To give you the best possible experience, this site uses cookies. If you continue browsing, you accept our use of cookies. You can review our privacy policy to find out more about the cookies we use.
It is not only the health of the Pope that worries the Holy See. From the collapse of vocations to the conservative wind in the USA, there are many ills to face.
Updated Dec. 4, 2023 at 6:05 p.m.
ROME — "How am I? I'm fine... I'm still alive, you know? See, I'm not dead!"
With a dose of irony and sarcasm, Pope Francis addressed those who'd paid him a visit this past week as he battled a new lung inflammation, and the antibiotic cycles and extra rest he still must stick with on strict doctors' orders.
For the latest news & views from every corner of the world, Worldcrunch Today is the only truly international newsletter. Sign up here.
The Pope is dealing with a sensitive respiratory system; the distressed tracheo-bronchial tree can cause asthmatic reactions, with the breathlessness in his speech being the most obvious symptom. Tired eyes and dark circles mark his swollen face. A sense of unease and bewilderment pervades and only diminishes when the doctors restate their optimism about his general state of wellness.
"The pope's ailments? Nothing compared to the health of the Church," quips a priest very close to the Holy Father. "The Church is much worse off, marked by chronic ailments and seasonal illnesses."
Declining faith
Among the first issues is undoubtedly the collapse of new priests and nuns, and the declining number of believers, causing a sort of depression in the belly of the episcopates of Europe, the birthplace of Catholicism.
Empty seminaries, semi-deserted parishes. The conferences to analyze this decades-long bleeding wound have not served to recover the antidotes and find suitable remedies. "We have lost our heart," someone whispers. "There is no more affection, capacity for listening, or responding."
This causes unpredictable chain effects: some, indulgent, accepting unsuitable seminarians, ultimately posing a risk if their faith wanes; others wink and yield to politics to find strength, compromising the humanitarian vision, the magnet of this pontificate. A recent example comes from Veneto, where some monsignors and high prelates have stood in the way of welcoming refugees. Is it better to get political favor (with Italy's right-wing government) than to welcome the least fortunate?
Others, however, point out that the crisis of a decline in believers is seen solely from a Eurocentric perspective: indeed, enthusiasm from parishes in Africa and Asia is alive and well. The youth is passionate and many churches struggle to accommodate all the faithful.
But optimism cools when confronting a practical issue, namely economic support, as new believers in those parts of the world contribute less than what used to come from Europe and North America during the golden times.
November 26, 2023 - Due the flu, Pope Francis did not look out of the window of the Apostolic Palace as usual, but recited and blessed the crowd gathered in St. Peter's Square but live on television from Santa Marta.
But the fever of the church's disease comes exactly from North America's schismatic will against Francis that the media has often emphasized. Timothy Broglio, leading the Catholic bishops of the United States, tempers as much as he can, prioritizing internal diplomatic channels in the dialogue rather than pouring everything into the media.
This conservative polarization is expected to grow.
He minimizes the significance of those ultra-conservative American Catholic leaders advocating schism, reminiscent of the time when Pope Benedict XVI had to manage the Latin-Mass traditionalist, the Lefebvrists, who remain highly critical of the pontiff to this day.
But some trends are still noteworthy. The clerical community in the U.S. is taking increasingly traditionalist positions, as reflected in a recent study from the Catholic University of America. This conservative polarization is expected to grow, influenced also by the expanding Mormon and Pentecostal realities.
The study is based on interviews with 131 bishops and more than 10,000 priests. Among those ordained since 2010, more than half consider themselves "conservative" or "very conservative," while not a single priest ordained after 2020 defines themselves as "very progressive."
Finally, a substantial 85% of younger priests theologically adhere to "conservative and very conservative" dogmas. This is data that must be weighed carefully, but could this reality influence the choice of U.S. cardinals in a future conclave?
First ideas of a Francis successor
The question is a symptom of another seasonal flu spreading in the Vatican, especially at a time when the reigning pope shows health problems. In the lottery of papal candidates, the odds of an Italian successor, with particular attention on the current Secretary of State, Cardinal Pietro Parolin, gathers broad consensus, which could mean a cooling between the two men.
Downsizing opens wounds.
Would Parolin be the happy medium between the progressive and conservative camps? It is a premature hypothesis that Pope Francis himself would dismiss with his sharp humor: "I'm not dead yet... eh...," also because today everyone recognizes that he is firmly in control after reshaping the curial power mosaic over the past 10 years, choosing only loyalists.
Yet, even here, discontent rises because efficiency and functionalism are not enough. The downsizing already opens wounds. The trial of Cardinal Angelo Becciu and the action against the ultraconservative American Cardinal Raymond Burke represent the most visible point of an internal policy aimed at punishing those who are believed to use their privileges against the Church or to stoke disunity.
We have to await the verdict in the Becciu trial and see if Burke will indeed lose his home and salary; but certainly, even influenced every day by Pope Francis, being a good Jesuit, he does not hesitate. Neither do his trusted aides, starting with Cardinal Mauro Gambetti, the general vicar for the Vatican, who continues onward with the reforms to eliminate perks and pockets of privilege.
These are moves that increase dissatisfaction, thickening the group of papal opponents, those who complain about a rigid management of the dicasteries, without weights and counterweights.
"Let's look forward, forward," the pope always repeats to his collaborators. But lately, he'll speak while holding back a cough. His influence is trivial compared to the evils accelerating the Church's decline.
Can a pope resign?
The resignation of a pope is a rare occurrence, as almost all have served until their death. But it is permitted under canon law. Pope Benedict XVI notably resigned in 2013, citing health reasons and the challenges of leading the Catholic Church. He was the first pope to resign since Gregory XII in 1415.
The resignation process involves the pope making a formal declaration before the College of Cardinals, and the resignation becomes effective when accepted by the cardinals.
Who is Pietro Parolin?
Cardinal Pietro Parolin is an Italian prelate who has been serving as the Secretary of State for the Vatican since October 2013. Born on January 17, 1955, in Schiavon, Italy, he was ordained a priest in 1980 and entered the diplomatic service of the Holy See. Cardinal Parolin has held various diplomatic posts, including serving as the Apostolic Nuncio to Venezuela and the Holy See's Permanent Observer to the United Nations in New York. As the Secretary of State, he is considered the Vatican's equivalent of a prime minister and is a key advisor to the Pope, handling diplomatic and political matters.
Who is Raymond Burke?
Raymond Leo Burke is an American prelate of the Catholic Church. He is a bishop and a cardinal, and was a patron of the Sovereign Military Order of Malta from 2014 to 2023.
Burke has long been a part of an American group of conservatives who oppose the positions taken by Pope Francis along with his plans for the Catholic Church's reforms. As a part of a recent crackdown against oppositional voices in the church, Francis told the heads of the Vatican that he has plans to evict Cardinal Burke and relieve him of his salary.
New Zealand has reversed its decision to implement the world's toughest anti-smoking law, to the disappointment of many inside and outside the island nation. But how are other laws aimed at tobacco use faring around the world?
Updated Nov. 27, 2023 at 6:50 p.m.
In 2022, New Zealand announced that the country would enact a pioneering anti-smoking law that would ban the sale of cigarettes to anyone born after 2008. The decision was hailed by health activists as a radical and righteous measure that would help prevent the deaths of millions every year.
But only one year later, New Zealand has backtracked on it its toughest-in-the-world anti-tobacco stance.
For the latest news & views from every corner of the world, Worldcrunch Today is the only truly international newsletter. Sign up here.
The laws were due to be implemented from July 2024, but in an attempt to fund tax cuts, New Zealand's new government scrapped this idea completely over the weekend, triggering the outrage of many health activists in the country and head-scratching elsewhere.
While New Zealand's shock decision is a major step back for anti-tobacco campaigners in the nation of 5.2 million, many other countries have been busy implementing laws to combat the associated health risks of cigarettes. One of the reasons that this cause has been accelerated in recent years is the COVID-19 pandemic, which highlighted the risk of impacted lungs through respiratory issues caused by the coronavirus.
Here’s a deeper look into New Zealand's decision and the ways in which other countries have joined the fight.
The COVID-19 pandemic highlighted the importance of quitting smoking given cigarettes’ impact on lungs
The original motivation behind New Zealand’s ban was to decrease deaths caused by smoking, which is the leading cause of preventable deaths in the country. In particular, the Indigenous Maori population is disproportionately impacted, with the highest rates of smoking and affiliated diseases in the country.
Hapai Te Hauora, a National Maori health organization, called the decision to reverse the laws an "unconscionable blow to the health and wellbeing of all New Zealanders", with public health officials calling its consequences "catastrophic" for the Maori population.
The legislation would have effectively created a "smoke-free" generation
The legislation would have effectively created a "smoke-free" generation, starting from those born after 2008. The outlawing focuses on young people because this is when they often pick up a hard to break nicotine habit. The reforms gained international acclaim for their projected efficacy, with measures including the limiting the number of stores that are allowed to sell cigarettes and decreasing their addictive nicotine content. It was projected to save up to 5000 lives a year and $5 billion in the health industry for not needing too treat cigarette-caused illnesses.
But this was all the plan of the past government, which lost on Oct. 14 to the National party by 38% of votes. The new Prime Minister Chris Luxon had not included the reversal of the anti-smoking laws into his campaign, but he had previously argued that a ban would lead to the rise of a tobacco black market. Still, despite this step back, New Zealand aims to reduce its smoking rates by 5% by 2025, with the goal of one day eliminating it all together.
Bhutan ban creates black market
Bhutan made waves in 2010 by ending the distribution, manufacturing and selling of tobacco. (Controlled imports were allowed with hefty fines.) The small Himalayan kingdom has a long history of tobacco regulation, with its first control law passed in 1729. Such controls have widespread support in the majority Buddhist nation, where the tobacco plant is believed to have grown from a demoness’ blood and smoking is viewed as sinful.
In the face of prohibitions, a black market has thrived, with cigarettes smuggled from neighboring India. Consequently, while other countries strengthened their smoking restrictions during the pandemic, Bhutan actually loosened its 2010 ruling; Bhutan had few COVID-19 cases compared to India, and despite having closed its borders, infections were coming in from abroad.
So Prime Minister Lotay Tshering (a doctor who still practices on weekends) decided to lift the ban on tobacco sales (now allowed at state-owned outlets) to limit potential disease spreading. Although, Prime Minister Tshering clarified these measures are temporary.
Some countries placed restrictions on cigarette packaging
After years of next to no regulation largely due to the influence of the tobacco industry and the popularity of smoking in the region, Costa Rica adopted one of the world’s strictest smoking laws in 2012. The Central American country banned cigarette usage in the majority of public and private buildings and many outdoor spaces, while also not allowing separate "no smoking areas."
The legislation, which also placed restrictions on cigarette packaging and advertising, led to a 49% increase in the price of cigarettes, with demand continuing to decrease in the years since: In 2018, 11.1% of the age 20+ population used tobacco products, compared to 14.2% in 2010, according to Costa Rica’s Social Security System.
Further, Costa Rican cigarette production ended in 2018 and it has joined the World Health Organization’s list of countries that have been most successful in reaching tobacco-control goals. Costa Rica has recently fortified its standards, halting electronic cigarette and vapes use in public and placing a tax on these devices that will benefit care for tobacco-related diseases.
California leads in United States cigarette sales bans
Urban areas in the most populous U.S. state are increasing restrictions on various tobacco products. In September, San Jose became the largest American city to make the sale of menthol cigarettes and flavored e-cigarettes illegal. The goal was to prevent consumption by teens drawn to the sweet varieties; the ordinance also places limits on new shops opening near schools, community centers and libraries.
Although, these sorts of embargoes can have unexpected negative consequences; for example, when San Francisco residents voted to end the sale of flavored nicotine and tobacco items, the rates of teens smoking traditional cigarettes increased. While none of these products are good for lung health, vaping is less harmful. Still, San Francisco, the home of e-cigarette giant Juul Labs, went on to ban all e-cigarette sales in 2019.
Elsewhere, the upscale municipality of Beverly Hills effectively blocked cigarette sales within city limits at the start of 2021. The ordinance was passed unanimously by the Beverly Hills City Council, allowing cigarette sales only at hotels and cigar lounges. The Los Angeles County enclave has long been a pioneer in tobacco regulation as the first California city to stop cigarette smoking in restaurants more than 30 years ago.
Urban areas in the most populous U.S. state are increasing restrictions on various tobacco products
Like many Asian countries, Japan had a smoking culture that has been a hard habit to break. But cities have taken measures over the past two decades to make it harder to light up. Selected wards in Tokyo have prohibit smoking on the streets.
Kyoto has banned cigarettes on 7.1 kilometers of its streets
Yet perhaps the toughest big city in the world on public smoking is Kyoto, which has banned cigarettes on 7.1 kilometers of its streets, and has police officers patrolling parks and other public spaces, handing out 1,000 yen ($8) fines. Of course, the other deterrent is prices, which are going up in Japan and elsewhere in large part because major new taxes have been levied on the sale of tobacco projects.
In April of 2020 a new smoking law made it illegal to consume cigarettes indoors, with the exception of private homes, hotel rooms, selected small-sized restaurants and cigar bars. To reduce the social incentive to smoke, the government is constantly attempting to make the number of establishments where smoking is permitted smaller and smaller.
For years, mindfulness has been promoted as a near panacea. But just how much does the brain affect the body?
In 2019, Debra Halsch was diagnosed with smoldering multiple myeloma, a rare blood and bone marrow disorder that can develop into a type of blood cancer. Her doctors recommended chemotherapy, she said, but she feared the taxing side effects the drugs might wreak on her body. Instead, the life coach from Piermont, New York tried meditation.
