Thursday, April 11, 2024

Spilling the Secrets to Early Literacy

For young children, learning to read is a critical step in their educational journeys, as literacy helps build cognitive abilities and language proficiency and has a direct impact on later academic achievement.

While there are no shortcuts to early literacy, there are steps parents can take to promote the development of children’s reading abilities. Dr. Lauren Loquasto, senior vice president and chief academic officer at The Goddard School, and Steve Metzger, award-winning author of more than 70 children’s books, share this guidance for parents.

Get Started Early
It’s never too early to start reading with children. In fact, they respond to being read to prenatally. One of the best ways to encourage early literacy is modeling the act of reading. Young children love to imitate, and if they see their parents reading, they are more likely to want to read themselves. Instead of scrolling on your phone or watching television while your children play, pick up a book or magazine.

Use Conversation to Build Literacy
To help build their vocabularies, consistently engage children in conversation. Literacy is more than reading and writing; it’s also listening and speaking. Children understand words before they can articulate them, so don’t be discouraged if it feels like a one-way conversation.

Expose Children to More Than Books
Make your home environment print-rich, as the more exposure children have to letters and words, the better. For example, keep magnetic letters and words on the fridge, put labels on your toy containers and position books and magazines in different rooms. Also remember reading isn’t limited to books. Words are everywhere, from street signs to restaurant menus. Take advantage of every opportunity to connect with your children through words throughout your day.

Let Them Take the Lead
Children engage with books in different, developmentally appropriate ways. Some children quickly flip through pages or only look at pictures while others might make up stories or their own words or songs. Some only want to read the same book over and over and some want to read a new book every time. Embrace and encourage their interest in books, no matter how they choose to use them.

Establish a Routine
Parents of young children often have busy and hectic lives, so it isn’t always easy to find time to read. Consistency is key, so be intentional about setting aside time for reading every day – perhaps it’s after dinner or before bedtime – and stick to it.

Select the Right Books
Helping young children choose books is an important part of their learning-to-read process. Developmental appropriateness is critical. For infants and toddlers, start with nursery rhymes, which are mini-stories that grasp children’s attention through repetition, rhythm and rhyming. Visuals are also important because they aren’t yet pulling words off the page. For emerging readers, choose books that align with their interests. Focus on books that are printed with text that goes from left to right and top to bottom.

Expose children to both fiction and non-fiction books. Non-fiction provides real-world knowledge children crave and helps them make sense of what they read in fictional stories. For example, the learnings about the life cycle of a bat they read in “Bat Loves the Night,” a non-fiction book, can help them better understand what’s happening in “Stellaluna,” a fiction book about a young bat.

If you’re in doubt about book choices, consult with a teacher or librarian, who can make recommendations based on your children’s interests and reading levels.

Foster a Love of Reading
Children’s early exposure to books can set the stage for a lifetime of reading. Make reading a time for discovery. Take children to a library or bookstore and encourage them to explore and find books on their own. Display genuine interest in their selections and use books as a tool for engaging and connecting with them. Don’t pressure children to learn how to read. Accept, validate and encourage them as they progress on their unique literacy journeys.

To watch a webinar recording featuring Loquasto and Metzger providing additional literacy guidance and recommendations, and access a wealth of actionable parenting insights and resources, visit the Parent Resource Center at

The Goddard School

Sunday, March 31, 2024

Lessons from sports psychology research

Scientists are probing the head games that influence athletic performance, from coaching to coping with pressure

Since the early years of this century, it has been commonplace for computerized analyses of athletic statistics to guide a baseball manager’s choice of pinch hitter, a football coach’s decision to punt or pass, or a basketball team’s debate over whether to trade a star player for a draft pick.

But many sports experts who actually watch the games know that the secret to success is not solely in computer databases, but also inside the players’ heads. So perhaps psychologists can offer as much insight into athletic achievement as statistics gurus do.

Sports psychology has, after all, been around a lot longer than computer analytics. Psychological studies of sports appeared as early as the late 19th century. During the 1970s and ’80s, sports psychology became a fertile research field. And within the last decade or so, sports psychology research has exploded, as scientists have explored the nuances of everything from the pursuit of perfection to the harms of abusive coaching.

“Sport pervades cultures, continents, and indeed many facets of daily life,” write Mark Beauchamp, Alan Kingstone and Nikos Ntoumanis, authors of an overview of sports psychology research in the 2023 Annual Review of Psychology.

Their review surveys findings from nearly 150 papers investigating various psychological influences on athletic performance and success. “This body of work sheds light on the diverse ways in which psychological processes contribute to athletic strivings,” the authors write. Such research has the potential not only to enhance athletic performance, they say, but also to provide insights into psychological influences on success in other realms, from education to the military. Psychological knowledge can aid competitive performance under pressure, help evaluate the benefit of pursuing perfection and assess the pluses and minuses of high self-confidence.

Confidence and choking

In sports, high self-confidence (technical term: elevated self-efficacy belief) is generally considered to be a plus. As baseball pitcher Nolan Ryan once said, “You have to have a lot of confidence to be successful in this game.” Many a baseball manager would agree that a batter who lacks confidence against a given pitcher is unlikely to get to first base.

Various studies suggest that self-talk can increase confidence, enhance focus, control emotions and initiate effective actions.

And in fact, a lot of psychological research actually supports that view, suggesting that encouraging self-confidence is a beneficial strategy. Yet while confident athletes do seem to perform better than those afflicted with self-doubt, some studies hint that for a given player, excessive confidence can be detrimental. Artificially inflated confidence, unchecked by honest feedback, may cause players to “fail to allocate sufficient resources based on their overestimated sense of their capabilities,” Beauchamp and colleagues write. In other words, overconfidence may result in underachievement.

Other work shows that high confidence is usually most useful in the most challenging situations (such as attempting a 60-yard field goal), while not helping as much for simpler tasks (like kicking an extra point).

Of course, the ease of kicking either a long field goal or an extra point depends a lot on the stress of the situation. With time running out and the game on the line, a routine play can become an anxiety-inducing trial by fire. Psychological research, Beauchamp and coauthors report, has clearly established that athletes often exhibit “impaired performance under pressure-invoking situations” (technical term: “choking”).

In general, stress impairs not only the guidance of movements but also perceptual ability and decision-making. On the other hand, it’s also true that certain elite athletes perform best under high stress. “There is also insightful evidence that some of the most successful performers actually seek out, and thrive on, anxiety-invoking contexts offered by high-pressure sport,” the authors note. Just ask Michael Jordan or LeBron James.

Many studies have investigated the psychological coping strategies that athletes use to maintain focus and ignore distractions in high-pressure situations. One popular method is a technique known as the “quiet eye.” A basketball player attempting a free throw is typically more likely to make it by maintaining “a longer and steadier gaze” at the basket before shooting, studies have demonstrated.

“In a recent systematic review of interventions designed to alleviate so-called choking, quiet-eye training was identified as being among the most effective approaches,” Beachamp and coauthors write.

Another common stress-coping method is “self-talk,” in which players utter instructional or motivational phrases to themselves in order to boost performance. Saying “I can do it” or “I feel good” can self-motivate a marathon runner, for example. Saying “eye on the ball” might help a baseball batter get a hit.

Researchers have found moderate benefits of self-talk strategies for both novices and experienced athletes, Beauchamp and colleagues report. Various studies suggest that self-talk can increase confidence, enhance focus, control emotions and initiate effective actions.

Moderate performance benefits have also been reported for other techniques for countering stress, such as biofeedback, and possibly meditation and relaxation training.

“It appears that stress regulation interventions represent a promising means of supporting athletes when confronted with performance-related stressors,” Beauchamp and coauthors conclude.

