How to build a habit in 5 steps, according to science | CNN

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Most of us assume those superachievers who are always able to squeeze in their workout, eat healthy foods, ace their exams and pick their kids up on time must have superhuman self-control. But science points to a different answer: What we mistake for willpower is often a hallmark of habit.

People with good habits rarely need to resist the temptation to laze on the couch, order greasy takeout, procrastinate on assignments or watch one more viral video before dashing out the door. That’s because autopilot takes over, eliminating temptation from the equation. Having established good habits, little to no willpower is required to choose wisely.

Sounds great, right? The only catch is that building good habits takes effort and insight. Thankfully, science offers both guidance on how to begin and strategies to lighten your lift. Here are a few research-backed steps sourced from my book, “How to Change,” that can set you on the path from where you are to where you want to be.

The way you define the goal you hope to turn into a habit does matter. Goals such as “meditate regularly” are too abstract, research has shown. You’ll benefit from being more specific about what exactly you aim to do and how often.

Don’t say “I’ll meditate regularly.” Say, “I’ll meditate for 15 minutes each day.”

Having a bite-size objective makes it less daunting to get started and easier to see your progress.

Now that you have established a specific goal, it’s time to think about what will cue you to follow through. Scientists have proven that you’ll make more progress toward your goal if you decide not just what you’ll do, but when you’ll be cued to do it, as well as where you’ll do it and how you’ll get there.

A plan like “I’ll study Spanish for 30 minutes, five days a week” is OK. But a detailed, cue-based plan like “Every workday after my last meeting, I’ll spend 30 minutes studying Spanish in my office” is much more likely to stick as a habit.

Making this kind of plan reduces the chances you’ll forget to follow through because the when and where in your plan will serve as cues to action that jog your memory. Even better: Put your plan on your calendar so you’ll get a digital reminder. An established, hyperspecific plan also forces you to anticipate and maneuver around obstacles and makes procrastination feel more sinful.

When we set out to build a new habit, most of us overestimate our willpower and set a course for the most efficient path to achieving our end goal. Say you hope to get fit by exercising regularly — you’ll likely look for a workout that can generate quick results such as grinding it out on a treadmill. But research has shown you’ll persist longer and ultimately achieve more if you instead focus on finding ways to make goal pursuit fun.

When it comes to exercise, this might mean going to Zumba classes with a friend or learning how to rock climb. If you’re trying to eat more fruits and vegetables, it might mean swapping doughnut breakfasts for tasty smoothies, which can combine multiple servings of fruits and veggies in one delicious drink. Because you are far more likely to stick with something you enjoy and repetition is key to habit formation, making the experience positive is critical, but it’s often overlooked.

One excellent way to make goal pursuit fun is to try what I call “temptation bundling.” Consider only letting yourself enjoy an indulgence you crave while working toward your goal. For example, only let yourself binge-watch your favorite show while at the gym or enjoy a beloved podcast while cooking healthy meals. My own research shows that temptation bundling improves follow-through; it transforms goal pursuit into a source of pleasure, not pain.

By the time we put a behavior on autopilot, a lot of us fall into fairly consistent routines, tending to exercise, study or take our medication at the same time of day and in the same place. But when you’re in the start-up phase of habit building, contrary to popular opinion, my research suggests it’s important to insert some variability deliberately into your routine.

You’ll still want to have a first best plan — maybe an 8 a.m. meditation session if you’re trying to kick-start a mindfulness habit. But you should also experiment with other ways of getting the job done. Try to mix in a noon session and maybe a 5 p.m. meditation, too.

Successful habit building relies on frequently repeating a behavior, and if your routine becomes too brittle, you’ll follow through less often. A flexible habit means you can still do what you need to even when a wrench is thrown in your first best plans — say, a traffic jam on the way to dropping the kids off at school that gets in the way of your morning meditation.

One way to be flexible that’s proven useful is by giving yourself “emergency reserves.” Emergency reserves are a limited number of get-out-of-jail-free cards for those days when you really can’t squeeze in your 10 minutes of meditation, regular jog or Spanish practice.

It’s more motivating to set a tough goal for yourself — meditating every day, for instance — than an easy one, according to research. But missing multiple subgoals along the way can be discouraging. A couple of emergency reserves each week give you the flexibility to miss a day when a real emergency arises without getting discouraged and abandoning your objective entirely.

This step is obvious but sometimes overlooked. Seek out social support. Social support isn’t just about having cheerleaders and people to hold you accountable — though both can add value, so I’d suggest telling your friends and family about your goals.

We’re strongly influenced by the behaviors of the people around us, evidence shows. Want to start running regularly? You’re probably better off joining an established running club than asking a few friends who aren’t yet in the habit of jogging to get in shape with you. People in the running club have already built the habits you want. You can learn from them about what works and gain friends who will make you feel like a slouch when you slack off.

Good habits are contagious, so try to catch some by hanging out with people who are a little ahead of you on the learning curve. It’s important not to get too crazy — if you try to train with marathoners when you’re just hoping to work up to a 5K, I’ve found it can be discouraging.

But in general, research by myself and others shows that finding people to socialize with and emulating those who have already accomplished what you want to accomplish can make a world of difference. As an added bonus, when you pursue your goals in tandem with people you like, that makes it more fun!

One last thing to keep in mind is that habits can take some time to form. They don’t click overnight. Despite claims that there’s a “magic number” of days it takes to form a habit, my collaborators and I have disproven this myth in our recent research. We all form habits at our own speed, but for simpler and frequently repeated behaviors such as hand sanitizing, we can expect speedier habit formation than for more complex behaviors such as hitting the gym, which, on average, can take months rather than weeks to put on autopilot.

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Urinary tract infections in men: Here are 10 things to know | CNN

Editor’s Note: Dr. Jamin Brahmbhatt is a urologist and robotic surgeon with Orlando Health and president of the Florida Urological Society.



CNN
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While urinary tract infections are more common in women, men can still get what’s commonly known as a UTI. Here are 10 things I’d like you to know about urinary tract infections, including who’s more at risk and how to get treatment.

UTI is short for urinary tract infection. It’s an infection of the organs in your body – I call them pipes – that are meant to funnel your urine out of your system and into the urinal. Most UTIs are caused by bacteria that work their way into the urethra, prostate, bladder or kidneys.

Way more women than men are diagnosed with UTIs. Anatomically, we feel this happens because women have a shorter urethra – the tube that connects the bladder to the outside world. The shorter length makes it easier for bacteria to travel to the urinary system. Men have longer urethras and therefore can be protected against urinary infections.

But the length of the urethra alone cannot protect men against UTIs – over their lifetimes, 12% of men will get urinary symptoms linked to a UTI. This by no means implies a urethra or penis are short or small. In men, there is usually a more clear pathologic cause to the infection beyond just the length of the urethra.

There are many reasons why a guy may get a UTI – all of them we take seriously and should not be ignored.

Men older than 50 tend to get more infections than younger men. As a urologist, I see men get recurrent infections when they do not properly empty their bladder because of an enlarged prostate. Beyond the prostate, men may not empty their bladder if they have nerve damage from stroke, uncontrolled diabetes or injury to the spine.

Men can also get infections that start from the prostate or testicles that seed up into the bladder, or the opposite can happen where the infection goes from the bladder to the other organs. Kidney stones can also be a cause of infection. (I know this from personal experience – I’ve had a kidney stone myself!)

Younger men may also present with urinary infections because of sexually transmitted diseases. Men can also get an infection if they have a recent procedure done in the urinary system.

4. What are the signs and symptoms of a UTI?

Burning with urination (dysuria), increased urinary frequency, urgency, incontinence, foul smell, blood in the urine, fevers, chills, pain in the abdomen near the bladder. Believe it or not, some men may have zero symptoms and still get diagnosed with a UTI based on urine cultures done for other purposes.

UTI is diagnosed by sending your urine off for a culture. This is when a sample of your urine is processed and evaluated for various strains of bacteria. The most common bacteria identified in urinary tract infections is E.coli. Once the culture is done, the results can guide treatment, which is usually oral antibiotics. There is a test called a urine analysis which can be done quickly in our office which can suggest an infection. However, the best test is an actual culture.

Doctors do not wait for the culture results – which can take one to three days – to start treatment. If an infection is suspected, an antibiotic will be started immediately and then adjusted based on the culture results.