A friend had told Halsch, now 57, about Joe Dispenza, who holds week-long meditation retreats that regularly attract thousands of people and carry a $2,299 price tag. Halsch signed up for one in Cancun, Mexico and soon became a devotee. She now meditates for at least two hours a day and says her health has improved as a result.
Dispenza, a chiropractor who has written various self-help books, has said he believes the mind can heal the body. After all, he says he healed himself back in 1986, when a truck hit him while he was bicycling, breaking six vertebrae. Instead of surgery, Dispenza says he spent hours each day recreating his spine in his mind, visualizing it healthy and healed. After 11 weeks, the story goes, he was back on his feet.
Halsch said she believes she can do the same for her illness. “If our thoughts and emotions can make our bodies sick, they can make us well, too,” she said.
In an email to Undark, Rhadell Hovda, chief operating officer for Dispenza’s parent company, Encephalon, Inc., emphasized that Dispenza does not claim meditation can treat or cure cancer. However, he does “follow the evidence when it is presented,” and has encountered people at workshops and retreats “who claimed to have healed from many conditions.”
For more than two decades, various studies have suggested that meditation and mindfulness — that is, being aware of the present moment — can help reduce and improve pain management, lending some credence to the notion that the brain can affect the body. Such results have helped the field grow into a multibillion-dollar industry, populated by meditation apps, guided workshops, and upscale retreats.
Yet the field has also faced sharp criticism from psychologists and researchers who say the health benefits are overstated and some of the research methodologically flawed. Meanwhile, claims that alternative approaches, including meditation can, by themselves, cure serious illness have been calleddangerous by medical experts, who fear a true believer might forego a life-saving treatment. As researchers investigate meditation’s effect on nearly everything from chronic pain to ADHD to brain function post-stroke to emotional regulation, the practice continues to be popular among converts and curious alike. And while no scientific findings suggest that meditation can go so far as to cure cancer, some researchers are interested in precisely how the brain affects the body’s immune system.
In fact, data collection for one of the largest research projects on the subject is being funded by none other than Dispenza, who is collaborating with scientists at the University of California San Diego and providing them with access to study attendees of his retreats. A study recently published by the group described an association between meditation and enhanced resiliency against Covid-19.
Overall, there are still a lot of unknowns about how meditation can affect disease processes, wrote Emily Lindsay, a researcher who specializes in the biological effects of mindfulness meditation at the University of Pittsburgh, in an email to Undark. “We know it impacts stress and sometimes stress biology, and we know that it can impact certain disease processes, but there’s still a black box in between.”
Whether Dispenza’s collaboration with mainstream scientists will shed light into that black box is an open question, and many scientists are skeptical.
Scientific studies on meditation
Over the last 20 years, meditation in the U.S. has gone from fringe hobby to mainstream. Between 2012 and 2017, according to the National Institutes of Health, the percentage of adults in the country who tried some form of the practice tripled, so that just over 14 percent of all Americans had meditated at least once in the last year. The American Heart Association has stated it may help reduce cardiovascular risk — while noting that further study is needed — and an article written by Mayo Clinic staff endorsed it as a “simple, fast way to reduce stress.”
With more use has come more study. In the last three decades, the NIH has funded more than 1,700 studies on meditation, at a cost of $570 million. And that number has swelled over time: In 2002, the agency devoted $5 million to study the practice. Last year, it earmarked $45 million.
While there are many different forms of meditation, most studies have looked at a type called mindfulness meditation, which has its roots in Buddhist practice and aims to achieve a state of calm by focusing on the present moment, accepting whatever thoughts and feelings arise without judgment — though definitions and approaches vary between studies.
“Scientists continue to make significant breakthrough discoveries on how meditation works, and whom it can benefit,” wrote J. David Creswell, a psychology professor at Carnegie Mellon University, in an email to Undark. “Our research shows that much of the health benefits can be attributed to meditation helping us become better stress managers.”
Much of the mindfulness research over the last two decades has focused on mental health and well-being, and studies suggest the practice can help with both. A seminal review assessing the impact of mindfulness meditation was published back in 2014: Researchers at Johns Hopkins University analyzed 47 randomized clinical trials involving more than 3,500 participants and found that there was moderate evidence meditation improved symptoms of anxiety, depression, and pain. Another meta-analysis, also from 2014, found that mindfulness-based interventions can reduce symptom severity in patients experiencing a depressive episode, while a 2015 review found that a meditative practice can help healthy individuals feel less stressed in their day-to-day lives.
Researchers have posited that meditation may help with stress and anxiety by increasing resiliency to challenging emotions through practicing awareness, acceptance, and non-judgment. “When you sort of open and broaden your awareness to everything that's occurring, everything that you're noticing, it sort of levels out the experience a bit and allows you to be less attached to that stress,” Lindsay said.
But not every study on meditation finds significant results. Lydia Brown is a clinical psychologist and researcher at the University of Melbourne, who, herself, is a meditator. She said she’s found the practice to be personally transformative, but when she analyzed results from 19 randomized controlled trials on how mindfulness improved heart rate variability — a physiological variable that’s indicative of how the body recovers from stress — she found that the evidence was mixed. Even so, if someone looked up meditation and heart rate variability, she said, they would see articles declaring that meditation can improve it. This can be problematic, Brown added, “because you might not be following the best evidence to improve your physical health or improve your mental health.”
“I would have loved this research to come up with a positive result,” she said, but as a researcher, she had to follow the data.
Conflicting results isn’t a new problem in meditation research. The 2014 meta-analysis, for example, actually had somewhat disappointing results for those who expected significant effects, said Elena Salmoirago-Blotcher, an associate professor of medicine, psychiatry, and epidemiology at Brown University School of Medicine. While the review, which was notable for being published in a highly reputable medical journal, found moderate improvements in anxiety, depression, and pain, there was little evidence for its effects on stress and mental health-related quality of life.
No studies have found that meditation can cure an illness such as cancer.
Other researchers have called attention to poor research methods in the field. In a 2017 paper, 15 psychologists and cognitive scientists urged readers to “mind the hype” surrounding meditation research, noting that many studies lacked an active control group to make a valid comparison, and were inconsistent in how they defined “mindfulness.”
Another issue in the field, Salmoirago-Blotcher said, is something called researcher allegiance bias: When study authors develop the intervention themselves, their personal investment may skew the outcomes of their study. Meanwhile, studies that recruit people who are already practiced meditators — such as the ones taking place at Dispenza’s workshops — could have skewed results. “People that meditate tend to have healthier behaviors, tend to smoke less, they tend to exercise more, they’re usually more educated and also higher socioeconomic status,” Salmoirago-Blotcher said. “So there is a lot of what we call confounding there.”
The self-regulation gained from mindfulness may lead to better life choices, like eating better or choosing to exercise, but do people who meditate have fewer heart attacks? No one has studied that yet, Salmoirago-Blotcher said, adding that even the American Heart Association has been cautious in how it describes the benefits of meditation, writing in a 2017 statement: “Overall, studies of meditation suggest a possible benefit on cardiovascular risk, although the overall quality and, in some cases, quantity of study data are modest.”
What seems clear, Salmoirago-Blotcher said, is that meditation seems to have some positive effects on depression and anxiety. Whether and how such benefits might manifest physiologically, however, remains murkier. In cancer patients, for example, meditation can help with distress, quality of life, and sleep. But Salmoirago-Blotcher says she’s seen nothing to suggest it affects cancer cells. “I don’t think there’s anything absolutely proven yet,” she said.
The health benefits
While no studies have found that meditation can cure an illness such as cancer — and some researchers, including Salmoirago-Blotcher, emphatically underline this lack of evidence — an increasing amount of research has focused on mindfulness’s effect on the central nervous and immune systems.
One 2016 study, for example found that mindfulness practices may be associated with changes in immune system activity, as meditators showed improvements in stress-related markers like inflammation and immune cell aging. And a 2019 study found mindfulness may have led to a reduction in the production of pro-inflammatory molecules and been associated with a quicker restoration of immune function in women undergoing breast cancer treatments.
There is some logic, researchers suggest, underlying the idea that a regular meditation practice might help boost the immune system. Because mindfulness seems to help with how the body manages stress, and because stress can affect immunity, the theory goes that meditation could help boost the body’s defenses.
“If you look across the big studies of immune system function in general, the meta-analyses do suggest that meditation is beneficial to the function of the immune system,” said Melissa Rosenkranz, a psychiatry professor at the University of Wisconsin School of Medicine and Public Health. “And that almost certainly has something to do with its effects on distress.”
If the body’s stress responses are activated on occasion, that’s okay, said Liudmila Gamaiunova, a postdoctoral researcher at the Institute for Social Sciences of Religions at the University of Lausanne in Switzerland. “But if it happens often, or if we get to this chronic state, of course then it has an effect on the immune system.”
Chronic stress has been linked to conditions such as heart disease and diabetes (the science on any connection to cancer is much less clear), but exactly how those illnesses manifest via stress is far from settled. One theory is that when the body has an acute stress response, the hormones norepinephrine, epinephrine, and corticosterone make sure immune cells are appropriately distributed throughout the body.
They also regulate inflammation, and while that can be useful at times, chronic inflammation has been associated with some diseases, including rheumatoid arthritis and Alzheimer’s. That state of chronic inflammation can keep the immune system from operating efficiently, said David Victorson, a professor of medical social sciences at Northwestern University’s Feinberg School of Medicine. He likened the immune system to a hard drive on a computer and inflammation to having a lot of tabs open on the desktop at once. With all of those programs running in the background, the hard drive cannot operate efficiently, he said. “When the volume is turned down on those other areas, it just frees up more space for the immune system to function properly, like it needs to.”
Some studiesfrom the last decade have suggested that meditation can help regulate certain bodily mechanisms that influence inflammation. And meditation seems to do that, Rosenkranz said, by changing the lens through which you experience the world and your reaction to the events in it.
“A state of psychological distress communicates something to your immune system that your immune system responds to,” she said. “When you change the way that you are filtering the environment, and what that means to you, as an entity, it really has a profound effect on your body.”
Reducing stress also can reduce the secretion of cortisol, a hormone that suppresses inflammation, regulates blood pressure, and regulates the immune system. But chronic elevations of it can lead to the immune system becoming resistant to it, compromising the immune response, research shows.
“These stress physiological systems didn't evolve to be chronically activated. They evolved to respond to punctuated stressors and then turn off,” said Robin Nusslock, a psychology professor and director of the Affective & Clinical Neuroscience Lab at Northwestern University. But now, “we have the capacity to activate the same stress physiology of a zebra running away from a tiger by thinking about our 401K.”
“The best target for meditation’s effect on the immune system would involve attenuating inflammation,” said Nusslock. “And inflammation is the common soil which fertilizes many mental and physical health problems.”
"Meditation could just be a marker for some other healthy behavior"
Wherever one comes down on Dispenza — and views among experts are mixed — some researchers see his meditation retreats as an opportunity for study. After all, they can attract up to 2,500 people each — a fertile ground for finding volunteers who can participate in intensive studies.
Scientists at the University of California, San Diego are currently conducting about a dozen studies investigating how meditation affects the body, both physiologically and mentally.
In academic medicine, it can sometimes take five years to recruit 150 people for a study, said Hemal Patel, a professor of anesthesiology at UCSD and one of the two principal collaborators on the studies. Those challenges aren’t an issue when Dispenza has a retreat, he said. “We would write up a study, we would solicit participants, we would get 800, 900 people volunteering to be involved in the study,” Patel said.
Study volunteers have donned skull caps to track electrical activity in their brain, worn devices to track their sleep data and heart rates, donated cheek cells to check DNA, and submitted stool samples to see changes in their microbiome. The idea is to see what, if anything, happens to their bodies after seven days of meditative practice. In an email to Undark, Patel noted that the meditation carried out at Dispenza’s retreats is not considered mindfulness and incorporates elements from different types of practices. “The goal of our research is to define exactly what this new type of [meditation] retreat is.”
Dispenza’s sample sets are unique in that recruits stay in the same environment, controlling for some of the variables that can confound results. However, there are still limitations to this type of study, including self-selection bias. The population of Dispenza acolytes may well be primed to believe meditation works, so a placebo effect may come into play, said David Vago, a meditation researcher and professor at the University of Virginia who is not involved in the UCSD research.
“Self-selection bias is certainly a problem,” Vago wrote in an email. “One advantage of the study is the built-in controls they had with participants who were in the same setting but did not get meditation training.” One of the UCSD studies, for example, hopes to examine the emotional states of twins, when one is meditating and the other is not.
The first research published looked at whether the type of meditation practiced at Dispenza’s retreats could be used to improve resiliency to the Covid-19 virus. In that paper, which was published in the journal Brain, Behavior, & Immunity - Health, researchers surveyed nearly 3,000 people who had attended a retreat organized by Dispenza. They asked how many had received a Covid-19 diagnosis and how quickly their symptoms resolved. The UCSD researchers found that the longer people had been maintaining a regular meditation practice, the less likely they were to report testing positive for the virus. And among those that did get infected, they reported having fewer symptoms and recovering much faster than those that had less or no meditative practice.
"I’ve always been concerned about pseudoscience around meditation, and Joe Dispenza certainly created some red flags for me, personally."
Studies that depend on self-reporting are viewed as less reliable, but the study by the UCSD researchers also utilized other more objective measures to test whether meditation might improve health outcomes.