Pursuing athletic perfection

Of course, sports psychology encompasses many other issues besides influencing confidence and coping with pressure. Many athletes set a goal of attaining perfection, for example, but such striving can induce detrimental psychological pressures. One analysis found that athletes pursuing purely personal high standards generally achieved superior performance. But when perfectionism was motivated by fear of criticism from others, performance suffered.

Similarly, while some coaching strategies can aid a player’s performance, several studies have shown that abusive coaching can detract from performance, even for the rest of an athlete’s career.

Beauchamp and his collaborators conclude that a large suite of psychological factors and strategies can aid athletic success. And these factors may well be applicable to other areas of human endeavor where choking can impair performance (say, while performing brain surgery or flying a fighter jet).

But the authors also point out that researchers shouldn’t neglect the need to consider that in sports, performance is also affected by the adversarial nature of competition. A pitcher’s psychological strategies that are effective against most hitters might not fare so well against Shohei Ohtani, for instance.

Besides that, sports psychology studies (much like computer-based analytics) rely on statistics. As Adolphe Quetelet, a pioneer of social statistics, emphasized in the 19th century, statistics do not define any individual — average life expectancy cannot tell you when any given person will die. On the other hand, he noted, no single exceptional case invalidates the general conclusions from sound statistical analysis.

Sports are, in fact, all about the quest of the individual (or a team) to defeat the opposition. Success often requires defying the odds — which is why gambling on athletic events is such a big business. Sports consist of contests between the averages and the exceptions, and neither computer analytics nor psychological science can tell you in advance who is going to win. That’s why they play the games.


Thursday, March 28, 2024

Walk Your Way to Better Health

A walk is not just good for your body, it’s also good for your soul. Physical activity, like walking, is one of the best ways to reduce stress and boost your mood. However, reports show walking rates are declining steadily in the United States.

On average, 1 out of every 4 U.S. adults sits for longer than eight hours each day, per research from the Centers of Disease Control and Prevention, which can have negative consequences on physical and mental health. Regular exercise improves mood, boosts energy and can even help you sleep better. Staying active is one of the best ways to keep your mind and body healthy.

Consider this advice from the American Heart Association, which has worked for decades to promote policies and strategies that make it easier for communities to get and stay active. One example is National Walking Day on April 3, established by the organization to encourage people to move more throughout the day so they can feel, think, sleep and live better.

Indeed, adding more movement can benefit your body and mind in numerous ways, such as:

Lowering disease risk. Getting the recommended amount of physical activity (at least 150 minutes of moderate, 75 minutes of vigorous or a combination of those activities per week) is linked to lower risk of diseases, stronger bones and muscles, improved mental health and cognitive function and lower risk of depression, according to the U.S Department of Health and Human Services.

Increasing sunlight exposure. Outdoor exercise is an easy way to get moving and take in the sunlight, which can improve mood, boost immunity and help you get some vitamin D. Spending time outdoors is a no-cost option and has been shown to reduce stress, promote a sense of belonging and improve mood.

Improving cognitive and mental function. Physical activity keeps your mind sharp now and later. Studies show higher fitness levels are linked to better attention, learning, working memory and problem solving. What’s more, a study published in the “British Journal of Sports Medicine” shows people who get the recommended amount of physical activity are less likely to develop depression.

Living longer. Healthy life expectancy can be positively impacted by increasing activity. According to research published in the “American Journal of Epidemiology,” swapping just 30 minutes of sitting with low-intensity physical activity reduced risk of death by 17%.

Get moving to reduce your stress and step into better health. Learn more at

Get Inspired to Get Moving

A little creativity can go a long way to make your walk more fun. You might think of walking as a solo activity, but a companion makes it even more enjoyable. Ask colleagues, friends or family to join you.

A walk is a perfect excuse to take a break from a long day at your desk. If you work remotely, take a conference call on the go or plan your walk as a reward for completing a project.

Use your walk as a guilt-free opportunity to listen to a new audiobook or create a walking soundtrack of your favorite upbeat music.

Mix up your scenery. Taking new routes keeps your walks interesting and helps prevent boredom from traveling the same predictable path.

If you need an extra nudge to get moving, a pet may help you get fit. Dog parents are more likely to reach their fitness goals than those without canine companions. In fact, according to the “Journal of Physical Activity & Health,” dog parents are 34% more likely to fit in 150 minutes of walking a week than non-dog owners. Pets can also help lower stress, blood pressure, cholesterol and blood sugar and boost your overall happiness and well-being.

American Heart Association

Tuesday, March 26, 2024

The growing link between microbes, mood and mental health

New research suggests that to maintain a healthy brain, we should tend our gut microbiome. The best way to do that right now is not through pills and supplements, but better food.

It is increasingly well understood that the countless microbes in our guts help us to digest our food, to absorb and produce essential nutrients, and to prevent harmful organisms from settling in. Less intuitive — perhaps even outlandish — is the idea that those microbes may also affect our mood, our mental health and how we perform on cognitive tests. But there is mounting evidence that they do.

For nearly two decades, neuroscientist John Cryan of University College Cork in Ireland has been uncovering ways in which intestinal microbes affect the brain and behavior of humans and other animals. To his surprise, many of the effects he’s seen in rodents appear to be mirrored in our own species. Most remarkably, research by Cryan and others has shown that transplanting microbes from the guts of people with psychiatric disorders like depression to the guts of rodents can cause comparable symptoms in the animals.

These effects may occur in several ways — through the vagus nerve connecting the gut to the brain, through the influence of gut bacteria on our immune systems, or by microbes synthesizing molecules that our nerve cells use to communicate. Cryan and coauthors summarize the science in a set of articles including “Man and the Microbiome: A New Theory of Everything?,” published in the Annual Review of Clinical Psychology. Cryan told Knowable Magazine that even though it will take much more research to pin down the mechanisms and figure out how to apply the insights, there are some things we can do already.

This conversation has been edited for length and clarity.

“Man and the Microbiome: A New Theory of Everything?” — with all due respect, isn’t that a wee bit ambitious?

That title is admittedly a bit overstated. But the point we are trying to make is that it isn’t really so odd that the microbiome is involved in everything, because the microbes were there first, and so our species has evolved in their presence. We have been able to show that growing up in a germ-free environment really affects the development of the mouse brain, for example, in a variety of ways.

Our immune system is also completely shaped by microbial signals. Via that route, inflammation in our gut can affect our mood and cause symptoms of sickness behavior that are quite similar to important aspects of depression and anxiety. Many psychiatric disorders are also known to be associated with various gastrointestinal issues, though cause and effect often aren’t clear yet. So if you study the body, including the brain, you ignore microbes at your own peril.

Most people are on board with the idea that gut microbes affect our health, but it may be more difficult to accept that they also influence how we feel and think. How did you convince yourself this was true?

I’m a stress neurobiologist, so I was trained in stress-related disorders like depression and anxiety, and my interest was really in using animal models of stress to look for novel therapeutic strategies.

When I moved to University College Cork in 2005, I met a clinical researcher, Ted Dinan, and we started working together to study irritable bowel syndrome, a very common disorder that is characterized by alterations in bowel habits and abdominal pain.

That was interesting to me, as it had become very clear that this is also a stress-related disorder. So we started working on an animal model called the maternal separation model, where rat pups are separated from their moms early in life and develop a stress-like syndrome when they grow up.

Siobhain O’Mahony, a graduate student at the time, also wanted to look at the microbiome, and I remember telling her, “No! Focus, focus!” But she went ahead anyway and found a signature of this early-life stress in the microbiome of adult rats. That was kind of a eureka moment for me.