UTIs generally are treated with oral or IV antibiotics. Most infections can be treated with oral antibiotics. However there are superbugs that may be resistant to what we can give you by mouth that may require the use of stronger antibiotics through an IV. Most treatments last seven to 10 days, but can be longer.

In severe cases of infection that has spread to the bloodstream, strong IV antibiotics are started immediately to control the infection. Patients are placed in the hospital to start these strong treatments. You do not have to stay in the hospital for weeks if you have infection in your bloodstream. As long as you are doing well – no fever, normal labs, heart and pulse OK – then you may continue these IV treatments from home. Each treatment is tailored to your condition.

As a doctor, my answer is: No. Men should not try to treat infections on their own. If you have symptoms, get yourself to a doctor or emergency room.

The best prevention is making sure first there is nothing anatomical that needs to be corrected, such as an enlarged prostate, kidney stone or blockage.

Proper hygiene can help prevent infections. Men with uncircumcised penises should make sure they can retract the foreskin and clean under the foreskin and the glans properly. Cranberry supplements have been shown to help prevent infections. Staying hydrated by drinking enough fluids/water during the day can also help. Making sure you don’t hold your urine can help, too. Staying in good health to avoid chronic medical conditions such as diabetes and heart disease will also protect against infections.

9. My infection is gone. Are there any long-term effects on my body?

Recurrent, untreated infections could cause strictures, or tight scars, in your urethra that would slow your stream and make it difficult to empty your bladder. Infections could also cause the bladder to lose its ability to fill and empty properly. In the long run, if you are getting constantly treated with antibiotics, we may run out of antibiotics to give you due to resistance.

The first priority is to clear the infection with antibiotics.

From there, we do a full workup with a detailed history, evaluation of chronic medical problems and exam of the genitals to look for anatomic issues such as a foreskin that won’t retract back. Imaging may include a CT scan of the abdomen and pelvis to look for kidney stones, blocked tubes and other abnormalities.

If you see a urologist, you will likely get a cystoscopy, where we place a camera inside of a small tube into the urethra to look at the inside of your urine channel. The cystoscopy helps look for strictures, large obstructing prostates and changes to the bladder walls. Once a cause is found, it’s aggressively treated with either medication or surgery.

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Nearly two years after Texas’ six-week abortion ban, more infants are dying | CNN



CNN
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Texas’ abortion restrictions – some of the strictest in the country – may be fueling a sudden spike in infant mortality as women are forced to carry nonviable pregnancies to term.

Some 2,200 infants died in Texas in 2022 – an increase of 227 deaths, or 11.5%, over the previous year, according to preliminary infant mortality data CNN obtained through a public records request. Infant deaths caused by severe genetic and birth defects rose by 21.6%. That spike reversed a nearly decade-long decline. Between 2014 and 2021, infant deaths had fallen by nearly 15%.

In 2021, Texas banned abortions beyond six weeks of pregnancy. When the Supreme Court overturned federal abortion rights the following summer, a trigger law in the state banned all abortions other than those intended to protect the life of the mother.

The increase in deaths could partly be explained by the fact that more babies are being born in Texas. One recent report found that in the final nine months of 2022, the state saw nearly 10,000 more births than expected prior to its abortion ban – an estimated 3% increase.

But multiple obstetrician-gynecologists who focus on high-risk pregnancies told CNN that Texas’ strict abortion laws likely contributed to the uptick in infant deaths.

“We all knew the infant mortality rate would go up, because many of these terminations were for pregnancies that don’t turn into healthy normal kids,” said Dr. Erika Werner, the chair of obstetrics and gynecology at Tufts Medical Center. “It’s exactly what we all were concerned about.”

The issue of forcing women to carry out terminal and often high-risk pregnancies is at the core of a lawsuit filed by the Center for Reproductive Rights, with several women – who suffered difficult pregnancies or infant deaths shortly after giving birth – testifying in Travis County court this week.

Prior to the recent abortion restrictions, Texas banned the procedure after 20 weeks. This law gave parents more time to learn crucial information about a fetus’s brain formation and organ development, which doctors begin to test for at around 15 weeks.

Samantha Casiano, a plaintiff in the suit filed against Texas, wished she’d had more time to make the decision.

“If I was able to get the abortion with that time, I think it would have meant a lot to me because my daughter wouldn’t have suffered,” Casiano said.

When Casiano was 20 weeks pregnant, a routine scan came back with devastating news: Her baby would be stillborn or die shortly after birth.

The fetus had anencephaly, a rare birth defect that keeps the brain and skull from developing during pregnancy. Babies with this condition are often stillborn, though they sometimes live a few hours or days. Many women around the country who face the prospect choose abortion, two obstetrician-gynecologists told CNN.

But Casiano lived in Texas, where state legislators had recently banned most abortions after six weeks of pregnancy. She couldn’t afford to travel out of the state for the procedure.

“You have no options. You will have to go through with your pregnancy,” Casiano’s doctor told her, she claimed in the lawsuit.

In March, Casiano gave birth to her daughter Halo. After gasping for air for four hours, the baby died, Casiano said during her testimony on Wednesday.

“All she could do was fight to try to get air. I had to watch my daughter go from being pink to red to purple. From being warm to cold,” said Casiano. “I just kept telling myself and my baby that I’m so sorry that this had to happen to you.”

Casiano and 14 others – including two doctors – are plaintiffs in the lawsuit. They allege the abortion ban has denied them or their patients access to necessary obstetrical care. The plaintiffs are asking the courts to clarify when doctors can make medical exceptions to the state’s ban.

Casiano and two other plaintiffs testified Wednesday about hoping to deliver healthy babies but instead learning their lives or pregnancies were in danger.

 Plaintiffs Anna Zargarian, Lauren Miller, Lauren Hall, and Amanda Zurawski at the Texas State Capitol after filing a lawsuit on behalf of Texans harmed by the state's abortion ban on March 7 in Austin, Texas.

“This was just supposed to be a scan day,” Casiano told the court. “It escalated to me finding out my daughter was going to die.”

Lawyers representing the state argued Wednesday that the plaintiffs’ doctors were to blame, saying they misinterpreted the law and failed to provide adequate care for such high-risk pregnancies.

“Plaintiffs will not and cannot provide any evidence of any medical provider in the state of Texas being prosecuted or otherwise penalized for performance of an abortion using the emergency medical exemption,” a lawyer said during the state’s opening statement.

Kylie Beaton, another plaintiff, also had to watch her baby die. Beaton, who didn’t testify this week, learned during a 20-week scan that something was wrong with her baby’s brain, according to the suit.

The doctor diagnosed the fetus with alobar holoprosencephaly, a condition where the two hemispheres of the brain don’t properly divide. Babies with this condition are often stillborn or die soon after birth.

Beaton’s doctor told her he couldn’t provide an abortion unless she was severely ill, or the fetus’s heart stopped. Beaton and her husband sought to obtain an abortion out of state. However, the fetus’s head was enlarged due to its condition, and the only clinic that would perform an abortion charged up to $15,000. Beaton and her husband couldn’t afford it.

Instead, Beaton gave birth to a son she named Grant. The baby cried constantly, wouldn’t eat, and couldn’t be held upright for fear it would put too much pressure on his head, according to the suit. Four days later, Grant died.

Amanda Zurawski of Austin, Texas, center, is the lead plaintiff in the lawsuit.

Experts say that abortion bans in states like Texas lead to increased risk for both babies and mothers.

Maternal mortality has long been a top concern for doctors and health-rights activists. Even before the Supreme Court decision, the United States had the highest maternal mortality rate among wealthy nations, one study found.

Amanda Zurawski, the lawsuit’s lead plaintiff, testified Wednesday that her water broke 18 weeks into her pregnancy, putting her at high risk for a life-threatening infection. Zurawski’s baby likely wouldn’t survive.

But the fetus still had a heartbeat, and so doctors said they were unable to terminate the pregnancy. She received an emergency abortion only after her condition worsened and she went into septic shock.

Zurawski described during Wednesday’s hearing how her family visited the hospital, fearing it would be the last time they would see her. Zurawski has argued that had she been able to obtain an abortion, her life wouldn’t have been in jeopardy in the same way.

“I blame the people who support these bans,” Zurawski said.