The group’s original hypothesis was that meditation could increase health resiliency because of the release of biological factors, like proteins or metabolites, into the bloodstream during meditation. They’d collected blood samples from retreat participants before the pandemic began, and then decided to pivot their focus specifically to SARS-CoV-2. To identify what those factors might be, the UCSD scientists created a pseudovirus to represent SARS-CoV-2, bearing the characteristic spike protein so it could enter a cell using the same mechanism as the real virus. While the pseudovirus did not contain any SARS-CoV-2 genetic material, it did include what’s called a “reporting protein” gene, which expresses a fluorescent red color. That way, researchers could see if and when the virus entered a cell.
The researchers then took blood from about 100 people at a Joe Dispenza meditation retreat — some who were experienced meditators, some who were new meditators, and some who did not meditate at all — then added plasma distilled from those blood samples into cultures of human lung cells. When they then exposed those cells to the pseudovirus they’d created and let them incubate for 24 hours, they found there were almost no viral particles inside the lung cells inoculated with the plasma of experienced meditators. There was some evidence of infection in the lung cells treated with novice meditator plasma, and in lung cells treated with non-meditator plasma, the virus appeared to have infected the cells unfettered.
“We showed that the blood of a meditator after the week-long event was able to keep the fake virus from entering the lung cells,” Patel said. The question then, was, how?
After further testing the participants’ plasma, the UCSD team found that the blood of meditators had elevated levels of a particular protein called SERPINA5, which inhibits a type of enzyme that the virus utilizes to infect a cell. In other words, that protein — which appeared to be increased in the bloodstream of experienced meditators during this type of meditative practice — seemed to give people an extra dose of protection against being infected.
“What I think is happening is that when you go into this elevated, emotional mental state during meditation, you're releasing things from your neurons in your brain. And then ultimately, those neurons, whatever is being released, has to filter through and eventually ends up in the blood,” Patel said.
Amesh Adalja, an infectious disease physician and a senior scholar at Johns Hopkins Center for Health Security said he doesn’t believe the study answered that question.
“This study doesn't give you enough information to say it's anything more than a hypothesis that needs testing in a more rigorous manner,” Adalja said. While noting the study’s limitations, he added, “there's biological plausibility in the sense that meditation decreases stress, and we know that stress responses do influence susceptibility to infectious diseases.”
Among other things, Adalja added, the UCSD team did not control for confounding variables that could have affected their results in the blood plasma study, like age or lifestyle habits, or whether a study participant had an immunocompromising health condition. By not taking into account each participant’s individual health status, Adalja said, the UCSD researchers cannot claim that the result they obtained was caused by meditation, because it may have been influenced by some other variable.
In theory, Adalja pointed out, it could be that people who meditate may also sleep eight hours a night, for example, and so perhaps they’re benefitting from the sleep and not the meditation. “Meditation could just be a marker for some other healthy behavior, or some other biological phenomenon that goes with it.”
Patel refuted Adalja’s critiques, saying his study only tested blood from individuals with no self-reported chronic or terminal disease so that there would be no confounding conditions to influence outcomes. He also noted that the survey portion of the study did control for confounding variables, and that a multivariate analysis was performed to address specific confounders in that data. “Our studies on the biological assays controlled for all of the issues that Amesh says we did not control for,” he said. “We were very careful to do this.”
Patel also argued that his team’s results pinpointed something specific about meditation. The group that did not meditate, he said, spent their days at the same resort as the meditators, during the same events, but instead of meditating, enjoyed a relaxing time away from work at the resort, in an environment that would be expected to also reduce stress. But the protective effect was only observed in the individuals who meditated, suggesting to Patel that it was the meditation — and not mere stress reduction — that mattered.
Disagreements over methodologies and results aside, the involvement of Dispenza, who was named as a co-author on the recently published study — and may be listed as one on future publications — has also raised eyebrows among some researchers.
“I’ve always been concerned about pseudoscience around meditation, and Joe Dispenza certainly created some red flags for me, personally,” said Vago, who is one of the co-authors of the 2018 “Mind the Hype” study. Vago cites Dispenza’s language in his workshops and videos, which he says can be exaggerated, with little to no science behind certain claims.
The podcast Conspirituality relates an instance where, at one retreat, Dispenza had a woman come up on stage who was having trouble getting pregnant because she feared she had waited too long and now felt guilty. Dispenza told her the guilt is stored in that same center of her uterus and that she could fix her infertility with her thoughts.
“He's charismatic and talks about healing people from chronic health conditions and rare genetic disorders in one session of meditation,” said Vago. “Those words are enough for me to be skeptical of anything else that he claims.”
Dispenza has been a popular figure in the yoga, meditation, and self-transformation community ever since appearing in the 2004 documentary, “What the Bleep Do We Know,” which focuses on the connection between quantum physics and consciousness. Today, he boasts 2.8 million followers on Instagram, where he posts inspirational quotations and promotes his teachings.
But critics take issue with the way Dispenza infuses scientific concepts into his lectures and books to make it sound like there is scientific evidence behind his theories.
Meditation is known to do some good in some situations, but it’s still unclear which situations and how.
“I think it's science that demystifies the mystical,” Dispenza told podcaster Aubrey Marcus in December of 2020. “And if you can combine a little quantum physics with a little neuroscience with neuroendocrinology with psycho neuroimmunology, the mind-body connection, epigenetics, all of those sciences point the finger at possibility.”
Julian Walker, an author and co-host of Conspirituality, doesn’t buy it. “This is the thing about New Age pseudoscience,” he said. “The claims are so big and so bold that if any one of them were true, even in the smallest way, it would be such a massive change in terms of how we understand life itself.”
For his part, Patel says he and his co-lead author designed all of the UCSD studies, and that they have full autonomy on how they are done and implemented. “This is something I was very adamant about to make sure we are doing critical and unbiased science,” Patel said. In the Covid-19 paper's author contributions, however, Dispenza is credited with helping conceive and design the study.
Dispenza has been involved in monthly meetings with the scientists, where he does, according to Hovda, "make suggestions to enhance the research." In her email to Undark, Hovda also said that Dispenza had not made direct monetary contributions to the studies, but has supported the research through in-kind donations. That includes paying independent contractors to collect the data on his behalf, a process that involves the use of 18 EEG machines purchased at a cost of $20,000 each.
Despite some of the pause some meditation researchers may take when hearing Dispenza is involved, Vago said he respects Patel’s previous work, and found their latest results fascinating. “I wasn't even familiar with that particular data, that the fake virus that they created and how they found that the blood of meditators, after a week-long event, was able to keep the virus that they created from entering the lung cells. That’s very impressive,” he said.
He noted that it is convincing to see that the research subjects’ meditation experience correlated with the findings, rather than something more objective.
“I guess my biggest problem is really with how Joe sells himself on the internet, because that comes across as pseudoscience, and some of the claims that he makes come across that way. But the research Patel is doing “all sounds pretty legitimate,” Vago said.
And it adds to a growing body of research showing meditation’s impact on immunity, from its effect on inflammatory markers like cytokines to its effect on parts of DNA, like telomeres on chromosomes. In fact, Vago is currently involved in a study at Vanderbilt University, where he was the former research director of the Osher Center for Integrative Medicine, where they are looking at the effects of meditation and breath work on the glymphatic system, which eliminates waste from the central nervous system.
Dangerous promises
As researchers continue to investigate the mind’s impact on the body through meditation, the business shows no sign of slowing down. A 2022 market analysis report by Data Bridge Market Research predicts the global meditation market will grow from $5.3 billion in 2022 to an estimated $20.5 billion by 2029.
While Salmoirago-Blotcher has found personal value in meditation, she cautions against expensive retreats that target people facing personal crises. “These people craft these wonderful programs where desperate people go — because they have nowhere else to go, right?” she said. Retreats that can cost thousands of dollars, Salmoirago-Blotcher said, run “really contrary to the spirit of how these practices were generated, which is the practice of generosity.”
Walker, of the Conspirituality podcast, is even more blunt, calling those who peddle mindfulness as a panacea nothing more than modern-day faith healers. “To me, it's no different than the faith healer who comes through town, sets up the big tent, tells people to bring their sick and disabled family members and that through the Holy Spirit, they're going to be cured,” he said.
Like Salmoirago-Blotcher, Walker is himself a long-time meditator, but he said the practice is powerful because of its more subtle, everyday effects, including helping people manage stress better, become more aware of their bodies, and connect with emotions — not because it brings about miracles.
Such promises can be dangerous: Conspirituality recently featured an interview with a woman whose husband was undergoing chemotherapy to treat pancreatic cancer when he started attending Joe Dispenza retreats and almost decided to stop his treatments. Although he continued with the chemotherapy — and died from his illness at the age of 45 — his wife was scared, the podcast said, by how pseudoscientific beliefs might affect his health outcomes.
In her email to Undark, Hovda stated that Dispenza does not recommend individuals dealing with an illness stop their current treatment plan. “There are many choices that people have during a treatment and cure for their disease,” she wrote, “and these evolve with time as well as how the disease is progressing. Meditation and self-regulation are paths that need further exploration, and it is one modality we are researching that should be considered in conjunction with traditional approaches to further assist one’s body in returning back to homeostatis.”
Whether results from the other ongoing UCSD studies will show significant effects remains to be seen. And while research has found meditation can improve some health outcomes — such as decreasing blood pressure and biomarkers of stress — its effect on the biological mechanisms underlying human health is less clear. It’s known to do some good in some situations, but it’s still unclear which situations and how.
As for Halsch, she attributes her improved health, in part, to her meditative practice. “I believe with my whole heart and soul it’s because I’m back on track meditating every day,” she said, “receiving healings, participating in healings — and eating plant-based.”
Caren Chesler is a journalist on the Jersey Shore whose work has appeared in The New York Times, The Washington Post, Smithsonian, and Wired.
It’s easier than ever to get prescription drugs online. Should regulators be paying more attention?
It started with a Google search for prescription medications I might get online.
Almost immediately, ads from telehealth companies began chasing me around the internet, promising access to drugs to make me prettier, skinnier, happier, and hornier. Several of these companies sell anti-aging creams. While decidedly pro-aging, I don’t love the visible effects of my sun-soaked youth. “Sure,” I thought. “Why not?”
Within the hour I had joined the millions of Americans who get prescription drugs from providers in cyberspace.
Telehealth, an umbrella term for health care delivered by phone, video chat, or messaging, exploded during the pandemic. Since then, it has become a mainstay of many medical practices. Also riding the telehealth wave is a raft of internet-based companies that facilitate prescribing — and often sell — medications for complaints that because of time, money, or embarrassment people don’t want to discuss with a doctor face-to-face.
The dark side of telehealth
My experience represents the sunny side of direct-to-consumer telehealth. It took about 15 minutes to fill out a medical history, upload photos of my face, and enter my credit card information on forhers.com, a website run by the telehealth company Hims & Hers Health, Inc. Twenty minutes later, a nurse practitioner had prescribed a Hers product containing tretinoin, a well-studied Vitamin A derivative that smooths fine wrinkles and fades dark spots. Six days after that, it showed up at my door.
Compared to the conventional health care system, the process of obtaining the prescription felt like scoring a fast pass at Disneyland.
But last year, urologist Justin Dubin discovered a darker side of DTC telehealth. Alarmed at seeing patients who had been prescribed the hormone testosterone without good medical reason or warnings about side effects, Dubin went undercover as a secret shopper at seven platforms targeting men’s health. Following a script, he described himself as a happily married 34-year-old man bothered by low energy, decreased sex drive, and erectile dysfunction. “I read about low testosterone and its symptoms online,” he told potential prescribers, “and I am worried that I might have it.”
The explosion of DTC telehealth is a direct result of the failures of our health care system.
Dubin, who like his alter ego was 34, submitted his own lab results showing healthy hormone levels. “It was pretty clear that I did not need testosterone,” said Dubin, who treats patients at Memorial Healthcare System in Florida. Nonetheless, as he detailed in a study published in JAMA Internal Medicine in December 2022, providers working for six of the seven companies defied medical society guidelines to offer to prescribe him injectable testosterone. They also offered to sell him several other testosterone-boosting drugs and supplements that were inappropriate for his hypothetical case.
“This was just egregious, what Dubin found,” said Steven Woloshin, a professor of medicine at Dartmouth. Even though Dubin’s script made it clear that he and his wife wanted to have a child in the near future, half of the telehealth providers offering testosterone failed to warn him that, in addition to other risks, taking the hormone can reduce fertility. “For this simulated patient it could interfere with his goal to have children, and they were treating something he didn’t have,” said Woloshin. “It just seemed like it was just a terrible practice of medicine.”
Woloshin said the paper has big implications about the poor quality of online care: “There’s no reason to think that this is unique to urology.”
In an accompanying editorial, Woloshin, and my former colleague Lisa Gill, an investigative reporter at Consumer Reports, called for better oversight of standalone DTC telehealth services. “Consumers need to be aware of the potential for bad care,” they wrote, “and regulators need to do more to protect them.”
Compensating the healthcare system's shortcomings
For telehealth, everything changed with the onset of the Covid-19 pandemic. In the U.S., telehealth use skyrocketed with lockdowns in the spring of 2020 and then stabilized at 38 times higher than pre-pandemic levels by early 2021, according to a report from the consulting firm McKinsey & Company.
By and large, DTC companies fall into two main business models. Companies such as Teladoc, Amwell, DoctorOnDemand, and MDLive most closely resemble traditional medical practices. They take insurance, send prescriptions to your pharmacy, and offer a range of services, including urgent care, primary care, psychiatry, mental health counseling, and dermatology.
Then there are a host of platforms that treat a narrower set of conditions, such as Ro — which focuses on skin, hair, fertility, weight loss, and sexual health — and the men’s health clinics that Justin Dubin shopped. These companies typically don’t take insurance and charge little or nothing for patient visits. Instead, they make money by selling products that their providers prescribe. “It’s simply a route to market for a drug,” said Mark VanderWerf, a telehealth entrepreneur and consultant.