The next part of the puzzle came when we showed that mice born in a germ-free environment have an exaggerated stress response when they grow up. So we’d already shown that stress was affecting the microbiome, and now we’d shown that the microbiome is regulating how a mouse responds to stress. It turned out that a very nice study from Japan had already shown this.

The third part of the puzzle for me was to ask whether we could alter the microbiome to alleviate some of the effects of stress. In 2011, we were able to show that a specific strain of the bacterium Lactobacillus, when given to normal, healthy mice in a stressful situation, was able to dampen down the stress response, and that the vagus nerve connecting the gut to the brain was required for that.

These three things together, from 2006 to 2011, really crystallized my interest in the link between the gut microbiome, brain and behavior. Since then, we’ve been on this magical journey to try and understand these discoveries, uncover the mechanisms and find how they translate to humans.

Can you explain what a depressed or anxious mouse looks like, and how you quantify that?

One way to look at fear is to quantify how often mice venture into wide open areas, which they normally avoid. If we give a mouse Valium or another anxiety-reducing drug, it will go out and explore and be carefree, not to say a bit reckless. Depression is often studied by looking at mice in a cylinder of water. They are good swimmers, but they don’t like swimming, so after a while, they’ll stop and adopt an immobile posture. Yet if you give them antidepressant drugs, they keep going.

These types of paradigms have shown their validity in studies of pharmacological agents used in human psychiatry, and so they’re ideal to explore whether microbiome manipulations have similar effects. This can be done by transplanting the microbes from a mouse model for a psychiatric disease to a healthy mouse to see whether that creates similar issues, or vice versa, to see if it can resolve them.

Following a similar logic, we have shown that the microbiome can be important in brain aging and cognitive decline. We took the microbiome from eight-week-old mice and gave it to 22-month-old animals — these are very old mice. And we were able to show wide-scale changes across the body — in the microbiome and the immune system, but also in the hippocampus, a brain structure involved in memory.

In the old animals that received the microbiome from young ones, the hippocampus looked completely rejuvenated in its chemical composition. They also performed significantly better in mazes designed to test their memory. This finding has now been replicated in two other labs, giving it further credence.

Such experiments are difficult if not impossible to do in people. How to make that jump?

One thing we can do is to transplant microbes from the guts of people with psychiatric disorders to rodents, to see if they cause comparable behaviors. This has now been done for depression, anxiety, schizophrenia, social anxiety disorder and even Alzheimer’s disease. In one of our own studies, we transferred fecal microbiota from depressed patients to a rat model. This resulted in behavior reminiscent of that in rat models for depression, such as increased anxiety and an uninterest in rewards, in addition to inflammation.

In addition, we can see if bacterial strains we’ve identified as troublemakers in rodents also occur in people with psychiatric issues, and if strains that are beneficial in rodents can help humans as well.

What I’d really like to do is follow a large group of healthy people for a couple of years and track their mental and brain health as well as the changes in their microbiome, and regularly transplant their gut microbes into mice. This would give us a much better view on how this relationship evolves.

Do you think some of the probiotics available in stores today might be helpful, or not quite?

In my opinion, many so-called probiotics aren’t probiotics at all. Probiotics, per definition, are live microorganisms that, when taken in adequate amounts, can confer a health benefit. Most of what’s for sale in shops would never meet that criterion. To demonstrate that something confers a health benefit, you need clinical trials to show it is more effective than a placebo. That’s the first thing. Second, you have to show that the microbes are alive, and that they can survive the stomach acid.

There have been properly randomized controlled trials for some products. But for most products available over the counter today, such studies haven’t been done, because the regulatory authorities do not require them for probiotics as they would for medicines.

There’s a lot of snake oil out there. For most people, it’s probably harmless, but if you are immunosuppressed, it could be dangerous: Even beneficial bacteria can cause great harm if your immune system does not function properly.

Don’t get me wrong, I think there are many promising findings, but this field is very much in its infancy. I’m much more enthusiastic right now about whole-food approaches that adjust people’s diets to include more fermented foods — a source of beneficial bacteria — and the fibers that many beneficial members of our microbiome need to survive. And this, everyone can already do.

Have you done any experiments that show such a diet can improve mental health?

We’ve just done a small study with what we call a psychobiotic diet. Kirsten Berding, a German dietician who did a post-doc in my group, took a group of people with bad diets who were stress-sensitive — namely, our student population — and put them on a one-month diet to really ramp up fermented foods and fibers to the benefit of the microbiome. What we showed was that the better individuals followed the diet, the greater the reduction in stress.

The study wasn’t perfectly blinded, because people knew what they were eating, but they didn’t know what they were eating it for. And this was just the beginning: We’re now doing a much longer study trying to really untangle this.

We’ve also done a small randomly controlled study with a polydextrose fiber that was shown to improve the performance of healthy volunteers on a range of cognitive tests.

Obviously, more work of this kind is necessary. But in this case, I don’t think we should wait for that. Think about the experiment where we’ve transplanted microbes from young to old mice, for example: I’m not advertising poop transplants for aging adults. What we’ve found is that the more diverse your diet, the more diverse your microbiome, and the better your health when you get old. If you look at the beige, bland food served in many nursing homes and hospitals today, that is not the kind of diet that helps people to maintain a healthy microbiome and therefore a healthy brain.

“Perhaps if you’re thinking of having a midlife crisis, forget about the motorbike and start growing vegetables.”


We’ve done a study in mice where we adjusted their diet to contain much more inulin, a fiber that we know supports the growth of beneficial bacterial strains, and found we could dampen down the neuroinflammation that is often associated with cognitive decline in aging. This fiber is present in our everyday diet — there is a lot of it in vegetables like leeks, artichokes and chicory. So perhaps if you’re thinking of having a midlife crisis, forget about the motorbike and start growing vegetables.

This is all in healthy patients. Do you think the diet might also help people with mental health issues?

I do, but we need to test it, of course. An earlier study of ours showed that students born by C-section, who missed out on some of the microbes that newborns acquire during vaginal birth, had an elevated immune and psychological response to both chronic and acute stress, in line with our findings in mice. It would be very interesting to test if a psychobiotic diet might benefit them.

As I said, many psychiatric disorders are also associated with inflammation and other problems in the gut. Of course, this relationship works both ways, and it’s not always clear to what extent the irregularities in the gut are the cause or the result of the mental issues — or whether it’s a bit of both. But if we can show a healthier microbiome can improve mental health, that would be great news.

This is what’s appealing about the microbiome: It’s probably more modifiable than the rest of our body. If we understand how it works, that might give people more options to improve their health, even if they didn’t have the best start, microbially speaking. That’s what we hope to achieve.

Saturday, March 23, 2024

Why isn’t dental health considered primary medical care?

Nature Made

Ailments of the mouth can put the body at risk for a slew of other ills. Some practitioners think dentistry should no longer be siloed.

The patient’s teeth appeared to be well cared for, but dentist James Mancini did not like the look of his gums. By chance, Mancini knew the man’s physician, so he raised an alert about a potential problem — and a diagnosis soon emerged.

“Actually, Bob had leukemia,” says Mancini, clinical director of the Meadville Dental Center in Pennsylvania. Though he wasn’t tired or having other symptoms, “his mouth was a disaster,” Mancini says. “Once his physician saw that, they were able to get him treated right away.”

Oral health is tightly connected to whole-body health, so Mancini’s hunch is not surprising. What is unusual is that the dentist and doctor communicated.