Zurawski previously said the language in Texas’ abortion laws is “incredibly vague, and it leaves doctors grappling with what they can and cannot do, what health care they can and cannot provide.”

Pregnancy is dangerous, and forcing a woman to carry a non-viable pregnancy to term is unnecessarily risky when it’s clear the baby will not survive, argued Dr. Mae-Lan Winchester, an Ohio maternal-fetal medicine specialist.

“Pregnancy is one of the most dangerous things a person will ever go through,” Winchester said. “Putting yourself through that risk without any benefit of taking a baby home at the end, it’s … risking maternal morbidity and mortality for nothing.”

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What you should know if there’s no sexual attraction for your partner, according to a therapist | CNN

Editor’s Note: Ian Kerner is a licensed marriage and family therapist, writer and contributor on the topic of relationships for CNN. His most recent book is a guide for couples, “So Tell Me About the Last Time You Had Sex.”



CNN
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A lot of heterosexual male clients are coming into my practice admitting they picked their partner without considering sexual attraction.

During couples therapy sessions with his partner in the room, the man will claim that he doesn’t know why he isn’t experiencing desire. Maybe it’s stress, low testosterone or feeling anxious.

But when I meet with him individually, he often tells a different story. He tells me he picked his partner without prioritizing sexual attraction.

Why would a person pick a potential life partner without feeling the spark of sexual attraction? And can these relationships survive and thrive? Can something like sexual attraction that wasn’t there in the first place be cultivated later?

I’ve talked with many men in their 30s who have told me, “When I found the woman I wanted to marry, she checked all the boxes. Except one.”

Characteristics on that list include “being my best friend,” “will make an amazing mother,” “our friends and families get along so well,” and “she really loves me.” The one box that didn’t get ticked? Sexual attraction — and often the men didn’t even list that quality to start.

I was stunned.

Sexuality is the one thing that really distinguishes a romantic relationship from a platonic one: I find that it’s one kind of “relationship glue” that helps couples stay together through hard times. That’s why I’m puzzled that so many people devalue sex in picking a partner for a long-term relationship.

Research shows that, while physical attractiveness is usually among the most important traits people desire in a romantic partner, it doesn’t actually top the list for men or women,” said Dr. Justin Lehmiller, a research fellow at the Kinsey Institute at Indiana University, a research center dedicated to sexuality. “Traits like intelligence, humor, honesty and kindness are often at least as important, if not more.”

Some men have internalized an “either/or” view of women: those who make great wives and mothers and those who are sexually adventurous, according to Chicago-based sex therapist Dr. Elizabeth Perri.

“I’ve observed this in male patients who are out in the dating world and feel the pressure to pick someone whom they perceive as ‘wife material’ but without sexual attraction, rather than waiting to find a partner who is a better fit both emotionally and sexually,” Perri told me.

This is what you need to fall in love (2014)

Good sex can help protect against psychological distress, including anxiety and depression, helps couples achieve a deeper connection, and improves relationship satisfaction.

“If a relationship is a meal, the sexual portion ought to be considered an integral part of it, such as the protein, instead of a frivolous part like dessert,” says Eva Dillon, a sex therapist based in New York City.

“In my experience, it’s possible for women to cultivate desire for a partner with considerable effort, but if a man does not have desire for his partner at the beginning of a relationship, he will never desire her,” Dillon told me. Why count on sexual attraction coming later when you can prioritize it in a partner and enjoy the benefits from the beginning?”

Still, lower levels of sexual attraction isn’t always a problem for couples, said sexologist Dr. Yvonne Fulbright.

“For some people, a lack of sexual attraction can lead to infidelity or divorce. For others, a lack of sexual attraction only becomes a problem when one tunes into societal expectations around sex and desire,” said Fulbright, who is an adjunct professorial lecturer in the department of sociology at American University in Washington, DC.

“A lot of pressure is being put on couples to maintain active sex lives, and hot ones at that. People have the sense that there’s a type and quality of desire that needs to be achieved, with any disinterest in such considered a problem that needs to be solved.”

Some of my therapist colleagues caution against putting too much emphasis on the importance of immediate sexual attraction.

“We have this misconception that we must be physically attracted to someone when we first meet or there is no relationship potential. That’s just not true,” said sex therapist Dr. Rachel Needle. “Attraction can grow as you get to know someone and experience increased closeness and connection.”

Better way for couples to argue Staying Well _00000411.jpg

The better way for couples to argue (2019)

What should you do if you and your partner are running out of sexual steam? Or if you want to turn up the heat on a relationship that didn’t have any to start with?

Fulbright cautioned against giving any sweeping advice. “Only partners can figure out the best way to manage this challenge in their relationship,” she said.

Non-monogamy may work for some, but not others. Couples need to decide how honest to be with each other, how much this matter is a dealbreaker in staying together versus not, and how much weight should be given to this issue in light of other good things they have going for them,” she added via email.

Don’t feel that all is lost if you’re in a long-term relationship. For some couples, sexual desire can grow over time if they focus on it. “It often isn’t until our 30s that we get comfortable enough to ask for what we want in bed,” Dillon said.

But I refuse to agree with anyone who thinks that married couples will stop having sex anyway so why bother prioritizing sexual attraction.

“Many couples in their 50s can explore and expand their sexuality thanks to maturity and empty nests. For couples in their 60s, 70s and beyond who are able to expand their definition of sex beyond orgasm and co-create intimacy, sex can continue to be vibrant and rich,” Dillon added via email.

And keep in mind, your sexual health is a barometer of your overall health. So if you really are experiencing an inexplicable drop in sexual interest, consider talking to your medical provider. Maybe your testosterone levels really have fallen.

Whatever the source of your lack of sexual interest, just be up front with your partner. Honesty, as it turns out, can be a turn-on (eventually).

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A 45-year-old got pregnant in a state with a ban on abortions. She flew across the country to get one | CNN



CNN
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When 45-year-old Victoria realized she was five weeks late and the lines showed as positive on two pregnancy tests, the New Orleans resident dreamed up a plan to get an abortion.

Traveling out of state was the only abortion option for Victoria, who asked CNN to withhold her last name out of fear of backlash against her and her family. Louisiana is one of several states that have essentially banned all abortions.

“It was probably one of the hardest things I’ve had to go through, from the moment of discovering that I was pregnant at age 45 to actually having to have to take time off work, travel across the country, do a meeting with a doctor, and then take the pills and then skedaddle back home and then go to work like nothing had happened,” Victoria told CNN of her experience earlier this year.

Victoria’s story about the distance she traveled and the hardships she endured to get an abortion reflects a wider American reality, where women seeking the procedure must navigate through a patchwork of states with varying levels of access.

The average travel time to an abortion facility more than tripled, from less than 30 minutes to more than an hour and a half, after the US Supreme Court overturned Roe v. Wade in 2022, according to a November study in the Journal of the American Medical Association. And for women in Texas and Louisiana, average travel times to the nearest abortion facility were seven hours longer – almost a full workday in travel time to get an abortion.

Victoria says she was grateful she could drop everything and afford to spend $1,000 for the procedure, including same-week airfare with connections both ways and appointment and medication fees.

“It was so hard for me wrap my head around the fact that I was able to do this, but I’m one of the lucky ones and that there are so many women who are in much tighter positions,” Victoria said. “And, God, what are they going to do?”

Victoria says plans materialized quickly once she knew which states seemed more accessible.

She researched the parameters for abortion in a state, how long she would have to take off work, travel options and how soon she could get an appointment. She found abortionfinder.org to be a helpful and reliable source, she says.

“Because the situation is so fluid, it changes from day to day, that was really of paramount importance for me to be able to have a reliable source of information,” she said.

Driving to a neighboring state was not an option, as every state adjoining Louisiana has a similarly restrictive law that bans virtually all abortions. Victoria says she considered close states, like Florida, but she ultimately dismissed them because available appointments were farther out.

“Once I saw that Oregon was so, so protective of reproductive rights, I said, ‘Why would I think about going anywhere else?’” she said. “The second I got the definitive pregnancy result, I was like, ‘OK, let’s book a flight to Oregon. When can we do this?’”

She reached out to a friend from college and asked if she could stay with her, detailing the reason for her visit. She then made an appointment and booked a flight for that week, she says.

The provider sent instructions, including that the patient must be in Oregon for the telehealth appointment, according to documents provided to CNN. They contacted her within an hour of making the appointment to make sure she had proof of travel documents because she had made it from Louisiana, where the procedure is illegal.