From the patient perspective, the DTC approach has demonstrated benefits, said Ateev Mehrotra, a physician and health care policy scholar at Harvard Medical School who started researching telehealth a decade ago. As I discovered, it’s efficient. No travel time; no scrolling on my phone in a waiting room. “Patients’ time is valuable,” he said. “And the convenience of it is obviously really critical.”
Plus, because of the efficiencies built into the telehealth model, said Mehrotra, “many of these companies can provide care at lower cost.” That’s a huge plus for people facing poor insurance coverage or high deductibles.
Those virtual clinics can also specialize in serving populations that otherwise struggle to get care, said Crystal Beal, a family medicine physician who provides treatment and education through the website QueerDoc. Because many doctors don’t feel confident and comfortable providing gender-affirming care, Beal told me, some of their patients previously had to travel more than 200 miles for appointments. DTC options, they said, are sometimes “really the only option for trans and gender-diverse patients.”
The explosion of DTC telehealth is a direct result of the failures of our health care system, said Ashley Winter, who until recently served as the chief medical officer of Odela, a DTC telehealth company focused on women’s sexual health. Winter previously treated both men and women as a urologist and sexual medicine physician at a large managed care organization, and she said she joined Odela to help more patients: “I was drowning in need.”
personne assise tout en utilisant un ordinateur portable et un stéthoscope vert près de
While DTC platforms can compensate for some of the shortfalls of America’s health care system, they can also bring out its worst money-grubbing tendencies.
Mehrotra is most concerned about what he refers to as “solutions oriented” platforms where people come seeking drugs for, say, weight loss or erectile dysfunction that company providers dutifully prescribe. “They really turn the clinical model on its head,” he said. Good medical practice involves taking a history, diagnosing the patient, and then deciding on what treatment is best for the patient, he said, not starting from the treatment and asking whether the patient is right for it.
Of course, you can easily find brick-and-mortar versions of that approach to medical care — men’s health clinics peddling testosterone and penile injection therapies, for example, or clinics promoting diabetes drugs for weight loss. But the DTC model supercharges that clinical model, allowing providers to reach far more potential customers.
The system is built for throughput. As in my case, people often discover DTC telehealth websites through targeted ads promoting access to prescription medications. Unlike traditional drug advertising, which is more closely monitored by federal regulators, marketing from DTC telehealth providers often neglects to mention side effects, or promotes uses of drugs that haven’t been approved by the Food and Drug Administration.
Once a user clicks on one of those ads, they are transported to a website where chatbots may answer questions and guide potential customers to a treatment. Artificial intelligence algorithms can tailor questions about each patient’s medical history and suggest a possible diagnosis to the provider. With electronic assistance, human clinicians can complete hundreds of e-visits daily, according to a 2019 JAMA viewpoint by Mehrotra and colleagues.
That model offers little incentive to provide referrals or other care for patients. Dubin pointed out that given normal testosterone levels, his hypothetical patient’s symptoms should have triggered further investigation for, say, uncontrolled diabetes, a mental health problem such as anxiety or depression, or alcohol or drug use. A lot of these online men’s health clinics are a “one-stop shop for a Band-Aid,” said Dubin, and aren’t invested in getting to the source of the problem.
The profit model, critics say, also presents obvious incentives for physicians to prescribe more drugs. Queer Doc founder Beal is critical of any practice, be it DTC telehealth or an in-person clinic that makes money on the medications prescribed. “If you are financially incentivized by the product you’re selling, you are going to try to sell more of it,” they said.
There’s limited data on whether telehealth sites that focus on specific ailments overprescribe, although Dubin’s paper suggests that at least some companies are offering drugs too enthusiastically.
Some recent cases also point to problems in the industry. Last year, for example, federal agencies launched investigations into DTC telehealth companies Cerebral and Done Global regarding the prescription of stimulants to treat ADHD. An investigative series in The Wall Street Journal cites current and former employees who describe corporate environments they say pressured clinicians to prescribe the drugs based on cursory appointments with little follow up.
Industry sources chalk up such cases to the work of a few bad actors, rather than inherent flaws with the clinical model. Ashley Winter told me that she followed the same medical guidelines at the DTC telehealth company Odela as when she treated patients in person. While Odela does sell the drugs its providers prescribe, that practice is no more a conflict of interest than surgeons profiting from the procedures that they recommend, she said: “You just have to be ethical.”
The DTC telehealth company Ro, which offers treatment for sexual health, fertility, hair, skin, and weight loss, has layers of safety checks, according to an email from Nicholas Samonas, the company’s associate director of communications. The company has an audit program, he said, and uses software that flags when a medication may not be appropriate for a patient.
Samonas pointed me a company-sponsored study of 10,000 male patients, which found that men treated for erectile dysfunction through Ro experienced the same type and distribution of side effects, and discontinued medications, at about the same rate as in published studies of men receiving in-person care. Those results, published in the Journal of Urology and Research in 2020, suggest that telehealth treatment was on par with conventional care, according to Ro researchers.
However, in a 2021 study published in the American Urological Association’s Journal of Urology, a panel of experts gave Ro and Hims mixed scores on how well they adhered to the organization’s guidelines for treating erectile dysfunction. Both companies did a decent job advising patients on risks and benefits of medications, but performed poorly in other areas, notably not telling men with low testosterone that drugs such as sildenafil (Viagra) may work better when combined with testosterone therapy. Neither company prescribes testosterone.
Dubin is a huge proponent of telemedicine in general, but worries that, left unchecked, the DTC model can potentially introduce questionable medical practices to vast new audiences. “Direct-to-consumer telemedicine has a lot of room to grow,” he said. “There’s a lot of things that need to be worked out in that space to make sure that we’re providing good care.”
Lack of regulation
So exactly who is minding these virtual combination clinic-drugstores?
The onus mostly falls on state medical boards — groups of physicians charged with monitoring other physicians. But the boards typically just respond to complaints, rather than go looking for bad actors, and disciplinary action for telehealth prescribers appears to be rare.
“The disciplinary system is just totally unresponsive and inactive,” said Rebecca Haw Allensworth, a professor at Vanderbilt Law School.
As for those ads trailing me around the internet, the FDA is responsible for ensuring that promotions for prescription drugs are truthful, balanced, and accurate, FDA press officer Charlie Kohler wrote in an email. By law, ads that refer to a prescription drug by name and make claims about what it does must include a balanced description of benefits and risks.
In practice, that doesn’t always happen. The online company Nurx ran an ad on Facebook touting the anti-aging effects of tretinoin, but neglected to list (admittedly mild) side effects such as skin irritation and increased sun sensitivity. Similarly, a RocketRx ad for sildenafil, generic Viagra, promotes the drug for erectile dysfunction, but doesn’t tell you that it can cause dizziness, headache, flushing, and stomachache as well as more serious side effects such as painful, prolonged erections, abnormal vision and a sudden loss of hearing. And a MaleMD ad doesn’t mention that the prescription finasteride in its Hairsy 3-in-1 hair growth medicine can cause testicle pain, decreased sexual desire, and an inability to have or maintain erections.
Until someone starts regulating this more carefully, there's a potential for harm.
In addition, while doctors commonly prescribe drugs for uses not approved by the FDA — beta-blockers to lessen stage fright, for example, or the diabetes drug Ozempic (semaglutide) for weight loss — the agency bans “off-label” promotion directly to consumers. But, again, DTC telehealth sites often appear to exploit a loophole allowing them to ignore those regulations.
The Hims website, for example, promotes off-label use of the antidepressant Zoloft (sertraline) for premature ejaculation. Click the “early climax” on the forhims.com home page and an animated cactus pops out of a pot, cheerily announcing: “you’re on your way to lasting longer in bed.” But despite the appeal to young men worried about their sexual performance, the site’s lengthy discussion of sertraline never says that the drug carries a black box warning — the strongest type — about the increased risk of suicidal thoughts and behaviors in teens and young adults.
In an emailed response, Hims & Hers company spokesperson Khobi Brooklyn noted that customers receive safety information on products as part of the consultation process and with prescription shipments. They also have unlimited access to health care providers to ask questions about side effects, she wrote.
Questions about the legality of the DTC telehealth ads that Kristina Bitzer saw online prompted her to dig into the topic during law school. Her analysis, published in the Northern Illinois University Law Review in 2021, found that many DTC platforms fall into a regulatory gray area defined by what they are not. The DTC companies themselves aren’t medical providers, because they contract with the professionals who provide care. They aren’t pharmaceutical companies, either, because they don’t actually make the drugs that they promote and sell. But they are also not online pharmacies, because they contract with outside companies to fill prescriptions.
Instead, they’re middlemen who can exploit that status to market drugs online, free from government oversight.
Brooklyn confirmed that Hims & Hers does not consider itself to be a medical provider, drug maker, or pharmacy and so is not subject to FDA regulations for prescription drug marketing and promotion. “Hims & Hers connects people seeking care to independent licensed healthcare providers who work through the Hims & Hers telehealth platform,” she wrote. When asked about the specifics of purchasing and receiving a treatment, Brooklyn noted: “Prescriptions are fulfilled by one of our partner or affiliated pharmacies, who ship the product directly to customers.”
The FDA’s Kohler would not comment on specific ads, but he did acknowledge that some companies are out the agency’s purview. Social media companies, whose policies appear more lenient than federal law, have also been permissive toward DTC drug advertising. For example, Meta, the parent company of Facebook and Instagram, allows ads that “share information around medical efficacy, accessibility and affordability of different types of treatments,” company spokesperson Rachel Hamrick wrote in an email. No mention of risks is required.
In theory, DTC telehealth is a good idea, said Bitzer. The problem, she said, “is that without any kind of real governance of the system, and where these telemedicine platforms are saying, ‘Well, we don't fit into any of that, we're doing our own thing,’ there's a real issue for patient safety.”
Potential for harm
I wondered if I got suckered by ads, or if my prescription face cream was as good of a deal as it seemed like at the time. As a point of comparison, I made an appointment with a local dermatologist, who did a skin-cancer check, noted mild psoriasis on the back of my neck, and wrote me a prescription for tretinoin. The drug was cheaper at my local pharmacy, I discovered, but under my health plan I had to pay $190 out of pocket for the doctor visit. Although I got a more thorough exam in person, it was a far more expensive way to get the prescription.
In addition, the Hers cream is a nicer moisturizer. And, in any case, like many of these platforms, Hers automatically signs you up for a recurring subscription and I haven’t gotten around to cancelling.
But for many patients, the stakes are much higher. It makes sense that regulators should specifically address the DTC market.
In their JAMA Internal Medicine editorial, Woloshin and Gill called on the Federation of State Medical Boards, a nonprofit organization representing medical and osteopathic boards in U.S. states and territories, to be proactive — perhaps by encouraging state boards to periodically conduct undercover spot checks of randomly selected telehealth sites.
Whether state medical boards are willing and able to provide that kind of oversight is another question. State boards have no jurisdiction over businesses, just individual practitioners, said Lisa Robin, chief advocacy officer at the FSMB. And in the absence of a complaint, state boards don’t audit practices, said Robin. “That’s just not how the system is set up in this country.”
That traditional regulatory model has started to fall apart when it comes to DTC platforms, said Mehrotra. The company, not individual providers, decides how to create questionnaires, screen patients, and advertise products, he said. So while it seems like the company should be regulated, said Mehrotra, “we don’t have a regulatory framework for that.”
However, Allensworth, the law professor, is leery of imposing extra regulations on DTC platforms. Putting special limitations on where and when doctors prescribe can limit access to care, she said. “We have such a terrible health care shortage in this country,” she said. “And I just think that’s almost always going to be the wrong way to respond to it.” Medical boards do have the authority to undertake robust investigations and discipline errant telehealth providers, she pointed out. Like Woloshin and Gill, she’d like to see a national effort for the boards to do so.
As for anything-goes advertising, Bitzer suggested in her analysis that, at the very least, Congress could update laws so that telehealth platforms are subject to the same regulations as drug companies marketing and promotion.
In the near term, the FDA seems unlikely to take action. Spokesperson Charlie Kohler said that the agency doesn’t comment on future potential regulatory activity, but telehealth is not listed on any of the FDA’s agendas for this year.
In the meantime, as a minimal check on who is treating them, prospective customers can look up their provider’s credentials and disciplinary record on the FSMB-run website DocInfo.org.
Patients need to be cautious, said Woloshin. “Until someone starts regulating this more carefully,” he added, “there's a potential for harm.”
With the social value of sports having recently been officially acknowledged in the Italian constitution, writer Simonetta Sciandivasci reflects on the cult of excessive health, and rants about the impossibility of keeping up beauty trends masked as self-care.
-Essay-
Gyms open before coffee bars. Some never close. Seven days a week, 24 hours a day, 365 days a year.
Years ago, unions rose up in vain against the continuous, eternal openings of supermarkets, accusing the "Save Italy" decree of blurring, even nullifying, the distinction between weekdays and holidays, day and night, overtime and regular time. Many spoke of deregulation, oppressive liberalism, a "capitalist assault on sleep."
None of those voices ever even whispered a complaint against the non-stop hours of gyms. And now you are here, at 6 a.m., living through the consequences. As badly as you wish you could buy a cappuccino and a croissant, the only light you can see lit from the street is that of the hall of a fitness center. It looks like it was tastefully decorated by a minimalist sadist who is passionate about the Ming dynasty and Nazism.
Coffee bars closed and gyms open. The market has chosen: physical maintenance above all else.
Sport comes first, which is now even in the Italian Constitution. On Sept. 20, the Chamber of Deputies approved a clause that recognizes the "educational and social value" of sports activities in Article 33.
