In 2010, researchers at Purdue University and the University of New South Wales began an investigation into a macabre question: What's the upper temperature limit at which humans can survive? The answer, according to their calculations, was 95 degrees Fahrenheit (35 degrees Celsius) at 100% humidity — a "wet bulb" temperature that sets an absolute "unsurvivable" threshold for the human body.

Beyond this temperature, a cascade of irreversible physiological processes begins, sending organs into shock, causing blood to clot and ending in inevitable death.

As the climate warms and heat waves multiply, more places across the globe are creeping towards this threshold, with climate models projecting the first 35 C wet bulb temperatures by the middle of the century.

But conditions don't have to be this hot or humid to be unlivable in a practical sense for wide swaths of the population. The threshold is lower for those who are older, for women, and those with certain medical conditions. Any kind of physical activity also raises the risk of heat stress.

In some parts of Asia, South America and Australia, the hottest days are already "unlivable," meaning a healthy adult sitting in the shade in a slight breeze could be at risk from heat illness, a recent study found.

In North America, the hottest days in parts of the Southwest and Southeast pose that same risk, the study found. And more heat is coming: Under projected warming, the country will see tens of thousands more heat-related deaths by 2100.

Nearly 20,000 people could die from extreme heat each year by the middle of the century in the United States. The U.S. and Mexico could see an additional 9,000 suicides each year.

Heat can kill directly, via heat stroke, but it can also worsen underlying cardiovascular health, turning chronic, manageable heart conditions deadly. Heat waves often occur hand in hand with droughts or other extreme weather and may lead to food and water price hikes or shortages, said Marina Romanello, a senior research fellow at the University College London Institute for Global Health who tracks how the climate affects health. In that sense, climate change acts as a stress multiplier.

And heat could erode health in other, subtler ways, making nights more sleepless and our cognition a bit cloudier.

"No individual metric really does justice to the overall risk to health and well-being of these multiple stressors being exacerbated all at once and compounding each other," she told Live Science.

Heat wave deaths

Heat kills most immediately through heat stroke, which occurs when the core body temperature soars over 104 F (40 C) and doesn't cool down. Dangerous heat waves — and resulting deaths — have already increased over the past several decades. In 2023, heat was described as the main cause or a major underlying cause of death on 2,325 U.S. death certificates, an increase from 1,069 in 1999, research shows. When adjusted for age of the population, that represented a 63% rise in heat-related deaths.

But scientists think heat already contributes to many more deaths than that, because heat isn't always listed as a contributor to death on official records, even if it may have played a role in exacerbating an underlying health condition.

Heat is particularly hard on people with cardiovascular issues, with the risk of a heart attack more than doubling on extreme heat days. The risk of stroke, too, nearly doubles on the hottest days. Some early evidence hints that heat's impact on the immune system may play a role in these cardiac cases. Deaths related to extreme heat days for all reasons are projected to more than double by the mid-century in the U.S., leading to up to nearly 20,000 deaths if temperatures warm 8.1 degrees F (4.5 degrees C).

And rates of hyponatremia, or low sodium levels — which can cause seizures and coma — are also projected to increase as climate change worsens.

Most at risk are older adults, kids and teens, and people who work outside. The heart pumps less efficiently as people age, so older people struggle to pump blood to the skin to cool down. Children produce more heat than adults, given differing fat makeup and a lower skin surface area, and sweat less, making them more prone to developing heat stroke. Outdoor workers often have to exert themselves on hot days and may struggle to hydrate enough to compensate for extreme heat.

People with certain medical conditions are also at high risk. Diabetes can impair sweating and the dilation of the blood vessels that helps cool the body in hot temperatures, making people with diabetes more susceptible to heat stroke. Some medications, including diuretics often taken by people with heart disease, beta blockers for people with heart conditions, and selective Serotonin Reuptake Inhibitors (SSRIs) taken for mood disorders, also increase the risk of heat-related illness because their side effects make it harder for the body to cool itself.

Mental illness itself is also a risk factor. Higher temperatures have been linked to an increase in suicides, with 0.7% more instances of suicides in the U.S. per for every 1.8 F (1 degree C) increase in monthly average temperature. Were temperatures to rise more than 5 degrees C (9 degrees F), that rise could translate to between 9,000 and 40,000 additional suicides in the U.S. and Mexico by 2050, the researchers wrote ‪—‬ similar to the increase in the suicide rate expected in a serious economic recession. (Fortunately, that temperature rise is now considered unlikely due to the world moving away from coal as an energy source.)

It's not clear exactly why hotter days fuel more suicide, but one possibility is that feeling hot and uncomfortable can increase the impulsivity that may underlie the behavior.

And impulsivity rises in people who struggle to stay comfortably cool in their homes, Kim Meidenbauer, a neuroscientist at Washington State University who studies the effect of heat on emotion and behavior, has found.

The effects may be hardest on those who have preexisting mental health conditions, ranging from schizophrenia to anxiety: Mental-health-related emergency department visits have been shown to rise with the temperature.

Perhaps the most universal way heat may compromise health in the U.S. is through sleep. Heat reduces both sleep quality and sleep quantity. For every degree-Celsius increase in nighttime temperature, there is a loss of 3 good nights of sleep per month per 100 people, according to one large-scale sleep-tracking study.

Those sleep disruptions may be the major reason heat has a corrosive effect on mood and mental health, even for those without existing mental health conditions, Meidenbauer noted.

"We see worsened emotional state," she told Live Science. "We see increases in impulsivity." And underslept people struggle to stay on an even keel, perhaps explaining both E.R. visits and a heightened risk of suicide.

"Emotion regulation is a lot harder if you've had poor sleep quality," Meidenbauer told Live Science.

Daily health in a hotter world

Heat affects the mind in other ways, too. People have trouble thinking clearly once temperatures reach 89.6 F (32 C), a study that administered math and verbal reasoning tests to 50,000 people in China found.

The number of days in the U.S. with heat indices over 100 F (37.8 C) is expected to double as soon as a decade from now, while the number of days with heat indices over 105 F (40 C) is expected to triple. The heat index is a measure of what the temperature feels when taking into account air temperature and relative humidity. The more humid the air, the harder it is for the body to cool off by sweating.

Nearly nine in 10 U.S. households have air conditioning, but that doesn't mean Americans are immune to heat waves. The 2024 study in China found that even short-term exposure to extreme heat — on the order of an hour in a couple of days — can cause small declines in math and verbal test scores, indicating some degree of mental sluggishness in hot weather.

Hotter days may drive people indoors, potentially worsening physical and mental health. Exercising outdoors may provide a mental health boost above and beyond exercising indoors. The data is limited by research designs that don't always follow rigorous methods, but losing outdoor exercise opportunities could mean a slide in physical fitness even if people switch to indoor workouts. For example, cancer survivors randomly assigned to indoor and outdoor exercise worked harder when exercising outside, according to one 2020 study. Likewise, teen boys with obesity prescribed playful exercise outside lost more weight and saw greater increases in a molecule that regulates appetite and wakefulness than those who were assigned to use a treadmill indoors, a 2019 study found. People also reported more satisfaction with outdoor exercise versus indoor exercise, which might influence their willingness to keep working out.

Hot days could also curtail kids' sports, which are often played outdoors. In Japan, summer outdoor youth sports in much of the country might need to be restricted for one to four months a year, even under lower-warming scenarios; similar issues could crop up in much of the U.S., which sits at approximately the same latitude as Japan.

Overall, studies find a U-shaped relationship between obesity and temperature, with higher body mass index (BMI) in the coldest and hottest places. One study in Australia found that regular exposure to temperatures above 86 degrees F (30 degrees C) was associated with increases in BMI and obesity.

Adapting to extreme heat

People do adapt to warmer temperatures over weeks or months through physiological changes, as their sweat glands become more efficient and their water retention increases. The cognition study conducted in China found that people who lived in climates that were warmer on average were more resistant to declining test scores in the face of warmer temperatures, perhaps indicating that these physiological changes have practical impacts.

However, extreme heat — and short-term spikes — outpace the human body's ability to adjust, as the increases in heat-related deaths already measured between 1999 and 2023 attest. Likewise, kids are already suffering, especially those in the South where temperatures are highest. A study of two major hospitals in Texas found a 170% increase in pediatric emergency department visits for heat-releated illness between 2012 and 2023.

What works to reduce the impacts of extreme heat is an open question, said Marshall Burke, a professor of global environmental policy at Stanford University. Cities often open cooling centers during heat waves, which may save lives, but whether they do enough hasn't been well studied, he told Live Science.

To try to answer that question, Burke and his colleagues have put together a website, the Environmental Hazard Adaptation Atlas, to pull together data on temperature, heat-related illness and death, and what adaptations might help.

"We need good case studies of what things have worked," he said. "We need good systematic evidence."

Researchers have pioneered a way to create miniaturized copies of a person's carotid artery that could help doctors predict and manage the patient's stroke risk, a new study suggests.

In the research, published in July in the journal Cell Biomaterials, scientists used these "arteries-on-a-chip" to monitor how real blood flows through a patient's carotid arteries, which carry blood to the brain, face and neck. This could enable doctors to identify not just how and what type of clots form in that specific patient, but also determine which medications would be most effective in dealing with the blockage.

While the technique is currently a proof-of-concept, someday, it could help medical practitioners to better tailor treatments for each patient.

"I see this approach being most relevant to difficult clinical cases," said study first author Charles Zhao, a doctoral student at the University of Sydney. "For example, patients who have experienced recurrent events despite treatment, or cases where clinicians have several possible treatment strategies but limited functional information to distinguish between them." Zhao told Live Science in an email.

Ischemic stroke is one of the leading causes of death worldwide, second only to heart disease. The medical emergency is most often caused by a loose blood clot blocking an artery in the brain, starving the cells of oxygen. Obesity, high blood pressure and high cholesterol are all important risk factors for ischemic stroke, and roughly 1 in 5 of these events results from atherosclerosis, or fatty plaque buildup in the arteries.

"When the inner lining of an artery is damaged, material underneath the cells, including collagen, becomes exposed to the blood," Zhao said. A bloodborne protein called von Willebrand factor (VWF) grabs hold of platelets from the flowing blood. Those platelets then stick together and recruit more platelets, building a clot, he said.

But forming a clot is only half the story; it's what this mass does next that determines the risk to the patient.

In some cases, the growing ball of clotted blood will stay firmly rooted to the artery wall, slightly impeding blood flow but not posing any immediate danger. However, if tiny fragments break off this static clot, they can travel toward the brain, where they risk blocking smaller vessels and thus causing a stroke.

"Clinically, we are very good at imaging how narrow an artery is," Zhao said, "but narrowing alone does not tell us exactly how a clot will behave."

This is where artery-on-a-chip models come in, he said. Rather than relying purely on medical scans, the team's model recreates the exact shape and structure of an individual patient's blood vessels using 3D printing. To create the models, they first use a patient’s existing CT scans to 3D print a plastic replica of their carotid artery, including any narrowing caused by atherosclerosis. Next, the inside of this plastic structure is coated with collagen, and then cells that line the carotid artery get layered on top. Blood is passed through the replica artery, mimicking the speed and pressure of blood flow in the body.

"Then [we] use a very small laser injury to expose the collagen underneath," Zhao explained. "We can then flow human blood through the artery and watch thrombosis happen under a microscope." Thrombosis is the formation of a blood clot in a blood vessel.

The researchers created these models for six patients with different types of arterial damage and used various calculations to understand the impacts of changes in blood flow through the structures.

By combining these calculations with the patient-specific artery structures, as well as tests using real blood flow, the researchers built up a far more accurate picture of how clots formed and shed than medical images alone could capture. This revealed striking differences between seemingly equivalent patients.

"We found that two arteries with apparently similar disease can behave very differently because their three-dimensional shapes create different patterns of blood flow," Zhao said. These local conditions within the artery are important in determining whether a clot grows stably or becomes prone to shedding fragments, he added.

These functional differences are particularly important when thinking about how best to reduce a person's stroke risk. Some treatments prevent platelets clumping together into clots. Others prevent platelets from sticking to the artery walls, while still others inhibit the key clot-forming protein VWF. The most effective medication for a given patient will therefore depend on how their clot forms and grows, making these new physical models a valuable complement to traditional imaging, Zhao said.

The team now hopes to expand this research further with the ultimate goal of establishing artery-on-a-chip models as an additional diagnostic step between initial medical imaging and treatment selection for patients.

This article is for informational purposes only and is not meant to offer medical advice.

What do you know about the body's hardest-working muscle? Find out with our heart quiz!

Concerns are on the rise about young people's social media use as governments, parents and schools look to curb children's exposure to threats such as cyberbullying and sexual harassment. Other experts are worried about the rise in misinformation, including misleading medical and health content or the oversimplification of conditions like ADHD.

One proposed solution is to ban children below a certain age from using social media platforms altogether. Last year, Australia put this option into practice, with a world-first law that requires social media platforms to prohibit users under age 16 from having accounts. The U.K. enacted a similar ban that will go into effect in spring 2027, and several U.S. states have established social media bans for minors, though a larger federal ban has not been passed.

In a Live Science poll, we asked our readers whether they thought such a ban would be effective.

More than 150 people voted in our poll, published Aug. 16. As of Aug. 18, the results showed a fairly close split between the top two answers, with 36% of voters picking "No, there's not enough enforcement, and young people will just find other ways to get online," and 29% of voters picking "Yes, I believe that this could help young people's well-being." About 21% of voters leaned against a blanket age ban, picking "No, a ban causes too many unintended harms, and other changes to social media would be more effective."

Readers' comments added more details to their voting choices, with one commenter writing, "They were not created for anyone to ban, if you still think that the old elites (ruling classes) are capable of opposing the new, then you are being disingenuous. You will not be able to ban/defeat anything. Only a more interesting alternative, that's all."

Another commenter said the ban could encourage young people to find workarounds, stating, "Look, we were all kids. How many times were we able to use work arounds to side step some of our parents [sic] rules. If you think these rules are going to stop kids from using social media, I've got a bridge in Brooklyn I would like to sell you."

For others, the logistics of how a ban could be enforced gave some pause. One commenter wrote that they're on the fence. "I'm not sure how such a law could be enforced without methods that require giving out personal information like an ID, which is iffy when it comes [to] security concerns with online sites," they said.

The brain develops in stages, and it's important that certain cells form before others so that precise neural connections can emerge later. But miniature models of the brain, called organoids, may not share this same sense of time, a new study finds.

These brain organoids are clusters of lab-grown neurons that mimic structural and functional aspects of full-size brains. Some scientists use these "minibrains" to study brain disorders that can arise during fetal development.

If the precisely timed processes involved in brain development go wrong, it can lead to conditions like macrocephaly and microcephaly in which the brain grows abnormally large or small, said study co-author Simon Hippenmeyer, a neuroscientist at the Institute of Science and Technology Austria.

Because it's not possible to directly study these conditions in human fetuses, scientists like Hippenmeyer turn to brain organoids. But the new study, published Aug. 12 in the journal Nature, suggests that organoids may be missing some crucial ingredients that would help them resemble real brains.

A matter of time

In earlier experiments in mice, Hippenmeyer's team tracked the stem cells that make neurons, called radial glial progenitors (RGPs), during early embryonic development. They did this by giving pregnant mice a drug that activated fluorescent labels on individual stem cells. Then, they traced the resulting lineages of those stem cells after birth to see how many cells they produced and how that number changed as development progressed.

In the new study, they used that data as a reference to compare with brain organoids grown from mouse embryonic stem cells. They aimed to see if the developmental sequence in the organoids resembled that in the real brains.

The organoids produced the same major types of cells as the real brain did, the team found. However, the sequence of development was not preserved.

During normal brain development, RGPs in the cerebral cortex — the brain's outermost tissues — divide to increase their numbers and then differentiate, forming neurons and glial cells, which help to support, nourish and insulate neurons. In the organoids, however, some RGPs formed neurons too early, while others were still proliferating.

Normally, RGPs from later stages of development produce fewer descendants than the stem cells do in early development. But in the organoids, they produced more descendants regardless of the developmental time frame.

After seeing these patterns, the team investigated the variety of neurons that a single RGP could produce in an organoid. The cortex is made up of six layers of tissue, and normally, an individual RGP can produce both deeper-layer neurons (earlier in development) and upper-layer neurons (in the later stages). But in the organoids, about one-third of the RGPs became restricted to just one of these fates and then couldn't make the other type of neuron.

In a real brain, Hippenmeyer noted, there are blood vessels, extracellular structures and metabolic signals that affect the organ's development but are absent in the organoid. The researchers think these external signals may help coordinate the timing of neuronal development and the later formation of neural circuits.

"This suggests that there is something about the local environment of the cells [in the brain] that gives rise to the neurons," said Denis Jabaudon, a neurobiologist at the University of Geneva who was not involved in the study. However, scientists don't have a precise understanding of what those signals are yet, Jabaudon said.

For neurons to find each other, they have to be in the right place at the right time, Jabaudon added. "So, if you shift the timing of development, you're going to be shifting the opportunities for connections and the opportunities for specific circuits" to form, he told Live Science.

Identifying what's missing from these organoids will involve identifying and investigating those external signals neurons receive in the live brain. Then, scientists can identify differences between real brains and organoids that inform us about how the process naturally happens, Hippenmeyer said.

Once these missing ingredients are identified, this could "open the door" to systematically add back those signals in organoids in a way that would mimic the real brain closely, he told Live Science. Hippenmeyer added that the team also plans to grow brain organoids with human cells and investigate the same questions.

"We are very keen on finding out how those radial glial stem cells would behave in a human system," he told Live Science.

See how much you know about the most complex organ in the human body with our brain quiz!

The patient: A 65-year-old woman in Qatar

The symptoms: The woman had been dealing with unexplained chest pain for several months, although earlier tests of her heart health had come back normal. She had stopped attending follow-up appointments regarding the chest pain.

But then, she experienced three days of chest pain and shortness of breath that got worse with activity. The symptoms, which began shortly after she attended her daughter’s wedding, initially brought her to a clinic, according to a report of the case.

An electrocardiogram (ECG or EKG) showed changes in her heart's electrical activity. This is a sign doctors look for when diagnosing a heart attack, because during the event, blood flow to the heart is impaired and that can injure or kill heart-muscle cells. So, the patient was rushed to a hospital emergency department.

What happened next: By the time the patient reached the emergency room, her chest pain had eased, but a repeat ECG showed different electrical abnormalities from the local clinic.

Blood tests showed an elevated level of troponin, a protein that leaks into blood when heart muscle is damaged. An ultrasound of her heart showed that its main pumping chamber, the left ventricle, wasn't squeezing properly; its pumping strength, known as ejection fraction, had dropped from 58% five months earlier to just 35%. (The healthy range is 50% to 70%.) The left ventricle had also ballooned out of shape at the tip.

Doctors performed an angiogram, a test that uses a thin tube and dye to check for blocked arteries, and found that her arteries were clear.

An X-ray of her heart confirmed the same ballooning shape that was seen on the ultrasound, and an MRI ruled out permanent damage from a silent heart attack or scarring of the tissue.

The diagnosis: Doctors diagnosed the patient with takotsubo cardiomyopathy, also known as stress cardiomyopathy or "broken heart syndrome." The condition temporarily weakens the heart muscle and causes it to balloon, producing symptoms that closely resemble a heart attack.

The condition is thought to be triggered by a sudden surge of stress hormones, such as adrenaline (also called epinephrine), that temporarily stun the heart. The diagnosis was confirmed using the Mayo Clinic's diagnostic criteria, which require ruling out other potential causes, such as heart inflammation (myocarditis), and confirming that there are no significant artery blockages.