Historically, dentistry and medicine have operated as parallel fields: Dentists take care of the mouth, physicians the rest of the body. That is starting to change as many initiatives across the United States and other countries work to integrate oral and whole-body care to more effectively tackle diabetes, cardiovascular disease, joint replacements and many other conditions. The exact relationship between health of mouth and teeth and physical ailments elsewhere in the body is not well understood — and in some cases, is contentious — but experts agree there are links that should no longer be overlooked.

In recent years, dental hygienists have started working in medical clinics; physicians and dentists have started a professional association to promote working together; and a new kind of clinic — with dentists and doctors under one roof — is emerging.

“We are at a pivotal point — I call it the convergence era — where dentistry is not going to be separated from overall health for much longer,” says Stephen E. Thorne IV, founder and CEO of Pacific Dental Services, based in Irvine, California. “Dentistry will be brought into the primary care health-care team.”

Sick mouth, sick body

The list of connections between oral health and systemic health — conditions that affect the entire body — is remarkable. For starters, three common dental issues — cavities, tooth loss and periodontal disease — are all associated with heart disease, the leading cause of death in the United States. “To me, the number one hidden risk factor for the number one killer in our country is oral health,” says Ellie Campbell, a family physician in Cumming, Georgia, and board member of the American Academy for Oral Systemic Health, founded in 2010 to increase awareness of how oral and whole-body health are related.

Periodontal disease, infection and inflammation of the gums and bone that support the teeth, is the main culprit. Nearly half of adults 30 and older have periodontal disease; by age 65, the rate climbs to about 70 percent. In the early stages, called gingivitis, gums are swollen and may bleed. Periodontitis, a more serious condition in which gums can pull away from the teeth, is the sixth most common human disease.

Periodontitis is associated with a slew of systemic ills: heart attacks, strokes, heart failure, diabetes, endocarditis, chronic kidney disease, recurrent pneumonia, chronic obstructive pulmonary disease, gastritis, rheumatoid arthritis, cancer and cognitive impairment.

Bad habits, including tobacco use, alcohol consumption and high-sugar diets, are implicated too. They raise the risk for cavities and most oral diseases, and are also linked to ills such as cancer, chronic respiratory disease and diabetes.

Such connections were apparently lost on officials at the University of Maryland in 1837, when the university rebuffed a proposal from two physicians to teach dentistry to the school’s medical students. At the time, medicine wanted nothing to do with dentistry, which was practiced by unregulated and inadequately trained itinerants, says medical and dental historian Andrew I. Spielman, a dentist and oral surgeon at the New York University College of Dentistry. “There were a lot of charlatans,” he says. “They had a very bad reputation.”

The dismissal prompted the rejected physicians, Horace Hayden and Chapin Harris, to establish the world’s first dental school, the Baltimore College of Dental Surgery. Today, dentistry is a highly regulated profession, and the United States has 73 accredited dental schools.

Despite their disparate training, both doctors and dentists are aware that mouth health is important to whole-body health, Campbell says. “Ask a family practice doctor and they will say ‘Oh yeah, if the patient has diabetes, they’re going to have bad teeth and gums, and I can never get their diabetes better until the dentist fixes their gums,’” she says. “And the dentist is going to say, ‘Well, I’ll never get their gums better until the primary care doctor gets their sugar under control.’”

Mancini, the Pennsylvania dentist, says dentists often are asked to examine a patient’s mouth before physicians will proceed with certain treatments. “Physicians know any infection in a patient who’s being treated for cancer could be very much life-threatening,” he says. “The orthopedic guys are now sending all of their patients to the dentist for the same reason.”

Hurdles to holistic care

But working together to improve a patient’s health is not as simple as it might seem. A decade ago, the federal government hired the National Network for Oral Health Access to run a pilot program merging oral and primary health-care centers. The network’s dental consultant, Irene Hilton, a dentist with the San Francisco Department of Public Health, said three barriers to integration became clear.

The fragmented way that health care and dental care are paid for is one of them. While more than 90 percent of Americans have health insurance, only 77 percent of US adults ages 19 to 64 have dental coverage, which typically is sold separately from health insurance. The nation’s largest insurer — the federal Medicare program — generally does not cover dental services, and nearly half of Americans 65 and over have no dental coverage.

That causes problems for patients who need, say, a joint replacement that would be covered by insurance but who cannot afford the dental work that is needed in advance. Surgeons won’t replace a knee until patients first get their dental work done, Mancini says, “so we’re kind of the barrier to them improving their life.”

Another barrier is that dentists and physicians are not routinely trained to work with each other, Hilton says.

Dental students study anatomy, physiology and other sciences related to the whole body, then home in on clinical care for mouth and teeth. But many physicians have almost no training in oral health. A 2009 survey found that 10 percent of medical schools that responded offered no oral health curriculum, and 69 percent offered fewer than five hours on the subject.

A third issue is what Hilton calls infrastructure. In most cases, the electronic health records used by physicians are incompatible with those used by dentists, so sharing information electronically is impossible. Likewise, dental offices are typically not embedded in medical clinics, where doctor-dentist referrals might be easier.

If oral and systemic health are to be integrated broadly, “these are the things that have to be overcome or addressed,” Hilton says.

The situation is not much different in other parts of the world. In 2021 the World Health Organization — noting that oral diseases are a global public health problem affecting nearly 3.5 billion people — recommended that dentistry focus more on prevention and be more integrated with primary care services.

Demonstrated links

In the past quarter-century, a great deal of research has demonstrated the links between oral and whole-body health. For example, when researchers followed 15,456 patients from 39 countries with stable coronary heart disease for nearly four years, they found that those who had lost the most teeth had the highest risk of having a stroke, heart attack or cardiovascular death. Similarly, a study that tracked 7,466 US adults ages 44 to 66 for an average of 14.7 years revealed that those who had severe periodontitis had a greater risk of cancer than those with no or mild periodontitis.

In 2015, the Harvard School of Dental Medicine launched an initiative to support integration of the two fields — in education, insurance and professional practice. (The initiative gets funding from dental product brands and health insurance companies, and Thorne, the Pacific Dental Services CEO, serves on its board.) “We’ve published papers identifying links between periodontal disease and diabetes, hypertension, dementia, adverse birth outcomes, low birth-weight babies, preterm birth, spontaneous abortion, kidney disease,” says Jane Barrow, the initiative’s executive director.

But correlation is not the same as cause and effect, and scientists have not nailed down the exact relationship between periodontitis, which affects more than 11 percent of the global population, and various systemic diseases.

Periodontitis is associated with bacteria in the bloodstream and systemic inflammation, which can affect organs such as the liver and bone marrow. That, in turn, can trigger or aggravate other conditions. And the periodontal bacteria — that travel via the bloodstream, inhalation or ingestion — may also cause infections or exacerbate inflammation in other parts of the body.

When the major professional societies for periodontology in the United States and Europe convened a group of global experts in 2012 to review the science, they concluded that it was “biologically plausible” that the inflammation of periodontitis ups the risk of cardiovascular disease and influences type 2 diabetes and other maladies – but “plausible” was as far as they would go.

Seven years later, the European Federation of Periodontology and the World Heart Federation again gathered experts to review new studies on the link between periodontitis and cardiovascular problems. Again, though scientists had made some headway in identifying possible biological mechanisms to explain the link, experts have since concluded that the evidence does not yet prove that periodontitis actually causes strokes, heart attacks or anything else.

Flipping the question on its head, does preventing or treating periodontal disease help to prevent heart problems? Several observational studies, in which researchers observe individuals and measure particular outcomes, but don’t intervene, suggest that oral health care, including toothbrushing and dental cleanings, make a difference. For example, a study that tracked the health habits of 11,869 adults 35 and older in Scotland found that within eight years, those who rarely brushed their teeth had more cardiovascular problems compared with those who brushed twice a day.