Paralympic athlete Bebe Vio said in her speech to the Chamber: "I have often been asked how I manage to train and study at the same time: actually, I think we are very good at inventing excuses."
We've turned wellness into an illness.
And everyone says: true, we don't know how to use our time; we should wake up at 3 in the morning to be able to do everything and do it perfectly. So there they are, on the treadmill at 6:15 in the morning, already in caloric deficit, while you are starving. It's a nervous hunger, of course, but also cultural, because eating every day is a choice, not a need, and that's why intermittent fasting is so good for you.
How can we detoxify ourselves from the religion of the body if we live in neighborhoods where the only places that never turn off their lights are gyms? Filling magazines and runways with curvy models, filming XS-size influencers while they eat and say "yum," and XL-size influencers undressing: nothing has worked.
In fact, almost every body-positive advocate, actor or influencer offers you every day the miraculous effects of squats, along with their skincare routine (you've seen more blackheads on celebrities in their natural state than an army of Korean aestheticians), and the records set by their step counters, and their diets. "My nutritionist said" has replaced "My psychologist said."
Health influencers
In the 1990s, we used to stick photos of Naomi Campbell on the fridge to stick to our diets; now, we follow hundreds of influencers on Instagram. We've turned wellness into an illness: it's called orthorexia.
The "beach body" has become a daily state exam. The article that the New York Times (not Cosmopolitan, the New York Times) has offered you most often this year is titled "How to Become a Morning Exercise Person." You've read more vibrant and better-documented things about "healthy living" than you have about Crimea, French suburbs, energy transition or gender-based violence.
You don't want to be so harsh as to blame the cultural failure of body-positive practices to the fact that its activists, one after another, can be found on TikTok advising you to start your day with a sixteenth of a walnut, a fat-free yogurt, three Goji berries and liquid collagen, followed by wall yoga, pelvic gymnastics, facial gymnastics and meditation.
You need to be honest and admit that you are an active part of that failure. You must acknowledge that in the notebook where you try to keep up with politics, the only quote of Italian Prime Minister Giorgia Meloni that you wrote down is: "I start my diet every morning and finish it before lunch." You even drew a little heart next to it.
You have to admit that when you return home, reflecting on your right to have breakfast, believing that starting the day with carbohydrates and butter is a way of loving yourself, your algorithm welcomes you to exercise instead. And you, torn but proud, certain of your ability to synthesize virtue and pleasure, you obey the algorithm.
While eating a packaged croissant, you download the "Better Me" app, and your phone nestles it between your newspaper apps. You resort to a virtual weight loss and toning programs, fine, but you're still an intellectual.
After your 15/20 minutes of wall pilates, massage your thighs for 15 minutes with a scrub. Take care of your face. According to mytonicface.official, a face coach who appeared on your timeline at some point — whom you trust without knowing who they are, where they studied, or if they ever did — you should spend 15/20 minutes a day massaging your face.
Everything always takes 15/20 minutes: that's how long the French police take, on average, to decide whether to accept or reject an asylum seeker.
Do facial yoga. It says: the epidermis has no memory, so massage until the cream is completely absorbed. You can make the mask yourself! It's only 15/20 minutes, if you only have the patience to grate a lemon, open an aloe and/or cactus leaf and extract the gelatinous substance inside, then blend, add brown sugar and spread it on your cheeks.
Smile. You are making yourself beautiful and healthy for yourself.
Then, massage your lips with a hard-bristle brush for 15/20 minutes. Take a pen, put it in your mouth, and activate the "antagonistic elevator muscles of the depressors" by moving the pen from bottom to top for 15/20 minutes. Go out. While you're going to the office, puff up your cheeks, first the right and then the left, alternating for 15/20 minutes while you walk, don't worry about who might see. Smile.
Who knows how many, like you, become radicalized without ever asking Siri, Google, or ChatGPT: what is a ketogenic diet, how many pounds can I lose in a month, will I become immune to cancer if I eat twice a week and always between 4:50 and 5:20 in the morning, is it safe for no one to notice if when I'm sitting I contract and dilate my vaginal muscles to prevent uterine prolapse?
Smile. You are making yourself beautiful and healthy for yourself. Rejoice in how much more strenuous it has become to take care of yourself since you no longer do it for a man, for standards, for sacraments, or to avoid dying alone: now you do it for yourself, to live longer and better, to create, to honor the Constitution. You have put yourself on a regimen; you have returned to your beautiful youth. Well done.
There are obvious and not-so-obvious reasons that adult men tend to do a bad job in taking care of their health and well-being.
Updated Oct. 19, 2023 at 7:50 p.m.
When the doctor asked a friend of mine what he was doing at the clinic that day, the answer was a jovial: “I don’t know. Well, I do — so my wife, who told me to come, can stop busting my balls!”
My friend, an almost 50-year-old father of three, is telling me about his health check a few days ago. His wife smiles a smile which sits somewhere between relief for her insistent win, and resignation at the narrative. I feel a bit uncomfortable: Am I a sour grape if I don’t smile along with him? Should I say something? I haven’t been asked anything, so I stay quiet, not wanting to be a bore.
It did however feel like a great opportunity to bring up this issue. It reminded me of a diploma in masculinities and social change which I took last year, led by Argentine psychoanalyst Débora Tajer. She spoke of how men come to health care late, and when they do it, it’s at a woman’s suggestion, or because we simply can’t ignore it anymore.
Of course, some men do get basic health checks, irrespective of it being on their own initiative or at someone else's (be it a medical certificate needed for work or sports). But it’s not the norm, nor is it the only way we can describe our relationship to our health, or how we look after ourselves.
Joking about self-care
In an article titled “Why do men hardly go to the doctors, and how does it affect their health?” in Spanish daily newspaper El País, doctor Benno de Keijzer describes a pattern where boys usually see their doctors up until they are 13, before “disappearing and returning as pensioners in their 60s with aches and pains”. The specialist from Mexico, who is also an anthropology professor at the Autonomous University of Mexico, adds wryly: “What we do find is young men and adolescents holding up the A&E units of hospitals on a Friday or Saturday night”.
Then there’s the care we don’t take care of. Take prostate checks, something which could help detect the cancer which most affects men. According to the Latin American Movement against Prostate Cancer (MOLACAP), more than 65% of cases are detected when they are already at an advanced stage. One of main reasons men won’t rush to see a urologist is because it is seen as a taboo; there can be a lot of fear around having a rectal area checked during a medical.
Which guy hasn’t heard the comment — delivered as part lecture, part joke — about whether it’s OK to slip in a finger or two back there? It’s an indicator of whether you like anal sex, which brings the threat that you might be gay ever closer. And being “gay” means you’re weak, that you rank lower on the unattainable scale of hegemonic masculinity. (Luckily the fourth series of British show Sex Education is out on Netflix — and goes to task exploring this taboo amongst heterosexual men.)
The reality has a lot to do with machismo.
Now that I think of it, there are distinct instances or the most basic facets of self-care which reveal themselves in the jokes which try to suggest the paths that men should take (if we don’t want to be seen as lesser men).
When it comes to food, advice from the World Health Organization and general consensus amongst experts is that a varied diet, rich in fruit and vegetables, without too much sugar and alcohol, can limit the risk of illnesses. I go about trying to incorporate healthier habits, until I’m scolded (and especially in my steak-heavy country of Argentina) with variations such as: “You’re eating a salad? Don’t be a sissy! Eat this rib”; or: “You’re not drinking?! C’mon, that water’s going to hurt going down. Have some wine instead”.
It’s common sense that physical exercise helps general fitness, both mental and physical. But there are some sports which count as exercise, and some others. “Oh, you do yoga and pilates? It’s going to turn you gay, watch out. Oh, I see, you’re smart! You’re going to look at asses, right?”
Mental health is another of our biggest taboos. It has helped that elite sportsmen — successful, talented, millionaires — have shown their vulnerable sides and told their stories publicly with regards to their own mental health, from Spanish footballer Andrés Iniesta to U.S. swimmer Michael Phelps.
Mental health remains a stigma though, which in a sense is more complex for those men who think they can do it solo. But what extremes will we go to in our situations before we’ll finally seek out therapy, or ask for help?
The reality has a lot to do with machismo. Men die from suicide far more than women worldwide, and this difference between the sexes increases with age.
Andoni Ansean, a psychologist and president of the Spanish Foundation for Suicide Prevention, told Spanish newspaper El Mundo: “The expectations are different for each gender, and it becomes assumed by the individual. It’s murky terrain, but it’s what it means to tell a girl she is a princess in her pink dress and a boy that he is a prince with his sword. It’s telling boys not to cry. All of these roles make it harder for men to ask for help than women”.
That the tendency across the world is the same — that so many men kill themselves — is something we should think about. There is no honor in keeping pain or sadness to one’s self. Looking after ourselves makes all the difference.
I have to confess that I have never felt so much doubt, fear, worry and questions than in these last five years, since becoming a father. Amongst other things, something which surprised me is that it is not a conversation that we often have amongst each other, which was also one of the reasons I started this newsletter. I’m not alone; others do it well, like Kevin Maguire’s The New Fatherhood and Sebastián Blanco’s Soy papá (“I’m a Dad”, in Spanish). They bring important topics to light, like postpartum depression in men.
Being a man
It’s hard to say what really makes a man in the twenty-first century. Those signals which show us we’re moving away from hegemonic masculinity are the clearest. All of this has to do with how men relate to their health.
Among the notes I took from the class with Débora Tajer, I highlighted these:
“In general, men tend to live seven years less than women. Excesses and exposure to the risk of hegemonic masculinity. Living for achievements, violent conflict resolution, failing to understand fatigue. Men come to their senses later (when it comes to a heart attack or broken bone, etc). Masculine excess mortality has avoidable causes, like car accidents from speeding, murders, suicides, extreme sports, initiation rites. Groupness: things that men would not do alone, are done together in a group. Men kill and are killed more than women. Alcohol as a self-prescribed drug, to be uninhibited or manage situations of anxiety or depression. My self-esteem will take a hit if I am not working, if I stop, if I am not successful”.
Lorenzo was not even a year old when he was told “don’t cry, don’t be gay”.
Now that I am 41 and am raising two boys, I find it easier to deal with some of those demons. And of course having spent the last decade in therapy helps, and I can look at some of those problems from the bigger picture, in a time when feminists are making themselves heard amidst so much struggle, and also because of the pandemic, when mental health worries really became more evident.
Yet, I’m always surprised by how deeply ingrained all of this is, and sometimes subtly.
Just by looking at how society and its different actors and institutions (education, health) relate to my children, I can understand a lot. I see how “being a real man” has begun for my eldest in the nursery he goes to — from the colors he should pick, to the clothes he should wear, to the sports he should be playing, and the superheroes he should love, the girls he should like, and the list goes on…)
I am not exaggerating. These last four years I’ve seen Lorenzo, my son, changing, and even more so because at home, we give him the freedom to choose what he wants. That shopping list of conditioning he receives may seem like tiny drops from a leaky tap, but the bucket overflows at a certain point.
Lorenzo was not even a year old when he was told “don’t cry, don’t be gay”, like many other boys have been told. Since then, we’ve heard the same phrase dressed up in different ways: “don’t cry, it’s nothing”, “little superhero boys don’t cry”, and so on. Lorenzo was not allowed to have a folder with an image from the movie Frozen on it, since it was “for girls” — like the color pink which he liked but does not pick anymore.
We went to a birthday party the other day, and in the middle of a musical game, I noticed that Lorenzo was not dancing — he was shy, so instead he jumped around and did a cartwheel to show that he didn’t care for the music. Some of the fathers were joining in the game, dancing with their kids, but in the end only the girls were holding up the dancefloor. Why didn’t boys join? Why didn’t Lorenzo dance there, if we often find him treating the living room as his own personal disco? I see him dancing in secret, but when I enter the room he smiles and stops, until we ourselves get in on the dancing ourselves.
There are some places we can start to change this: demystifying masculinity, for example, because self-care does not make us any less of the men we are, rather it makes us more responsible (for ourselves, for our wellbeing, and for those around us).
It’s not easy, but it’s good to come back to a core idea: we are not, and don’t have to be invulnerable. It’s completely fine if we can’t manage everything. We could be depressed, or suffer from depression. We don’t need to hide it, lessen it, or occupy ourselves to move away from it. We all face emotional challenges. Looking for help is not a sign of weakness, but a sign of courage.
I know it’s complex. Being as strong as a superhero is something that we have internalized. I find it difficult to tell Lorenzo who’s stronger: Lionel Messi, or the Incredible Hulk. By the time he was four, Lorenzo had already understood that “being stronger” was something fundamental. I know he’s weighing it all up by the kinds of questions he asks me — whether I cry in this or that situation, for example. And that’s where I feel I can accompany him in the feeling, because being honest could be a way of showing him how to be vulnerable, and it's not synonymous with weakness, nor is it something to be ashamed of.
Like every father, it’s about giving our children what we feel we didn’t have. It's trying to teach them that taking care of their mental and physical health is a sign of strength and wisdom. I repeat it to my kids, because I repeat it to myself too: “There’s nothing wrong in asking for help. Superheroes don’t exist. Look after yourself, kid”. Look after yourselves, my friends. Which is what I should have told my friend instead of thinking I was going to be a bore.
What are the leading causes of death among men?
Causes of death among men varies by region, but globally the most recent figures indicate that the five leading causes are: 1. Heart Disease and Strokes 2. Cancer. 3. Accidents (including car and motorcycle crashes) 4. Chronic Respiratory Diseases. 5 Suicide and Mental health issues
What mental health issues affect men?
