turnover rates in the sector. These conditions are typified by high caseloads and long working hours. For example, Ravalier found that social workers worked, on average, over 8 hours per week more than they were contracted to. The picture is similar in other social and health care roles.

I would bravely suggest that, even if our health and social care workers could have regular decent wage increases, what would make more of a difference is decent support, at a level which provides the resources they need to make a difference. After all, study after study has shown that this is why they join the sector—to make a difference in the lives of the ill and vulnerable people who live in their very communities.

So what do we need to do to support our health and social care workforce? Well, firstly, claps don’t work. While they started as a nice gesture, they do not make up for the political, societal, and/or organisational issues highlighted above. We need better investment and support of the workforce which is so vital to the UK and beyond. We need to allow health and social care workers to have the resources they need to make a real difference. This will reduce turnover, improve satisfaction, and reduce sickness absence.

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