That still does not prove that preventing periodontitis will hold heart problems at bay: Some other habit or feature of the toothbrushing group could have been the important factor. The relationship is difficult to tease out, Barrow says, because people who are taking good care of their mouths tend to take good care of themselves in general. “Could you say that people who are taking care of their mouths are in better health overall? You would probably find that to be true,” she says. “Is it because they’re taking care of their mouth? I can’t say that.”

And nobody else should say that either, according to a 2018 editorial in the Journal of the American Dental Association. The coauthors, a group of dental and public health researchers, cautioned against overstating the oral-systemic health connection. “The main reason for maintaining good oral health is because it is important in and of itself,” they wrote.

One of the contributors, Bryan Michalowicz, a dental researcher at HealthPartners Institute in Minnesota, later led a team that reviewed the medical records and insurance claims of 9,503 patients to see if periodontitis treatment improved the health outcomes of those with coronary artery disease, cerebrovascular disease or type 2 diabetes.

Overall, cardiovascular patients who received dental treatment and follow-up maintenance saw no difference in the rate of heart attacks, strokes, bypass surgeries or angioplasty procedures compared to those who were not treated, the team reported in 2023. Likewise, periodontal treatment did not significantly lower the blood-sugar levels in patients with type 2 diabetes.

Overdue integration

But the data suggesting connections have been enough to spark many grassroots efforts at integration. In addition to the American Academy for Oral Systemic Health, the National Network of Healthcare Hygienists, founded by hygienist Jamie Dooley in 2018, helps prepare hygienists who want to integrate oral health into health-care systems.

And in California, Thorne’s business is trying to make those interactions easy by putting dental and medical services under one roof. In December 2023, Pacific Dental Services opened a clinic, Culver Smiles Dentistry, in a space shared with a medical practice. It’s the first of 25 planned dental-medical practices that will operate through a partnership between MemorialCare, a big Southern California health system, and Pacific Dental.

Health-care leaders, Thorne says, are beginning to realize that they can improve their patients’ health by incorporating dental care into primary care.

It’s sort of crazy, he says, that our mouth and our jaw and our throat have been considered separate from the rest of our body for so long. “It is changing now, and health care is realizing that the mouth is the gateway to so much of our overall health.”

Nature Made

Thursday, March 21, 2024

A Better-for-You Way to Begin the Day

Starting a journey toward better health and wellness can begin the same way you can (and should) start each day: with a nutritious breakfast. A morning meal loaded with nutrient-boosting flavor provides the foundation you need not only for the day at hand, but for a sustainable long-term eating plan, as well.

Consider this Sweetpotato Breakfast Bake as a budget-friendly way to feed your family with plenty of leftovers for days to follow. Full of eggs, bell peppers and turkey sausage, it’s a surefire crowd-pleaser that’s also loaded with shredded sweetpotatoes. According to the American Diabetes Association, sweetpotatoes are a “diabetes superfood” because they’re rich in vitamins, minerals, antioxidants and fiber, all of which are good for overall health and may help prevent disease.

Plus, they offer both a natural sweetener and “sweet” flavor without added sugar to give homemade dishes a perfect touch of deliciousness. Ideal as a key ingredient in both simple and elevated recipes, sweetpotatoes can be prepared in several ways, ranging from cooked on the stove to baked, microwaved, grilled or even slow-cooked.

At your next breakfast or brunch get-together, share this fun fact: the North Carolina Sweetpotato Commission deliberately spells sweetpotato as one word after the one-word spelling was officially adopted by the National Sweetpotato Collaborators in 1989 to help avoid confusion between sweetpotaotes and equally unique, distinctive white potatoes in the minds of shippers, distributors, warehouse workers and consumers.

Visit to find more nutritious breakfast ideas to support your wellness goals.

Watch video to see how to make this recipe!

Sweetpotato Breakfast Bake

Recipe courtesy of Tessa Nguyen, RD, LDN, on behalf of the North Carolina Sweetpotato Commission
Prep time: 10 minutes
Cook time: 15 minutes
Servings: 12
  •             Nonstick cooking spray
  • 1          cup sweetpotatoes, shredded
  • 1/2       cup cooked turkey sausage crumbles or cooked turkey bacon
  • 1/4       cup green onions, sliced
  • 1/2       cup bell pepper, diced
  • 9          eggs, beaten
  • 1/2       cup cheddar cheese, shredded
  • 1/2       teaspoon black pepper
  1. Heat oven to 400 F. Spray 13-by-9-inch baking dish with nonstick cooking spray.
  2. Evenly spread sweetpotatoes, sausage or bacon, green onions and bell peppers in dish. Pour eggs carefully into baking dish. Sprinkle shredded cheese and black pepper over eggs.
  3. Bake 15 minutes.
  4. Slice into 12 pieces and serve hot.

Monday, March 18, 2024

7 Steps to Start Growing Produce at Home

Growing your own produce is an all-around smart practice, from the money you’ll save at the grocery store to the contributions you can make toward a cleaner planet.

Maintaining a garden takes some effort, but it’s a project even a beginner can tackle with ease. Consider these tips to start growing your at-home garden:

  1. Select a perfect spot. You’ll want to place your garden in an area where you see it often so you’re reminded to weed and care for it regularly. Find a flat area you can access easily, where erosion and other pitfalls (including hungry wildlife) won’t be a problem.
  2. Choose between ground and containers. There are pros and cons to gardening in containers vs. the ground, and there’s no universal right choice. Rather, the best garden depends on your goals and preferences. A ground garden usually offers more space and may provide a better growth environment for roots. However, a container garden is often easier to maintain and may be all you need if you wish to grow just a few plants.
  3. Understand the importance of quality soil. You may think any dirt will do, but keep in mind the soil you plant in will be the primary source of nutrients for your produce. Not only that, but quality soil provides stability so plants can root firmly and grow healthy and sturdy to support their bounty. Quality soil also allows for ample drainage. Organic matter like compost, leaf mold or aged manure all help improve soil quality.
  4. Keep water close. Lugging water can quickly eliminate the pleasure of tending your garden, so be sure you’re situated near a hose. You’ll know it’s time to water when the soil is dry about an inch below the surface.
  5. Plan for plenty of sun. A bright, sunny spot is a must, since most vegetables, herbs and fruits depend on six or more hours of sun every day. Remember the sun’s path changes throughout the year, and as trees and foliage grow, they may produce more shade with each growing season.
  6. Consider what you’ll grow. Starting with veggies you know you like is a smart starting point since you’ll be pouring sweat equity into making them grow. Over time, you might add new varieties, but early on, keep your focus on foods you know you like so you can see a meaningful return and avoid waste. You’ll also need to consider what you can grow to maturity within your area’s growing season. If necessary, you might want to start transplants you can nurture indoors before moving them outside when the temperatures allow.
  7. Plant according to a calendar. Knowing how long it takes different foods to mature will help you create a planting calendar. You don’t want to harvest everything at once, and if you stagger planting and replant what you can, you’ll have a garden that produces food for your family for a longer period of time.

Find more helpful tips for managing your home and garden at


Treatment Options to Help Overcome Knee Pain for Sports Enthusiasts

Millions of people experience chronic pain, with knee pain among the most common. Athletes and active adults know the impact activities like running and skiing can have on their knees, but when chronic knee pain makes it difficult to do those activities, or even day-to-day tasks like walking up the stairs, people may often face challenges.

According to the journal “Cartilage,” unlike other tissues, cartilage does not repair itself and, without proper treatment, can worsen over time and become more difficult to treat. However, options like FDA-approved knee cartilage repair surgery MACI (autologous cultured chondrocytes on porcine collagen membrane) uses a patient’s cells to help repair cartilage defects and may help alleviate knee pain.