Common psychological health issues for men include depression, anxiety, stress, and substance abuse. Men may also struggle with issues related to masculinity, body image, and self-esteem.
What is toxic masculinity?
Toxic masculinity refers to cultural norms and expectations around traditional male behavior and the harmful behaviors and attitudes that can result from these norms. It is not a condemnation of masculinity itself but rather a critique of certain destructive aspects of it. Here are some key points to understand about toxic masculinity:
Toxic masculinity promotes the idea that men should conform to traditional gender roles and exhibit characteristics often associated with masculinity, such as dominance, aggression, emotional suppression, and the rejection of traits considered "feminine." Men influenced by toxic masculinity may feel pressured to hide their emotions, except for anger, and may avoid seeking emotional support or therapy when needed. This emotional suppression can lead to mental health issues and difficulties in forming healthy relationships.
The pandemic brought attention to an overlooked condition. But researchers are still fighting to show smell matters.
Growing up, Julian Meeks knew what a life without a sense of smell could look like. He’d watched this grandfather navigate the condition, known as anosmia, observing that he didn’t perceive flavor and only enjoyed eating very salty or meaty foods.
The experience influenced him, in part, to study chemosensation, which involves both smell and taste. Meeks, now a professor of neuroscience at the University of Rochester, told Undark that neither gets much attention compared to other senses: “Often, they’re thought of as second or third in order of importance.”
The pandemic changed that, at least somewhat, after it left millions of people without a sense of smell, albeit some temporarily. In particular, more researchers started looking at a specific type of condition called acquired anosmia. Common causes include traumatic brain injury, or TBI, neurodegenerative diseases like Parkinson’s or Alzheimer’s, or following a viral infection like COVID-19. Due to the pandemic, “many people found it scientifically interesting to focus their research on smell,” said Valentina Parma, the assistant director of the Monell Chemical Senses Center, a nonprofit research institute in Philadelphia. By one account, NIH funding of anosmia research nearly doubled between 2019 and 2021.
But many of the research findings do not apply to those who have lacked the ability to smell since birth: congenital anosmics. And, despite the increased attention to smell loss more broadly, some researchers still face challenges in funding studies. In March 2023, for instance, Meeks received a peer review for a small grant, of less than $275,000, from the National Institutes of Health, with which he had planned to look into anosmia in the context of TBI.
For Meeks, the response was frustrating. One expert reviewer in particular “didn’t really understand why there would be any need to establish a preclinical model of anosmia with TBI,” he said, noting that the reviewer also wrote that because anosmia is not a major health problem, the value of the research was low. The comment, Meeks added, was “quite discouraging.”
In response to a request for comment on that decision, Shirley Simson, a spokesperson for NIH’s National Institute on Deafness and Other Communication Disorders, or NIDCD, which funds smell and taste research, replied that “NIH does not discuss the peer review process for individual grant applications.” She noted in a separate email that “all NIH grant applications, including those submitted by investigators to NIDCD, undergo the same review process.”
A complex sense
The sense of smell is complicated, and not fully understood. Jay Piccirillo, an otolaryngologist at Washington University School of Medicine in St. Louis, likens its complexity, with its many neuronal connections, to Times Square. Compared to the nose, the eye looks relatively simple, he told Undark.
There are a few basic steps, however, on which researchers do agree. Humans smell by detecting molecules, or odorants, in the environment around them. These odorants latch on to one of 400 receptors in the nose, called olfactory receptor neurons, which then send a signal the brain. The result: a dizzying array of odors.
“We can smell and discriminate tens of thousands or maybe billions or trillions of smells,” said Hiroaki Matsunami, an olfaction researcher at Duke University who, along with colleagues, recently published a study on how one of these receptors works.
Both congenital and acquired smell loss can either entail complete loss (anosmia) or minimal loss (hyposmia). Some people also have a distorted sense of smell, a condition known as parosmia, or perceive odors that aren’t there, known as phantosmia. And because of the connection between smell and taste, sometimes smell loss is accompanied by the inability to taste, or ageusia, as it did for many COVID patients.
When anosmia was reported as a symptom of COVID-19, there was a switch.
Any form of anosmia can have a broad effect on daily function. For one, it can be a safety hazard, since affected people may not be able to detect a fire, gas leak, or spoiled food. Smell loss is also associated with depression, and because of the close link between smell and taste, the condition can affect appetite and, by extension, nutritional health.
The cause of anosmia isn’t entirely known. For congenital anosmia, researchers suspect a genetic link or developmental abnormalities. As for acquired anosmia, an injury or illness appears to disrupt the transmission of an odorant to the brain, but the exact spot of that break isn’t clear — and it may vary, depending on the cause. When it comes to COVID, for instance, some researchers initially suspected that the virus was killing the cells that transmit the odorant signal to the brain. More recent research suggests that, instead, it could be because of inflammation or damaged supporting cells.
It’s also not entirely clear how many people have anosmia. In 2012, research analyzing the U.S. National Health and Nutrition Examination Survey estimated that 23% of Americans over the age of 40 report some alteration to their sense of smell. A 2016 paper that examined results from a later version of same survey estimated that more than 12% of American adults had some sort of olfactory dysfunction. And Fifth Sense, a charity for smell and taste disorders, estimates that 1 in 10,000 people have congenital anosmia.
The numbers are uncertain in part because, compared to other sensory dysfunctions like vision or hearing loss, experts say there are fewer resources or people involved in smell research. And prior to the pandemic, anosmia research was typically relegated to smellandtaste research centers or otolaryngologists (also known as ear, nose, and throat doctors). “It was like a niche,” said Thomas Hummel, a smell and taste disorder researcher at the University of Dresden in Germany. Studying smell loss, he added, wasn’t “in the foreground of research.”
Special exhibition on topic 'coal and art' by Helga Griffiths
When anosmia was reported as a symptom of COVID-19, there was a switch. Smell and taste researchers were suddenly inundated with requests. For Hummel, who works in a clinic, the phone didn’t stop ringing from patients. Others were similarly in demand. “We were flooded with emails, with calls by patients and reporters,” said Parma. “It was the time I gave the most interviews in my entire career.”
While NIH did not provide Undark with statistics detailing exactly how much the field of smell loss research grew, a search for the word “anosmia” on their online database turned up 35 distinct projects, totaling more than $14.6 million in funding for the 2019 fiscal year. In the 2021 fiscal year, that number grew to $28.5 million in funding for 63 projects.
As a result, experts say, the anosmia research community began collaborating more, wanting to use their knowledge and skills to help in whatever way they could. Many researchers, including Parma, developed smell tests that could gauge a user’s sense of smell and, by extension, to see whether they had a COVID-19 infection at a time when PCR and antigen tests were limited. Some conducted longitudinal surveys where they could track reported progression of smell loss and quality of life among COVID-19 patients. Others started exploring potential treatments of COVID-19-linked anosmia, such as olfactory training and topical steroids.
While the effectiveness of such treatments is still unclear, more than three years later, interest in such scientific collaborations is still going strong. “Even if that’s not your primary area of research, many people are at least considering the question or reaching out to other investigators that are experts on taste and smell disorders to ask ‘What is a question I can add in my research?’ or ‘Can we collaborate?” said Paule Joseph, a researcher at NIH’s Division of Intramural Clinical and Biological Research within the National Institute on Alcohol Abuse and Alcoholism.
Despite the interest, some scientists, like Meeks, are still running into the same problems they had before the pandemic: It’s difficult to capture funding and attention related to smell and smell loss. When Meeks took to X, the platform formerly known as Twitter, to lament the discouraging peer feedback on his grant proposal for traumatic brain injury and anosmia, he said, the responses were telling.
“There were several people who responded that they had received similar critiques on their own research grants or their scientific research by whoever was evaluating the research or the grant proposal,” he told Undark. “Although it was nice to know we weren’t singled out, it was a moment where I became a little bit more conscious of the need for greater communication with the broader public and with other scientists.”
Parma thinks some may be dubious to invest in research given the lack of sufficient treatments. “The biggest counterargument is: We don’t know how to treat this, so therefore it’s okay for us not to care about it,” she said. And when there are successes in the field, it’s difficult to implement them on a larger scale. Although Parma’s group has received NIH funding for their smell test, for instance, smell tests are often not covered by insurance.
But research, many scientists in the field say, is not just about developing tests or finding a cure. It’s also about informing and understanding the anosmia experience. This is especially important because not all anosmia affects the olfactory system in the same way — and it is not always treatable. A recent survey found that within a sample of nearly 30,000 Americans who were infected with COVID-19, for instance, 60% lost some sense of smell and taste. Among those, a quarter didn’t fully recover.
In one longitudinal survey to assess people who contracted the virus and lost their sense of smell, researchers from Virginia Commonwealth University found that among 267 people, more than half reported partial recovery and 7.5% reported none over a two-year period. And out of 946 people who had lost their sense of smell for at least three months, more than half reported partial recovery, and more than 10% reported no improvement at all.
“It depends on how severe the damage is,” said Richard Costanzo, director of research at the Smell and Taste Disorders Center at VCU and an author of the study, noting that if there is damage in certain regenerative cells in the nose, there is a lower likelihood of recovery.
While recent studies that focus on COVID-19 anosmia can be applied to other forms of acquired smell loss, one group has largely been left out of research: congenital anosmia. The condition is a different, and understudied, form of anosmia.
“It’s like the community of woodworking but the whole world only knows about wooden bowls,” said Sam Lenarczak, a Seattle-based 23-year-old with the condition. And congenital anosmics, like Lenarczak, want to be understood.
“Every time I look to see if I can get involved in research, they’re recruiting very specific people,” said Charlotte Atkins, who also has congenital anosmia and lives in the U.K. Those studies, she added, are nearly always about acquired smell loss, so she’s unable to participate.
Atkins acknowledges that acquired anosmia can be treated. The culprit, especially in the case of COVID-19, can be known. But she is concerned about what treatment for those conditions could mean for congenital anosmics like her — or really anyone who hasn’t had a successful recovery. “I worry that with a cure comes no more help with living,” she said, “which is what a lot more people need.”
The idea that smell is just a luxury is a “dated and narrow-minded view” that needs to be broken.
Joseph, the NIH researcher, agreed that much of anosmia research focuses on smell loss — and she sees qualitative studies of other anosmics as a next step. By understanding the lived experience, she said, researchers can develop interventions that could help people with smell loss navigate day-today life: “We need evidence to be able to develop policies, to develop guidelines, to just have a way to inform patients of what is the latest thing that could be helpful to them. We need the science.”
Still, there are some COVID-era innovations that may be repurposed. Parma is among a group of researchers pushing to implement testing more universally so that the inability to smell can be gauged earlier on, as many congenital anosmics don’t realize their condition until they start school — or even much later. In Europe, Hummel has received funding for research in olfactory dysfunction more generally, not just reserved to COVID-19 patients.
Meeks is also looking to the future, and determined to push back against the idea that smell is just a luxury and its loss pales in comparison to the loss of any other sense or bodily function. To him, it’s a “dated and narrow-minded view” that needs to be broken if the field wants to keep making progress. And despite the initial pushback from the grant reviewers, Meeks is determined to continue his research. In July, he submitted a new grant application on the topic.
“We’re not going to stop,” he said. “We’re going to keep going as long as we can.”
Hannah Docter-Loeb is a freelance writer based in Washington D.C. Her writing has appeared in the Washington Post, National Geographic, Scientific American, and more.
The World Health Organization has long walked the uneasy tightrope between evidence-based and traditional medicine. It is time to dismantle this unrealistic balance.
-Analysis-
The World Health Organization (WHO) held its First Global Summit on Traditional Medicine in August. The event, held in the city of Gandhinagar, India, was preceded by a social media advertising campaign that left scientists and serious science communicators reeling. It presented in a "friendly" way – equivalent to an implicit endorsement – alternative practices that contradict the best scientific evidence, such as homeopathy and naturopathy, and that are in no way “traditional”: the first was invented in Germany 200 years ago and the other in the U.S., a little over a century ago.
“For centuries, traditional and complementary medicine has been an integral resource for health in households and communities. It has been at the frontiers of medicine and science, laying the foundation for conventional medical texts. Around 40% of pharmaceutical products today have a natural product basis, and landmark drugs derive from traditional medicine, including aspirin, artemisinin, and childhood cancer treatments. New research, including on genomics and artificial intelligence are entering the field, and there are growing industries for herbal medicines, natural products, health, wellness and related travel. ”
At first glance, this paragraph contains two confusions and a riddle. The first confusion occurs between what some philosophers of science call the “context of discovery” and the “context of justification.” The context of discovery is the one from which scientists get their ideas, where they will find the questions they want to answer and the problems they set out to solve. The “justification context” is where scientists perform the heavy work of testing hypotheses, controlling confounding factors, conducting experiments, and producing or seeking evidence – in short, everything that allows a discovery to be called truly scientific.
When it states that “around 40% of current pharmaceutical products are based on natural products, and reference medicines are derived from traditional medicine, including aspirin”, the WHO is saying that traditional medicines are a rich part of the discovery context – which is true.
The fact that tradition is a source of good ideas does not mean that all of the ideas that come from there are good.
But this is just the first step – it is in the context of justification that the wheat from the chaff is separated, and the hypotheses that are nothing more than “brilliant theories” are separated from the ones that really work.
The fact that tradition is an abundant source of good ideas does not mean that all (or even most) of the ideas that come from there are good. And even among the good ideas, not all end up paying off in the real world.