Victoria planned to take a day off to fly across the country and work remotely for two days, which fits her hybrid work situation. She says she was grateful to have a supportive, female boss who showed understanding for why she had to take the unexpected time off.

“She was the only person I actually kind of broke down and cried for,” Victoria said. “I think it’s because I had been holding it back all week, and telling her was sort of the last thing that I needed to get in place before I could do everything.”

Victoria says the hardest part of her experience was telling her mother because she didn’t know how her mom would feel about it. Victoria and her siblings were raised Catholic. Her father had a strong faith and her mother was a non-practicing Catholic, her mother says. Victoria’s mom asked not to be named for privacy reasons.

Victoria’s mother says she wanted to support her daughter, even if she does not agree with what her daughter did. Victoria coming to her with tickets purchased and a full plan made it easy for her mother to support her, the mother says.

“I agreed to drive her to the airport and that that was the only thing I could do because this would be a real game-changing thing in her life,” her mother said. “I wanted to support what she wanted to do because she has supported me on several family crises. I just wanted to do it because I love her. “

Victoria said she appreciated her mom for being supportive in a way she didn’t expect. They talked about some of her mother’s friends who had abortions throughout the years, both say. Victoria’s mother even told her about when she tried to get her tubes tied, but her husband found out and she did not pursue it.

“I feel like, if anything, it’s made our relationship stronger,” Victoria said. “We already had a fantastically strong relationship, though. So, it’s another rock in the wall.”

After boarding early on a Wednesday in March, Victoria traveled for eight hours on two flights and landed in Portland, Oregon.

Victoria reunited with her friend, and they did the things that old friends do, from staying up late talking about college memories to talking about why Victoria was there. They both described the situation as surreal.

“The vast majority of reproductive conversations I have with friends at this point are people who are trying desperately to get pregnant,” said her friend, Emily, who asked that CNN not use her last name to keep Victoria’s privacy. “The sort of irony is that there could still be an unplanned pregnancy and it would still be just as devastating as it would have been when we were in our teens and twenties was kind of a shock to me.”

Emily, who has been friends with Victoria for about 25 years, says it took so little effort for her to drive to the airport and let her friend stay with her.

“I felt honored that she trusted me,” she said. “I was really proud of Victoria. I was impressed that she had taken this in stride and that she had reached out to someone she knew – I think a lot of people would have been ashamed or hidden it.”

After the telehealth appointment the next day, Victoria received an overnight package.

Victoria took two medications as part of a medication abortion. She took mifepristone at her friend’s home. The next day she took misoprostol before boarding her flight home – she was careful not to take them in her home state, where it’s illegal.

Misoprostol, taken after mifepristone, is a common combination prescribed for a medication abortion.

“It was like a heavy period,” she said. “I took some Aleve, had to get some extra jumbo pads, and I bled a lot on the flights home, but it was fine.”

Physically, she felt fine – it was more of what was happening psychologically that she noticed, she says.

“I had this feeling that I should be having some kind of deep, psychological moment of reckoning or something, but I didn’t really feel that,” Victoria said of the experience. “I’ve never wanted to have a kid. I wasn’t torn about this decision.”

When Victoria learned she was pregnant, a big part of the shock came from not thinking she could get pregnant at age 45, she says.

“You hear so much culturally out there about you’re in your forties, are told you’re too old to get pregnant and carry a child to term,” she said. “I feel like I had sort of a false sense of security.”

Victoria joked that she’s “careening toward menopause,” but she says she has not been diagnosed as perimenopausal.

Her pregnancy news came several months after she was treated for a uterine fibroid, a benign growth, in July 2022, according to medical records. Victoria also tested positive for a PALB2 gene mutation, which can lead to an increased chance of breast cancer, according to a study in the New England Journal of Medicine. She underwent a preventative double mastectomy and reconstruction earlier in 2022, according to medical records provided to CNN.

She says she got an excellent standard of care around her surgeries, but it felt dissonant with her state’s laws around abortion.

“It felt so surreal to get this really high standard of care around my secondary sexual characteristics, but then to have that freeze, slam shut when it comes to reproductive health, it just felt abrupt,” she said.

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The planet is getting hotter fast. This is what happens to your body in extreme heat | CNN



CNN
— 

The Earth recently recorded its hottest day ever – a record experts warn will likely be repeatedly broken as the climate crisis drives temperatures higher and higher.

And it’s happening fast: a new report found last month was the planet’s hottest June by a “substantial margin,” meaning the nine hottest Junes have all occurred in the last nine years.

Extremely hot days – what could be considered the hottest days of the summer – are more frequent now than in 1970 in 195 locations across the US, according to the research group Climate Central. Of those locations, roughly 71% now face at least seven additional extremely hot days each year.

The effects have been devastating.

In one Texas county, at least 11 people died in just over a week during an unrelenting June heat wave. In Mexico, soaring temperatures have killed at least 112 people since March. A recent heat wave in India killed at least 44 people across the state of Bihar.

Here’s what happens to your body in extreme heat, what you need to watch out for and how to stay safe.

Normally, your body is used to a certain range of temperatures, usually between 97 to 99 degrees Fahrenheit. When your brain senses a change – either lower or higher than that – it attempts to help your body cool down or heat up, according to Dr. Judith Linden, executive vice chair of the department of emergency medicine at Boston Medical Center and a professor in the emergency medicine department at Boston University’s school of medicine.

“There are a number of different ways in which (the brain) attempts to cool the body down. One way, the most common way we think of, is that you sweat,” Linden said. “The pores open, the body sweats and the sweat evaporates, that cools the body.”

The second way your body cools itself down is by dilating vessels and upping your heart rate, which helps bring heat and blood to the surface of your body and helps releases that excess heat.

When you’re exposed to high temperatures, it becomes harder for your body to try and keep up with cooling itself down. And if your environment is hot and humid, sweat doesn’t evaporate as easily – which pushes your body’s temperature even higher, according to the Mayo Clinic.

“The higher the humidity, the lower temperatures you need for extreme heat,” Linden said.

High body temperatures can lead to damage to the brain and other vital organs, the CDC says. They can also lead to several heat-related illnesses.

Mild-heat related illnesses, including heat cramps, are most common, Linden said. Heat cramps can develop in people who sweat a lot, including during exercising. The excessive sweating uses up all of the body’s salt and moisture and can lead to muscle pains or spasms, usually in the abdomen, arms or legs, according to the CDC.

A heat rash can also develop. That’s a skin irritation caused by too much sweating in hot and humid weather, and is most common in young children, the CDC says. It is usually a red cluster of pimples or blisters, and tends to be in places including the neck, upper chest or in elbow creases.

When your body’s beginning to exceed its ability to cool itself down, you can develop what’s known as heat exhaustion.

“In this case you’re going to see excessive sweating because your body is really going to try and keep up with that extra heat. You’re going to feel light-headed, you may feel dizzy, often people present with nausea, headaches and their skin often looks pale and clammy and their pulse is often fast,” Linden said.

“This is the body’s last attempt to cool itself before it really goes into a point of no return.”

A heat stroke is the most serious heat-related illness, and, if left untreated, can lead to death.

“That’s where your body’s temperature goes above 104 to 105 degrees or so, and this is where your mechanisms are starting to fail,” Linden said.

Warning signs may include extremely high body temperatures, red and dry skin, a rapid pulse, headache, dizziness, nausea or loss of consciousness, according to the CDC.

The hallmark of a heat stroke is confusion and agitation, Linden said.

“So when somebody’s in the heat and they become confused and agitated, that’s heat stroke until proven otherwise and you need to call 911 for that or get help immediately and get the person out of the heat.”

Elderly, people with chronic medical conditions as well as children are at higher risk for severe heat-related illnesses.

The elderly and people with chronic medical conditions may be less likely to sense and respond to temperature changes and may be taking medication that make the heat effects worse, the CDC said.

“Very young (people) as well, because they’re less likely to recognize heat-related illness and they’re less likely to get out of the heat if they’re starting to feel overheated,” Linden said.

Student-athletes and pets are also at higher risk, she added.

“In this weather, you must never, ever, ever leave a child or a pet in the car for even a minute,” Linden added.

When your community is facing extreme heat, there are several things you can do to keep yourself and others safe.