The criteria also require that the affected part of the heart extend beyond the area supplied by just one artery — different from a typical heart attack, which usually damages only the region fed by a single blocked vessel. Doctors also look for new ECG changes with modest troponin elevation.

The treatment: The woman was treated with standard medications for heart failure medical therapy, such as beta blockers, and discharged once she was stable, with a follow-up scheduled at a heart-failure clinic. She resumed her usual daily activities without limitations, and a follow-up ECG showed that her heart's pumping function had recovered to 56%, close to her original baseline.

What makes the case unique: According to the report, takotsubo cardiomyopathy is most often triggered by distressing events, such as the death of a loved one or a serious diagnosis. In this case, though, the trigger was a happy one, which made it an example of "happy heart syndrome," a rare subtype of the condition first described by researchers in 2016. Intense positive emotions can activate some of the same stress pathways in the body that negative ones do, as these cases demonstrate.

Takotsubo cardiomyopathy accounts for an estimated 1% to 3% of cases of acute coronary syndromes, an umbrella term for conditions that involve sudden reduced blood flow to the heart. Within that group, the happy heart variant is rarer still. An analysis of the International Takotsubo Registry, which has data from more than 1,700 broken-heart patients around the world, found that positive emotional triggers were behind about 4.1% of emotionally triggered cases. The large majority were tied to grief, fear or other distressing events.

Compared with the classic symptoms of broken heart syndrome, happy heart syndrome tends to produce a different pattern of heart muscle ballooning that more often affects the middle or base of the heart in addition to the tip. That alternate pattern was not seen in this case, though.

Some research suggests happy heart patients may have milder symptoms and better outcomes than broken heart patients; they have a lower chance of severe heart failure during their hospital stay, for instance. That said, the authors noted that further data is needed to confirm this difference.

This article is for informational purposes only and is not meant to offer medical advice.

Can you guess the diagnosis in these strange medical cases? Find out with our diagnostic dilemma quiz!

Controversial wellness products called peptides are rising in popularity as they're touted by leaders like Health and Human Services Secretary Robert F. Kennedy Jr.

While some peptides — including drugs like Ozempic — have been rigorously tested and approved by the Food and Drug Administration (FDA), many peptides are untested and unregulated. These untested peptides are often accessible online for anyone to purchase from loosely regulated manufacturers. There's now a multibillion-dollar gray market for these products, in which many peptides are sold without human-safe manufacturing processes or human testing to demonstrate their effectiveness, scientists say.

Recently, an FDA advisory panel voted to increase consumers' access to several peptides, saying the products — marketed for sleep issues, wound healing, cognitive disorders and more — should be available through compounding pharmacies with a prescription. These pharmacies, which offer customized medications, are subject to less oversight than traditional pharmacies and can distribute drugs that have not been FDA approved. Opponents of the advisory panel's decision argue that these peptides have not gone through rigorous clinical testing and could pose risks to consumers.

So what does this advisory panel decision mean for peptide regulation, and how might it affect consumers? And at the end of the day, are the peptides safe? Here's what you need to know.

What are peptides?

Broadly speaking, peptides are short chains of amino acids, the same building blocks that make up proteins. Peptides are smaller than proteins, and their structures are less complex.

Body-made peptides can act as messengers throughout the body, telling cells what to do. Some are considered hormones and some are not. There are about 7,000 known peptides that help organs communicate with each other and direct various bodily functions and behaviors, including blood sugar control and mood. Insulin, oxytocin, vasopressin and endorphins are examples.

The first synthetically manufactured peptide was insulin, which is normally produced by the pancreas to regulate blood sugar levels but is lacking in people with diabetes. Recently, peptides called GLP-1 agonists — the class of drugs that includes Ozempic and Wegovy — have become incredibly popular. Naturally expressed in the gut, the GLP-1 hormone functions, in part, by telling the brain that you've had enough to eat.

While these peptides are usually injectable medicines, others are taken orally or inhaled via nasal sprays. Peptides that are intended to treat or prevent disease, or to affect the structure or function of the body, are legally considered drugs and should be regulated and approved for safety and effectiveness by the FDA. (However, that doesn't always happen, as we'll explain in the following section.)

Plant- or food-derived peptides, such as collagen peptides, are considered supplements. Supplements are less strictly regulated than drugs are, which results in their potency and purity being more variable than that of approved drugs.

What uses of peptides are backed by scientific evidence (and which aren't)?

Peptides like insulin and GLP-1 agonists have been extensively studied for years through rigorous trials to determine whether they are safe and effective for human use and to treat specific ailments. This is what is required to obtain FDA approval. The FDA has approved the use of about 100 peptides for therapeutic use against specific conditions, such as diabetes and multiple sclerosis.

That said, there are also peptides that have become popular for general wellness and even "biohacking," a form of self-experimentation to optimize physical and mental performance. These unapproved peptides are sold online, often with the label "research use only." The label acts as a loophole to legally bypass the regulatory oversight that would usually be applied to approved drugs. That said, the FDA has come after companies that explicitly advertised and sold these products for human use, despite that research-only label.

"Only a few peptides are actually FDA approved meaning they are safe and efficacious for certain diseases," Dr. Jonathan Long, a peptide researcher and associate professor of pathology at Stanford University, told Live Science in an email. "Many other peptides are still not FDA approved and should be considered experimental."

How is the regulation around peptides changing in the U.S.?

In July, an FDA advisory panel discussed seven unapproved peptides and voted to recommend increased access to six of them. The products are marketed for myriad uses, including boosting muscle recovery, treating gut damage, dampening inflammation, improving metabolism, enhancing cognition and extending longevity.

The panel recommended that these peptides be allowed to be prepared and distributed by compounding pharmacies. This is a recommendation and not a binding decision, meaning the FDA can now decide whether to go with the panel's idea. The FDA must complete a formal rulemaking process before any policy change becomes final.

According to Dr. Katrin Svensson, another peptide researcher and associate professor of pathology at Stanford University, this move could represent a reversal of U.S. peptide regulation. The FDA restricted these six peptides and others from compounding in 2023, deeming them too dangerous for compounding pharmacies to make, she told Live Science in an email.

"[These peptides] are not approved medicines, they have not been tested in humans and have little or no experimental data in cells or animals," she emphasized.

Notably, the FDA advisory committee includes eight members recently appointed by Kennedy, many of whom have ties to the peptide industry. Although their recommendation is not binding, this support of increased access to unapproved compounds could spur online sellers to promote even more unregulated peptide usage. There's also a concern that allowing the products to be sold more widely could undermine research into their legitimate medical uses, given companies can sell them without hard evidence.

What is the scientific evidence behind the decision?

"There is no new scientific evidence tied to these decisions, which is partly the problem," Svensson said.

Long agreed. "This decision does not say that these peptides are more scientifically legitimate, or that they are safe, or that they are efficacious," he said. "The only thing this vote does is to potentially allow more people to access these peptides via compounding pharmacies."

Are the changes to peptide access expected to help or hurt consumers?

While increased access to peptides may result in more people injecting themselves with untested substances, compounded peptides are at least safer than research-grade peptides, experts told Live Science.

"Obtaining peptides from a compounding pharmacy means that it will be the peptide in the vial, and that the purity will be high, and that the vial will be sterile," Long said. "But it still does not mean that these peptides are safe for human use, or that they can treat any human diseases."

However, Svensson cautioned that peptides are not one thing.

"They range from medicines to unproven experimental compounds, and this shift is driven by policy, not new science," she said. "Easier access doesn't lower the evidence bar, and the trials that would show whether these actually help still haven't been done."

What should consumers know about peptides?

It's possible that allowing compounding pharmacies to make the six peptides could mean they're less likely to contain contaminants and may be more consistently pure than completely unregulated versions of the products. But that doesn't mean they will do what they have been promoted to do or be safe to use in the long term or in combination with medicines or with other peptides.

"'Allowed to be compounded' does not mean 'FDA-approved,'" Svensson said. "For most wellness peptides the human evidence is thin, the right dose is unknown, and you can't be sure what's in the vial."

"I myself personally would not be injecting myself with any experimental molecules," Long said.

Concerns about young people's social media use are growing, with governments, parents and schools looking for ways to protect children from potential harms, such as stalking, cyberbullying or sexual harassment. Experts also cite concerns about misleading health and medical content online, including posts that may glamorize or oversimplify conditions such as ADHD and potentially encourage young users to self-diagnose.

One possible solution is to ban children below a certain age from using social media platforms altogether.

Australia already took a major step in December 2025, introducing a world-first law that requires social media platforms to prevent users under 16 years old from holding accounts. However, some experts argue that there are better ways to ensure kids' safety online without completely barring them from social media.

What do you think? Do you believe bans are helpful or necessary? Vote in the poll below and let us know what you think in the comments.

Social media has upended how people engage with healthcare, as it provides a platform for people to share their experiences, find support groups, and learn more about symptoms and conditions. But it's also given nefarious actors a platform to promote products, spread misinformation and prey on people's fears. Meanwhile, algorithms deliver users an individually tailored stream of content, promoting and prioritizing the most engaging posts with little oversight.

In her book "Bad Influence: How the Internet Hijacked Our Health" (Oneworld Publications, 2026), author Dr. Deborah Cohen, a broadcaster, journalist and editor who has a medical degree from the University of Manchester in the U.K., examines how social media platforms and influencers have transformed people's views of healthcare, from the proliferation of weight-loss drugs and hormone therapies to billionaires seeking immortality.

Cohen spoke with Live Science about her book, the shifting landscape of healthcare discussions moving online, and how health literacy is now key. "Bad Influence" has been short-listed for the 2026 Royal Society Trivedi Science Book Prize.

Read an excerpt: 'A fine line between reducing stigma and trivialising conditions': Social media, self-diagnosis and the glamorization of ADHD

Hannah Osborne: You wrote in the book that we're in the middle of a global experiment in public health that will take years to understand. What do you think the results are going to be?

Deborah Cohen: What we know about healthcare is our ideas, concerns and expectations shape health. So if you go to a doctor, what they're trying to establish is what your ideas might be about your particular condition, your concerns and what you want to take away from that particular consultation. Obviously, our ideas and concerns or expectations are very much shaped by the information environment, and this is going to change again when we're adding large language models [LLMs] into the mix. We're going to have a new wave of health literacy.

My concern from writing the book is there's possibly a lack of understanding of what healthcare can always deliver. One of the challenges I felt was when you go to social media and it provides you with certainty and often quick fixes, but then you go to the Health Service [the National Health Service (NHS), the U.K.'s health system], where they can't really provide you with certainty, and there's complex solutions or there isn't an obvious solution. You're balancing competing risks, benefits and harms.

I do wonder about how realistic our expectations [are] about what health and science can actually deliver ‪—‬ our expectations about what a health professional should do, or how much time they have available. You know, our tech is available 24/7. And particularly with large language models, you can query that at any time of the day or night. What does that do to trust? We think there are quick fixes for stuff where inherently there isn't.

I think our experiment really underpinning all of that is, what do we want from our Health Service? What do we want health to look like or to be? What do we want from our doctors or our therapists? What do we want those relationships to do or be, on top of the tech that is going to be more and more widespread? What's going to be the role of the doctor in all of this? These are very live questions.

I suspect it's going to be different for different generations, different cultures, different within different health services as well. If you've got an abundant Health Service, which no country has, perhaps there's less need for these tools to bridge the gaps.

HO: We have strained healthcare systems. Is the gap between doctors and patients widening because of social media, or is social media filling a gap?

DC: It's both. And that's what the problem is — the gap is filled, but not necessarily by the right things. If you are looking for support, does it have to be on TikTok? Are there other ways of having forums and that kind of support delivered on a digital device? Are there other, safer ways of doing this online?

Equally, there's something about the way the content is delivered there that appeals. It's the short storytelling, and [health authorities are] having to compete against that. What's the solution? It's multifaceted, but if people are used to getting their information on TikTok or Instagram, and then you look at the NHS website, which is as dull as dishwater, it's no wonder social media is more appealing.

You've probably got to change how you deliver information. Maybe you need more storytelling rather than really dry content. If people are used to getting that, and that's what they respond to, then you need to think about that. It's a connection. What does that tell us more broadly about our society? How do we better deliver information in the way people need? That might be an LLM, [but] again, that's a whole other debate.

HO: You spoke to a lot of people about how they use social media for their health. Did you find an overriding theme in what they were looking for?

DC: It was women. It was a lot of feeling unseen and unheard. You have whacking great lists of gynecological issues. There's a sense that female health has been massively underfunded — and it has. But I guess it's, what fills the gap? That doesn't mean "femtech" in all its glory fills that gap. Empowerment isn't fully evidenced interventions. It's like, we've got this app, no idea what it does; it actually might do you harm, but it's filling a gap. That's not good healthcare.

It's a variety of issues. One of the issues of social media is that people passively consume information — health information as well — so it will bring up information you didn't even know you were necessarily interested in. You hear repeatedly that "the algorithm knows me better than me." There's a sense that these algorithms are objective and they get to know you.

One psychologist told me, "they know your neurosis better than you do." But is that really true about the algorithm? That's where one of the challenges of diagnosis is. These will be questions for large language models for diagnostic purposes.

Then, for others, it's more active. They'll have active people that they follow who provide health information, particularly around menopause, longevity, ADHD ‪—‬ stuff like that.

HO: In terms of those algorithms and how they increase anxieties, is there any way of backpedaling when, as an industry, it's making people a lot of money?

DC: What was interesting was how people now do ADHD on TikTok according to what's going viral, because they want more engagement — and we know engagement drives money. It's as linear as that in many ways. Part of the problem, then, is if you start to see a particular condition on social media, what does that do to our understanding of that particular condition?

They're all the broader questions about how the algorithm behaves. But what do you do about it? The algorithm needs sorting. When we talk about what tech companies can do, I think the algorithm potentially is one of the more harmful aspects of social media.

HO: While you were researching and writing, was there anything that really surprised or shocked you?

DC: I've been an investigative journalist for so long that little shocks me these days. Where there's a gap, people will step in and make money. We live in a capitalist society.

For me, as someone with a medical background, it's the behavior of doctors who should know better. That is the bit that doesn't sit very well with me. I think the GMC [General Medical Council, an independent regulator of doctors, physician associates and anesthesia associates in the U.K.] needs to start thinking about what to do because one of the techniques that influencers use is parasocial relationships, where they lean into the artificial relationships that feel real to the followers, and there's all sorts of techniques they do to enhance that. There are doctors doing that.

Then, they lean into authority bias and say, "Well, actually, I'm a doctor, and this is what I do, and this is how I use my treatment; this is how I treat myself." Using that to promote a product is really uncomfortable.

Yet that is employed on social media. They tell the similar hero's journey. "I have terrible symptoms; then I did this, and it totally transformed me and changed my life." It's when it's a health professional and they use social media as a front gate to their clinics, and advertising their platform to their clinics to offer interventions that lack an evidence base or are potentially harmful.

It's not shocking, because I've been in the depths of all sorts of investigations ‪—‬ but I thought that was pretty ick.

HO: The book isn't all negative. There are positive stories about support groups and help groups. Is there any way to separate the bad from the good?

DC: It's really hard. What I say to people is to ask why that person on the platform is telling you what they're telling you. What's this person trying to tell me? There's a lot of people on there who are genuinely trying to do good, who want to either share their journey or help people understand the complexities of health and science.

But ask, are they trying to sell me something? How are they making their money? Are they promoting something? Just ask yourself, why should I believe you? Why should I listen to you? Why should I trust you? What are they getting? Is it fame? Are they getting their 15 minutes and more on social media? Are they getting a little bit of a dopamine hit from that?

I use the dopamine here advisedly because hormones and neurotransmitters are totally misused on social media — we're just a bag of hormones or neurotransmitters when we're far more complicated, really.

If they're telling you about the benefits of the treatment, are they telling you about the harms? Because nothing is harm-free. What's the risk of doing this thing, or what happens if I do nothing? What are the alternatives to what I'm being sold? It's just basic health literacy and skepticism.

HO: We've touched on this a bit, but with the emergence of LLMs, how do you see the landscape shifting in the next five to 10 years?

DC: We're still working out how the information environment fits together. There are potential benefits with LLMs — we've got to know where the information is provided, and we all know about the hallucinations. But can they help people interpret medical information, medical jargon better? Can they use them to sort of brainstorm what treatment they want?

On the other hand, are they more uncertain? We know there's been concerns over them [AI chatbots] being sycophantic. How does this all fit together?

When I wrote the book, I thought it's going to be out of date because LLMs have come along and no one's going to be using social media. But then research from about a month ago found that 50% of Americans under 50 use social media as a source of information about health.

It's going to fit together in different, complex ways for different people. They might hear about something on social media and then use LLMs to explore it further, and then use that to help guide treatment or diagnosis.

How it all fits together is still a bit of a conundrum.

This interview has been condensed and edited lightly for clarity.

Four lemurs that had close contact with people, including one via a "lemur yoga" class, caught a human herpesvirus and subsequently died, a new study shows.

The virus at fault was herpes simplex virus type 1 (HSV-1), which is extremely common in humans. In people, the infection usually causes no symptoms or produces cold sores. In primates, though, the infections can often be deadly — in this case, all four lemurs developed encephalitis, or inflammation of the brain, and died.

This is the first time that an HSV-1 infection has been confirmed in lemurs via a molecular analysis — namely, PCR tests like a doctor might use to diagnose a person's infection. Human herpesvirus infections have been documented in lemurs in the past, albeit rarely, and those reports used laboratory methods other than molecular analysis.

These recent cases highlight the dangers of close contact between animals and humans, scientists say.

"We've evolved these kissing behaviors that have resulted in pretty effective transmissions [of HSV-1] to the point where you look at infection rates of humans and they're very high," study co-author Dr. Jim Wellehan, a professor at the University of Florida's College of Veterinary Medicine, told Live Science. But when HSV-1 infects lemurs, the consequences can be far more severe, he emphasized.

Lethal "lemur yoga"

In the study, published in July in the Journal of Zoo and Wildlife Medicine, Wellehan and colleagues confirmed HSV-1 infections in two ring-tailed lemurs (Lemur catta), one black-and-white ruffed lemur (Varecia variegata) and one ruffed-lemur hybrid (Varecia rubra x Varecia variegata). All four lemurs were privately owned.

The problem isn't limited to lemurs. HSV-1 has previously caused fatal disease in other captive and wild primates, including marmosets, saki monkeys, gibbons and other monkeys. That said, these cases of human herpesviruses jumping to primates have been uncommon.

"Herpes, as viruses, have amazing host fidelity," Wellehan said in a statement. "They don't do big host jumps very often."

The four cases in the study occurred over an eight-year period in the U.S. One of the four infected lemurs had been used in a "lemur yoga" program. "People are doing yoga, and there's lemurs wandering around," Wellehan said in the statement. "It's not good for the lemurs."

That animal's infection was almost certainly related to its close contact with humans during these yoga sessions, Wellehan said, although the study cannot prove that transmission occurred during a particular yoga session. The other three lemurs were exotic pets and also had close contact with humans.

From cold sores to brain disease

HSV-1 and its close relative HSV-2, which mostly causes genital herpes, require relatively close contact to spread. HSV-1 is most often transmitted through contact with saliva or skin surfaces in or around the mouth, or with cold sores. Most adults have HSV-1 and many have no notable symptoms. It is possible to spread the virus even when symptoms aren't present.