The second confusion is between market power and therapeutic legitimacy. The existence of “growing industries for herbal medicines, natural products, health, wellness and related travel” does not imply the efficacy or safety of these medicines and products (nor do the supposed beneficial effects of travel to water resorts or other “healing places”). It is true that the combined market for traditional medicines in China (which sponsored the report 'WHO Traditional Medicine Strategy 2014-2023') and India (the summit's host country, which has a special ministry just to promote alternative therapies) probably already exceeds 10 billion dollars annually. But commercial success and scientific validity are very different worlds.
The enigma is contained in the brief excerpt 'New research, including on genomics and artificial intelligence are entering the field'. The question is, shouldn't tradition be valuable by itself? Who needs these modernist fads?
“Around 40% of current pharmaceutical products are based on natural products, and reference medicines are derived from traditional medicine."
WHO's introductory text is a balancing act. In six paragraphs, the word “evidence” appears five times. Being part of the UN and, therefore a political but also a technical (or technical but also political) body, the WHO juggles things to impress its sponsors who want to capitalize on “traditions” in the globalized health and wellbeing market, without betraying its commitment to human health.
Sometimes this doesn't work out very well, as seen in the social media campaign for the India summit or the disastrous 2019 decision to include traditional Chinese medicine diagnoses in the International Classification of Diseases. However, the conflict becomes really clear from a careful reading of the most up-to-date material on traditional medicine recently made available by WHO. At the heart of it is that word “evidence”. Consider this paragraph obscured in the FAQs sections the WHO press website (dated August 9, 2023):
“Integration of T&CM [traditional, complementary and integrative medicine] with national health system and the mainstream of health care must be done appropriately, effectively and safely, based on the latest scientific evidence. WHO assists countries that want to embrace traditional medicine practices to do so in a science-based manner to avoid patient harm and ensure safe, effective and quality health care. An evidence-based approach is crucial; even if traditional medicines are derived from longstanding practice and are natural, establishing their efficacy and safety through rigorous clinical trials is critical.”
This is a true statement of principles, and it stands in contrast to the report 'WHO Traditional Medicine Strategy 2014-2023' published 10 years ago. The latter contained vague mentions of “traditional medicine with proven efficacy, safety and quality” (without explaining how were they “proven”, by what criteria, or by whom) and problematic statements such as “although there is much to learn from controlled clinical trials, other evaluation methods are also valuable”.
This is what happened with aspirin and artemisinin, two drugs originally inspired by traditional uses of plants, but which are now duly incorporated into the arsenal of evidence-based medicine. Read together, the WHO's current statements on the subject seem to push traditional medicines, gently but firmly, into the context of discovery. And with the full intention of leaving them only in that context, which is quite the opposite of what was suggested a decade ago.
The 10 billion-dollar question: Is this stance really serious? Or is it just a rhetorical bone thrown to critics to distract them while some new traditional Chinese medicine CID-sized atrocity is cooked up behind the scenes?
In any case, it is notable that the declaration of principles contained in the FAQ condemns, even if implicitly, public policies already implemented by countries that integrate alternative practices into their health systems.
If taken seriously, the recipe dismantles the current tenuous bridge between the alternative and the mainstream.
In India, the ministry in charge of traditional medicine has, as part of its founding mission, the promotion of homeopathy – which has never been able to prove its merits in the “rigorous clinical trials” that the WHO considers “fundamental” for the integration of therapies to the health system. In Brazil, the National Policy on Integrative and Complementary Practices (PNPIC) not only includes homoeopathy, but defends it with the argument that traditions, especially those associated with oppressed groups, have epistemic value independent of the scientific method. (Never mind that most of the practices present in the PNPIC are of North American or European provenance.)
If taken seriously, the recipe presented in the FAQ dismantles the current tenuous bridge between the alternative and the mainstream. At the same time that it lays the groundwork for a new one, linking the traditional with scientific medicine. If it manages to withstand the bombardment of political, ideological, and economic interests that it will certainly suffer, it could yet be an imposing structure.
On this day in 2020, the worldwide death toll from the COVID-19 pandemic reached one million.
Get This Happened straight to your inbox ✉️ each day! Sign up here.
What was the initial global response to the COVID-19 pandemic?
In the early stages of the pandemic, countries implemented various measures such as travel restrictions, quarantine protocols, and public health campaigns to raise awareness about the virus. The World Health Organization (WHO) declared COVID-19 a global pandemic on March 11, 2020. WHO facilitated information sharing, provided guidelines, and coordinated efforts to ensure equitable access to medical supplies and vaccines. Initiatives like COVAX were launched to ensure fair distribution of vaccines to lower-income countries.
Were there any challenges in the global response to COVID?
Challenges included: Vaccine Distribution Disparities: Access to vaccines was unequal, with wealthier countries obtaining more doses, leading to concerns about vaccine equity. Misinformation: The spread of misinformation and conspiracy theories complicated public health efforts. Economic Impact: Lockdowns and restrictions led to economic downturns, affecting livelihoods and economies worldwide.
How did the pandemic affect healthcare systems?
Healthcare systems faced unprecedented challenges, with surges in cases straining resources and hospital capacities. Telemedicine gained prominence as a way to provide care while minimizing in-person contact.
Between breastfeeding, playdates, postpartum fatigue, birthday fatigues and the countless other aspects of mother- and fatherhood, a Cuban couple tries to find new ways to explore something that is often lost in the middle of the parenting storm: sex.
HAVANA — It was Summer, 2015. Nine months later, our daughter would be born. It wasn't planned, but I was sure I wouldn't end my first pregnancy. I was 22 years old, had a degree, my dream job and my own house — something unthinkable at that age in Cuba — plus a three-year relationship, and the summer heat.
I remember those months as the most fun, crazy and experimental of my pre-motherhood life. It was the time of my first kiss with a girl, and our first threesome.
Every weekend, we went to the Cuban art factory and ended up at the CornerCafé until 7:00 a.m. That September morning, we were very drunk, and in that second-floor room of my house, it was unbearably hot. The sex was otherworldly. A few days later, the symptoms began.
She arrived when and how she wished. That's how rebellious she is.
No desire, no brain cells...
She was born on a hot June morning. After recovering from the C-section, we returned home with a nearly five-kilogram baby in our arms and the new life of first-time parents on our shoulders. Everything from that moment can be summarized in three words: crying, breastfeeding and poop.
How was sex in that first year? I don't know. I'm not even sure we had it. A cloud of diapers obscures that memory. Lust and wild passion didn't exist. Instead, there was an infected C-section wound with staph bacteria from the delivery room, my overweight, eternal fatigue and sleepiness, breast pain from her inexperienced latch, and an excess of milk.
I know friends who started having sex before the postpartum period ended. I envied them a lot; I couldn't understand where they found the energy. I still don't understand. My partner says we did have sex, but he doesn't remember any specific moments.
Those initial months were all about learning, maximum concentration and above all, dedication to the new family member. There was no desire or brain cells left for sex.
Making love or playing hide-and-seek?
A year passed, and sex returned, but as a routine. We were a young couple, but it wasn't the same. We had to manage it differently, look for new strategies, try other places in the house because the baby's crib was in our room until she turned four.
I couldn't have sex in the bedroom. He would start caressing me, and I imagined that the child would wake up.
We were a young couple, but it wasn't the same.
We experimented in another room on the ground floor, in the living room, in the kitchen, but I couldn't stop worrying about her. I couldn't see her, I didn't know if she was breathing or doing okay. My motherly thoughts didn't let me enjoy or have orgasms as I should have.
I also don't recall masturbating during that time. Perhaps I did, probably hiding in the bathroom during the few minutes I had to shower, because the baby could need my breasts at any moment.
During labor and the first weeks of breastfeeding, pregnant bodies produce oxytocin. The hormone shortens labor and makes it less stressful; so much so that some women think about having another baby. In my case, oxytocin flew in abundance and made me forget the difficult moments, the good ones — and sex. It made me forget if we had it during that period.
"When there's a child, you have to plan things more carefully."
Until she finally reached an age where she could stay with her grandparents. One weekend with the maternal grandparents and another with the paternal ones. The earthly paradise and the return of sex.
Children complicate certain practices such as sexy dances, loudness, pre-party music, role-playing and group activities. It depends on each couple's intimacy, but we needed certain things.
We were lucky to have the "old folks." This marked the beginning of a second season in our relationship and our bed. We returned to some parties and bars, met new people and reconnected with old friends.
Five years, married, and with plenty of fantasies in mind.
Sex is not discussed
In university, sex was always a topic of conversation. In any gathering, amid any work, we ended up talking about penetration, fellatio, indecent encounters and related topics.
It was delightful to discuss these things with friends. After becoming parents, our circle of friends was mainly composed of other young parents like us. Geeks with sons and daughters. We would meet at children's playgrounds, birthdays or any impromptu kid-friendly gathering, but the topics were not the same as before.
Complaints about elementary school teachers or head lice were the center of discussion. Anything related to sexuality was forbidden because children could hear us, and "they understand everything."
Polygamy and group sex practices are complicated after giving birth. When there's a child, you have to plan things more carefully. My partner and I discussed inviting a "unicorn" girl to our home to break the routine, but questions about the child always arose. Our experiences were limited to when she was with her grandparents, and it usually lasted only one night.
During an outing with friends, I ran into the girl I had my first kiss with, before I became a mother. There was only one kiss between us, and we never saw each other again. We had never bumped into each other, not even in the bus queue. There was joy in our reunion. We caught up in just a few hours. She was a mother and married. We arranged for the girls to play at her home in Vedado. We became quite close during those days, and the girls got along well and were happy.
"The girl from the kiss" talked to me on the way to her daughter's daycare. Her husband and she wanted to try with another couple, and we were the chosen ones. But it had to be at their place, and carefully organized because their daughter and the girl's mother would be there.
We scheduled a weekend. One thing about having children is that plans can fall apart at any moment. No matter how many schedules you have, no matter how much you plan ahead, you can never be sure it will happen. The first agreed-upon weekend, one of the girls had a slight fever, and we had to cancel.
Our encounters with them started at their house, with the girl asleep but there. No noise, so as not to wake her. No moaning, spanking or motivating phrases. We had a rehearsed response in case she woke up and asked what her parents and uncles were doing in bed. Everything happened stealthily, but it was enjoyable. It was something new and thrilling for all four of us.
On one occasion, we met at our house when they had their place occupied and her mother started to suspect. At our home, it had to be in the afternoon since the girls were at the daycare center. We would stop around 4:00 p.m. and pick them up.
Around that time, I was reading a book that was given to me by "the girl from the kiss"'s husband, a sort of manual for polyamory: The Ethical Slut by American authors Dossie Easton and Janet W. Hardy. That book helped me understand many things that were not clear to me until then, especially in terms of managing emotions. I understood that polyamory is not a simple practice, and it shouldn't be taken lightly; on the contrary, it requires a lot of maturity, trust, communication and emotional responsibility.
Europe and the more open minds
After emigrating and living in Europe, we discovered a broader world of sex and affection, more colorful than the one we knew in Cuba.
So, we still limit ourselves to having sex.
Swinger clubs and saunas, apps to find singles or swinger couples, nightclubs open at all hours, theme bars of all kinds, sex shops, dark rooms, BDSM parties, erotic dancers, escorts, nudist beaches — much more open and willing people. I've thought that if all this existed in Cuba, the divorce rate would be much lower. Also, if there were babysitters and decent salaries to afford them.
But here, there are no grandparents. So, we still limit ourselves to having sex. Our Olympic performances take place in the mornings and early afternoons. We don't want to disturb the neighbors either. In these apartments, everything can be heard, especially in the silence of the night. Despite her age, our daughter still doesn't get used to sleeping alone in her room and comes to ours. That's detrimental to our sexual health.
The reality is that, in both Cuba and Spain, we are still parents, but also a young couple. The desires to explore, to learn, to exchange, to delve a bit into the new possibilities offered by European culture. Better and wetter times will come.
Fermented foods — from sauerkraut to kimchi to yogurt — are known to protect intestinal health, improve mental health and even help prevent cancer. But scientists say we need to be careful about overstating the benefits.
WARSAW — They include sauerkraut, dill pickles, pickled beets, and kimchi … but also kefir and sourdough bread. These foods — traditional to Polish, Korean, and West African cuisines — are trending across the world thanks to their diverse health benefits.
Pickles, or fermented foods, are technically defined as "food or beverages produced by the controlled growth of microorganisms and the transformation of food ingredients by enzymatic action." Aside from the traditional pickled vegetables found in jars, the benefits of fermented foods can also be found in any foods which are made using lactic acid fermentation — even bread made on a fermented base, such as sourdough.
Research shows that fermented foods can not only strengthen gut health but also boost mental health and well-being, improve mood, and help foster a healthy immune response.
Mind-Body Benefits
One of the main health benefits of fermented foods is that they are rich in beneficial microorganisms and metabolites: substances produced by bacteria during fermentation, which are crucial to maintaining a healthy gut. Fermented foods contain not only live bacteria but also non-digestible ingredients that stimulate the growth or activity of beneficial bacteria in the large intestine.
The bacteria contained in fermented foods strengthen the intestinal walls, preventing their contents from entering and contaminating the bloodstream. Among other benefits, this is known to help avert “leaky gut syndrome,” a condition affecting the intestinal lining whose symptoms include bloating, cramps, and food sensitivities. Research also shows that pickled foods can help treat allergies, type 2 diabetes, hypertension, and even eczema. Eating fermented milk products specifically has been linked to lower risks of bladder cancer as well. The health benefits are so great that in some circles, fermented milk products and yogurt are recommended for children as young as six months old.
In Poland, the end of summer is “pickling season.”