First, keep an eye out for symptoms of heat exhaustion or other illnesses.

“If somebody starts feeling light-headed, dizzy, nausea or headache, that is the time to act immediately,” Linden said. “That means getting them out of the heat and into a cool environment.”

Putting water on someone who may be experiencing symptoms and giving them fluids can help cool them down. If someone is starting to lose consciousness or has nausea or vomiting, call 911.

“If you see anybody with any type of confusion, that’s an immediate red flag,” Linden added.

When it’s hot outside, try to avoid outdoor activities – especially between the hours of 11 a.m. and 3 p.m., according to Linden. If you have to go outside, wear light-colored clothing, cover your head and drink plenty of fluids.

Don’t wait until you’re thirsty to drink water – as that can be a sign of dehydration. Linden recommends drinking at least one glass of water – or more – an hour.

“If you do start to feel light-headed, dizzy, sweating, fast pulse, get out of the heat immediately,” Linden said.

Try to find air conditioning, or places in your area where you can go to stay cool, according to Ready.gov. Even spending a few hours in a shopping mall or public library can help.

When you’re home, fans can help, but don’t rely on them as your only way of cooling down – while it may feel more comfortable, they won’t help prevent heat-related illness.

“If you’re in a super hot room, if you’ve got a fan, is it helpful? No. I think, if you’ve got a fan, and you’re able to mist yourself … then fans can be helpful,” Linden said. “Fans are not foolproof.”

Finally, make sure you’re checking on your neighbors, parents and friends – especially older individuals who may be living alone or are isolated, Linden said.

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Laziness isn’t why you procrastinate. This is | CNN

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CNN
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If you’re stuck in what seems like an endless cycle of procrastination, guilt and chaos, you might be wondering, “Why am I so lazy?” or “Why can’t I just get myself together?”

Despite that common perception, laziness usually isn’t the reason behind procrastination, said Jenny Yip, a clinical psychologist and executive director of the Los Angeles-based Little Thinkers Center, which helps children with academic challenges.

“Laziness is like, ‘I have absolutely no desire to even think about this.’ Procrastination is, ‘It troubles me to think about this. And therefore, it’s hard for me to get the job done.’ That’s a big difference.”

Knowing why you procrastinate and learning how to combat it are the only ways to change your behavior, according to experts. Psychologist Linda Sapadin sought to help this self-improvement effort with her book “How to Beat Procrastination in the Digital Age.”

You could be the perfectionist, the dreamer, the worrier or the defier — these are all procrastination styles that Sapadin lists in her book.

These procrastination types aren’t specific diagnoses and aren’t backed by research, but “they are psychological types or reasons why someone might procrastinate,” said Yip, who is also a clinical assistant professor of psychiatry at the University of Southern California’s Keck School of Medicine.

Procrastination can have practical consequences, such as falling behind at work or failing to achieve personal goals or to cross off errands from a to-do list. But there are also emotional or mental impacts. It has been associated with depression, anxiety and stress, poor sleep, inadequate physical activity, loneliness and economic difficulties, according to a January study of more than 3,500 college students.

“Particularly in America, where so much of our worth is tied up into what we do, how we work, what we produce — it can feel very shameful if you can’t do that,” said Vara Saripalli, a Chicago-based clinical psychologist. “It can leave people feeling very defeated and feeling like there’s no point in trying.”

Knowing why you procrastinate can make you self-aware, but you still need strategies to break the habit. “Otherwise, we’ll just keep repeating things,” Saripalli said. “The strategy you’re going to employ to beat procrastination is going to change based on the purpose procrastination is serving for you.”

Here’s how to explore which type of procrastinator you might be — though remember, you could embody the traits of more than just one type.

A procrastinator is usually a perfectionist, Yip said.

“Because the perfectionist needs things done perfectly — all Ts crossed and Is dotted — it takes an insurmountable amount of effort. And if (they) don’t have a plan of how to get this task completed, then the perfectionist will get lost.”

Worriers tend to be indecisive and dependent on others for advice or reassurance before taking initiative on their own. They also have a high resistance to change, preferring the safety of the known.

Both perfectionists and worriers might put off starting tasks due to a fear of failure or criticism, said Itamar Shatz, a researcher at the University of Cambridge in the United Kingdom and creator of the website Solving Procrastination.

Challenge those beliefs and your behavior by recognizing that perfectionistic standards are unrealistic, Shatz said. “Replace them with standards that are good enough instead while giving yourself permission to make some mistakes,” he added.

Avoid all-or-nothing thinking and give yourself a time limit for completing a task. (And then stick to that time limit — don’t just give up if you don’t meet it.)

A “dreamer” procrastinator doesn’t like the nitty-gritty logistical details often needed to get projects done, Saripalli said. “They like to have ideas,” she added. “That stuff is fun. It’s kind of difficult or boring to then execute these visions.”

Dreamers might also think of themselves as people for whom fate will intervene, making proactive hard work and efficiency appear unnecessary.

And like a perfectionist, a dreamer might always want something better, Yip said. Train yourself to differentiate between dreams and goals, and approach goals with six questions: what, when, where, who, why and how. Change “soon” or “one day” to specific times. Write your plans into a timeline, specifying each step.

People with defiant procrastination tend to view life in terms of what others expect or require them to do, not what they want. This pessimism diminishes their motivation to complete tasks.

If you have this mindset, find positive ways to feel in control, Shatz said. Strive to act rather than react and try to work with a team or supervisor, not against them.

“If something doesn’t sit well with you, rather than being passive-aggressive about it, acknowledge what is or isn’t working and then have a conversation with whoever is giving you this assignment,” Yip said. “Defiers usually don’t feel equipped to have these conversations with who they see as authority figures, or they don’t believe that having the conversations would give them any benefit or positive outcome. … That’s not necessarily true.”

Just like working on anxiety or other mental health issues, addressing procrastination can be hard, especially if it comes from deep-rooted issues, Shatz said.

For some people who procrastinate, “their sense of self is so fragile that the idea of doing something and failing would just tip them over into complete worthlessness,” said Sean Grover, a New York City-based psychotherapist specializing in group therapy.

In such cases, “consider contacting a professional, like a psychologist, who might be able to help you,” Shatz added.

“Visualization works,” Yip said. “If you can visualize yourself completing (a task), then it becomes more achievable simply because you have an idea that it can be done.”

At the end of the day, how you approach life is “all about your belief system,” Yip said. “If you believe you can, you can. If you believe you cannot, you can’t. So whatever you believe, you’re right.”

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Black or ‘Other’? Doctors may be relying on race to make decisions about your health | CNN

Editor’s Note: CNN’s “History Refocused” series features surprising and personal stories from America’s past to bring depth to conflicts still raging today.



CNN
— 

When she first learned about race correction, Naomi Nkinsi was one of five Black medical students in her class at the University of Washington.

Nkinsi remembers the professor talking about an equation doctors use to measure kidney function. The professor said eGFR equations adjust for several variables, including the patient’s age, sex and race. When it comes to race, doctors have only two options: Black or “Other.”

Nkinsi was dumbfounded.

“It was really shocking to me,” says Nkinsi, now a third-year medical and masters of public health student, “to come into school and see that not only is there interpersonal racism between patients and physicians … there’s actually racism built into the very algorithms that we use.”

At the heart of a controversy brewing in America’s hospitals is a simple belief, medical students say: Math shouldn’t be racist.

The argument over race correction has raised questions about the scientific data doctors rely on to treat people of color. It’s attracted the attention of Congress and led to a big lawsuit against the NFL.

What happens next could affect how millions of Americans are treated.

Carolyn Roberts, a historian of medicine and science at Yale University, says slavery and the American medical system were in a codependent relationship for much of the 19th century and well into the 20th.

“They relied on one another to thrive,” Roberts says.

It was common to test experimental treatments first on Black people so they could be given to White people once proven safe. But when the goal was justifying slavery, doctors published articles alleging substantive physical differences between White and Black bodies — like Dr. Samuel Cartwright’s claim in 1851 that Black people have weaker lungs, which is why grueling work in the fields was essential (his words) to their progress.

The effects of Cartwright’s falsehood, and others like it, linger today.