That makes frequent, direct contact between humans and lemurs particularly concerning, the researchers said.

The four examined lemurs showed a range of symptoms, including lethargy, loss of appetite, mouth and throat ulcers, and breathing problems. One ring-tailed lemur developed prolonged, repeated seizures and died two days after initially being seen by veterinarians.

After the lemurs died, researchers examined their tissues under a microscope. In the brain, they found inflammation and destruction of the tissue, along with intranuclear inclusions, which are abnormal structures inside cells that can occur during herpesvirus infections.

The researchers then used various tests to identify the presence of HSV-1 in the body, detecting the virus's genetic material and proteins in the animals' brain cells. This provided additional evidence that the germ had caused the encephalitis.

In two of the lemurs, oral or mucous swabs collected while the animals were alive tested positive for HSV-1, while the testing of the other two occurred after death. The results from living animals means that similar samples could potentially help veterinarians diagnose infections before death in the future, rather than confirming the infection postmortem.

While humans and HSV-1 have had a long evolutionary relationship, lemurs and HSV-1 have not.

"This is a virus that's highly endemic in our species," Wellehan said. "Fortunately for lemurs, this isn't something you can catch from breathing in the same airspace, as [HSV-1] requires a more direct contact. But this is the story of a pathogen jumping into a new host, which is the story of evolution in the history of life."

The researchers noted that, while the lemurs in these cases were privately owned, accredited zoos have strict biosecurity measures designed to reduce the chance of pathogens passing between people and animals.

The cases illustrate a broader lesson about the risks of putting humans and captive primates into unusually close contact, Wellehan said. "It may be fun, but it's not [in] a lemur's best interest."

What do you know about chimpanzees and great apes? Test your smarts with our primate quiz.

Over the last few decades, the number of people going online for their healthcare needs has skyrocketed. Google receives hundreds of millions of health related search queries daily. Half of U.S. adults under 50 now get health and wellness information from podcasts or social media influencers.

In her book "Bad Influence: How the Internet Hijacked Our Health" (Oneworld Publications, 2026), author and journalist Dr. Deborah Cohen explores the impact social media, influencers, trends and tech are having on our health. She investigates how algorithms are pushing content that heightens concerns and potentially drives people away from traditional healthcare systems.

In this excerpt, Cohen looks at the portrayal of attention-deficit/hyperactivity disorder (ADHD) on platforms like TikTok, where self diagnosis and the proliferation of "lesser known symptoms" as entertainment runs rife — but the reality of the condition is far more bleak.

"Despite it All" has been short-listed for the 2026 Royal Society Trivedi Science Book Prize.

Many ADHD symptoms exist on a spectrum throughout the general population and identifying impairment and frequency of symptoms as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) is a judgement call. These symptoms often overlap with anxiety, depression and learning disabilities. Responsible clinicians should rule out alternative explanations before diagnosing ADHD and prescribing medication.

This nuance sometimes goes out of the window when you go online. Viral videos on Instagram and TikTok list "common signs" of ADHD describing their impact on daily life. Megan McHugh, a UK DJ and radio host, is one content creator who has gone viral on TikTok after listing "lesser known" tell-tale signs of the condition with a video captioned: "Six ADHD behaviour traits you might not have known about." She cites overpromising and wondering: "Why the fuck can I not just say no?" "Your long-term memory is fucking shocking… You have some sort of subconscious tic, usually, whether it's pressing your lips or scrunching your nose," McHugh told her followers.

She's far from alone in sharing her experiences in this way. Others point to indicators of ADHD that include trouble getting up in the morning, problems choosing what to eat in a restaurant, missing deadlines, and being unable to finish a book.

A study by Vasileia Karasavva from the University of British Columbia and a team of researchers question the way symptoms are described on social media. When researchers examined the top 100 ADHD TikTok videos on a single day, 10 January 2023, clinical psychologists found only 48.7% of claims accurately reflected DSM-5 symptoms.

Of those inaccurate claims, nearly 70% depicted experiences that many people without ADHD would have; about 50% showed symptoms common across multiple disorders as being specifically ADHD; and almost 20% better matched different conditions entirely. Videos often portrayed behaviours like bumping into furniture, repeatedly playing the same songs or craving sweets as ADHD symptoms. Content typically lacked nuance — only 4% acknowledged their claims might not apply universally, and less than 2% mentioned that these experiences could occur in people without ADHD.

Of creators sharing credentials, 84% claimed "lived experience" while 13% identified as life coaches. Not one top video came from a clinical psychologist or psychiatrist. When researchers showed these videos to 843 psychology students — which may limit the applicability of the study to the general population — they generally rated scientifically inaccurate videos much more positively than experts did, while slightly downgrading expert-approved content.

The students either did not have ADHD, had a formal diagnosis or had self-diagnosed ADHD. Overall, self-diagnosed students rated all videos the highest, giving even expert rejected content higher marks than those with formal diagnoses. This, the researchers say, suggests that young people prioritise relatability over clinical accuracy.

For self-diagnosed people especially, previous painful and frustrating experiences of being dismissed may make TikTok's validating content particularly appealing: people like Alyssa Brown, who found that these ADHD descriptions matched many symptoms she had documented. She speaks warmly about discovering an ADHD community on social media after her experiences were disregarded by conventional healthcare. "I always assumed everyone experienced the world like I did. Finding out that's not true was eye-opening. It's deeply reassuring to connect with people who share similar experiences," she explains.

One of Alyssa's favourite accounts features quirky conversations between a husband and his wife who has ADHD. She and her fiancé bond over these videos. Some of these creators also have merchandise to sell, including t-shirts with slogans such as "What if you're not a lazy useless loser" and "Caution: mid hyperfocus." "We both just laugh about it because it's super-relatable," she says.

Mental health specialists are divided on viral ADHD content. Some value its destigmatising effect, while others worry it trivialises a serious condition or blurs diagnostic boundaries. Celebrity advocates like Steven Bartlett have shaped public perception further. For instance, the most decorated gymnast in history, Simone Biles, announced her diagnosis on X in 2016. "Having ADHD, and taking medicine for it is nothing to be ashamed of nothing that I'm afraid to let people know," the U.S. athlete said.

Similarly, UK singer Jessie J shared in a July 2024 Instagram post what her ADHD diagnosis evoked: it both "empowered" and "overwhelmed" her. Like Bartlett, she described her condition as "a superpower," given proper support. "If there is one thing social media has given me," she wrote, "it's the chance to relate, connect and heal with strangers that have kind hearts and are going through a similar thing."

But this celebrity endorsement sits uncomfortably with some researchers. Oxford University psychologists Drs Lucy Foulkes and Jack Andrews caution that, despite good intentions, celebrity disclosures might inadvertently elevate certain conditions into "prestige items." This social value can make diagnoses seem desirable, particularly on social media platforms. The resulting glamorisation focuses attention on high-profile cases while overlooking those suffering in less privileged circumstances.

This chimes with Professor Susan Young, a clinical psychologist who set up the first national adult ADHD service at London's Maudsley Hospital in 1994 and co-authored the 2008 National Institute for Health and Care Excellence (NICE) guidelines. She objects to the "glib" tone of some content online. "If you look at TikTok in particular, it's all about entertainment. I feel uncomfortable with having a condition that people can really struggle with being used for entertainment purposes," she tells me.

Having worked extensively in the penal system, Young knows that the reality of ADHD for many does not involve Olympic gold medals, multi-million-dollar record deals or TV stardom. Her 2015 study found that ADHD prevalence in prison populations significantly exceeds that of the general population; in youth prison populations five times as many young people (30.1%) and in adult prison populations ten times as many people (26.2%) have ADHD than in the population as a whole globally. The outlook is bleak for prisoners with ADHD: they are more likely to be involved in violent incidents, engage in self-harm and have substance abuse disorders.

Yet in this environment, far removed from TikTok's portrayal, the condition remains under-diagnosed, with sufferers unlikely to receive support, making rehabilitation substantially more difficult. "People talk about, 'ADHD is my superpower! I love having ADHD! I'm zany and I'm fun.' It can undermine the condition," Young adds. This glosses over all those, predominantly from marginalised backgrounds, for whom the condition has wreaked havoc on their already fragile lives.

US research — also replicated in other countries — shows children from low-income backgrounds are more likely to meet the criteria for ADHD but are less likely to receive treatment. David agrees. The "ADHD is a superpower" idea really bothers him too. "I honestly can't see any true advantages to having ADHD itself. For someone to be diagnosed as having ADHD, it has to actually cause problems or impairment in your life — that's a medical requirement — but we rarely talk about what 'causing problems' really means," he says.

That isn't to say people can't adapt to their challenges or develop strengths in spite of their difficulties. But it doesn't mean the condition itself is beneficial, he explains. Social media awareness campaigns about mental health walk a fine line between reducing stigma and trivialising conditions to the point where they lose credibility. This can lead people with diagnoses and difficulties brought on by ADHD to question their own experiences.

Excerpted from "Bad Influence: How the Internet Hijacked Our Health," Oneworld Publications, 2026

People with a rare disorder that causes excessive burping may benefit from an unlikely treatment: singing therapy.

A new study suggests that this singing approach could offer a more engaging alternative to diaphragmatic breathing, or belly breathing, which involves engaging the diaphragm muscle to take very deep breaths. This is commonly used to help patients stop burps before they happen.

As singing also involves diaphragmatic breathing, researchers wanted to determine if singing might be more engaging for patients while offering the same benefits. Their results suggest it may actually offer superior benefits to the breathing exercises.

When it comes to singing, however, one expert told Live Science that the approach doesn't address the entire underlying issue behind the disorder, adding that the study had significant limitations.

No ordinary burps

The burping disorder, called supragastric belching, doesn't involve ordinary burps. Instead of releasing air that has collected in the stomach, people with the condition rapidly pull air out of their esophagus and then push it back out as a sort of belch.

"That is why it's called supragastric belching, because it's not gastric," said Dr. Daniel Sifrim, a gastroenterologist at Queen Mary University of London who specializes in esophageal disorders and was not involved in the study. (The prefix "supra" here means "above," meaning supragastric belching occurs above the stomach.)

Supragastric belching is considered a behavioral disorder, as the action is typically a learned response. It may start when someone is feeling discomfort in the abdomen or experiencing symptoms of reflux and discovers that belching can help relieve the discomfort. The person then repeats the movement until it becomes habitual, Sifrim explained.

Supragastric belching is considered pathological when it becomes "excessive" and causes significant distress to a person's quality of life. While rare in the general population, the behavior is more common in people with reflux and other digestive disorders. To treat the condition, doctors often combine breathing techniques with therapy, such as cognitive behavioral therapy, aimed at addressing the underlying mental triggers behind the behavior.

The new study, published July 22 in the journal Clinical Gastroenterology and Hepatology, involved 72 people diagnosed with supragastric belching at two hospitals in China. The researchers used established criteria to diagnose the condition, assessing each person's symptoms to rule out other causes. They also surveyed the patients to assess the severity of their symptoms, their overall quality of life, and feelings of sadness or anxiousness.

The researchers randomly assigned the participants to one week of either structured singing therapy or diaphragmatic breathing. The singing therapy involved five-minute sessions, repeated three times a day for seven days, in which the patient would sing one of four Chinese folk songs accompanied by musical instruments. Patients were allowed to add more five-minute sessions, if desired.

The breathing therapy included guided breathing exercises that involved visualizing the diaphragm's movements and putting a hand on the belly to feel the breath. In both treatment groups, patients worked to hit a target volume of 80 decibels with either their singing or deep breathing — that's roughly the same volume as a food blender.

The researchers checked the patients' symptoms one week after their treatment and again a month later. After one week of treatment, roughly 72% of the people in the singing group had cut their belching frequency by at least half, compared with only 39% of people in the breathing group. This advantage continued at the one-month checkup: 50% of people in the singing group still met the study's definition of a successful treatment, compared with 31% of those in the breathing group.

The singing group also reported a larger boost in quality of life and greater relief from belching immediately after the treatment than the breathing group did.

Questions remain

However, Sifrim was not convinced by these findings.

He questioned whether all 72 participants had been definitively diagnosed with supragastric belching, which is just one of several belching disorders. It can be difficult to distinguish supragastric belches from gastric belches, he explained, because the former diagnosis is made by asking patients about their symptoms.

"The only way to be sure is to measure it with impedance technique," he explained. Esophageal impedance monitoring measures acidic and nonacidic reflux from the stomach into the esophagus and can help doctors determine whether a belch originates in the stomach or involves air being sucked into the esophagus. This objective measurement was missing, "so I am concerned about the way they made a diagnosis," he said.

He also cautioned that the singing therapy does not necessarily address the underlying problem: the cognitive trigger that causes a person to belch excessively to begin with.

"There are two components of the treatment," Sifrim said. "One is a cognitive component, and the other is a behavioral component. The singing is doing only the behavioral component by modifying the diaphragm."

In his experience, the cognitive aspect is most important, he said. With his own patients, he applies techniques like cognitive behavioral therapy to address the cause of the belching.

This is a common treatment course combined with diaphragmatic breathing. But notably, the current study didn't address the cognitive aspect in either treatment group; it looked at each physical treatment in isolation and compared the two head-to-head, finding singing to be more helpful.

While further investigation is needed, the researchers say that their study points to a potential new avenue to explore in future research about this rare condition.

Long-term memories may not "stick" in the brain for the reasons we thought, a study of mice in artificial hibernation reveals.

Instead of relying on many individual, strong links between neurons — which would typically be pared down during hibernation — long-lasting memories seem to require higher-level patterns in connectivity, the study found.

"This topological architecture of the broader network seems to be more important" than individual, sturdy connections, said study co-author Kazumasa Tanaka, head of the Memory Research Unit at the Okinawa Institute of Science and Technology.

The findings, published Thursday (Aug. 13) in the journal Science, may complicate the picture of how memory retention works.

Tanaka and colleagues used hibernation to study memory because past studies of hibernating animals have found that their brains shrink and pare down cell-to-cell connections during these extended periods of low metabolic activity. At the same time, the brain's activity slows to a crawl, and the loss of connections is thought to be related to this energy-saving mechanism.

Despite this brain shrinkage, hibernating animals, such as alpine marmots (Marmota marmota) and European ground squirrels (Spermophilus citellus), still retain memories they formed before they went into hibernation. "Some studies report their memories are intact, even after, so they can remember conspecifics [members of the same species], like their friends, or they can remember the locations of their food," Tanaka told Live Science.

The new study aimed to tackle the question of what allows those memories to stick around even after many connections between brain cells disappear.

A "switch" in the brain to turn on hibernation

A central dogma of neuroscience holds that memories are made when connections between neurons grow stronger.

Through a process called long-term potentiation (LTP), neurons that send frequent chemical messages to their neighbors start to release more of those signals. In turn, their neighbors grow more sensitive to the signals by increasing their number of receptors and the size of their dendritic spines — the physical structures that receive inputs from other neurons. Ultimately, LTP forges a strong bond at the point where two neurons meet, called the synapse.

An old adage in neuroscience sums up the idea: "Neurons that fire together, wire together."

"I don't think our study argues against this LTP hypothesis," Tanaka said, noting that many studies support the idea that LTP is critical for the brain to forge new memories. However, when it comes to holding on to memories over time, LTP may not be the most essential ingredient.

Recent studies have found that the structures of memories in the brain are actually very dynamic. Rather than relying on a strict and consistent set of connections between specific neurons, these physical traces of memories "drift" over time, within days, Tanaka noted. As a memory drifts, the original LTP-strengthened connections that made that memory can be lost — and yet, the memory persists.

The question is how.

The new study zoomed in on the hippocampus, a major memory processing hub in the brain. It focused on episodic memories, meaning those concerned with specific events and personal experiences. These memories are born in the hippocampus, remain there for a time, and then get transferred to other parts of the brain for super-long-term storage. That transfer can take weeks, months or more, and some neuroscientists think contextual details of the memories — such as the environment where they were formed — remain forever embedded in the hippocampus.

In this case, the researchers were interested in that initial period of memory storage in the hippocampus, so they ran lab mice through several experiments to imbue them with new memories. In one experiment, they'd been taught to associate a specific setting with a mild shock to their paws; in another, they'd learned the locations of sugar pellets placed within a maze.

Then, they pushed those mice into artificial hibernation for two days, by switching on a special set of neurons in the brain that had been identified in past work. In mere minutes, the mice's brains started to change.

"We knew that some degree of the remodeling happens, but the degree was much bigger than what we expected," Tanaka said. Within 30 minutes, the brain was already paring down synapses, and within 24 hours, they "found more than half of the synapses were already gone," he said.

Completely intact memories

Despite this drastic change in the hippocampus, the mice remembered what they'd learned prior to hibernation. After hibernation, the mice froze in place when they were placed in the setting where they were shocked, ‪and in the maze, they navigated to the food as easily as they did before hibernation ‪—‬ indications that they remembered both events.

"To compare the animals with or without hibernation, their behaviors are not different whatsoever," Tanaka said.

To get to the bottom of how that could be possible, the team compared the hibernating mice to another set of lab mice, which were instead put under long-term anesthesia and treated with a molecule that blocks neurons from strengthening their synapses. The latter group of mice also saw dramatic synapse loss, but unlike the hibernating mice, their memories didn't linger after the treatment. What made the difference?

Peering closer into both sets of brains, the scientists spotted a distinction: In the hibernating mice, certain clusters of synapses appeared to be resilient and survived the culling.

These spared connections tended to be hubs where a single neuron sending outgoing messages linked up with several neighboring cells, broadcasting its messages. They also appeared in places where many dendritic spines — the points where neurons receive messages — were bunched close together and received messages from multiple neurons at once.

"That unique structure is preserved during hibernation, Tanaka said. "Under anesthesia, we found they're completely disrupted."

The size of the dendritic spines didn't seem to matter, he added. It was this clustering pattern that seemed to be key for memories' survival.

Looking forward, there's much more to learn about these clusters and their relationship to memory retention. The scientists are now working to characterize the clusters at a molecular level. Eventually, they hope to manipulate the clusters' structure and formation to see what that does to memory. They are also running experiments to figure out how the brain preferentially spares these clusters while pruning away so many other connections in the hippocampus, Tanaka said.

Beyond neuroscience, the research could help engineers design better ways to store data in computer systems, he noted. But when it comes to the memory of living creatures, the study furthers scientists' understanding of how the physical traces of memory in the brain can change so much without sacrificing the memories themselves.

"With this study," Tanaka said, "we just opened up another door to tackle this problem."

Losing mature trees from a neighborhood may be a matter of life and death, a new study suggests.

The research, published Aug. 5 in the journal GeoHealth, tracked tree canopy cover and mortality across Chicago neighborhoods over 11 years. It found that it wasn't the number of trees in a neighborhood that was most strongly linked to residents' survival — it was whether the overall tree canopy was shrinking or growing from one year to the next.

Neighborhoods that kept losing tree cover tended to see death rates climb, especially in the hottest parts of the city, while neighborhoods that kept gaining canopy saw death rates fall.

The study can't say for certain that losing trees is what spiked death rates; it only shows the two trends moving together. But the finding adds to growing evidence that urban tree cover plays an outsized role in protecting people from extreme heat as the planet warms. Trees cool city blocks by shading pavement and buildings and releasing water vapor that lowers the surrounding air temperatures.

The new study's finding is less about discovering trees are good for people's health — scientists have suspected that for years — and more about how the researchers tracked it, said Vivek Shandas, a professor of urban studies and planning at Portland State University who wasn't involved in the work.