“Sports-related pain should be evaluated quickly, especially when it’s difficult to put weight on the knee, swelling occurs or there is restricted range of motion,” said Dr. Alexander Meininger, orthopedic surgeon and MACI consultant.

Justin Keys, a former patient of Meininger and avid skier, knows that the long-term outcomes of knee cartilage surgery can be worth the short-term sacrifices. After several injuries, including an ACL injury, Keys struggled with most activities except walking on flat, paved surfaces. After consulting with Meininger, Keys chose knee cartilage repair to help get back to his active lifestyle.

Keys considered whether to manage the injury as-is or choose MACI and undergo rehabilitation to potentially get back to his favorite activities in the future. He knew he could no longer use short-term relief methods and had to address his pain with a treatment to help provide lasting relief.

For athletes like Keys who want to fix knee pain, it’s important to consider these steps:

Discuss Options with Your Doctor
Patients should talk to their doctors and undergo an MRI to help assess the internal structures of the knee. Meininger recommends patients and their doctors discuss options forlong-term knee restoration health, preserving function for future decades and recognizing the short-term sacrifice.

Set Yourself Up for Success
Experts like Meininger suggest patients take steps ahead of surgery to help their recovery.

“The important thing is to be as fit as possible and use the preseason months to undergo surgery and rehab,” Meininger said.

Patients can take steps to prep their home for recovery, which may include:

  • Bringing necessities down from hard-to-reach shelves
  • Moving furniture to ensure clear pathways
  • Installing shower safety handles to minimize potential falls

The Road to Rehab and Recovery
Rehabilitation takes time and everyone’s experience is unique. It can be as much of a mental challenge as it is physical. Committing to a physical therapy regime, staying hydrated and eating well are important aspects to support recovery. Patients should talk to their doctors with questions and before starting any exercises.

Do not use if you are allergic to antibiotics such as gentamicin or materials from cow or pig; have severe osteoarthritis of the knee, other severe inflammatory conditions, infections or inflammation in the bone joint and other surrounding tissue or blood clotting conditions; had knee surgery in the past 6 months, not including surgery for obtaining a cartilage biopsy or a surgical procedure to prepare your knee for a MACI implant; or cannot follow a rehabilitation program post-surgery.

MACI is used for the repair of symptomatic cartilage damage of the adult knee. Conditions that existed before your surgery, including meniscus tears, joint or ligament instability or alignment problems should be evaluated and treated before or at the same time as the MACI implant. MACI is not recommended if you are pregnant. MACI has not been studied in patients younger than 18 or over 55 years of age. Common side effects include joint pain, tendonitis, back pain, joint swelling and joint effusion. More serious side effects include joint pain, cartilage or meniscus injury, treatment failure and osteoarthritis. See Full Prescribing Information for more information.

Find more information by visiting

*Testimonials by MACI patient and paid Vericel consultant


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Sunday, March 17, 2024

Psychedelic drugs and the law: What’s next?

The push to legalize magic mushrooms, MDMA, LSD and other hallucinogens is likely to heighten tensions between state and federal law, drug law expert Robert Mikos says

When Oregon’s first psilocybin service center opened in June 2023, allowing those over 21 to take mind-altering mushrooms in a state-licensed facility, the psychedelic revival that had been unfolding over the past two decades entered an important new phase.

Psilocybin is still illegal on the federal level. But now, as researchers explore the therapeutic potential of psilocybin and other psychedelics, including LSD and MDMA (also known as Molly or ecstasy), legal reform efforts are spreading across the country — raising tensions between state and federal laws.

As a class, psychedelic drugs were outlawed in the United States by the Controlled Substances Act of 1970. The act designated psychedelics as Schedule I drugs — the most restrictive classification, indicating a high potential for abuse and no accepted medical use. That status limits research to federally approved scientific studies and restricts federal funding to research with “significant medical evidence of a therapeutic advantage.”

Despite these limitations, researchers have demonstrated the potential of psychedelics in the treatment of post-traumatic stress disorder, major depressive disorder, anxiety and addiction. A 2020 systematic review of recent research found that psychedelics can lessen symptoms linked to a variety of mental health conditions. While that review found no serious, long-term adverse physical or psychological effects from ingesting psychedelics, more research is needed on the latter.

Today, decades after research on the effects of hallucinogens on the brain was sidelined by the act, academic and cultural interest in psychedelics is on the rise. More than 60 percent of Americans now support regulated therapeutic use of psychedelics, while nearly half support decriminalization, and nearly 45 percent support spiritual and religious use. An estimated 5.5 million US adults use psychedelics each year.

In opening psilocybin service centers where adults can buy and consume “magic mushrooms” without a doctor’s prescription, Oregon took the biggest step yet toward expanding legal psychedelic access in the United States. In the process, it joined a growing number of states and municipalities that are carving their own paths with drug laws. Colorado legalized the use and possession of hallucinogenic mushrooms and three other psychedelics in 2022 and aims to open licensed use facilities by the end of 2024. And California’s legislature passed a bill in 2023 that would have legalized adult possession of psilocybin, the related psilocin and two other hallucinogens (dimethyltryptamine, or DMT, and mescaline), although Gov. Gavin Newsom vetoed it in October, asking for legislation that focuses on therapeutic uses.

In all, 20 states introduced psychedelic-related legislation in 2023, ranging from plans to establish research councils and working groups to proposals to legalize use and possession of certain drugs. Meanwhile, cities in California, Michigan and Massachusetts have stopped enforcement or otherwise decriminalized possession of some psychedelics, typically ones that are naturally found in plants and fungi. Washington, DC, the seat of the federal government, has also loosened its psychedelic laws.

Some of these reform efforts aim to revive research that might lead to badly needed mental health treatments; others are pushing back against what many deem unfair criminal punishments stemming from the “war on drugs.” The result is a growing patchwork of state and local laws that stand in conflict with the Controlled Substances Act.

What does the future hold? Robert Mikos, an expert on drug law at Vanderbilt University Law School in Tennessee, says the history of marijuana law reform may offer some indicators.

In 1996, California voters approved the medical use of marijuana, and today 38 states have medical marijuana programs, while 24 states and the District of Columbia have legalized recreational use. Seventy percent of Americans support marijuana legalization, up from about 25 percent when California first changed its law. And yet marijuana, which is sometimes itself considered a psychedelic, remains a Schedule I substance.

For marijuana, too, public perception underwent dramatic shifts as research demonstrated its relative safety and effectiveness for the treatment of pain and nausea, among other maladies.

Mikos analyzed the implications of marijuana reform history for the legal future of psychedelics in the 2022 Annual Review of Law and Social Science. In an interview with Knowable Magazine, he explored the path toward rescheduling, why different types of psychedelics need to be considered separately, and the interplay between federal and state drug laws.

This conversation has been edited for length and clarity.

What have you learned from studying the history of marijuana reform in terms of what’s now happening with psychedelics?

The biggest lesson is that you don’t have to put all your eggs in one basket and get the federal government to sign on, which is extremely difficult to do. The states provide an alternate forum for pursuing reforms. We’ve seen some small changes to federal law, but in the last 26 years or so, we’ve seen the states figure out ways around all the obstacles erected by the federal government. There are some compromises and sacrifices that have to be made to work around federal law, but you can pull this off and have meaningful reform without agreement from the federal government — even with some hostility from the federal government.

Do you think the legal journey of marijuana should inform the future for psychedelics?