In 2016, researchers asked White medical students and residents about 15 alleged differences between Black and White bodies. Forty percent of first-year medical students and 25% of residents said they believed Black people have thicker skin, and 7% of all students and residents surveyed said Black people have less sensitive nerve endings. The doctors-in-training who believed these myths — and they are myths — were less likely to prescribe adequate pain medication to Black patients.

To fight this kind of bias, hospitals urge doctors to rely on objective measures of health. Scientific equations tell physicians everything from how well your kidneys are working to whether or not you should have a natural birth after a C-section. They predict your risk of dying during heart surgery, evaluate brain damage and measure your lung capacity.

But what if these equations are also racially biased?

Race correction is the use of a patient’s race in a scientific equation that can influence how they are treated. In other words, some diagnostic algorithms and risk predictor tools adjust or “correct” their results based on a person’s race.

The New England Journal of Medicine article “Hidden in Plain Sight” includes a partial list of 13 medical equations that use race correction. Take the Vaginal Birth After Cesarean calculator, for example. Doctors use this calculator to predict the likelihood of a successful vaginal delivery after a prior C-section. If you are Black or Hispanic, your score is adjusted to show a lower chance of success. That means your doctor is more likely to encourage another C-section, which could put you at risk for blood loss, infection and a longer recovery period.

Cartwright, the racist doctor from the 1800s, also developed his own version of a tool called the spirometer to measure lung capacity. Doctors still use spirometers today, and most include a race correction for Black patients to account for their supposedly shallower breaths.

Turns out, second-year medical student Carina Seah wryly told CNN, math is as racist as the people who make it.

The biggest problem with using race in medicine? Race isn’t a biological category. It’s a social one.

“It’s based on this idea that human beings are naturally divided into these big groups called races,” says Dorothy Roberts, a professor of law and sociology at the University of Pennsylvania, who has made challenging race correction in medicine her life’s work. “But that’s not what race is. Race is a completely invented social category. The very idea that human beings are divided into races is a made-up idea.”

Ancestry is biological. Where we come from — or more accurately, who we come from — impacts our DNA. But a patient’s skin color isn’t always an accurate reflection of their ancestry.

Look at Tiger Woods, Roberts says. Woods coined the term “Cablinasian” to describe his mix of Caucasian, Black, American Indian and Asian ancestries. But to many Americans, he’s Black.

CNN RED TIGER WOODS

“You can be half Black and half White in this country and you are Black,” says Seah, who is getting her medical degree and a PhD in genetics and genomics at the Icahn School of Medicine at Mount Sinai in New York. “You can be a quarter Black in this country — if you have dark skin, you are Black.”

So it can be misleading, Seah says, even dangerous, for doctors to judge a patient’s ancestry by glancing at their skin. A patient with a White mother and Black father could have a genetic mutation that typically presents in patients of European ancestry, Seah says, but a doctor may not think to test for it if they only see Black skin.

“You have to ask, how Black is Black enough?” Nkinsi asks. And there’s another problem, she says, with using a social construct like race in medicine. “It also puts the blame on the patient, and it puts the blame on the race itself. Like being Black is inherently the cause of these diseases.”

Naomi Nkinsi is a third-year medical and masters of public health student at the University of Washington in Seattle. She has been advocating for the removal of race correction in medicine.

After she learned about the eGFR equation in 2018, Nkinsi began asking questions about race correction. She wasn’t alone — on social media she found other students struggling with the use of race in medicine. In the spring of 2020, following a first-year physiology lecture, Seah joined the conversation. But the medical profession is nothing if not hierarchical; Nkinsi and Seah say students are encouraged to defer to doctors who have been practicing for decades.

Then on May 25, 2020, George Floyd was killed by police in Minneapolis.

His death and the growing momentum around Black Lives Matter helped ignite what Dr. Darshali A. Vyas calls an “overdue reckoning” in the medical community around race and race correction. A few institutions had already taken steps to remove race from the eGFR equation. Students across the country demanded more, and hospitals began to listen.

History Refocused BLM White Coats

Four days after Floyd’s death, the University of Washington announced it was removing race correction from the eGFR equation. In June, the Boston-based hospital system Mass General Brigham where Vyas is a second-year Internal Medicine resident followed suit. Seah and a fellow student at Mount Sinai, Paloma Orozco Scott, started an online petition and collected over 1600 signatures asking their hospital to do the same.

Studies show removing race from the eGFR equation will change how patients at those hospitals are treated. Researchers from Brigham and Women’s Hospital and Penn Medicine estimated up to one in every three Black patients with kidney disease would have been reclassified if the race multiplier wasn’t applied in earlier calculations, with a quarter going from stage 3 to stage 4 CKD (Chronic Kidney Disease).

That reclassification is good and bad, says Dr. Neil Powe, chief of medicine at Zuckerberg San Francisco General Hospital. Black patients newly diagnosed with kidney disease will be able to see specialists who can devise better treatment plans. And more patients will be placed on kidney transplant lists.

On the flip side, Powe says, more African Americans diagnosed with kidney disease means fewer who are eligible to donate kidneys, when there’s already a shortage. And a kidney disease diagnosis can change everything from a patient’s diabetes medication to their life insurance costs.

Dr. Neil Powe says by simply removing race from the eGFR equations,

Powe worries simply eliminating race from these equations is a knee-jerk response — one that may exacerbate health disparities instead of solve them. For too long, Powe says, doctors had to fight for diversity in medical studies.

The most recent eGFR equation, known as the CKD-EPI equation, was developed using data pooled from 26 studies, which included almost 3,000 patients who self-identified as Black. Researchers found the equation they were developing was more accurate for Black patients when it was adjusted by a factor of about 1.2. They didn’t determine exactly what was causing the difference in Black patients, but their conclusion is supported by other research that links Black race and African ancestry with higher levels of creatinine, a waste product filtered by the kidneys.

Put simply: In the eGFR equation, researchers used race as a substitute for an unknown factor because they think that factor is more common in people of African descent.

Last August, Vyas co-authored the “Hidden in Plain Sight” article about race correction. Vyas says most of the equations she wrote about were developed in a similar way to the eGFR formula: Researchers found Black people were more or less likely to have certain outcomes and decided race was worth including in the final equation, often without knowing the real cause of the link.

“When you go back to the original studies that validated (these equations), a lot of them did not provide any sort of rationale for why they include race, which I think is appalling.” That’s what’s most concerning, Vyas says – “how willing we are to believe that race is relevant in these ways.”

Vyas is clear she isn’t calling for race-blind medicine. Physicians cannot ignore structural racism, she says, and the impact it has on patients’ health.

Powe has been studying the racial disparities in kidney disease for more than 30 years. He can spout the statistics easily: Black people are three times more likely to suffer from kidney failure, and make up more than 35% of patients on dialysis in the US. The eGFR equation, he says, did not cause these disparities — they existed long before the formula.

“We want to cure disparities, let’s go after the things that really matter, some of which may be racist,” he says. “But to put all our stock and think that the equation is causing this is just wrong because it didn’t create those.”

In discussions about removing race correction, Powe likes to pose a question: Instead of normalizing to the “Other” group in the eGFR equation, as many of these hospitals are doing, why don’t we give everyone the value assigned to Black people? By ignoring the differences researchers saw, he says, “You’re taking the data on African Americans, and you’re throwing it in the trash.”

Powe is co-chair of a joint task force set up by the National Kidney Foundation and the American Society of Nephrology to look at the use of race in eGFR equations. The leaders of both organizations have publicly stated race should not be included in equations used to estimate kidney function. On April 9, the task force released an interim report that outlined the challenges in identifying and implementing a new equation that’s representative of all groups. The group is expected to issue its final recommendations for hospitals this summer.

Race correction is used to assess the kidneys and the lungs. What about the brain?

In 2013, the NFL settled a class-action lawsuit brought by thousands of former players and their families that accused the league of concealing what it knew about the dangers of concussions. The NFL agreed to pay $765 million, without admitting fault, to fund medical exams and compensate players for concussion-related health issues, among other things. Then in 2020, two retired players sued the NFL for allegedly discriminating against Black players who submitted claims in that settlement.

01 race correction Kevin Henry Najeh Davenport SPLIT

The players, Najeh Davenport and Kevin Henry, said the NFL race-corrected their neurological exams, which prevented them from being compensated.