Much of the past work linking tree canopy to mortality relied on a single snapshot of a neighborhood's greenery, including a 2022 analysis of heat-related mortality tied to tree cover across dozens of U.S. cities. In this new study, researchers followed how canopy actually changed year to year, and it was that change rather than the raw number of trees that tracked with mortality.

The finding "reinforces what we've found in other cities," Shandas, who studies heat exposure and tree canopy loss in the U.S., told Live Science in an email. "Across 33 U.S. cities, nearly three-quarters were losing greenery, and the hottest neighborhoods were generally losing more — or gaining less — than cooler neighborhoods."

The effect size in the new study was notable: each year-over-year percentage-point increase in canopy was tied to roughly a 10% drop in mortality, with the greatest reductions in cardiovascular, respiratory and mental health-related deaths.

To reach their conclusion, the researchers combined annual satellite measurements of tree canopy for every Chicago census tract from 2011 through 2021 with more than 220,000 death records from state and city health departments. They built statistical models that controlled for factors like summer temperature, air pollution, income and residential segregation, which past studies show are tied to higher levels of mortality.

The team then grouped neighborhoods by their degree of canopy cover, and teased out how the heat and mortality data related to that metric. That helped them pinpoint where the effects of canopy loss or gain were strongest.

It's a rigorous design, Shandas said, but like any observational study it has limits: it can show canopy loss and mortality moving together, not prove that one causes the other. Plus, satellite measurements can miss newly planted trees and thus underestimate canopy cover, whereas finer-resolution tools could potentially pick up young, small-canopied trees that coarser satellite data misses.

It's still not entirely clear why tree cover seems to help, although the data suggest that the shade provided by trees isn't the whole story. That's because canopy loss was tied to higher death rates from a range of conditions, not only those strongly related to heat.

Geographically, the patterns highlighted in the study echoed Chicago's history of disinvestment. The South Side and West Side saw the sharpest canopy losses, hottest summers and highest mortality rates, despite sometimes starting with above-average tree cover. Lakefront neighborhoods stayed cooler by contrast, with lower mortality.

Study co-author Harrison Garcia, a Northwestern medical student, said the project began with a walking tour of sparsely treed Chicago blocks. "I noticed how much more exhausting it felt to walk through areas with little tree cover compared to nearby blocks lined with mature trees," he said in a statement.

The team modeled a hypothetical citywide canopy increase of 0.03% a year — roughly matching Chicago's current pace of planting 14,000 trees annually — and estimated it would prevent about 105 deaths per year, thanks to canopy growth.

Shandas said that figure is best read as a useful estimate of scale rather than a precise promise, since it comes from a statistical model rather than a count of trees planted and lives actually saved. He added that a newly planted tree doesn't deliver a mature tree's shade overnight, and prior research in Portland found planted trees were tied to greater reductions in human mortality as those trees aged.

This pattern, Shandas said, only reinforces the study's central point that protecting existing, mature trees may matter more than planting new ones.

Between outbreaks of explosive diarrhea leading to nationwide lettuce recalls and cases of Salmonella tied to eggs and jalapeños, foodborne diseases in the United States have been hitting the headlines hard this summer.

But is the U.S. really contending with more foodborne infections than usual this year, or does the extensive news coverage just make it feel that way?

Live Science spoke with researchers to find out. Here's what the experts wish people knew about the recent outbreaks.

What is Cyclospora, and how many people have been infected?

Cyclospora cayetanensis is a single-celled parasite that, when ingested, can cause an intestinal illness known as cyclosporiasis. Symptoms of the infection include watery diarrhea, nausea and cramping. It's rarely fatal, but its symptoms can be severe; specific antibiotics can clear the infection.

There are currently several unrelated outbreaks of cyclosporiasis in the United States, most of which have not been linked to specific sources of contamination. Across all of the outbreaks combined, 10,468 lab-confirmed and a further suspected 12,255 cases were reported in the U.S. between May 1 and Aug. 4.

Health officials have linked the largest of the outbreaks to iceberg lettuce sourced from central Mexico and supplied by Taylor Farms. A recall of the affected produce was issued July 17. As of Aug. 5, over 6,300 cases of cyclosporiasis across 15 states have been linked to this outbreak, resulting in 278 hospitalizations and two deaths.

However, despite the large number of cases involved, the outbreak linked to lettuce does not necessarily represent a cause for alarm.

"This particular outbreak traces back to a single independent farm in central Mexico that Taylor Farms estimates supplies under 1% of the U.S. iceberg [lettuce] supply," Jessica Steier, a public health scientist, told Live Science by email. "One contamination event, on one farm, growing product that gets shredded and distributed nationally through food service is enough to produce thousands of illnesses and isn't necessarily a trend."

Considering the total number of Americans and the volume of lettuce consumed annually each summer, "you're looking at a very small fraction," she said. "For the large majority of Americans, the risk right now is very low."

Furthermore, the exposures to the contaminated lettuce are likely behind us, she noted. Cyclosporasis symptoms can take two weeks to show up, and the nation's capacity to test for the parasite is limited. Those factors mean the case counts are catching up.

How does the Cyclospora situation compare with previous years?

The Centers for Disease Control and Prevention (CDC) has confirmed more than 10,000 domestically acquired cases of cyclosporiasis since May 1, with another 12,000-plus awaiting confirmation, compared with roughly 2,000 to 3,000 in a typical full year, Steier said. "This is the largest documented cyclosporiasis outbreak in US history," she told Live Science.

Although the primary Cyclospora outbreak has been tied to lettuce, how that lettuce became contaminated is not yet known. Exposure typically occurs as a result of irrigation water that is contaminated with tiny amounts of human waste bearing the parasite or improper sanitation for workers during growing, harvesting or handling, according to the State of Rhode Island Department of Health.

Cyclosporiasis was first detected in the United States in 1985 — the illness was seen in four travellers who had returned to New York from Haiti and Mexico. The first U.S. outbreak occurred in Illinois in 1990; there were just 21 clinically defined cases associated with contaminated tap water. The next recorded outbreak occurred in Florida in 1995, with just 45 cases; the following year, there was a single outbreak of more than 1,400 cases across 20 states linked to raspberries imported from Guatemala.

As a result of these outbreaks, in 1999 the disease became nationally notifiable, meaning new cases are reported to the CDC. On average, there have been around 3,600 cases of cyclosporiasis in each of the past few years.

Steier attributes the growing trend in Cyclospora cases to Americans eating more fresh produce year-round, with much of it grown in ‪—‬ and imported from ‪—‬ tropical and subtropical regions where the parasite is commonly found. In 1990, when the U.S. had its first cyclospora outbreak, imports accounted, respectively for only around 35% and 10% of the nation’s fresh fruit and vegetable availability; today, those figures have risen to around 60% and 35%. Additionally, tests that detect the pathogen have been improved, so there's a greater rate of diagnosis.

Is there one Cyclospora outbreak, or many?

Part of the problem is that some news coverage "keeps reporting a singular number that keeps increasing, which is not useful," Steier said. "Almost every story leads with a number, and almost none explain what it's counting."

There are many metrics being reported, including the CDC's confirmed national case count, the confirmed cases in the 15-state outbreak, the cases still awaiting confirmation, travel-associated cases, and various states' totals, which sometimes combine probable and confirmed cases.

If you conflate all those counts, Steier cautioned, "we create the appearance of one massive outbreak, which is not necessarily the case." In other words, "Cyclosporiasis reported in 47 different states is not the same thing as an outbreak in 47 states, and media coverage doesn't reflect that distinction."

Ellen Shumaker, a food safety scientist at North Carolina State University, said by email that "Clear and frequent communication with the public is really important in outbreaks like these, to make sure consumers are getting accurate information and have clear steps of what to do."

Shumaker also noted that these outbreaks highlight the need for better traceability for foodborne illnesses. Such improvements are expected to come in July 2028, from which point the U.S. Food and Drug Administration (FDA) will require companies to maintain more detailed records tracking food products across the supply chain, linked to critical events such as harvesting, processing or packing. This change — which was pushed back from its original implementation date of January this year to give the industry more time to adapt — is expected to not only enable much faster tracing but also allow product recalls to be more targeted around contaminated lots, thereby helping to minimize food waste.

What is Salmonella, and what outbreaks are ongoing?

Recent weeks have also seen two prominent outbreaks of Salmonella infection, or salmonellosis. Salmonella is a group of bacteria that can infect the intestinal tract, causing diarrhea, stomach pains and, sometimes, vomiting.

The first of the two outbreaks led to a recall of white shell eggs and brown, cage-free shell eggs sold by Midwest Poultry Services with best-by dates between July 20 and Aug. 17. The recalled eggs — sold under the brand names Country Morning, Cal-Maine Sunups, Brookshire's, Simple Truth and Kroger — were shipped to Arkansas, Louisiana, Mississippi, New Mexico, Oklahoma and Texas.

According to the FDA, although Midwest Poultry Services was identified as a common egg source by the traceback investigation, this producer does not account for all of the illness in the outbreak. In fact, as of July 24, there have been 98 confirmed cases across 17 states, including 26 hospitalizations and no deaths. Investigations to determine if there are other illness sources ongoing.

A second Salmonella outbreak has been tied to fresh jalapeños from the Mexican state of Sinaloa. These were sent by Coast Citrus Distributors to food service companies, restaurants, distributors and wholesalers across the United States.

Taylor Fresh Foods has issued a recall for multiple products made with jalapeños with “Best If Used By” dates up to and including Aug. 16. These include products sold at Hannaford, Kroger, Stop and Shop and Hannaford, Target, Trader Joe’s, Walmart and Whole Foods stores.

The Food Safety and Inspection Service has also issued a public health alert for meat and poultry products containing jalapeños that may be contaminated with Salmonella. These include products sold at Albertsons, Dillons, Hannaford, H-E-B, Kroger, RaceTrac, Randalls, Tom Thumb, Walmart and Wawa stores.

This second outbreak has been linked to 345 confirmed cases of Salmonella across 27 states as of Aug. 10, with 36 hospitalizations and no deaths.

Are there more Salmonella cases than usual?

The number of Salmonella infections this year is not abnormal, according to Steier.

Last year, for example, an outbreak of Salmonella infections tied to eggs distributed by County Eggs LLC led to 105 cases across 14 states in August; June saw 134 cases across 10 states as the result of an outbreak linked to the August Egg Co.; and 21 people were infected by contaminated home deliveries from Metabolic Meals across 13 states.

Looking at the big picture, "ninety-eight cases tied to recalled shell eggs and 345 tied to jalapeños are unremarkable for a pathogen that causes something like 1.35 million infections in this country every year," Steier said.

Salmonella may be getting more attention than usual, she added, "because Cyclospora has everyone on high alert."

Dr. Zoe Weiss, a clinical microbiologist at Tufts Medical Center in Boston, added that COVID-19 pandemic may have also had a lasting effect on people's reactions to infectious disease.

"The average person is just more aware of infectious diseases and has a more sophisticated understanding of disease spread," she said.

How can consumers stay safe?

The key thing for consumers to do is to keep checking the relevant product recall lists, such as those for lettuce, eggs and jalapeños, and not eat any of the recalled products.

Cyclospora is only really eliminated by cooking, and cannot be rinsed off lettuce. When it comes to Salmonella, Steier stresses that recalled eggs should be thrown out or returned, not “cooked more carefully.”

"Please don't panic — and please don't come away thinking you need to avoid lettuce or other produce beyond what has been recalled," she added, noting that the recalls related to specific products and not, for example, lettuce in general.

"What worries me is the collateral damage," she added. "Product sales have taken a hit, lettuce especially, and most Americans were not eating enough vegetables to begin with. Swearing off produce is a real cost to your health in exchange for protection you’re not actually getting."

Deep-sea divers take careful measures to avoid "the bends," a painful condition where gas bubbles form in divers' blood and tissues when they ascend from the depths too quickly. Now, a new study using unlikely test subjects — pigs in diving suits — has shown that switching up the gas they breathe underwater may help divers avoid this dreaded decompression sickness.

One day, the lessons from the research may help humans dive deeper for longer and get back to the surface more quickly, the study authors say. The work was published Aug. 10 in the journal PNAS.

Study co-author Dr. Richard Moon, an anesthesiologist and professor of medicine at Duke University, has treated many cases of decompression sickness over his career. He's even suffered from mild cases of the bends himself. While Moon only experienced slight joint pain in these instances, serious cases of decompression sickness can be fatal, blocking blood flow around the body and damaging the heart and other organs.

The trouble begins with the gases divers breathe to stay alive underwater.

Diving pioneers like Jacques Cousteau, who went underwater while breathing compressed air, noted the confusion and elation they felt during extended dives, calling it the "rapture of the deep." What they were truly feeling was the effects of nitrogen narcosis; this side effect of breathing nitrogen at high pressures makes divers feel drunk.

Divers who ascended rapidly would be beset with severe cramps that doubled them over in agony. These cramps came from bubbles of nitrogen that had dissolved in their blood and tissues in the deep ocean. When the divers ascended too quickly, the dissolved gas started bubbling out, and their bodies essentially became shaken-up cans of soda.

Many divers now minimize the risk of both nitrogen narcosis and the bends by using nitrox, a gaseous mixture of nitrogen and oxygen that has a higher oxygen content than regular air. And commercial deep divers often breathe heliox, a mix of helium and oxygen that reduces the risk of nitrogen narcosis.

However, high levels of oxygen can be toxic in the abyss, and heliox is pricey and can still produce bends-like effects. Safe diving practices, such as tight limits on how long someone spends deep underwater, further cut the risk, but they can't erase it.

"The risk for diving injury almost exponentially increases with depth," said Dr. Kay Tetzlaff, a clinician researcher at the University of Tübingen who was not involved in the research.

For decades, Moon and his colleagues have studied ways to make deep-sea dives safer. The scientists knew that one way to stop gas from entering the body's tissues so quickly was to use a gas with larger molecules. But this replacement gas also had to be less soluble than helium or nitrogen.

"Our first idea was neon," Moon said. But this plan was undermined by Russia's invasion of Ukraine, which sent neon prices spiraling. Instead, they settled on carbon tetrafluoride (CF₄), which, like helium, is inert, meaning it wouldn't chemically react with the body's tissues.

The team tested the gas inside a big, blue tank in Duke's hyperbaric facility. The pressure inside the vast tank can be altered to simulate the crushing conditions 200 feet (61 meters) below sea level.

The team ran their experiments with 40 pigs, whose biology makes them an appropriate model for studying the effects of diving. These pigs were fitted with custom-built suits featuring a hood, a built-in heater and a diaper, for emergencies.

All of the animals were sedated for hour-long simulated dives. Half breathed heliox for the entire dive, while the other half were switched to a mix of oxygen and CF₄ for the last 10 minutes of their submersion. During this period, the helium in the pigs' bodies left their tissues and was replaced by the CF₄. Because the latter gas is less soluble, it entered tissues more slowly than the helium left them. By the time these pigs resurfaced, there was less inert gas in their tissues, which reduced the risk of the bends.

Both groups of pigs were removed from their simulated dives at the same rate, and afterward, they were carefully monitored for three hours. The pigs that had breathed only heliox had much more pronounced signs of decompression sickness, such as impairment in their ability to walk and more bubbles of gas, or embolisms, in their hearts.

In many instances, these cases of depression sickness proved fatal; the dive and subsequent decompression killed over 80% of the heliox-breathing pigs in the three hours after the dive. By contrast, none of those that switched to CF₄ died.

Both Tetzlaff and Moon acknowledged that the findings won't immediately translate to a new standard of practice for human divers. For starters, the risk of decompression sickness for recreational divers is low enough ‪—‬ and the cost of CF₄ is high enough ‪—‬ that few would likely switch their gases.

"I think the expense would limit it to commercial or military diving," Moon said.

Even if the population of people who would use CF4 is small, the new data could still have an important impact, Tetzlaff noted.

"Every dive that you can make safer is worth the effort, right?" he said. "Even if it only applies to a few people."

This article is for informational purposes only and is not meant to offer medical or diving advice.

A push to raise the minimum age for social media and other online services is gaining momentum, beginning with Australia, which recently banned those under 16 from creating social media accounts.

Proponents present compelling studies on the harms of youth social media use and point to evidence that the threat of age restrictions is already pushing some companies to make their products safer. Critics counter that requiring adults to submit to intrusive age checks creates privacy harms and security risks, that blocking young people from these services infringes on their right to participate in public life, and that it pushes them toward riskier alternatives, such as Telegram.

This debate speaks to our professional experiences at New York University's Center for Business and Human Rights, and a 15-year career as a Google executive. We are also both parents, so the outcome will affect our families directly. We recognize that minimum-age requirements will continue to advance if platforms fail to comply with targeted design requirements. We propose two positive, solution-oriented initiatives that we urge policymakers to adopt before they consider implementing minimum-age restrictions.

Enforce targeted, proportionate restrictions

Creating safe online spaces without being overly intrusive is difficult. Human rights law provides a methodology for assessing government actions that restrict individual rights for any legitimate reason: Does the restriction achieve its purpose, or could a lesser restriction work?

Applied here, a government would have to show that switching off or altering harmful platform features or expanding parental controls would not suffice and that nothing short of removing children from the service would work. Answering that question requires specifying which harm is at issue, since each calls for a different fix. There were 21.3 million suspected online child sexual exploitation incidents reported to the U.S. National Center for Missing and Exploited Children in 2025. Such exploitation may be enabled by children having publicly discoverable profiles, recommendation systems that surface those profiles, and frictionless messaging between children and adults.

Cyberbullying ‪—‬ which, according to one 2025 study, had affected almost one-third of American teens in the past 30 days ‪—‬ may be facilitated by pseudonymous accounts and group chats that allow adding someone without permission. Keeping children from accessing some of these features and keeping adult strangers out of child-focused spaces, like Roblox, would address both harms without placing unnecessary restrictions on children.

Age-inappropriate content is harder to define. Adult-content filters in school have been critiqued for treating health-related content as if it were pornographic. In addition, potentially sensitive material does not affect all children equally. Parents and caregivers, rather than regulators, may be better at making the calls about specific categories to restrict.

The compulsive use of social media emerges from systems designed for growth and engagement optimization — features like infinite scroll, autoplay, variable reward notifications, and algorithmic feeds. These exploitative design patterns affect every user, not just children, and they exist in other online services, like gaming platforms. The best response may be to restrict these features across the board or, as the New York SAFE for Kids Act does, to turn them off by default unless adults opt in.

Examining each harm separately suggests the risk lies not in the platforms but in particular design choices. Most of these elements can be altered by the companies or, where necessary, age restricted, without removing young people from these services altogether.

A wholesale ban could then be explored if those targeted measures fail or platforms don't comply. Indonesia and Canada are now taking that approach by requiring that these platforms meet defined safety criteria before children can create accounts.

Learn from other industries

For features that do require age verification, we need to develop safety systems similar to those in areas like architecture, drug testing and food service. Such infrastructure can be considered "high-stakes," because it is implemented when laypeople cannot directly evaluate a product’s safety themselves and the consequences of failure are severe, such as the collapse of an apartment building.

We argue that online identity verification matches this pattern; no user can verify whether a vendor or platform properly handles and disposes of the photographs and identity documents required to verify their age, and the consequences of failure — misuse by the platforms or identity theft — are severe and often irreversible. For example, in 2025 the Federal Trade Commission received over 1.3 million reports of identity theft, with estimated losses of more than $15.8 billion.

We do not endorse specific technical standards, as our experience in counter-abuse technology shows that adversaries continually work to subvert online protections. Just as a bridge decays over time due to weather and usage, and needs to be maintained, regularly inspected and eventually replaced, we need to continue recognizing and adapting to new online threats over time.