There are differences here. No one even agrees on what the term psychedelics encompasses. Some people think immediately of plant-based psychedelics like psilocybin. Others would include lab-made drugs like LSD. It’s a much more diverse array of substances than marijuana. If someone wants to legalize psychedelics, they may have to pick one substance and run with it. That is a clearer path to success than saying you’re going to legalize all psychedelics. I don’t think any state would be willing to do that at this point.

Framing its use as medical helps — that was certainly true with marijuana. It’s much easier to sell the public on legalizing something for medical use rather than recreational or spiritual use. Under the Controlled Substances Act, the only lawful use of a controlled substance is medical, so there was a natural inclination to frame marijuana use as medical.

Politically, it would be easier to convince a majority of the public to support a ballot initiative to legalize some psychedelics, like psilocybin, for medical use. It would be a simpler story than saying, “Some people here want to go out and trip.”

In 2023, the US Department of Health and Human Services, which is tasked by the Drug Enforcement Administration with reviewing the medical and scientific evidence for a drug’s scheduling, recommended reclassifying marijuana from Schedule I to Schedule III, indicating federal recognition of its accepted medical use. That move would open the door to federal approval of medical marijuana but keep it criminally controlled. Could that be a path for psychedelic reform?

If the Drug Enforcement Administration does reschedule marijuana, it would show that you could get this done at the federal level — but consider that the Controlled Substances Act was passed more than 50 years ago. Marijuana could still end up moving only one rung, to Schedule II, which is very tightly controlled — cocaine is there right now. My takeaway is: Don’t hold your breath waiting for the federal government to change its laws.

And for psychedelics, it’s more complicated. You’d need to make that same demonstration to the Food and Drug Administration — that the drug has medical uses — for each and every drug you were interested in. (The FDA evaluates a drug’s safety and medical efficacy, as well as potential for abuse, among other factors, in its analysis.)

Still, there’s at least a sign, now, that you can convince the federal government to lower the controls on some of these long-forbidden substances. But given how much time it’s taken and how limited that impact would be, it suggests you need to do something else — probably going through the states again and not the federal government.

To what extent is the Controlled Substances Act dictating the trajectory of psychedelic reform?

The Controlled Substances Act privileges medical use, which is going to frame the debate around these substances. But I think people are going to shoehorn in uses that are not genuinely medical uses of the drug.

People are trying to scientifically test these drugs, but ironically, the Controlled Substances Act makes that very difficult. If a drug is on Schedule I, to move it off you need clinical trials demonstrating that it’s effective at treating some medical condition. But conducting those medical trials is really difficult because it’s Schedule I.

The federal government wants to make sure that something someone says is going to be used in a clinical research trial is not sold on the black market. So it imposes special controls, which it could relax to make it easier for universities, hospitals and scientists to test the medical efficacy of different psychedelics.

Even though psychedelics are often discussed as an entire class of drugs, they differ in their chemistry, how they’re created and how they affect individuals who take them. How will that influence the way advocates approach reform?

At the federal level, even if you conduct mountains of research demonstrating that LSD has some accepted medical use, that won’t have any effect on whether to reschedule psilocybin. Politically, it may be difficult to form alliances in that situation between people who believe strongly in legalizing psilocybin versus those who support legalizing a different psychedelic drug.

At the state level, it could get tricky. Will there be enough people out there who are willing to support an initiative targeted at just one of these psychedelics? We don’t have much public opinion research on psychedelics in general, and certainly not on individual psychedelics, which may be the route that reformers need to take.

MDMA was granted “breakthrough therapy” status in order to be studied as part of treatment for post-traumatic stress disorder, and the completion of a Phase 3 trial in fall 2023 means it could be approved by the FDA for this use as early as 2024. Would that require the drug to be rescheduled? And how would that change the trajectory for psychedelics overall at the federal level?

It would necessitate rescheduling. You can’t keep a drug on Schedule I if it has accepted medical use. Which other schedule it falls on depends on the relative harms and likelihood of abuse. But I’m not sure there are broader ramifications. The Controlled Substances Act calls for the scheduling of individual substances, rather than classes of substances, so the scheduling of MDMA has no implications for the scheduling of psilocybin.

What does the tension between state and federal psychedelics law look like?

It’s a bit like a chess match. The states can liberalize their laws and allow people to use, manufacture and distribute some psychedelics, such as psilocybin in Oregon, without fear of arrest from the state government.

The federal government could try to counter the states by making it very difficult for the states to regulate psychedelics. This was true in the early days of state marijuana law reforms. The states wanted to create a safe and heavily state-regulated supply system, but the federal government was threatening to crack down on suppliers, so states didn’t try to set up regulated supply systems. In California, for example, people set up enormous collectives that served tens of thousands of patients, but those suppliers weren’t regulated to the same degree they are now.

You saw state regulation take off only around 2009 when the Obama administration announced it would stop raiding medical marijuana distributors. But that was more than 12 years into state marijuana reforms. Prior to that, states said, “We’re going to call your bluff.… We’re not going to arrest patients. Instead, we’re going to tell patients to grow it themselves, get it from a friend or the black market.”

That’s less than ideal. The states didn’t want some 70-year-old terminal cancer patient having to grow their own medicine, but they said that’s better than threatening to arrest that patient. You might see a similar tit-for-tat in the psychedelics realm.

Oregon has tried to jump the gun a little bit with psilocybin. What they’re envisioning is a tightly regulated state supply system. You can’t buy it and use it at home at your leisure — you have to use it at a state-licensed psilocybin service center.

The problem with that is that it’s much easier for the federal government to shut down state-regulated suppliers because you’ve got a list of them, so it puts those suppliers in harm’s way. They can be arrested, prosecuted, thrown in prison for long terms and have their assets seized.

But if the federal government cracks down on those psilocybin service centers, Oregon might just lift its prohibition on making and distributing this drug. And then the federal government might come back to the table, as it eventually did with medical marijuana.

It’s a back-and-forth between the states and the federal government to figure out how much the federal government will tolerate.

What lessons have we learned from the early stages of psychedelic law reform?

Oregon passed Measure 109 back in fall 2020. It took three years for the first psilocybin service center to open. It takes time to figure out how to do this, especially for early adopters. Can we actually have a system where the state is looking over your shoulder while you’re taking this drug? Or is that going to backfire and is the federal government going to use that to crack down on these centers?

As long as the sky doesn’t fall and you don’t see some disasters from these early adopters, I think other states will warm to it. But the first few years are going to be slow going.

Are there indications yet about whether psychedelics will be able to gather the same kind of political backing that helped push marijuana reform?

I am deeply skeptical. If you look at marijuana, we’ve had the majority of Americans support legalization for recreational or adult use for 10 years and we’re just now getting some tepid indications that somewhere down the line the Biden administration might change federal law governing marijuana to allow for medical use.

It’s going to take a while before you get that sort of public support for psychedelics reform, if you ever get it, and you’d need that before whoever is in federal office 10 to 20 years from now actually embraces this.

The forecast at the federal level doesn’t sound favorable for reform advocates, but at the state level, do you think psychedelic reform is inevitable at this point?

Not necessarily. Psychedelics aren’t nearly as popular or familiar to the general public as marijuana is, so advocates of reforms will have a bigger job educating the public and convincing them that legalization is a good idea.

I don’t think we’re going to see a sudden rush to embrace psychedelics. You might see it in a few states like Oregon and California. Other states will wait on the sidelines and see how it works: Did they figure this out? Is it safe? Is it effective? Were they able to control it? Once you see that demonstration you might see some momentum pick up, especially if public support for psychedelics grows.