According to court documents, former NFL players being evaluated for neurocognitive impairment were assumed to have started with worse cognitive function if they were Black. So if a Black player and a White player received the exact same scores on a battery of thinking and memory tests, the Black player would appear to have suffered less impairment. And therefore, the lawsuit stated, would be less likely to qualify for a payout.

Race correction is common in neuropsychology using something called Heaton norms, says Katherine Possin, an associate professor at the University of California San Francisco. Heaton norms are essentially benchmark average scores on cognitive tests.

Here’s how it works: To measure the impact of a concussion (or multiple concussions over time), doctors compare how well the patient’s brain works now to how well it worked before.

“The best way to get that baseline was to test you 10 years ago, but that’s not something we obviously have for many people,” Possin says. So doctors estimate your “before” abilities using an average score from a group of healthy individuals, and adjust that score for demographic factors known to affect brain function, like your age.

Heaton norms adjust for race, Possin says, because race has been linked in studies to lower cognitive scores. To be clear, that’s not because of any biological differences in Black and White brains, she says; it’s because of social factors like education and poverty that can impact cognitive development. And this is where the big problem lies.

In early March, a judge in Pennsylvania dismissed the players’ lawsuit and ordered a mediator to address concerns about how race correction was being used. In a statement to CNN, the NFL said there is no merit to the players’ claim of discrimination, but it is committed to helping find alternative testing techniques that do not employ race-based norms.

The NFL case, Possin wrote in JAMA, has “exposed a major weakness in the field of neuropsychology: the use of race-adjusted norms as a crude proxy for lifelong social experience.”

This happens in nearly every field of medicine. Race is not only used as a poor substitute for genetics and ancestry, it’s used as a substitute for access to health care, or lifestyle factors like diet and exercise, socioeconomic status and education. It’s no secret that racial disparities exist in all of these. But there’s a danger in using race to talk about them, Yale historian Carolyn Roberts says.

We know, for example, that Black Americans have been disproportionally affected by Covid-19. But it’s not because Black bodies respond differently to the virus. It’s because, as Dr. Anthony Fauci has noted, a disproportionate number of Black people have jobs that put them at higher risk and have less access to quality health care. “What are we making scientific and biological when it actually isn’t?” Roberts asks.

Vyas says using race as a proxy for these disparities in clinical algorithms can also create a vicious cycle.

“There’s a risk there, we argue, of simply building these into the system and almost accepting them as fact instead of focusing on really addressing the root causes,” Vyas says. “If we systematize these existing disparities … we risk ensuring that these trends will simply continue.”

Nearly everyone on both sides of the race correction controversy agrees that race isn’t an accurate, biological measure. Yet doctors and researchers continue to use it as a substitute. Math shouldn’t be racist, Nkinsi says, and it shouldn’t be lazy.

“We’re saying that we know that this race-based medicine is wrong, but we’re going to keep doing it because we simply don’t have the will or the imagination or the creativity to think of something better,” Nkinsi says. “That is a slap in the face.”

Shortly after Vyas’ article published in The New England Journal of Medicine, the House Ways and Means Committee sent letters to several professional medical societies requesting information on the misuse of race in clinical algorithms. In response to the lawmakers’ request, the Agency for Healthcare Research and Quality is also gathering information on the use of race-based algorithms in medicine. Recently, a note appeared on the Maternal Fetal Medicine Units Network’s website for the Vaginal Birth After Cesarean equation — a new calculator that doesn’t include race and ethnicity is being developed.

Dorothy Roberts is excited to see change on the horizon. But she’s also a bit frustrated. The harm caused by race correction is something she’s been trying to tell doctors about for years.

“I’ve taught so many audiences about the meaning of race and the history of racism in America and the audiences I get the most resistance from are doctors,” Roberts says. “They’re offended that there would be any suggestion that what they do is racist.”

Nkinsi and Seah both encountered opposition from colleagues in their fight to change the eGFR equation. Several doctors interviewed for this story argued the change in a race-corrected scores is so small, it wouldn’t change clinical decisions.

If that’s the case, Vyas wonders, why include race at all?

“It all comes from the desire for one to dominate another group and justify it,” says Roberts. “In the past, it was slavery, but the same kinds of justifications work today to explain away all the continued racial inequality that we see in America… It is mass incarceration. It’s huge gaps in health. It’s huge differences in income and wealth.”

It’s easier, she says, to believe these are innate biological differences than to address the structural racism that caused them.



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Blueberries have joined green beans in this year’s Dirty Dozen list | CNN

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CNN
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Blueberries, beloved by nutritionists for their anti-inflammatory properties, have joined fiber-rich green beans in this year’s Dirty Dozen of nonorganic produce with the most pesticides, according to the Environmental Working Group, a nonprofit environmental health organization.

In the 2023 Shopper’s Guide to Pesticides in Produce, researchers analyzed testing data on 46,569 samples of 46 fruits and vegetables conducted by the US Department of Agriculture. Each year, a rotating list of produce is tested by USDA staffers who wash, peel or scrub fruits and vegetables as consumers would before the food is examined for 251 different pesticides.

As in 2022, strawberries and spinach continued to hold the top two spots on the Dirty Dozen, followed by three greens — kale, collard and mustard. Listed next were peaches, pears, nectarines, apples, grapes, bell and hot peppers, and cherries. Blueberries and green beans were 11th and 12th on the list.

A total of 210 pesticides were found on the 12 foods, the report said. Kale, collard and mustard greens contained the largest number of different pesticides — 103 types — followed by hot and bell peppers at 101.

Dirty Dozen 2023

2023 Dirty Dozen (most to least contaminated)

  • Strawberries
  • Spinach
  • Kale, collard and mustard greens
  • Peaches
  • Pears
  • Nectarines
  • Apples
  • Grapes
  • Bell and hot peppers
  • Cherries
  • Blueberries
  • Green beans
  • “Some of the USDA’s tests show traces of pesticides long since banned by the Environmental Protection Agency. Much stricter federal regulation and oversight of these chemicals is needed,” the report said.

    “Pesticides are toxic by design,” said Jane Houlihan, former senior vice president of research for EWG. She was not involved in the report.

    “They are intended to harm living organisms, and this inherent toxicity has implications for children’s health, including potential risk for hormone dysfunction, cancer, and harm to the developing brain and nervous system,” said Houlihan, who is now research director for Healthy Babies, Bright Futures, an organization dedicated to reducing babies’ exposures to neurotoxic chemicals.

    There is good news, though. Concerned consumers can consider choosing conventionally grown vegetables and fruits from the EWG’s Clean 15, a list of crops that tested lowest in pesticides, the report said. Nearly 65% of the foods on the list had no detectable levels of pesticide.

    2023 Clean 15

    2023 Clean 15 (least to most contaminated)

  • Avocados
  • Sweet corn
  • Pineapple
  • Onions
  • Papaya
  • Frozen sweet peas
  • Asparagus
  • Honeydew melon
  • Kiwi
  • Cabbage
  • Mushrooms
  • Mangoes
  • Sweet potatoes
  • Watermelon
  • Carrots
  • Avocados topped 2023’s list of least contaminated produce again this year, followed by sweet corn in second place. Pineapple, onions and papaya, frozen sweet peas, asparagus, honeydew melon, kiwi, cabbage, mushrooms, mangoes, sweet potatoes, watermelon, and carrots made up the rest of the list.

    Being exposed to a variety of foods without pesticides is especially important during pregnancy and throughout childhood, experts say. Developing children need the combined nutrients but are also harder hit by contaminants such as pesticides.

    “Pesticide exposure during pregnancy may lead to an increased risk of birth defects, low birth weight, and fetal death,” the American Academy of Pediatrics noted. “Exposure in childhood has been linked to attention and learning problems, as well as cancer.”

    The AAP suggests parents and caregivers consult the shopper’s guide if they are concerned about their child’s exposure to pesticides.

    Houlihan, director of Healthy Babies, Bright Futures, agreed: “Every choice to reduce pesticides in the diet is a good choice for a child.”

    Nearly 90% of blueberry and green bean samples had concerning findings, the report said.

    In 2016, the last time green beans were inspected, samples contained 51 different pesticides, according to the report. The latest round of testing found 84 different pest killers, and 6% of samples tested positive for acephate, an insecticide banned from use in the vegetable in 2011 by the EPA.

    “One sample of non-organic green beans had acephate at a level 500 times greater than the limit set by the EPA,” said Alexis Temkin, a senior toxicologist at the EWG with expertise in toxic chemicals and pesticides.