Three attributes common to existing high-stakes safety systems would help address online age verification.

First, expert-led committees typically set and update safety standards, which agencies such as the U.S. Food and Drug Administration adopt and enforce. The technical standards behind age verification are very new, and they don't have the same level of government support to help develop or enforce them. For example, Google and Apple take different technical approaches to secure age verification in their mobile operating systems, which could make different systems less compatible over time. We strongly encourage governments to invest in supporting information security, internet and web standards bodies to move their work forward more quickly and to help the entire tech industry converge on common practices. Those standards should also be revised on a fixed schedule, in the same way that the building code is updated every three years.

Second, products in most high-stakes industries require review before they can be rolled out. Drug trials are extensive and scientifically rigorous, buildings require certified plans and inspections, and restaurants require a health certificate before they can serve a single meal. Age-verification vendors should face similar preapproval inspection, with computer architecture assessments, code reviews and adversarial security testing. Critically, social media companies should pass an equivalent review before deploying age verification.

Third, our food, drugs and buildings are safer than they otherwise would be because we fund full-time government experts in proportion to commercial activity in those sectors. This often takes the form of significant up-front fees for the companies involved ‪—‬ pharmaceutical companies must fund drug trials, and contractors must obtain building permits. This money covers the salaries and operating costs of trained inspectors. Vendors and social media companies should pay similar high fees, both up front for pre-review and annually for ongoing supervision, scaled to each company's audience size and scope of services.

In conclusion, we call on governments to approach child safety online as an ongoing challenge rather than a one-time regulatory fix. Making children safer online will take years of continued research into both child behavior and new technologies. One useful model is the progressive regulation of automobiles. Since the mid-1960s, new technologies and government targets have driven tailpipe emissions for most passenger vehicles down 99% and fatalities per mile down 78% per million vehicle miles traveled. If we take a similar approach to reducing online harms to our children, we are confident that we can achieve similar remarkable improvements in the years to come.

This article is for informational purposes only and is not meant to offer medical advice.

Opinion on Live Science gives you insight on the most important issues in science that affect you and the world around you today, written by experts and leading scientists in their field.

The patient: An 82-year-old woman in Bologna, Italy

The symptoms: The woman was admitted to the hospital with abdominal pain that had worsened over the previous four days. The symptom was accompanied by constipation and episodes of nausea and vomiting.

What happened next: During a physical examination, doctors found that the patient's abdomen was distended and tender. Laboratory results from a blood test indicated that her white blood cell count was elevated, which is often a sign of an immune response to an infection.

When doctors performed an abdominal X-ray, they discovered that parts of the woman's intestines had expanded due to gas or fluid, while other portions of her intestines had collapsed. An abdominal CT scan revealed that the woman had a solid object blocking her intestinal loops on the right side ‪—‬ a situation known as a small bowel obstruction (SBO).

The diagnosis: SBOs have several possible causes, including tumors. Additionally, a section of the bowel can twist, forming a "volvulus," or a mass of tissue can push through a tear in the intestinal wall, causing a hernia.

However, in a report of the case, the doctors wrote that SBOs can sometimes be foreign bodies, such as swallowed objects; gallstones that migrate to the intestines; packed masses of parasites, like roundworms or nematodes; or bezoars, which are solid clumps of undigested matter that collect in the gastrointestinal system.

Bowel obstructions can be life-threatening if the blockage completely shuts off the intestinal tube and the condition goes untreated. In this case, the doctors recommended emergency surgery to clear the patient's blockage and prevent strangulation, meaning tissue death that affects parts of the intestines when the blood supply is cut off.

The treatment: Surgeons performed a procedure called a laparotomy, making a small abdominal incision to access the patient's intestines. They then pinpointed the location of the mass and surgically removed it. The object measured just over 2 inches (5.5 centimeters) long and was a phytobezoar, meaning a bezoar composed of plant material.

In addition to undigested plant matter, the surgeons found something they did not expect. As they extracted the bezoar, what they initially identified as "a small live insect" jumped from the vegetable mass and crawled up the sterile surgical drapes, they wrote in the report. The authors did not report the creature's size, but it was smaller than the bezoar.

The medical team captured the live intruder, sent it to a lab for analysis and learned that it was not an insect but rather a different type of land arthropod in the order Isopoda. These animals are crustaceans, relatives of crabs and shrimp. Terrestrial isopods have flattened bodies with rigid, segmented exoskeletons and seven pairs of legs.

Land isopods are found around the world and have hundreds of common names. They are most often called pill bugs, sow bugs, roly-poly bugs or wood lice. In the U.K., their regional nicknames are especially diverse and include chucky pig, monkey pea, cheese log, daddy granfer and granny grunter.

Isopods feed on decaying vegetation, and the doctors hypothesized that the patient had accidentally swallowed the isopod along with a mouthful of unwashed vegetables or fruit.

She recovered from the surgery and, shortly after, moved to a retirement home, where she was still living 18 months later during a follow-up visit, according to the report.

What makes the case unique: Only about 25% of all SBO cases are caused by foreign bodies such as bezoars; in people over age 50, the most common SBO is a volvulus.

The isopod group contains more than 11,000 species, of which about half live in the ocean. Some of those marine isopods parasitize fish, such as the tongue biter that consumes and then replaces its host fish's tongue. However, no terrestrial isopod is known to parasitize humans, the physicians wrote in the report.

If a person accidentally swallows a nonvenomous insect, spider or other small arthropod, the digestive system typically treats it like any other type of protein and dissolves it with acids and enzymes. In this case, though, the capsule of compressed plant matter in the woman's digestive tract may have protected the isopod, temporarily keeping it alive inside her body.

For more intriguing medical cases, check out our Diagnostic Dilemma archives.

This article is for informational purposes only and is not meant to offer medical advice.

Can you guess the diagnosis in these strange medical cases? Find out with our diagnostic dilemma quiz!

When penicillin was first introduced to the public, it earned the nickname "the wonder drug" because it cured infections that had once been deadly. It ushered in the golden era of antibiotics, during which the bacteria-killing drugs entered widespread use, driving down rates of severe disease and death from infections.

Unfortunately, the sweeping adoption of these medicines also set the stage for their obsolescence. Once hailed as miracles, antibiotics are now losing their power as bacteria evolve strategies to evade them.

Today, the world is contending with a "silent pandemic" of antibiotic resistance, driven largely by the misuse and overuse of these critical medicines. Curbing resistance, then, means changing how doctors prescribe ‪—‬ and patients use ‪—‬ antibiotics.

I traveled to Japan because a government initiative aimed at correcting antibiotic misuse has helped slash unnecessary prescribing and I wondered if a similar approach could work in the U.S. The program offers "tips" of 800 yen (about $5) to the clinics of pediatricians and ear, nose and throat doctors (ENTs) who withhold antibiotics in cases when they're likely not needed.

My findings suggest that many of the factors that drive antibiotic misuse in outpatient clinics overlap in the U.S. and Japan. But the cultural, governmental and insurance landscape may differ too greatly between the two countries for America to copy-and-paste Japan's approach. Instead, here's what I think could work to close the gaps in antibiotic overprescription in the U.S., based on my conversations with doctors.

Similar pressures, different systems

In both Japan and the U.S., sick visits are mere minutes long, so doctors must determine quickly whether an antibiotic is needed. Few rapid tests exist for bacterial infections, introducing a degree of diagnostic uncertainty. Children's caregivers sometimes request antibiotics when they're not needed, and depending on the doctor, that social tension can be enough to prompt an unnecessary prescription, research has found.

I learned that children's caregivers value doctors who can answer questions and clearly explain their reasoning. They don't necessarily arrive at an appointment expecting a specific "solution," such as an antibiotic prescription — even if they sometimes request one. When faced with parents who request a prescription, doctors can often defuse the tension by explaining why antibiotics aren't necessary, my reporting found.

On paper, Japan's antibiotic incentive gets at both halves of this pediatrician-parent dynamic. It offers pediatricians and ENTs extra payment to avoid antibiotics for certain types of infections. To claim that cash for their clinics, the doctors must explain their reasoning for withholding antibiotics to the child's caregivers, to help educate them about appropriate antibiotic use.

Although the pressures that lead to overprescription are similar in the U.S., the countries have several big differences.

For one, Japan has a national insurance system in which children's healthcare is essentially free. People in Japan report a relatively high degree of trust in their national government overall, and they specifically report being very happy with their healthcare system, with satisfaction rates far exceeding those of similarly wealthy countries.

By contrast, the U.S. has a patchwork of private, subsidized and public insurance. About 27 million people — roughly 8% of the population — are uninsured, and those with insurance frequently face issues with using their coverage and major barriers to care, such as prior authorization and claim denials. Navigating these barriers can derail and delay medical care, spurring frustration. Meanwhile, the number of people able to cover medical care is falling as costs spike, and people worry that insurers hold too much sway over health policy.

These layers of complexity are baked into the U.S. healthcare system, whereas in Japan, the federal government can introduce an insurance policy and affect change across the whole system at once. That's how the 800-yen incentive for pediatric clinics was implemented.

Hesitations from U.S. doctors

Japanese doctors readily accepted the notion of "tips" for withholding unneeded antibiotics, in part because those types of small-scale incentives already exist in Japanese healthcare.

Clinics earn incentives by claiming an add-on fee when they seek insurance reimbursement for a given appointment. That reimbursement rate is dictated by Japan's federal government, which sets healthcare pricing, so it's simple to introduce such incentives at scale. Similar add-on fees have been used to encourage doctors to prescribe cheaper "biosimilars" over costlier drugs with the same effects and to adopt better treatment approaches for conditions like hip fractures and painful periods.

In contrast, reimbursement rates in the U.S. are set by a dizzying array of agencies and private companies, all with their own goals.

I asked U.S.-based doctors whether a similar incentive could work here. Their responses were mixed.

"I think a program like the Japanese one could work in the U.S.," Dr. Conor Blanco, a pediatric ENT based in New Jersey, told me in an email. He noted that many physicians' pay is determined partially by patient satisfaction scores, so there are existing financial incentives that steer their behavior. If you set up a similar incentive around proper antibiotic use, "maybe it makes a difference, it's tough to say," he said.

Dr. Dmitry Volfson ‪—‬ chief medical officer of CityMD, a large urgent care provider in New York and New Jersey ‪—‬ agreed that it might work. "But [it] may be difficult to implement" given America's multitude of insurance payers, Volfson told me in an email.

Other doctors were less open to the idea.

"On first pass, it feels very unethical to me," said Dr. Morgan Leafe, a pediatrician who worked in both inpatient and outpatient settings for 11 years. Children's caregivers might be upset to hear that clinics get paid more when they don't prescribe an antibiotic, given that some are already under the impression that U.S. doctors are overly motivated by money, she told me in a direct message.

Doctors already widely criticize insurers for denying what physicians deem necessary care. Dr. Jennifer Shu, a pediatrician with Children's Medical Group in the Atlanta metro area, worries that insurers might set up the incentive in a way that restricts doctors' prescribing patterns too aggressively or doesn't align with current scientific evidence.

"I do not believe that financial incentives should dictate clinical practice," said Dr. Erik Blutinger, an emergency medicine physician for the Mount Sinai Health System in New York who also works in its urgent care centers. "It should boil down to the patient's health and ultimate well-being over finances."

Dr. Ilan Shapiro, a community pediatrician at AltaMed Health Services in Southern California, said he could see an incentive driving down unnecessary antibiotic prescriptions, but he added that it could also overcorrect, encouraging doctors to hold back antibiotics that are actually needed.

"I'm not a believer in the carrot or the stick," Shapiro told me.

How incentives work in the U.S.

Notably, many U.S. doctors are already financially incentivized to improve antibiotic prescribing — but those incentives apply at a high level, rather than case by case.

For example, many American health insurance plans use a tool called the Healthcare Effectiveness Data and Information Set (HEDIS) to assess patients' quality of care at the medical centers they visit. The tool is used by many commercial insurers, as well as by private groups that manage Medicare and Medicaid plans.

Some insurers incentivize providers to achieve higher HEDIS scores by offering higher reimbursement in exchange, "but this is not universal," Volfson explained. There are HEDIS metrics that track how often antibiotics are used for ailments that are frequently viral, like upper respiratory infections, sore throat and bronchitis, he added.

These incentives fall under "value-based care," which aims to reward behaviors that tend to improve patient outcomes and lower healthcare costs. That's opposed to the more dominant "fee-for-service" model, which compensates practices for individual services provided.

Medicare has its own value-based care approach that includes metrics to track antibiotic use, including for upper respiratory infections. These metrics get factored into one composite score that can boost reimbursement (if the score is high) or lower it (if the score is low) for eligible clinicians and practices covered by the program.

Medicaid, which covers nearly half of U.S. children and is run at the state level, does not have an equivalent to this Medicare approach, but it has other ways of tying reimbursement rates to metrics like antibiotic use.

Medical practices' participation in value-based care is growing, but fee-for-service remains dominant. Some doctors are skeptical of the alternate approach, Leafe noted, because they feel it puts them on the hook for outcomes that are not completely within a healthcare team's control. But Shapiro, whose healthcare system uses value-based care, sees it as a way to encourage doctors to consider the long-term trajectory of a patient's health rather than only the acute ailment at hand.

"You have to have some sort of guardrail"

U.S. doctors were often put off by the idea of clinical decisions being steered by a potential bump in payment. "Patient-related outcomes are more important than financial incentives when it comes to shaping my clinical decision-making," Blutinger said.

Shapiro embraces value-based care but expressed doubts about the Japanese approach to incentives. My interviews suggested that incentives awarded for individual actions — such as offering $5 to not prescribe antibiotics for a given child's cold — might not be accepted as easily in the U.S. as they are in Japan.

As Shu expressed, that may partially come down to a lack of trust in insurance companies. There may also be a lack of trust in other doctors and practices; multiple doctors I spoke with expressed worries about underprescription.

"What if people become disincentivized to give antibiotics at all, even when they need them?" asked Dr. Shruti Gohil, an infectious-disease specialist with UCI Health who has designed antibiotic stewardship interventions for hospitals. "You have to have some sort of guardrail on that."

Gohil noted that, in Japan's case, the government incentive aims to promote a "culture of safety, whereas with an insurance company, it's just about finance." In other words, she worries that U.S. insurance companies mainly care about their bottom line, not public health. An insurer incentivizing doctors to provide less care struck her as "unsettling."

In contrast, the pediatricians I spoke with in Japan expressed concerns about other doctors overusing antibiotics, not underusing the drugs, and they argued that some doctors still don't take antibiotic resistance seriously. Their salaries are also lower than those of other medical specialties, and the doctors explicitly stated that they appreciate that the antibiotic add-on boosts their practices' profits.

Alternative approaches?

U.S. doctors may not accept a clone of Japan's incentive program, and given America's complex mix of insurance providers and systems, a similar incentive could be difficult to implement uniformly and at scale. But based on my research, I think that incentives that fit more comfortably within our existing infrastructure could still move the needle.

Doctors are already incentivized to record certain metrics, such as body mass index (BMI) and ongoing weight-management plans, in their notes, Shu said. For example, Medicare and HEDIS bake this documentation into quality measures that affect reimbursement, as well as other calculations that help dictate insurance payments.

Borrowing from Japan's approach, I propose that clinicians and health systems could be paid more when they document that they've explained key facts about appropriate antibiotic use to patients' caregivers. These facts might include that childhood illnesses are often viral and that symptoms like fever or green mucus don't necessarily mean bacteria are to blame. They could note that unnecessary antibiotics can cause side effects like diarrhea and make the medicines less effective over time. These talking points could be added to the electronic medical record, where clinicians could easily access them.

This parent-education requirement could incorporate follow-up plans for further learning. That might include providing parents with physical materials, like pamphlets, or links to vetted websites like the American Academy of Pediatrics' HealthyChildren.org.

Gohil's practice regularly uses those types of patient-directed materials. "Nothing beats the conversation," she said, "but they [the materials] give you talking points and then allow the patient to reference something."

Various trials suggest that educating parents about appropriate treatment for respiratory infections and uses of antibiotics can help shift their expectations around the drugs, in turn reducing how often they seek antibiotics. There's also data to suggest that doctors' providing parents both verbal and written information can help the knowledge stick. Some trials have found that the number of antibiotic prescriptions fell after such educational interventions.

Particularly effective trials combine parent education with efforts aimed at healthcare providers: in-office materials and presentations about antibiotics, guidelines within the electronic medical record that point doctors toward best practices, data on antibiotic resistance rates in the community, or "audit and feedback," where clinicians get report cards comparing their prescription rates with those of others in their practice.

This approach would not specifically incentivize nonprescribing over prescribing, but it would prompt clinicians to educate patients and caregivers about appropriate antibiotic use while providing them a simple script to follow. U.S. adults report placing more trust in health information from their own healthcare providers than from government entities, suggesting that these messages are more likely to stick when doctors deliver them.

Targeting caregivers

Incentives might also help by rewarding children's caregivers for educating themselves about antibiotics. That approach might be less ethically dubious than directly incentivizing doctors' prescribing habits, and the infrastructure for such incentives already exists, my reporting suggests.

Major U.S. health insurers — including private and public insurance — now offer their members cash, gift cards or reward points when they engage in certain "health promoting" behaviors. Even life insurers are getting in on the idea. Participants earn rewards by completing an annual well visit, getting a routine cancer screening, logging a certain number of steps per day, or completing courses on healthy eating or nicotine cessation.

The hope is that, by rewarding such healthy habits, insurers can reduce their members' medical costs. Evidence suggests that these programs can motivate people to change their behavior and improve related health measures, especially in the short term. Their long-term and systemic impacts are understudied, although some research — about quitting smoking, for example — demonstrate long-term behavioral changes.

This same infrastructure could be used to enhance patients' understanding of antibiotics, and thus relieve some of the pressure on doctors to explain why the drugs may not be necessary. Children's caregivers could earn rewards for engaging with short, interactive courses or informational pages about the basics of antibiotics — what the drugs treat, what they don't, what "watchful waiting" is, and why antibiotic resistance is a problem. Short quizzes and surveys could check parents' understanding and prompt further rewards from the insurer.

These resources could explain that many common childhood infections are viral and resolve on their own or, similar to an app about childhood illness created in Japan, lay out the recommended care for acute viral infections and describe the signs that a bug might actually be bacterial. The creator of the app, Dr. Masahiko Sakamoto of Saku Central Hospital, has found that the platform changes how parents understand childhood illness and interact with the health system.

Such information is already available to parents via trusted sources like the American Academy of Pediatrics; the difference in this scenario is that caregivers would be paid to use it. Gohil thinks that incentivizing this type of patient education would be a "boon," especially when combined with strategies aimed at improving providers' antibiotic use, such as audit and feedback.

"Presumably, with that kind of continuing education of patients, they would perhaps seek antibiotics less and less and understand when they're necessary," she said. "I think that [idea] is so compelling."

This approach could benefit insurers by averting unnecessary doctors' visits and prescription costs, and on a larger scale, potentially help lower the risk of resistant infections.

Beyond pediatrics

Japan's incentive program focuses on pediatricians and ENTs, because the government recognized a pattern of overprescription in those groups. In the U.S., pediatrics clinics aren't the main source of overprescription — but urgent care centers may be a significant one.

Compared with other outpatient medical settings, like doctor's offices, urgent care centers are more likely to write unnecessary antibiotic prescriptions, several studies suggest. One study of millions of urgent care visits found that prescriptions were written for 15% of bronchitis cases, for which antibiotics are nearly never needed.