Research undertaken by Professor Tim Spector, an epidemiologist at King’s College London (whose team created the Zoe COVID Symptom Study smartphone application in March 2020), discovered a relationship between diet and the risk of severe illness from COVID-19. The study, which was co-led by scientists from Harvard and covered nearly 600,000 participants, showed that the risk of severe COVID-19 requiring hospital treatment was as much as 40% lower if people ate a healthy diet. Read: a diet rich in plant products and ... pickles. This is largely due to the positive impact of fermented foods on our gut microbiome, which is heavily linked to the body’s innate immune response — the body’s first line of defense against invaders.
The chemical compounds that form during the fermentation process have also been linked to positive changes in our mental health. Bacteria contained in fermented foods have cholesterol-lowering properties but also increase the level of serotonin, which stabilizes mood, regulates well-being, and eases anxiety. Regularly consuming fermented food products can also help improve the quality of your sleep.
It is scientifically proven that fermented foods positive impact on our gut microbiome.
little plant
Natural Probiotics?
Many of us use the term "natural probiotics" when referring to pickles. But is this accurate? I asked Professor Ewa Stachowska, M.D., a biochemist, and the head of the Department of Human Nutrition and Metabolomics of the Pomeranian Medical University in Szczecin, who admitted that though both can have similar health benefits, calling pickles a "natural probiotic" may be going a bit too far.
“There is a lot of confusion on this topic because the same types of bacteria that appear in fermented foods also appear in certain probiotics,”Dr. Stachowska told Gazeta Wyborcza’s podcast “Zdrowa Rozmowa” (Healthy Talk). “But the difference is — and this is a big difference — that a probiotic should include the specific strain of bacteria which was specifically tested for a particular purpose in clinical trials.”
“Of course, fermented foods are known for being beneficial to our wellbeing”, she added, “but when we talk about probiotics, we are talking about benefits observed in clinical settings in people with specific conditions, such as obesity, insulin resistance, or bowel dysfunction. We are saying that this specific strain of bacteria in this specific amount over this specific length of time worked in this specific way”.
According to Dr. Stachowska, aside from beneficial bacteria, fermented foods contain several bacterial metabolites, such as some types of vitamins and lactic acid — but they also include histamines, which can provoke negative health reactions in people suffering from certain digestive issues. This is why some people can, for example, have symptoms of bloating after eating sauerkraut. She recommends eating fermented foods daily in order to see health benefits, and taking probiotics when necessary for extra boosts.
What And Where To Eat
Many traditional cuisines rely heavily on fermented foods.
In Poland, the end of summer is “pickling season” where Poles can and store dill pickles, beets, peppers, onions, and more in preparation for the winter months. Usually served as a side dish, these pickled vegetables are an easy and tasty way of preserving gut health. Fermented foods and drinks are also a popular part of West African cuisine, which, according to The Conversation, are rich in dietary fiber, protein, calcium, iron, and potassium.
Kimchi is the most common and important dish in Korea
Looking to incorporate some pickles into your diet? These quick recipes from Polish website Interia.pl show you how to enjoy their health benefits at home. Best of all, all of them are ready to enjoy in a week or less!
Pickled Tomatoes
Place washed cherry tomatoes tightly next to one another in a large jar, along with a few cloves of garlic, fennel, a bay leaf, and a piece of horseradish root.
Pour in brine made of 2 tablespoons of salt per one liter of water.
Cover the tomatoes and set aside for one week, after which they are ready to eat. These go especially well with pasta or salads.
Pickled Beetroots
Carefully peel well-washed beetroots and cut them into thick slices. Pack them tightly together in layers in a jar, adding a few cloves of garlic, laurel leaves, dill, and allspice. Pour over the brine, making sure to coat all of the vegetables. Cover and let sit for 6 to 7 days before serving.
If you also want to try a flavored beetroot juice from the pickles, place a slice of rye bread on top of the jar as a cover, which will add flavor and help the fermentation process. The juice and the pickled beetroots will be ready to enjoy after a week, and taste excellent as a side dish to potatoes and meat dishes, or in salads.
Pickled Cauliflower
Arrange washed cauliflower florets tightly in a large jar. Add pieces of cut fresh horseradish and ginger root, as well as allspice. Pour over the salt brine, cover, and pickle for 3 to 5 days. Pickled cauliflower can be used in salads, sandwiches, pasta dishes, on top of baked tarts, or other similar dishes.
When making these pickle recipes, make sure that the contents of your jar can mix with oxygen for a few days — cover the jar but don't seal it shut. This will allow the fermentation gasses to escape. After the first few days, close the jar tightly, which will help fully preserve the pickles.
Women in Italy are living longer than ever. But severe economic and social inequality and loneliness mean that they urgently need a new model for community living – one that replaces the "one person, one house, one caregiver" narrative we have grown accustomed to.
ROME — Nina Ercolani is the oldest person in Italy. She is 112 years old. According to newspaper interviews, she enjoys eating sweets and yogurt. Mrs. Nina is not alone: over the past three years, there has been an exponential growth in the number of centenarians in Italy. With over 20,000 people who've surpassed the age of 100, Italy is in fact the country with the highest number of centenarians in Europe.
Life expectancy at the national level is already high. Experts say it can be even higher for those who cultivate their own gardens, live away from major sources of pollution, and preferably in small towns near the sea. Years of sunsets and tomatoes with a view of the sea – it used to be a romantic fantasy but is now becoming increasingly plausible.
Centenarians occupy the forefront of a transformation taking place in a country where living a long life means being among the oldest of the old. Italy is the second oldest country in the world, and it ranks first in the number of people over eighty. In simple terms, this means that Italy is home to many elderly people and few young ones: those over 65 make up almost one in four, while children (under 14) account for just over one in 10. The elderly population will continue to grow in the coming years, as the baby boomer generation, born between 1961 and 1976, is the country's largest age group.
But there is one important data set to consider when discussing our demographics: in general, women make up a slight majority of the population, but from the age of sixty onwards, the gap progressively widens. Every single Italian over 110 years old is a woman.
Never been better
The way people live after 60 has changed over time in relation to shifts in demographics. The current average age of the Italian population is 46.2 years, and life expectancy for women is almost 85 years, with these parameters steadily increasing. There are also social changes, such as a significant rise in the retirement age or the age at which people become parents and grandparents.
One consequence of these transformations is the emergence of a group we could call "young elders." This demographic shift also brings about cultural changes. Today, many elderly women enter universities and the job market, and quite a few continue to lead active social lives, travel, attend theaters, cinemas, and cultural events, and go to the gym well past the age of sixty.
Many are also breaking through glass ceilings. Marta Cartabia became the first female president of the Constitutional Court, and Gabriella Loppolo became the first female police chief in Messina. At the age of 72, Vienna Cammarota became the first woman to embark on the Silk Road, a 22,000-kilometer journey on foot from Venice to China. She wrote on her website, "I want to uproot the prejudices about women and the idea that a woman alone and of my age cannot or should not undertake this kind of adventure."
Women who cross the threshold of 60 find themselves caught between two opposing forces. The first is born of the spaces they have already conquered: their personal achievements and the lifestyles they have built. The second pushes them back towards outdated notions of what it means to be an elderly woman. Despite social norms, or perhaps because they have already challenged many of them, today's elderly women are reinventing how they experience old age. In part, as often happens, businesses have understood this shift: advertisements targeting 'young elderly' women who go out to restaurants, swim, and laugh about their watertight dentures are on the rise. Yet, in the collective media, political, and cultural imagination, elderly women have a single connotation: that of nonne (grandmothers), or even better, nonne who cook.
In her recently republished book Non è un Paese per Vecchie (No Country for Old Women), Loredana Lipperini illustrates how elderly women in Italy are essentially removed from the public space or only accepted if they behave, dress, and groom themselves "properly." This idea is also reflected in the essay "In Our Prime: How Older Women Are Reinventing the Road Ahead" by the American author Susan J. Douglas: "Too many businessmen, politicians, and certainly the media still have blinders on when it comes to us women. Because it is assumed that elderly women are, for the most part, and even more so than young women, quiet, docile, and invisible."
Domenica Ercolani is currently the oldest known living person in Italy.
For some, old age is the time to enjoy economic stability, leisure, and the company of loved ones, or to continue working and receiving recognition. However, for many others, old age means living through disastrous conditions.
The quality of one's life during old age depends greatly on their career during the active phase of life. Your pension determines whether you can have a comfortable home, pay for care services, or support your family. Women's lower participation in the labor market, career discontinuity, part-time work, and worse contractual and salary conditions create inequalities that have a lasting negative impact on their elderly years. Additionally, there is the burden of unpaid domestic and caregiving work, which falls disproportionately on women. Even when they do not participate in the labor market, women work more hours than men. As a result, they reach old age more worn out from work.
The large wage gap creates a population of elderly women living in poverty.
The 'gender pension gap' shows the disparity between pensions received by women and men. The INPS 2022 report highlights that even though women represent 52 percent of all pensioners, they receive only 44 percent of pension income. The average gross monthly income of men is 1,884 euros, 37 percent higher than the average 1,374 euros that women make. The majority of women fall into the category of low pension earners, creating a population of elderly women living in poverty.
The wage gap and the pension gap add to wealth disparity. It's a challenging estimate to make because in Italy, wealth, and poverty are measured on a household basis. However, in 2018, Giovanni D'Alessio conducted an experimental study for the Bank of Italy on the individual wealth of Italians, showing that the wealth gap between men and women is extremely high, and it grows wider as wealth increases (just like the wage gap). The individual net wealth of men is over 25 percent higher than that of women. This gap worsens to 35 percent when it comes to financial investments.
One of the consequences of these inequalities is that women live longer but reach old age in worse health conditions: LSTAT data indicate that women perform worse on all health indicators except for severe chronic diseases which are more common among men.
Of love and loneliness
Besides poverty and poor health, there's also a lack of love. According to LSTAT, only three out of 10 women over the age of 75 live in a couple relationship. For men, the equation is reversed. In other words, while it's quite reasonable for a man to expect to have company until his last day, it isn't so for a woman. Mara Gasbarrone, in an article oninGenere, emphasizes that loneliness significantly affects the quality of old age. The reason why many women live alone cannot be solely attributed to their greater longevity, Gasbarrone writes.
In Italian society, a union where the man is older is viewed favorably. It's the same culture that allows men to have an active romantic life for longer; in fact, after the age of 65, many more men marry than women, and as the groom's age increases, the age difference with the bride also increases. From the perspective of social sustainability, the opposite choice would make more sense: older women who are destined to live longer accompanied by younger men who are destined to live less.
And if in the past, the groom's older age was associated with greater economic stability, in 2022, the issue of stability no longer holds. For every couple that gets married, there's one that separates, and there's generally much more economic mobility than there once was. Only stereotypes remain.
In addition to stereotypes about relationships, there's the role of the traditional family as a privileged relational universe. The elderly almost always live very close to their children, but often without a strong network of friendships that would make new and different forms of cohabitation and companionship plausible. Most elderly people without a spouse live alone, and according to data reported by Gasbarrone, this increases the risk of dementia by 30 percent. In Italy, there are four and a half million women over 60 who live alone. They are mostly widowed but also single, divorced, or separated. They represent a significant part of the population – but generate hardly any discussion.
According to LSTAT, only three out of 10 women over the age of 75 live in a couple relationship.
The elderly women of today are the girls who participated in the feminist movement of the 70s. The presence of so many women who have transformed their lives through feminism and are now approaching old age could be a valuable resource. The same women who once spoke out against society could now break the silence on the living conditions of the elderly and the oppressive expectations posed on them. In Italy, they would have the numbers to lead a revolution.
In this worldview, it's essential to understand and support new forms of relationships and living arrangements. The Italian model – one person, one house, one caregiver – is unsustainable on many fronts and rife with the exploitation of caregivers. Among those women working in Italy with the most unfair contracts and lowest salaries, many are domestic workers and caregivers who have immigrated from Eastern European countries. In an analysis conducted before the Russian invasion of Ukraine, sociologist Francesca Alice Vianello observed that many of them are not young. In the Ukrainian community in Italy, 24 percent of women are over 60 years old, and only a tiny fraction receive a pension. The majority continue to work, primarily in domestic and caregiving roles.
We are therefore witnessing a general aging of a significant portion of the female foreign population living in Italy, accompanied by a parallel aging of the women employed as family caregivers. This is how we end up with young elderly women caring for older individuals.
The challenge, then, is to change the model and make possible reciprocity and mutual support. To rethink common services and shared housing. To nurture friendships that open up the possibility of cohabitation and cost-sharing. In Italy, particularly in the central-northern regions, the first experiments with senior cohousing have started, while Northern Europe already has established cohabitation experiences.
These are models in which individuals maintain their autonomy but share caregiving services and communal spaces. It's possible to sustain these arrangements with friends or by replacing dependence on the family of origin with interdependence among people who care for each other and have become a chosen family.
One could live in Sardinia with lifelong friends, cultivating tomatoes with a view of the sea.
Cohabitation doesn't necessarily require specific, codified places and spaces, but to make it happen, we need to change our concept of family and imagine a different form of welfare.
Undoubtedly, it would be wonderful to live in a house with an ocean view, like Jane Fonda and Lily Tomlin's characters in "Grace and Frankie." It's one of the rare TV series that depicts old age as a complex but vibrant time full of possibilities, including those of a romantic and erotic nature. However, one could also live in a house in Sardinia or Liguria (the two regions in Italy with the highest life expectancy) with lifelong friends, cultivating tomatoes with a view of the sea.
In France, women did just that when they built the La Maison Des Babayagas in 2012, a cohabitation project for women based on feminist, ecological, participatory, and solidarity principles, aimed at living "free and old." It's time to rethink what kind of lives we want after the age of 65, 75, or even beyond 100.