    When last tested in 2014, blueberries contained over 50 different pesticides. Testing in 2020 and 2021 found 54 different pesticides — about the same amount. Two insecticides, phosmet and malathion, were found on nearly 10% of blueberry samples, though the levels decreased over the past decade.

    Acephate, phosmet and malathion are organophosphates, which interfere with the normal function of the nervous system, according to the US Centers for Disease Control and Prevention.

    A high dose of these chemicals can cause difficulty breathing, nausea, a lower heart rate, vomiting, weakness, paralysis and seizures, the CDC said. If exposed over an extended time to smaller amounts, people may “feel tired or weak, irritable, depressed, or forgetful.”

    Why would levels of some pesticides be higher today than in the past?

    “We do see drops in some pesticides since the early ’90s when the Food Quality Protection Act was put into place,” Temkin said. “But we’re also seeing increases of other pesticides that have been substituted in their place which may not be any safer. That’s why there’s a push towards overall reduction in pesticide use.”

    Chris Novak, president and CEO of CropLife America, an industry association, told CNN the report “willfully misrepresented” the USDA data.

    “Farmers use pesticides to control insects and fungal diseases that threaten the healthfulness and safety of fruits and vegetables,” Novak said via email. “Misinformation about pesticides and various growing methods breeds hesitancy and confusion, resulting in many consumers opting to skip fresh produce altogether.”

    The Institute of Food Technologists, an industry association, told CNN that emphasis should be placed on meeting the legal limits of pesticides established by significant scientific consensus.

    “We all agree that the best-case scenario of pesticide residues would be as close to zero as possible and there should be continued science-based efforts to further reduce residual pesticides,” said Bryan Hitchcock, IFT’s chief science and technology officer.

    Many fruits and veggies with higher levels of pesticides are critical to a balanced diet, so don’t give them up, experts say. Instead, avoid most pesticides by choosing to eat organic versions of the most contaminated crops. While organic foods are not more nutritious, the majority have little to no pesticide residue, Temkin said.

    “If a person switches to an organic diet, the levels of pesticides in their urine rapidly decrease,” Temkin told CNN. “We see it time and time again.”

    If organic isn’t available or too pricey, “I would definitely recommend peeling and washing thoroughly with water,” Temkin said. “Steer away from detergents or other advertised items. Rinsing with water will reduce pesticide levels.”

    Additional tips on washing produce, provided by the US Food and Drug Administration, include:

    • Handwashing with warm water and soap for 20 seconds before and after preparing fresh produce.
    • Rinsing produce before peeling, so dirt and bacteria aren’t transferred from the knife onto the fruit or vegetable.
    • Using a clean vegetable brush to scrub firm produce like apples and melons.
    • Drying the produce with a clean cloth or paper towel to further reduce bacteria that may be present.

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    In extreme heat, here are 14 ways to keep your body and home cool without AC | CNN

    Editor’s Note: This story was first published in 2020 and has been updated.



    CNN
    — 

    Whether you’re without power, enduring extreme heat or trying to save money, there are ways to feel comfortable without artificial cooling.

    Heat can foster fun summer activities, but the body shouldn’t be too hot for too long, as too much heat can harm your brain and other organs, according to the US National Institutes of Health. Sweating is the body’s natural cooling system, but when that’s not enough, there’s increased risk for developing the heat-related illness hyperthermia — signs of which include heat cramps, heat edema and heat stroke. Heat combined with high humidity exacerbates this risk, since the air’s saturation level makes sweat accumulate on the skin, preventing the body from cooling naturally.

    Staying cool can be done by using some basic supplies and knowing how to manipulate your home to control its temperatures. Here are 14 methods for doing so.

    When you’re hot and flushed, hydrating yourself is the first and foremost step to cooling down, said Wendell Porter, a senior lecturer emeritus in agricultural and biological engineering at the University of Florida.

    The temperature of the water doesn’t matter since your body will heat it, he added. If your body is suffering from the heat and needs to cool itself, it can’t do that without enough moisture, since the body cools itself by sweating.

    Taking a cold shower or bath helps cool your body by lowering your core temperature, Porter said.

    03 cool down wellness

    For an extra cool blast, try peppermint soap. The menthol in peppermint oil activates brain receptors that tell your body something you’re eating or feeling is cold.

    02 cool down wellness

    Place a cold washrag or ice bags (packs) on your wrists or drape it around your neck to cool your body. These pulse points are areas where blood vessels are close to the skin, so you’ll cool down more quickly.

    Place box fans facing out of the windows of rooms you’re spending time in to blow out hot air and replace it with cold air inside.

    09 cool down wellness

    If the weather in your area tends to fall between 50 and 70 degrees Fahrenheit in the mornings and evenings, opening the windows on both sides of the house during those times can facilitate a cross-flow ventilation system. If you do this, you can opt to use or not use the fans, but the fans would help cool the house faster, Porter said. The outdoors can pull the hot air from your home, leaving a cooler temperature or bringing in the breeze. Just be sure to close windows as the sun comes out, then open them when the weather is cool again.

    Just resting near a fan would reduce your body temperature as well.

    If you have windows that face the sun’s direction in the morning through afternoon, close the curtains or blinds over them to “keep the sun from coming directly into the house and heating up (the) inside,” Porter said.

    05 cool down wellness

    You could also install blackout curtains to insulate the room and reduce temperature increases that would happen during the day.

    If you do turn the air conditioning on, don’t set it below 70 degrees Fahrenheit in an effort to cool the house faster, said Samantha Hall, managing director of Spaces Alive, an Australia-based design research company helping to create healthy, sustainable buildings.

    “It just runs for longer to reach that temp and will keep going until you start to feel a bit chilly and is then hard to balance,” she added. Instead, keep the unit temperature as high as possible while still comfortable.

    Cotton is one of the most breathable materials, so cotton sheets or blankets could help keep you cool through the night.

    04 cool down wellness

    The lower the thread count of the cotton, the more breathable it is, Porter said. That’s because higher thread counts have more weaving per square inch.

    If you can’t sleep through the night because you’re too hot, try sleeping somewhere besides your bedroom, if that’s an option. Heat rises, so if you have a lower or basement level in your home, set up a temporary sleeping area there to experience cooler temperatures at night.

    Common advice for staying cool without air conditioning includes refrigerating or freezing wet socks, blankets or clothing then ringing them out to wear while you sleep. But this isn’t a good idea, Porter said.

    Because of “the amount of energy they can absorb from your body that night, they will be warm in just a matter of minutes,” he said. “And then you’d have damp stuff that would mold your mattress. So you definitely don’t want to do that.”

    If no one’s using a room that doesn’t have vents or registers, close the door to that area to keep the cool air confined to only occupied areas of the house.

    Flip the switch for the exhaust fan in your kitchen to pull hot air that rises after you cook or in your bathroom to draw out steam after you shower.

    Incandescent light bulbs generate a higher temperature than LED light bulbs do. To make the switch, watch for sales on energy-efficient bulbs, then slowly replace the bulbs in your house, Porter said.

    08 cool down wellness

    Switching light bulbs can save money but won’t reduce a lot of heat in the home, Hall said. However, if you focus on switching the bulbs in areas you’re sitting near, that would make a more noticeable difference, Porter said.

    01 cool down wellness

    Oven heat can spread throughout your house. Keep the heat centralized in one area, such as a slow cooker. Or, cook outdoors on a grill to keep the heat outside.

    Eating an ice pop or ice cream to cool down may help for a moment. But don’t go overboard on the sugar if you’re overheated or at risk of being overheated, Porter said.

    06 cool down wellness

    “Sugar would run your metabolism up and you’d start feeling internally hot,” he said. “So the cool treat might be good, but the extra sugar might not.”

    If you’ve tried everything and still can’t beat the heat at home, you could look online for any local programs that are offering ductless air conditioners.

    Depending on your state, some cooling centers — air-conditioned public facilities where people might go for relief during extremely hot weather — may be open and taking precautions to ensure they’re as safe as possible. You could start by checking with your local utility offices, as they would know who is offering certain programs, Porter recommended.

    READ MORE: Get inspired by a weekly roundup on living well, made simple. Sign up for CNN’s Life, But Better newsletter for information and tools designed to improve your well-being.

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