Unlike primary care pediatricians, who see children's caregivers many times and have the opportunity to build trust, urgent care providers may see them only once. In a 2026 study of pediatric urgent care providers across the country, many reported feeling pressured to satisfy parental requests for antibiotics, and over 50% admitted to altering their care plans in response to such requests.

That said, 66% of those participants said parents are open to education about antibiotics, even when the provider's care plan didn't align with the caregiver's initial expectations. That suggests that prioritizing — and perhaps incentivizing — parent education in urgent care settings could help prevent unnecessary prescriptions.

"It does become challenging when you have a queue of patients waiting to be seen," Blutinger noted. Nonetheless, his practice aims to prioritize such education. He's found that parents are receptive to explanations about antibiotics, especially if he carefully listens to and addresses their concerns. "I've never found it helpful to make it a one-way, information-sharing conversation. It has to be two-way," he said.

The 2026 study included physicians, physician assistants (PAs) and nurse practitioners (NPs), with the latter two groups making up about half of the participants. (In Japan, only doctors can prescribe antibiotics, and there are no equivalent roles to NPs and PAs.)

Urgent care centers are often staffed largely by PAs and NPs, with one doctor on-site along with various medical assistants. That might be relevant to their antibiotic prescribing.

That's because some studies suggest that PAs and NPs are more likely to prescribe antibiotics than physicians are. In one study of acute respiratory tract infections, the providers were 30% more likely than doctors to write an antibiotic prescription for the same ailments, and that difference was more pronounced for visits with pediatric patients. In another study of outpatient providers, PAs and NPs had the highest likelihood of inappropriate prescriptions and pediatricians had the lowest.

The reasons for this difference aren't fully understood, although the study authors pointed out that efforts to improve antibiotic use have been aimed mostly at doctors. NP and PA education and training also tends to vary more widely than doctors' training, suggesting potential knowledge gaps.

These trends point to an opportunity to tailor interventions to NPs, PAs and urgent care providers. These might be easiest to implement in urgent care facilities affiliated with larger hospital systems, representing about 35% of U.S. urgent cares. These systems set the metrics that factor into bonuses that doctors, NPs and PAs frequently earn on top of their base salaries.

One metric that's already used widely is clinical documentation, which could be required to note when rationale for denying antibiotics was provided to patients. A large Utah urgent care network recently took a similar approach and gave their clinicians a goal to decrease antibiotic use for respiratory illnesses. They made a certain threshold of antibiotic use in a year a quality metric that clinicians could earn extra compensation for hitting.

That financial incentive didn't stand alone, though. It coincided with new educational materials for clinicians and patients about antibiotics, new guidance on antibiotics in the medical record, and the introduction of peer-to-peer comparisons of prescribing rates. Together, these strategies drove a substantial decrease in overall antibiotic use for respiratory ailments. Clinicians initially prescribed antibiotics for 48% of respiratory conditions; that fell to 33% within one year and to 26% the next.

It takes time for new antibiotic-use guidelines to filter down to individual providers, particularly when there's an existing culture of overprescription. Japan's experiment demonstrated that targeted incentives can reduce antibiotic misuse — at least in Japan. The exact same approach may not be acceptable or feasible in the U.S. But we can still take inspiration from the idea and explore it as one tool among many to fight this silent pandemic.

"Antimicrobial resistance is one of the world's most urgent public health threats," Dr. Sarah Kabbani, director of the Centers for Disease Control and Prevention's Office of Antibiotic Stewardship, told me in an email. "Because outpatient prescribing is so common, even small improvements can have a large impact on patient safety and population health."

This article is for informational purposes only and is not meant to offer medical advice.

The U.S. Food and Drug Administration (FDA) recently approved the first mRNA vaccine for seasonal influenza, bringing a bumpy approval process to a close.

The shot's approval appears to contradict the federal government's generally unfavorable view of mRNA vaccines. The U.S. Department of Health and Human Services (HHS) terminated half a billion dollars in funding for mRNA vaccine development, impacting 22 projects. A key vaccine advisory committee was remade to include people who have been vocally opposed to mRNA vaccines. Health Secretary Robert F. Kennedy Jr. has falsely called the mRNA-based COVID-19 shots the "deadliest vaccines ever made" and incorrectly claimed that mRNA vaccines don't work well against upper-respiratory viral infections.

Does the approval of a new mRNA vaccine signal a shift in this sentiment? Not necessarily, experts told Live Science.

"I don't read this as a shift in the administration's stance on mRNA," Jeff Coller, a distinguished professor of RNA biology and therapeutics at Johns Hopkins University, said in an email. Coller is also a co-founder of the Alliance for mRNA Medicines, an international association aimed at advancing mRNA technology, and he advises several RNA companies.

The approval does suggest, however, that the FDA's approval process isn't completely compromised by anti-mRNA sentiment, Coller said.

"What the approval does signal, and I think this is the more useful story: the statutory machinery still works when it is allowed to run," Coller said. "For companies and investors deciding whether to keep building in this space in the United States, that matters more than any statement from HHS."

A "tortured" approval process

The new flu vaccine, called mFlusiva, was made by Moderna. The company filed for the shot's approval in February, but initially, the FDA denied Moderna's request to have its materials reviewed.

Reporting by STAT News later found that career FDA scientists had planned to do the review but they had been overruled by Dr. Vinay Prasad, then director of the FDA's Center for Biologics Evaluation and Research (CBER). (Live Science has contacted the FDA for comment.)

"It's been a little tortured," Dr. Paul Offit, director of the Vaccine Education Center at Children's Hospital of Philadelphia, said of the approval process. In April 2024, before starting its final trial of the vaccine, Moderna ran its plans past the FDA, and the FDA confirmed in writing that the trial's design was acceptable. But when Moderna filed for approval using data from the trial, "Vinai Prasad, who had just been put in place at CBER … said no," Offit told Live Science.

"That didn't last long, nor did he last long, after that," Offit added. The denial was reversed within the month, and Prasad left the FDA in April.

"That refusal was reversed fifteen days later," Coller said. "Nothing about the evidence changed in those fifteen days." What changed were the choices made by FDA leadership, he said.

Once allowed to do so, the FDA's vaccine advisory committee, called the Vaccines and Related Biological Products Advisory Committee (VRBPAC), met to discuss the shot's safety and effectiveness. The group voted unanimously to recommend approving the vaccine for adults ages 50 and up. The FDA then followed this advice, making the approval official.

"They're experts in the field," Offit said of the VRBPAC members. He personally sat on the committee from 2017-2025. "It's a pleasure to go to those meetings because, you know, it's the way it's supposed to work," he said.

Unlike the Advisory Committee on Immunization Practices (ACIP), which advises the Centers for Disease Control and Prevention (CDC), VRBPAC has not seen a major overhaul in its membership since Kennedy's appointment, though it does have a number of open vacancies. However, its remaining members have ample expertise in infectious diseases, immunology, global health and genetics.

Next step for the new mRNA flu vaccine

Now that mFlusiva is FDA approved, the data must be reviewed by the CDC, which issues recommendations about how the vaccine should be given and to whom. Normally, a vaccine advisory committee would review the data first and then give the CDC guidance, but it's unclear how that might look in this case, Offit said.

That's because ACIP is in the midst of a lawsuit, which recently prompted a federal judge to put a freeze on several of the committee's recent changes. Those changes include the appointment of new committee members by Kennedy and a major revision of the childhood immunization schedule. While the litigation plays out, the committee could still issue new vaccine guidance if it appoints enough new members to compensate for the ones who are currently in limbo — but that hasn't happened yet.

The CDC could issue its own recommendations for mFlusiva without ACIP's help, Offit noted. It's within the agency's power to do so. But will that happen?

"I don't know," Offit said. "Robert F. Kennedy Jr. has ultimate say, and he's a science denialist and an anti-vaccine activist. So I don't know." Offit predicts that Kennedy "will do nothing to encourage vaccination, period, independent of what the vaccine technology is."

The shot is now licensed, thanks to the FDA approval, and that means it could be used without bespoke CDC recommendations, Offit said. But a lack of CDC recommendations may undermine insurance coverage for and access to the vaccines.

It would be useful to have an mRNA vaccine option available this upcoming flu season, Offit said, in part because trials suggest that the shot is more protective than existing options, especially for adults 50 to 64. There's also strong evidence that that's true for adults over 64, but for that age group, more data will be collected in the coming season to see how well mFlusiva stacks up against existing high-dose flu shots for older adults. Offit expects those upcoming results will likely be positive and back up the existing evidence, which involved measuring antibody levels in older adults given either vaccine.

Other strengths of mRNA-based flu vaccines are that they can be produced in about half the time that existing flu shots are made and they can be better tailored to match the targeted flu strains, Offit noted.

In the 2025-2026 flu season, there were at least 390,000 hospitalizations and 24,000 deaths from flu in the U.S. Flu shots are the best way to prevent severe illness and death from influenza.

Looking to the future of mRNA vaccines in the U.S., mFlusiva's approval suggests that vaccine regulatory bodies still have the means and will to review mRNA vaccine trials and approve new products, as Coller said. However, this stand-alone approval doesn't necessarily mark a sea change in the federal government's sentiment toward the technology, he noted.

"An approval is a legal determination on one application. It tells you the data met the standard, which everyone involved in reviewing it already knew," he said. "A genuine shift would look like the 22 canceled mRNA contracts being restored, or a retraction of the claim that these vaccines fail against respiratory viruses. As far as I know, neither has happened."

Live Science contacted the HHS for comment on the mFlusiva approval.

"Secretary Kennedy has been clear that he believes mRNA products warrant heightened scientific scrutiny. That's why this vaccine is entering the market with some of the strongest post-market study commitments FDA has required, particularly for individuals 65 years of age and older," HHS Press Secretary Emily Hilliard responded in an email.

"CDC has not yet issued its recommendations, and this vaccine is not mandated. Americans deserve transparent information, informed consent, and the ability to work with their physician to decide whether — and which — seasonal flu vaccine is right for them," she continued. "HHS will continue to follow the evidence and make safety and effectiveness data publicly available as additional information emerges."

This article is for informational purposes only and is not meant to offer medical advice.

Bolstering a type of bacteria that lives in the uterus may help counter age-related changes that can make it harder to get pregnant, a new study suggests.

While fertility decline is often linked to changes in egg number or quality, the uterus also becomes less receptive to an implanting embryo with age. The new research suggests that changes in the bacteria living there may be part of the reason.

In experiments, treating aged mice and lab-grown human uterine cells with a specific species of Lactobacillus, a group of bacteria often found in the uterus, reduced signs of aging in the uterine lining and improved embryo implantation. This improvement was also seen with a specific byproduct of Lactobacillus.

The findings, published Thursday (Aug. 6) in the journal Cell Host & Microbe, suggest that the uterine microbiome could be a promising target for treating age-related infertility. However, experts who were not involved in the study cautioned that the research is still preliminary.

"This is an interesting and promising approach, but we still don't know whether these findings will translate into meaningful improvements in human fertility," said Dr. Alex Robles, a fertility specialist at Columbia University Fertility Center who was not involved in the study.

"The microbiome can be influenced by many factors, including genetics, diet, geography, environmental exposures and other lifestyle practices," he told Live Science in an email, "which is why it's important to validate these findings across diverse populations before developing broadly applicable treatments."

To explore whether and how the uterine microbiome changes with age, the study researchers analyzed samples of the endometrium — tissue from the lining of the uterus — from 149 women ages 20 to 45 who were undergoing fertility treatment in China. The older women had lower levels of beneficial Lactobacillus bacteria, particularly L. gasseri and L. crispatus. These bacteria are generally associated with a healthy reproductive tract.

"One finding that surprised us was that overall microbial diversity did not change markedly across the different age groups," study co-author Dr. Rong Li, deputy director of the Department of Obstetrics and Gynecology at Peking University Third Hospital in Beijing, said in a statement. "Instead, the major differences involved particular bacterial species."

Later, 93 of the women underwent in vitro fertilization (IVF), and of those, 56 became pregnant. Those who became pregnant had higher levels of Lactobacillus in their uterine lining than those who did not get pregnant. That said, the pregnancy rates were similar across women of different ages who underwent IVF.

To better understand the effect of these bacteria on the uterus, the team isolated five Lactobacillus species and tested how they interacted with uterine cells. L. gasseri stood out because it attached strongly to uterine cells, and this attachment was associated with reduced inflammation and lower damage from oxidative stress. The bacterium also produced large amounts of exopolysaccharides (EPS), a type of sugar molecule.

The researchers then purified these sugars into a postbiotic they call LG-EPS. Unlike probiotics, postbiotics are products of bacterial cells and thus do not contain live bacteria.

Then, the researchers ran tests in older female mice (roughly equivalent to a middle-aged woman) to see whether introducing L. gasseri or LG-EPS to the vaginal canal could affect the aging uterus. After four weeks of daily vaginal treatment with either the bacterium or the postbiotic, the mice had fewer signs of uterine aging, less inflammation and higher embryo implantation rates than the untreated animals did. (That said, the team did not measure how much of each treatment actually reached the uterus.)

When they tried the same test with a modified strain of L. gasseri that could not make EPS, they found that many of these benefits disappeared. That suggested that the exopolysaccharides were responsible for much of the benefit. LG-EPS also reduced signs of aging in artificially aged human uterine cells, improving their ability to support embryo implantation.

Further experiments suggested that the postbiotic works by modifying a signaling pathway that helps control cell growth and tissue repair. This pathway was overactive in aged mice and uterine cells, but treatment helped to normalize its activity. Blocking a key protein in the same pathway eliminated the treatment's effects.

Robles said postbiotic treatments could be especially interesting because they may be easier to manufacture than treatments containing live bacteria. "If confirmed in future studies, these treatments could potentially be used alongside IVF to improve the uterine environment before embryo transfer," he suggested.

But he cautioned that the study should not prompt people to try over-the-counter probiotics or other supplements as ad hoc fertility treatments.

"The reproductive tract is a delicate ecosystem, and introducing or eliminating certain bacteria could have unintended consequences," Robles said. "We do not fully understand what constitutes a 'healthy' uterine microbiome. As such, any intervention should be approached with caution."

This article is for informational purposes only and is not meant to offer medical advice.

The U.S. Food and Drug Administration (FDA) has approved a new seasonal flu vaccine that uses mRNA as its base.

Moderna, the vaccine's maker, announced Wednesday (Aug. 5) that a vaccine advisory committee to the FDA unanimously agreed that the shot is safe and effective for preventing illness from seasonal influenza. The shot, called mFlusiva or mRNA-1010, has been approved for people ages 50 and older.

Similar to mRNA vaccines against COVID-19, the vaccine uses the genetic molecule mRNA to encode instructions for cells in the body. In this case, it prompts the cells to build hemagglutinin (HA), a protein found on the surface of influenza viruses. Flu viruses use this protein to infiltrate human cells, and it's the same protein targeted by conventional flu vaccines. Following vaccination with mFlusiva, the immune system learns to recognize the HA protein on targeted flu strains, thereby improving its ability to block the viruses from infecting cells.

The HA protein poses a major challenge for conventional flu vaccines because it mutates very rapidly as the viruses multiply and spread — and these existing vaccines take months to manufacture. That's one reason the resulting shots aren't always a great match for the flu viruses that end up circulating in any given year. A benefit of the mRNA platform is that vaccines can be produced very quickly and thus made to better match the season's dominant strains.

mFlusiva's approval was based in part on a late-stage clinical trial involving over 40,000 people ages 50 and up who were vaccinated for the 2024-2025 Northern Hemisphere flu season. Half received the mRNA-based shot, and half received a standard dose of a conventional flu vaccine (as opposed to the higher-dose option available to older adults in the U.S.).

Of the 40,000 participants, about 970 got sick with flu, including 2% of the mRNA group and 2.8% of the standard group. That means the mRNA vaccine was 26.6% more protective than the conventional vaccine against illness from flu in this trial.

mFlusiva also offered superior protection against each of the three flu subtypes included in the vaccine. And in participants ages 65 and up, the vaccine was 27.4% more protective, overall.

More people in the mRNA group experienced side effects like injection-site pain, headache, fatigue and achiness, compared with the standard group, but these effects were mostly short-lived and mild to moderate in severity. These side effects were consistent with what was seen in earlier trials of the vaccine.

An additional trial involved a group of adults ages 65 and older and directly compared mFlusiva to an existing high-dose flu vaccine, which is approved only for older adults in the U.S. The findings suggested that the mRNA vaccine generated superior immune protection than the conventional option, based on antibody levels.

These results led the FDA advisory committee to decide that the vaccine's benefits outweigh its risks, and the agency ultimately approved it. For adults ages 50 to 64, the vaccine earned standard approval, and for adults 65 and up, it earned "accelerated approval," meaning further trials will be conducted to confirm the benefit of the shot over the high-dose option for this population.

"Flu remains a significant public health challenge, and mFLUSIVA provides an important new option for America's seniors," Moderna CEO Stéphane Bancel said in a statement.

The approval appears to mark a shift in the government's stance on mRNA vaccines.

Under the second Trump administration, the federal government has been broadly retracting its support for mRNA vaccines, directly canceling hundreds of millions of dollars in funds for research and development and indirectly sending a chilling effect through the mRNA field, experts previously told Live Science. Even Moderna has been pulling back from investments, citing opposition from the U.S. market. Health Secretary Robert F. Kennedy Jr. has repeatedly voiced his opposition to mRNA technology.

When Moderna initially filed for mFlusiva's approval in February, the FDA declined to review the application — but then changed its mind one week later. The exact motivation for this reversal was unclear to experts.

This article is for informational purposes only and is not meant to offer medical advice.

In the past 20 years, an increasing number of bacterial infections caught by children have been resistant to antibiotics, a new study finds.

The research, published in July in the journal JAMA Pediatrics, looked back at the past two decades, as well as looked forward, to predict how resistance rates might change in the decade to come. By 2035, some critical antibiotics will be met with "steep increases" in resistance among common bacteria, such as Acinetobacter baumannii and Klebsiella, the analysis found.

Antibiotic resistance contributed to 840,000 deaths among children under 5 in 2021, global estimates suggest, so if resistance continues to increase, that number could grow.

"These forecasts are warning scenarios, not inevitable outcomes," said study co-author Dr. Yanhong Jessika Hu, a clinical epidemiologist and public health researcher at Murdoch Children's Research Institute (MCRI) in Australia. "The projections broadly assume that historical patterns continue without a major change in direction," Hu told Live Science in an email.

If significant action is taken, that trajectory could be altered, she said.

"Resistance increased across all regions"

Antibiotic resistance is sometimes called "a silent pandemic," as it poses a formidable threat without stirring as much concern as other health crises, such as viral outbreaks. Resistance has gained attention in recent years, but the data on how it has affected children is patchy, said study co-author Dr. Penelope Bryant, a clinician-researcher at MCRI, Royal Children's Hospital Melbourne, and the University of Melbourne.

"It's perceived as being a lesser problem in children," Bryant told Live Science. "It's not a theoretical problem; it's real, and it's happening. But I think the visibility is just substantially less than in adults."

That's partly because many resistance-tracking efforts combine adult and pediatric data, and the adult data ends up obscuring trends in children, Hu said. "Adult findings cannot simply be applied to children because children have different infection patterns, antibiotic exposure and treatment options," she noted.