A decade from now, maybe seven or eight states will have legalized one psychedelic, probably psilocybin, ostensibly for therapeutic use but, in reality, for any use, as Oregon has done. And then maybe the federal government will reschedule one of these psychedelics. But this took 25 years for marijuana. It will probably be similar for psychedelics.

Learn CPR as a Life-Saving Skill


While many Americans agree Conventional CPR (cardiopulmonary resuscitation) or Hands-Only CPR (HOCPR) significantly improve a person’s chance of survival from cardiac arrest, less than half are confident they can perform either Conventional CPR or HOCPR in an emergency.

Black or Hispanic adults who experience cardiac arrest outside a hospital setting are substantially less likely to receive lifesaving care from a bystander. In spite of these survey results, the American Heart Association is working to change this by empowering members of these communities to learn lifesaving CPR, and a growing segment of respondents are willing to act in an emergency.
The American Heart Association’s 2023 survey also revealed that as a result of the organization’s efforts to change attitudes about performing CPR, which can lead to lifesaving results, more than half of African Americans said they would be willing to perform CPR in an emergency compared to 37% two years ago. Additionally, Hispanic and Latino respondents are more confident in their abilities to perform CPR.

Committed to turning a nation of bystanders into lifesavers, the American Heart Association’s multiyear initiative, Nation of Lifesavers, helps teens and adults learn how to perform CPR and use an automated external defibrillator (AED); share that knowledge with friends and family; and engage employers, policymakers, philanthropists and others to create support for a nation of lifesavers.

“Each of us has the power in our own hands to respond to a sudden cardiac arrest,” said Anezi Uzendu, M.D., American Heart Association expert volunteer. “We simply need to know what to do and have the confidence to act.”

The long-term goal: to ensure that in the face of a cardiac emergency, anyone, anywhere is prepared and empowered to perform CPR and become a vital link in the chain of survival, aiming to double the survival rate of cardiac arrest victims by 2030. It takes just 90 seconds to learn how to save a life using HOCPR, which can be equally as effective as traditional CPR in the first few minutes of cardiac arrest.

Nationally supported by the Elevance Health Foundation, the American Heart Association’s HOCPR campaign is focused on chest compression-only CPR. If a teen or adult suddenly collapses due to a cardiac event, you can take two steps to save a life: immediately call emergency services and use these tips to begin performing HOCPR.

  1. Position yourself directly over the victim.
  2. Put the heel of one hand in the center of the chest and put your other hand on top of the first.
  3. Push hard and fast in the center of the chest at a rate of 100-120 beats per minute, which is about the same tempo as the song “Stayin’ Alive” by the Bee Gees, and at a depth of approximately 2 inches.
  4. Continue compressions and use an AED, if available, until emergency help arrives.

To learn more about how you could be the difference between life and death for someone experiencing a cardiac event, visit

American Heart Association

Saturday, March 16, 2024

Asthma meds have become shockingly unaffordable − but relief may be on the way

Its price will take your breath away. Brian Jackson/Getty Images
Ana Santos Rutschman, Villanova School of Law

The price of asthma medication has soared in the U.S. over the past decade and a half.

The jump – in some cases from around a little over US$10 to almost $100 for an inhaler – has meant that patients in need of asthma-related products often struggle to buy them. Others simply can’t afford them.

To make matters worse, asthma disproportionately affects lower-income patients. Black, Hispanic and Indigenous communities have the highest asthma rates. They also shoulder the heaviest burden of asthma-related deaths and hospitalizations. Climate change will likely worsen asthma rates and, consequently, these disparities.

I’m a health law professor at Villanova University, where I study whether patients can get the medicines they need. And I’ve been watching this affordability crisis closely.

In many ways, it shows what happens when law and policy decisions aren’t aligned with public health needs. The good news, however, is that there finally seems to be some political will to rein in the price of asthma meds.

Why inhaler prices are skyrocketing

In 2008, the U.S. Food and Drug Administration banned inhalers that use chlorofluorocarbons, or CFCs – which were once widely used as propellants – because they can damage the ozone layer. The FDA was following a timeline set by an environmental treaty, the Montreal Protocol, which the U.S. ratified in the late 1980s.

From 2009 onward, CFC inhalers were phased out and replaced with hydrofluoroalkane, or HFA, ones, which are more environmentally friendly. They’re also a lot pricier. For patients with insurance, the average out-of-pocket cost of an inhaler rose from $13.60 per prescription in 2004 to $25 immediately after the 2008 ban, a 2015 study found.

Today, the average retail price of an albuterol inhaler is $98. Unlike CFC inhalers, which have generic versions, HFA inhalers are covered by patents. While the drug itself hasn’t changed, the switch to a different device allowed companies to increase their prices.

In 2020, the FDA finally approved the first generic version of an albuterol inhaler. But generic competition still isn’t robust enough to lower prices meaningfully.

Patients with good insurance may pay very little or even nothing. But uninsured patients face steep market prices, and as of 2023, there were over 25 million uninsured Americans. Even insured patients may have trouble affording their asthma meds, the CDC has found.

The same asthma medication for which U.S. patients pay top dollar is available elsewhere at much cheaper prices. Consider the following case for inhalers. The pharmaceutical company Teva sells QVAR RediHaler, a corticosteroid inhaler, for $286 in the U.S.

In Germany, Teva sells that same inhaler for $9.

Seeking meds from Mexico and Canada

Some U.S. patients have traveled abroad to obtain cheaper asthma medication. After the 2008 ban on CFCs, it became common for patients to visit border towns in Mexico to purchase albuterol inhalers. They were sold for as little as $3 to $5.

A study of inhalers available to U.S. patients in Nogales, Mexico – about an hour south of Tucson, Arizona – found that Mexican products were generally comparable to U.S. inhalers. But researchers found some differences in performance, suggesting that American patients who use them could be getting a slightly different dose than their usual.

Asthma medication is seen on the shelves of a Mexican pharmacy.
Asthma meds are considerably more affordable south of the border. Jeffrey Greenberg/Universal Images Group via Getty Images

There have also been reports of Americans turning to Canadian pharmacies to purchase asthma inhalers at much cheaper prices. In one case, a U.S. pharmacy would have charged $857 for a three-month supply. A patient obtained it for $134 from a pharmacy in Canada.

One potential fix: Importing cheaper meds

U.S. law has long prohibited personal importation of pharmaceutical drugs. However, a recent development could pave the way for states to import cheaper asthma drugs.

In January 2024, the FDA authorized the importation of certain prescription drugs from Canada for the first time. For now, this authorization is limited to Florida, and it covers only drugs for HIV/AIDS, prostate cancer and certain mental health conditions.

Should it prove successful, the program could serve as a blueprint for other states.

Another possible solution: Price-capping

Policymakers could also try borrowing a page from the insulin playbook. Insulin prices climbed for almost two decades before Congress acted, capping the cost of insulin for Medicare patients. The 2022 Inflation Reduction Act established an out-of-pocket ceiling of $35 per month for prescription-covered insulin products.

If this cap had been in effect two years earlier, it would have saved 1.5 million Medicare patients about $500 annually, a recent study estimated. It also would have saved Medicare $761 million.

A similar approach could be taken for asthma meds.

Congress could create an asthma-specific rule similar to the insulin case. Or it could place provisions for asthma-med prices into a larger piece of legislation.

While this approach depends on the political environment, there are signs the government is becoming more willing to act. In January 2024, the U.S. Department of Health and Human Services hosted a meeting to discuss the problem with manufacturers and other stakeholders.

It’s a start. And – together with other measures – it brings some hope that asthma meds might soon become more affordable to those in need.The Conversation

Ana Santos Rutschman, Professor of Law, Villanova School of Law

This article is republished from The Conversation under a Creative Commons license.