Meanwhile, studies aimed only at children tend to vary in the age groups and clinical settings they include, making direct comparisons difficult, Hu said. This lack of granularity hinders efforts to counter resistant infections in children through changes in policy or clinical protocols. Children also have fewer antibiotic options than adults do at baseline, which makes preserving those options even more important, Bryant added.

To help fill the gap, the researchers turned to the Antimicrobial Testing Leadership and Surveillance database, which contains clinical samples from children and teens ages 0 to 18 across 82 countries. These bacterial samples were collected between 2004 and 2022 from a variety of medical settings, including hospital wards, intensive care units and outpatient clinics. The included countries ranged from high-income, such as the U.K. and the U.S., to low-income, such as Malawi and Uganda.

The analysis included over 106,000 bacterial samples and assessed which antibiotics these germs were resistant to. The antibiotics were grouped based on the World Health Organization's Access, Watch, Reserve (AWaRe) system: "Access" antibiotics target few bacteria and are recommended as the first choice for most bacterial infections, "Watch" antibiotics have broader effects and should be used selectively for more-resistant infections, and "Reserve" antibiotics are considered last-resort options to use when all alternatives have failed.

"Resistance increased across all regions, showing that this is not only a problem in lower-income countries," Hu said. "However, the highest resistance levels and some of the steepest increases were seen in lower-resource settings."

A wake-up call

Part of the analysis zoomed in on eight bacteria that are considered "critical" or "high" priority by the WHO, meaning they impose a particularly high healthcare burden due to their resistance. Across these germs, resistance rates were similar across high- and low-income countries in 2004, but those trends diverged by 2022.

Overall, resistance to Access antibiotics declined across the study period, but that improvement wasn't the same across all settings. In high-resource countries, resistance to Access drugs fell from 48% to 29% among the eight bacteria, while it rose slightly — from 44% to 47% — in low-income settings. These percentages correspond to the number of bacterial samples from each year that showed resistance to at least one Access drug.

The decline seen in some countries is "almost certainly because of the large investment that high-income countries have put into controlling MRSA," Bryant said, referencing methicillin-resistant Staphylococcus aureus. MRSA can cause painful skin infections as well as life-threatening complications, like sepsis.

Modeling future trends, the team predicts that resistance to Access antibiotics will stabilize or decline across most regions by 2035. However, resistance against Watch antibiotics rose between 2004 and 2022 and is projected to continue increasing. Among the eight critical and high-priority bacteria, it rose from 14% to 24% in high-income countries and from 16% to 48% in low-income nations.

Resistance to Reserve drugs also increased among these germs, rising from 9% to 25% in high-income countries and from 4% to 37% in low-income ones.

While the model predicted "steep increases" in Watch resistance, it projected slower increases in Reserve resistance over the next decade, by comparison. These trends were driven largely by increases in low-income settings, but high-income settings were not spared.

"With low-income countries, the problem is amplified because of poor sanitation and because of unregulated access to antibiotics," Bryant noted. Easy access to over-the-counter antibiotics makes it more likely for the medicines to be misused, which ultimately pressures more bacteria to evolve resistance.

This analysis gives a snapshot of how antibiotic resistance is affecting kids now and how it might do so in the future. However, the data it's based on has some limitations. For instance, the samples collected from each country aren't necessarily representative of the entire nation; they came from only certain participating medical centers and each country contributed different numbers and types of samples. So "the results should therefore not be interpreted as precise national prevalence estimates," Hu cautioned.

"But it's the first large dataset, really, to look specifically at children," Bryant said. And "it gives us an idea that things are getting worse."

The team has made their analysis freely available to other researchers on the website AMR in Kids, where "AMR" stands for antimicrobial resistance. Future steps include surveying resistant infections in children in a more representative way, as well as modeling how different intervention strategies could help drive down the rates.

"I'm hopeful that this is a little bit of a sort of wake-up call around children, that it really isn't a problem just in adults," Bryant said.

This article is for informational purposes only and is not meant to offer medical advice.

The patient: A 60-year-old man in Seattle

The symptoms: The man experienced paranoia, as well as auditory and visual hallucinations. He was also very thirsty but was fearful of drinking water that others offered to him.

What happened next: The man went to an emergency department because he was worried that his neighbor poisoned him. Doctors checked his vital signs and conducted a neurological examination, which did not highlight any immediate concerns.

That changed when blood tests revealed that his level of chloride ions — charged particles of the element chlorine — were above the normal range. This result suggested that the patient may have been suffering from hyperchloremia, a condition in which chloride ions build up in the blood. This usually occurs in people who are dehydrated or consume too much salt.

However, when doctors measured the concentration of other ions in the patient's blood, they realized that this initial interpretation was wrong.

In patients with hyperchloremia, the body cancels out the increase in negatively charged chloride ions by depleting negatively charged bicarbonate ions, which the body makes itself. In essence, the body tries to regulate the electrical balance of the blood.

However, in the man's case, tests revealed that his blood was too negatively charged overall. The most likely explanation was that a negatively charged poison had built up too fast for his body to buffer the change by depleting other ions.

The diagnosis: The man's doctors consulted the poison control department and figured out that he was experiencing a case of pseudohyperchloremia, a condition in which the lab test for chloride erroneously detects another negatively charged ion. This makes it seem like a patient's chloride is too high while masking the actual problem.

A common culprit behind this phenomenon is a high dose of salicylate (aspirin), but the patient didn't have high levels of this pain reliever in his blood.

The next suspect, and the more unusual one, was the poison bromide, a charged form of bromine. Bromine sits just below chlorine on the periodic table, meaning their ions share similar chemical properties, such as charge and size, and bromide has triggered the lab test for chloride in previous reports.

When the doctors measured the patient's bromide levels, they found that they were roughly 230 times higher than the normal range. They diagnosed him with bromide poisoning, also called bromism, which can cause neurological symptoms such as hallucinations and paranoia.

The treatment: The patient remained in a hospital bed for three weeks so doctors could monitor and replenish his electrolytes. On account of his paranoia, he tried to escape from the hospital, so the doctors had to hold him there involuntarily. They gave him daily doses of risperidone, an antipsychotic medication.

His symptoms improved, and he was weaned off medication and ultimately discharged. His condition remained stable during a follow-up assessment two weeks later.

What makes the case unique: After his condition improved, the patient informed the doctors that he had searched for a healthier alternative to table salt (sodium chloride) and had consulted ChatGPT for advice. The chatbot suggested he swap sodium chloride with sodium bromide, and he experimented with that suggestion for three months.

Medicines containing bromide salts used to be popular for treating various conditions, such as headache or upset stomach. These medications fell out of common use when doctors realized that bromide accounted for 8% of admissions to psychiatric hospitals in the early 20th century.

Because it is similar in size and charge to chloride, bromide can fill in for chloride's roles in the body — and that's a problem. For example, chloride contributes to the brain's electrical activity by passing through chloride channels in neurons. Bromide can also move through these channels and thus disrupt normal brain activity, bringing about neurological symptoms.

Bromide poisoning is rare nowadays, so doctors don't typically assume that their patients experiencing paranoia or hallucinations could have this form of poisoning. However, bromide supplements can be easily purchased online, opening the door to such cases, the doctors wrote in a report of the case.

The man's doctors wanted to see whether ChatGPT would again point to bromide salts if asked the same question. They prompted the chatbot with queries about ways to remove chloride ions from the diet, and once again, the bot suggested bromide salt as an alternative. This response didn't provide a health warning about the dangers of consuming too much bromide.

Given the willingness of chatbots to recommend bromide salts, the doctors argued in the report that it would be prudent to more seriously consider the possibility of bromism during psychological evaluations. This case highlights the dangers of relying on AI chatbots for medical advice, the doctors concluded.

Live Science contacted OpenAI, the developer of ChatGPT, about this case and is awaiting comment. According to the service terms at OpenAI, "You should always verify the information provided by ChatGPT for Healthcare and exercise independent professional judgment in decision-making about a patient without relying primarily or solely on the output."

(Live Science first covered this case when it was published in 2025, and at that time, an OpenAI spokesperson said that the company's safety teams were working to reduce the risk of using its services and to train its products to prompt users to seek professional advice.)

This article is for informational purposes only and is not meant to offer medical advice.

Can you guess the diagnosis in these strange medical cases? Find out with our diagnostic dilemma quiz!

One winter night in 2011, pediatrician Dr. Masahiko Sakamoto met two parents and a feverish infant who would shape the course of his career.

Sakamoto was working at a rural hospital in Japan's Fukushima prefecture, roughly 160 miles (260 kilometers) northeast of Tokyo. Around midnight, as a heavy snowfall coated the ground outside, two parents arrived with their young child. The infant had a mild fever but was otherwise in good shape, Sakamoto determined. There were no signs of an emergency that warranted a doctor's attention.

Then, Sakamoto learned that the parents had driven 1.5 hours from a small mountain village to reach the hospital.

"Driving a car, with such snow accumulated on the road ‪—‬ that's a very risky behavior," Sakamoto said. He told me he was shocked by the "imbalance" between the infant's mild case and the parents' decision to make a three-hour round trip on dangerous roads out of concern that their child might need emergency medical care.

The experience alerted Sakamoto to a broader pattern: Parents with a limited understanding of childhood illnesses can become especially anxious when their child gets sick and end up seeking unnecessary medical care. Pediatricians in both Japan and the U.S. have described a similar trend to me in the context of antibiotics; parents sometimes request antibiotics that aren't needed, in part because they believe the drugs will alleviate their child's suffering.

Many doctors make the effort to explain the basics of childhood illnesses and appropriate antibiotic use to children's caregivers. But given that they're pressed for time and those conversations can be tricky to navigate, doctors told me that it would be helpful if parents came to appointments equipped with that information. Since that snowy night, Sakamoto has made it his mission to help educate parents about childhood illnesses before they arrive at a medical facility.

"What I am currently most interested in as a pediatrician," he said, "is how to provide accurate medical information to the parents or guardians of the children."

Building a pocket-size doctor

By the time parents arrive at a doctor's office or hospital, the chance to avert an unnecessary visit has been missed, Sakamoto recognized. So he wanted to help give caregivers the information needed to weigh whether a visit is necessary. He hoped to relay which symptoms of serious disease should prompt medical intervention and teach them appropriate at-home care for mild symptoms.

He started giving public lectures on these topics. Later, he wrote manuals of childhood illness, featuring adorable illustrations and plain-language explanations. In 2016, those manuals went digital. The free "Oshiete! Doctor" app, whose name translates to "Teach me! Doctor," has been downloaded more than 500,000 times in Japan, with approximately 100,000 active users, Sakamoto told me.

"It's quite famous around here," Risa*, a mother of two in Saku, Japan, said of the app. Sakamoto now works at Saku Central Hospital, and the city provides funding for the app's operation and promotes its use at health centers and events aimed at children and their caregivers.

"As a parent, I'm really grateful to have something like that — a resource that makes it easy to access information — right at my fingertips," said Rie Shinohara, another mother of two in Saku.

The app's content gets updated annually and applies to children and teens up to about 15 years old. It provides information on hygiene, immunization schedules and disaster preparedness, such as how to care for kids' health while evacuating for a natural disaster. (The team translated the app's disaster preparedness content for caregivers affected by the war in Ukraine.)

The app also includes guidance on when children should visit a hospital and explanations of common childhood illnesses and injuries, such as what medications might reasonably be prescribed and how to manage mild symptoms at home.

For similar help with differentiating emergencies from minor ailments, parents in Japan can also look to online resources from The Japan Pediatric Society, or call #8000, a hotline that gives caregivers advice about whether to bring their child to a hospital. Japan's Ministry of Health, Labour and Welfare has recognized the "Oshiete! Doctor" app as a helpful complement to its national #8000 hotline and also awarded the app's developers for its design and impact.

Sakamoto and colleagues have studied the app's impact on caregivers. For instance, they've found evidence that app users utilize the emergency department more appropriately than nonusers do. In that study, 87% of users said the app made it easier to decide whether to visit the hospital, and 94% said they'd recommend it to others.

Challenges of educating parents

The team has also studied how the app's users feel about fever — the symptom that compelled the infant's parents to drive on snow-laden roads that night.

"The phenomenon known as 'fever phobia' among parents has long been recognized, and it is not unique to Japan," Sakamoto said. Notably, the American Academy of Pediatrics offers similar guidance to the "Oshiete! Doctor" app regarding fever, emphasizing that the symptom doesn't always require medical care and giving tips for when a doctor should be called.

Parents' worries about pediatric fever can be outsize compared with the threat it poses. Most fevers in kids are caused by viral infections that go away on their own, Sakamoto said, but caregivers can be compelled to seek care because they're concerned about fever triggering seizures or brain damage. This is especially true of first-time parents and parents with other children who'd had febrile seizures in the past, he added.

"With the first child, you just don't know. Why does he have a fever?" Shinohara noted. Of her firstborn, she added, "I probably took him to the doctor more often than necessary." But by her second, she felt she developed a better sense of when to seek medical care. Sakamoto's hope is that his app can help fill that information gap sooner.

In a survey-based study, Sakamoto and colleagues polled hundreds of caregivers in Saku about their understanding of fever, taking stock of which parents had downloaded "Oshiete! Doctor." Between 2017 and 2024, a greater proportion of parents understood that fever alone does not necessarily mean a child needs medical care. Plus, a lower percentage of parents thought that antibiotics are always needed to treat fever. On the latter point, users of the app were most likely to answer correctly, although nonusers also improved between the two survey years.

Sakamoto credits some of that improvement to the incentive offered to pediatricians to avoid unnecessary antibiotics, which requires that doctors explain appropriate antibiotic use to caregivers. He thinks the message is likely more powerful for parents when it comes from their pediatrician, rather than government information campaigns. That said, Sakamoto emphasized that it's important to have strong educational materials available to help support doctors' explanations to parents.

Despite these improvements, Sakamoto also observed that parental anxiety about fever complications increased between the two survey years — although, notably, the COVID-19 pandemic took place in that time frame, which could be a piece of the puzzle.

"Their knowledge about fever, how to manage fever, and also the appropriate use of antibiotics was enhanced, whereas the fear about the children's fevers worsened," Sakamoto said. "Even when knowledge improves, emotional anxiety does not easily disappear; this is one of the challenges of public education."

Other challenges include the rising use of AI chatbots among parents, Sakamoto noted. He's encountered parents whose anxiety was triggered by erroneous information from a chatbot that suggested their child's prognosis was worse than it was, for instance. "It is rather rare to see that the parents have holistically accurate information from AI," he told me.

If he can secure more funding for "Oshiete! Doctor," Sakamoto hopes to someday make the app multilingual. In the long run, he remains committed to providing parents with this vetted information to both alleviate their worries and optimize their use of the healthcare system.

"We have the responsibility to check how the information is delivered to the parents or guardians and how it leads to behavioral changes," Sakamoto said. "So it is not just us disseminating information but whether or not it is truly received."

Editor's note: Risa (marked with an asterisk) asked that only her first name be used for privacy.

This article is for informational purposes only and is not meant to offer medical advice.

Editor's note: This is a developing story and may be updated.

Michigan has reported two deaths in its ongoing Cyclospora outbreak, a wave of parasitic infections that has affected over 11,000 people in the state.

Since early May, 193 people in Michigan have been hospitalized with cases of Cyclospora cayetanensis infection, called cyclosporiasis. The parasite can enter the body when someone consumes food or water contaminated with the organism, and the cases in Michigan have been linked to iceberg lettuce sourced from central Mexico.

These two deaths are the first reported in the Michigan outbreak, as well as the first deaths documented in any of the ongoing Cyclospora outbreaks in the United States.

Multiple outbreaks have been detected in the country in recent months, but not all have been linked to a specific source of exposure, such as lettuce. Since May, the Centers for Disease Control and Prevention has confirmed over 6,700 cases of cyclosporiasis acquired within the U.S. (In some states, case counts are typical of what's usually seen this time of year, while in others, case counts are higher than normal.)

Regarding the deaths in Michigan, "according to medical records, both individuals had significant underlying health conditions that may have been impacted by cyclosporiasis and dehydration," the state's Department of Health and Human Services (HHS) said in a statement. "No additional information will be provided on these two cases."

Cases of cyclosporiasis range from mild to severe, with severe cases being more likely in young children, older adults, and people with weakened immune systems. Symptoms include loss of appetite, fatigue, low-grade fever, vomiting and diarrhea. The infection is treated with antibiotics, which block the parasite's ability to multiply.

In mild cases, the infection can sometimes resolve on its own, but without treatment, the symptoms can linger for over a month. Severe and prolonged infections can raise the risk of dehydration due to vomiting and diarrhea. Severe dehydration can then cause various complications, such as electrolyte imbalances and hypovolemia (severe fluid loss).

While these complications can be dangerous — causing kidney failure or shock, for instance — cyclosporiasis is not usually life-threatening. For instance, over 2,200 cases were reported in the U.S. between 2011 and 2015, but there were no associated deaths.

"Death resulting from cyclosporiasis is uncommon in the United States," Michigan HHS representatives noted in the statement.

This article is for informational purposes only and is not meant to offer medical advice.

A poop transplant — otherwise known as a fecal microbiota transplant (FMT) — may help adults with long-term insomnia sleep better, a small study suggests.

After the transplant, study participants' gut bacteria became more diverse than an untreated group of people with insomnia. Their sleep efficiency, meaning the percentage of time they spent asleep while in bed, also increased, researchers reported July 22 in the Journal of Internal Medicine.

If future studies confirm that FMT is safe and effective for the treatment of insomnia, it could become another tool against the sleep disorder, joining sleeping pills and cognitive behavioral therapy (CBT).

The findings "are aligned with a recent body of work over the last five years indicating that the gut microbiome may play a role in sleep-wake regulation," said Dr. David Gozal, a pediatric sleep specialist at Marshall University in West Virginia who wasn't involved in this study.

However, "these results should be regarded as promising proof-of-concept evidence rather than confirmation that FMT is ready for routine treatment of insomnia," Kenji Hashimoto, a forensic mental health researcher at Chiba University in China who wasn't involved with the study, told Live Science in an email.

Improving sleep with "poop pills"

The study included 80 adult women and men with chronic insomnia from seven hospitals in China; the participants did not have other health problems, such as migraine or obstructive sleep apnea, that could interfere with the results.

Half of the participants took antibiotics for two days to clear out some of their existing gut bacteria. Then, they swallowed 60 FMT capsules chockfull of gut bacteria from healthy donors who had been confirmed to be good sleepers. These bacteria were isolated from fecal samples from the donors. Two weeks later, this group took a booster dose of 20 capsules.

The other half of the participants instead took placebo pills in place of the antibiotics and FMT capsules.

The researchers used an overnight sleep assessment called a polysomnography, which records brain waves, eye movements, heart rate, oxygen levels and breathing patterns, to assess the participants. The results showed that sleep efficiency in the FMT group jumped from 79% before the transplant to 93% one month after treatment, on average. The placebo group's sleep efficiency barely changed, shifting from about 85% to 87%.

Additionally, the treated group woke up less throughout the night. Their time spent awake after initially falling asleep fell from 79 to 17 minutes, while the same metric increased from 37 to 42 minutes in the placebo group.

On questionnaires, the FMT group continued reporting better sleep from two all the way to six months after treatment.

It is "encouraging" that FMT treatment seemed to improve sleep not only on objective tests, but also in how the participants themselves rated their insomnia, added Harriët Schellekens, a neuroscientist and microbiome researcher at University College Cork in Ireland, who wasn't involved in the work.

Gut-sleep connection

The results also suggest that the treatment is safe. In the FMT group, only three out of 40 participants had side effects, and they were mild, such as nausea and transient fever.

However, experts noted several caveats. The trial was small and limited to relatively healthy adults in China, so the results may not apply broadly. Sleep was measured only once after treatment, at the one‑month mark, Hashimoto said. And because the treatment combined antibiotics with FMT, it's unclear how much of the benefit came from the donor microbes alone, Schellekens and Hashimoto noted.

Hashimoto added that the study focused exclusively on the gut microbiota. "Microbial communities in other body sites, particularly the oral and nasal cavities, may also influence sleep regulation through immune, metabolic, and neural pathways and through oral-gut-brain or nasal-gut-brain communication," he said.

The gut and brain communicate in various ways, including via chemicals made by gut microbes that travel to the brain via the bloodstream, Hashimoto explained. These chemicals may steer inflammation, stress responses and the body's sleep-wake control.

Shifts in certain microbes can alter these gut chemicals and gut barrier function in ways that ripple out to the brain and change sleep patterns, Gozal said. Conversely, disrupted sleep can reshape the microbiome. "The question is, what came first?" he said — a disordered microbiome driving insomnia, or insomnia reshaping the microbiome and worsening symptoms.

In the study, the mix of gut microbes in the FMT group shifted between the start and end of the study, but the placebo group's microbiomes stayed the same. Several types of bacteria became more abundant after FMT, while others decreased, suggesting that FMT reshapes the gut microbiome.

Not everyone responded to the treatment, and they mostly differed in what their gut microbiota looked like before FMT, not after. That suggests that a person's initial microbial makeup may help determine how well they respond to the treatment.

Gozal said he would have liked the study to measure the chemicals made by gut microbes before treatment and then show how those same chemicals changed after FMT.

More research is needed to understand the biological mechanisms underlying the improvements, Schellekens said. For now, "FMT remains an experimental approach for insomnia and is not something that should be used outside carefully controlled clinical studies."

The study's researchers did not respond to a request for comment by the time of publication.

This article is for informational purposes only and is not meant to offer medical advice.

How much do you know about sleep and dreams? Find out with our sleep quiz!

LONDON — In the packed halls of the recent Alzheimer's Association International Conference in mid-July, over 10,000 experts in brain research discussed strategies to beat dementia. But in one room, attendees gathered to watch a video from a nonscientist named Isabel Beltre, whose life was transformed by a recent trial.

Beltre was one of 1,200 participants ages 60 to 77 who took part in the Latin American Initiative for Lifestyle Intervention to Prevent Cognitive Decline (LatAm-FINGERS), the first trial to test a culturally adapted lifestyle intervention to prevent cognitive decline in Latin America. Rather than attempting to treat dementia after it has developed, the trial tackled risk factors that raise the likelihood of the condition, like smoking and a sedentary lifestyle.

In her native Spanish, Beltre thanked both God and the project for its impact on her life. There was a celebratory air in the conference room as the trial's results were released. The lifestyle interventions, which included exercise programs and brain training, had statistically improved participants' thinking skills, compared with a control group who received only bare-bones support, like general health advice.

Trials like LatAm-FINGERS — including a related U.S.-based trial called the POINTER study — ultimately aim to cut rates of dementia around the world. The LatAm trial is the most successful of these trials to date, raising hopes that this approach could help to prevent dementia en masse.

Whether that promise pans out remains to be seen, though, experts told Live Science.

The lifestyle factors that increase dementia risk

When it comes to dementia prevention, few guidelines are as influential as those written by the Lancet Commission, an expert-led review of the available evidence on dementia. Three editions of this review have provided comprehensive overviews of risk factors; the most recent, published in 2024, identified 14 factors, including smoking, infrequent social contact, and a lack of physical activity.

The commission estimated that, together, the identified risk factors contribute to 45% of dementia cases at a population level.

Long before the 2024 report, Dr. Miia Kivipelto, a professor of clinical geriatrics at the Karolinska Institute in Sweden, wanted to tackle these risk factors at the individual and population level in her work as a medical doctor and epidemiologist.

"I felt that I wanted to move on to interventions to really show that if you do something, you can change the risk," Kivipelto told Live Science.

The many contributing factors that lead to cognitive decline, and ultimately dementia, couldn't be tackled in isolation, Kivipelto realized. She designed a trial in her native Finland, called the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) study, that would aim to tackle many risks simultaneously.

The two-year project recruited 1,260 participants ages 60 to 77 and divided them into two groups. The first group received general health advice, such as tips on healthy eating and exercise, at the start of the study and then again after six and 12 months.

The other group additionally received a multipart intervention consisting of meetings with nutritionists to discuss personalized meal plans, brain training, exercise programs, social activities, and metabolic and vascular tests. These programs lasted throughout the study period, with the brain training alone including 144 sessions over 12 months of the study.

At the end, the two groups' cognitive skills, such as thinking speed and memory, were tested; the trial did not track dementia rates, only overall cognition. In both groups, these skills improved by the end of the study. But the headline finding was that in the group given the comprehensive intervention, overall brain function was judged to be 25% stronger than in the control group.

What did that difference mean in concrete terms? It turns out, the improvement was relatively small.

It was calculated in terms of a statistical measure called a z-score, which represented the extent of the improvement in brain-function test scores in each group. In the end, the difference in z-scores between the two groups was just 0.04 points, which a 2021 review defined as "small."

However, Kivipelto maintained that the improvement is significant. "It's as big as anti-amyloid treatments," she said.

Several drugs approved by the U.S Food and Drug Administration for the treatment of Alzheimer's disease target amyloid, a protein that forms unruly tangles in the brain. These drugs have been reported to marginally slow the disease's progression, but statistically, their overall effect is small.

Targeting those most at risk of dementia

Despite criticism of the trial's moderate effects, Kivipelto's FINGER intervention has since been repeated all over the world, including by the U.S.-based POINTER study, and, most recently, LatAm-FINGERS.

Dr. Gill Livingston, a psychiatrist at University College London who led the 2024 Lancet Commission report, told Live Science that the data from these trials shows that dementia interventions need to be tailored to the risks the participants actually face.

In the POINTER study, 70% of the participants had a college degree, compared with roughly 43% of the wider U.S. population. "People who are usually in randomized controlled trials are usually highly educated people who are very interested in health," Livingston noted. "And that means they're at less risk of developing dementia, and therefore, less can be done to help them" through lifestyle interventions.

The difference between the test group and the control group in the POINTER study was even smaller than in the original FINGER trial — just 0.029 points.

LatAm-FINGERS tried to maximize flexibility in its approach by better tailoring its interventions to its study participants, said study first author Dr. Lucía Crivelli, a neuropsychologist at the neurology center FLENI in Argentina. Dietary advice reflected the produce available in each region. Exercise programs considered local environmental factors; for example, sessions were held outside, avoiding hot gyms during the sweltering summers in Ecuador and Mexico.

The trial recruited volunteers across Argentina, Brazil, Bolivia, Chile, Colombia, Costa Rica, Ecuador, Mexico, Peru, Puerto Rico, the Dominican Republic and Uruguay. The participants were less highly educated than the POINTER cohort had been; 37% had no education beyond a high school diploma, compared to just 5% in the POINTER study. That likely made the study participants more representative of people who might benefit from the trial's interventions.

When Crivelli announced the results of the trial at the conference, a large cheer filled the room. The intervention had achieved a difference of 0.11 points between the test and control groups' z-scores — more than twice the difference seen in the FINGER trial.

That difference corresponded to a relative 55% improvement in overall brain function in the test group compared to the control group at the end of the study.

What made the difference?

Crivelli, Kivipelto and Livingston all pointed to one key factor in explaining the project's relative success. "In Latin America, there are more modifiable risk factors," Kivipelto summarized.

The study participants had lower academic attainment and higher cardiometabolic risk factors, such as high BMI, than the participants in previous studies. The trial had reaped the rewards of delivering the intervention to people who needed it most, experts concluded.

But the approach wasn't perfect. said Dr. Claudia Suemoto, a neuroscientist at the University of São Paulo who presented a detailed breakdown of the trial's results. They found that the intervention didn't improve men's overall cognitive ability, compared with the control group. Only women benefited.

The difference may be that men simply didn't engage in the trial as much as women did, Suemoto's data suggested. Livingston pointed to the trials' exercise classes as an example of an activity that men may not be as likely to participate in, although that's an assumption rather than being based on the trial data.

Can we really prevent dementia?

The LatAm-FINGERS results show that addressing the dementia risk factors that people face is the most effective way to prevent dementia, Livingston said.

And Livingston is leaning into the idea. She's planning a dementia prevention trial in the U.K. that will ask participants about their risk factors and then give them tailored interventions based on the risks they can realistically avoid.

"We ask them to choose which ones they want," Livingston said. "If somebody doesn't want to stop drinking or smoking, then they're not going to."

While LatAm-FINGERS has been the most successful of the FINGER trials to date, it's still unclear whether such projects actually reduce dementia rates.

Only two previous prevention trials have attempted to measure dementia incidence, and neither saw a notable change in their test group. That said, neither trial included cognitive training interventions like FINGER did; they instead focused on cardiovascular risk factors, such as low exercise rates and high body weight.

Measuring changes in dementia rates requires trials much longer than two years, and they also need massive recruitment. Implementing an intensive study like LatAM-FINGERS in the wider community "is not practical," Crivelli said. Instead, she said the study's interventions would need to be distilled into their essential parts so that they could be implemented at scale.

Kivipelto is optimistic that advances in Alzheimer's screening, including new blood-based tests, could provide an early biological measure to show that FINGERS-style interventions can help stave off dementia. This would be an indirect measure but wouldn't require as long a trial as tracking dementia rates.

Some of the risk factors the Lancet Commission identified, like air pollution, can't be modified at an individual level, Livingston noted. A combination of personal and governmental change could address this, she said, as it has in the realm of infectious-disease prevention.

While the scientific field still has uncertainty about the scale of change that trials like FINGERS can bring about, Beltre has little doubt about the trial's impact.

While she previously relied on help from family members like her grandson to complete everyday activities, she said, "I do everything myself now."

This article is for informational purposes only and is not meant to offer medical advice.

See how much you know about the most complex organ in the human body with our brain quiz!

LONDON ‪—‬ New blood tests for Alzheimer's disease aim to catch the condition in its earliest stages. Scientists hope that, someday, by spotting very early signs of dementia and enabling earlier treatments, these tests could significantly improve patients' prognoses.

But how well do current blood tests work for that purpose?

At the Alzheimer's Association International Conference in London on July 12-15, Live Science spoke with researchers and clinicians who study and use blood tests for Alzheimer's disease. Here's their take on the current state of these tests and their practicality for real-world use

Scientists' big hopes for the tests

People diagnosed with Alzheimer's disease face an incurable condition, but their outlook is marginally more hopeful than it was 10 years ago. That's because the first "disease-modifying" drugs for Alzheimer's, which target the disease's causes rather than its symptoms, have been approved in recent years.

These drugs, which include the lab-made antibodies lecanemab and donanemab, only slow, rather than stop, the progression of the disease. However, researchers hope these medicines could be the precursors to more effective treatments.

Alzheimer's disease researchers hotly debate the exact causes of the condition, but they are united on the idea that early intervention is likely to produce the best possible outcome for patients. The aim is to remove disease-linked proteins before they can damage the brain.

That's why new blood tests for Alzheimer's disease, some of which have been approved in the past year, are exciting so many scientists. These tests, which measure chemical signals of the disease circulating through the bloodstream, are currently paired with other clinical exams to provide an accurate Alzheimer's diagnosis for patients with early symptoms, such as subtle changes to memory or personality.

The hope is that if these patients could be identified at this stage, they could access clinical trials and treatments when they might be the most helpful.

What do Alzheimer's blood tests measure?

The U.S. Food and Drug Administration (FDA) has approved two blood tests for Alzheimer's disease: Roche's Elecsys pTau181 assay and Fujirebio's Lumipulse G pTau217/ß-Amyloid 1-42 Plasma Ratio test.

An additional test from Roche (the Elecsys pTau217 test) has received a basic safety certification in the European Union and U.K., which allows it to be sold but is not equivalent to FDA approval. This test is not approved in the U.S. yet. A second test from Fujirebio (the Lumipulse G pTau 217 Plasma assay) is in the same boat.

Plus, there are a host of other tests made in specific clinical laboratories; these are not FDA-approved but they are available in certain specialist clinics.

All of these tests in varying stages of approval measure "a core part of the pathology of Alzheimer's disease in the brain," said Dr. Sebastian Palmqvist, a clinical neurologist at Lund University in Sweden. These include two proteins that build up in the brains of Alzheimer's patients: tau and amyloid.

The Elecsys tests and the FDA-approved Lumipulse test measure levels of tau in the blood, while the other Lumipulse test measures the ratio of tau to amyloid. Both measurements can be used to indirectly assess the presence of amyloid plaques, sticky deposits in the brain that are associated with the disease's progression.

It's important to note that the blood tests alone aren't diagnostics for Alzheimer's disease, said Dr. Jemma Hazan, an old-age psychiatrist at University College London. Instead, "the test is telling you whether you have certain abnormal proteins in your brain." This, she said, makes it important to use the test in a setting where patients can be properly directed to the next steps of diagnosis and treatment.

How are Alzheimer's disease blood tests used?

Currently in the U.S., Alzheimer's blood tests are approved for use only for adults ages 55 and older who have signs of cognitive impairment, like memory problems. Palmqvist said these tests are best used by specialists with knowledge of dementia, such as doctors in memory clinics. They aren't approved for use by primary care doctors in the U.S.

"The clinicians working there [at memory clinics] have many, many years of experience of interpreting these types of biomarkers," he explained.

Before the advent of these blood tests, memory clinics had to rely solely on expensive brain scanning technology or invasive lumbar punctures to identify physical signs of Alzheimer's disease. The new tests greatly simplify diagnosis, Palmqvist said, but they still need to be used in combination with other tests.

So currently, if a patient receives a positive blood test, they must undergo further cognitive testing, brain scans or invasive biomarker analyses to confirm the diagnosis.

While for now the blood tests are best used by specialists, data that Palmqvist presented at the conference suggested that access to a blood test result may improve a primary care physician’s diagnostic accuracy to levels closer to a memory clinic specialist's. That hints that the test may eventually be usable in primary care, without more invasive diagnostics.

How well do the approved Alzheimer's tests work?

In clinical trials, the approved Lumipulse test had a sensitivity of 97.6% and a specificity of 90.8%. Sensitivity refers to the percentage of people who do have amyloid in their brains that test positive — so it's the rate of true positives. Specificity refers to the percentage of healthy people who test negative, meaning true negatives.

However, the test was recalled in February because it returned an unusually high percentage of false-positive results when it was used in the real world, compared to clinical trials. Palmqvist said there's now a newer version of the same test that avoids this problem.

Analyses comparing pTau217 and pTau181, the two tau biomarkers that Roche uses in its tests, have concluded that pTau217 is a more accurate indicator of Alzheimer's disease. That means it more closely matches results from gold-standard amyloid brain scans.

Dr. Ashton Harper, global medical affairs lead for neurosciences at Roche Diagnostics, said the Roche pTau217 test correctly spotted Alzheimer's-linked proteins 96.1% of the time and accurately ruled out that pathology 94.7% of the time in trials. By comparison, pTau181 — the Roche test approved in the U.S. — correctly identified Alzheimer's pathology 83.6% of the time and ruled out pathology in healthy brains 72.2% of the time.

Patients who take this more-accurate test are given one of three possible results based on two cutoff points, Harper said. If their tau level comes back above the upper cutoff — giving a positive result — clinicians can be "highly certain" that the patient has disease-linked amyloid in their brain, he said.

Below the lower of the two cutoffs, clinicians can be confident that their patient doesn't have any disease-linked amyloid in their brain. If the reading comes back in between the two cutoffs, though, the result is uncertain.

Current guidelines set by the Alzheimer’s Association require that patients end up in that gray area no more than 20% of the time, and the pTau217 test meets that requirement, Harper said. As with patients who get a positive test result, patients who receive these uncertain results are also advised to undergo further testing, such as scans or cognitive tests.

There are other reasons a person without Alzheimer's disease might get a positive test result; rare cases of severe kidney disease, for example, can artificially inflate the test's readings.

Harper said early data suggests that Roche's pTau217 test is roughly as accurate at detecting Alzheimer's disease proteins in cognitively unimpaired people as it is in those with symptoms. This may someday open the door to prevent Alzheimer's in patients who have not yet developed symptoms, he suggested, clarifying that Roche's test is not intended for that use yet.

How do Alzheimer's tests actually affect patients' care?

In the U.S., these tests can help patients get a diagnosis more quickly, but treatment options for the condition remain limited.

The approved antibody drugs are available through both private and government insurers, but they still cost the patient thousands of dollars each month. And again, these drugs only slow, rather than stop, the progression of the disease.

Researchers hope that early treatment with the drugs will enhance their effectiveness, but as of yet, there's no published data to back this idea up.

In the U.K., disease-modifying drugs like the antibodies have not been approved by the U.K.'s National Health Service (NHS) yet. Because the drugs only modestly slow Alzheimer's progression, ultimately, the NHS determined that they were too costly to cover without clearer signs of efficacy. That means British patients cannot access the drug for free.

Still, Hazan said a positive test could be beneficial for patients.

"Diagnostic accuracy is important in its own right so that people feel more certain about the diagnosis and also there are management implications," Hazan said. While they can't access antibody drugs, patients do have access to drugs that help ease the condition's cognitive and behavioral symptoms, as well as non-pharmacological treatments like behavior management.

Diagnosed patients can also access one of the many clinical trials for the condition. It's estimated that 50,000 patients are needed to populate these ongoing trials worldwide.

Hazan and Palmqvist agreed that, despite the blood tests' accuracy, they should not be used to preventively screen for Alzheimer's in people with no symptoms. That's because testing in a wider population, where fewer people will have Alzheimer's disease, naturally increases the number of false-positive results, even while the assay itself retains the same level of accuracy. This could lead many healthy people to be incorrectly diagnosed with Alzheimer's disease, which would cause stress for patients and have significant financial implications for healthcare systems.

Newer tests that are still in development may help reduce the likelihood of false positives by measuring only a subset of tau protein that comes directly from the brain rather than from the rest of the body, Palmqvist said. But for now, mass screening remains a goal, rather than a reality, for these blood-based Alzheimer's diagnostics.

"I think that's the next frontier," Palmqvist said.

This article is for informational purposes only and is not meant to offer medical advice.

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Bats have long posed an immunological mystery: They can harbor viruses that cause severe diseases in other animals, including humans, yet they rarely show signs of illness. Now, scientists have discovered a big clue as to why that is.

Researchers uncovered an unusual feature of bat immunity that could help to explain how these mammals evade infections. Vesper bats, the world's largest family of bats, may possess two separate genetic systems for producing the building blocks of antibodies, the immune proteins that latch onto germs. This configuration has never been found before in mammals.

"It was really surprising," study co-author Hannah Frank, an associate professor of ecology and evolutionary biology at Tulane University, told Live Science. "The only other vertebrates we see something similar in are fish."

The findings, published Wednesday (July 29) in the journal Science Advances, could open new avenues for studying viral infections and the evolution of immunity.

"The study provides a novel view into the evolution and diversity of adaptive immunity in bats," said Daniel Becker, an associate professor of biology at the University of Oklahoma who was not involved in the study. "The duplication seen in vesper bats is really intriguing and suggests that we need more immunological study of this globally distributed family of bats," Becker told Live Science in an email.

'More diversity in their antibodies'

Antibodies are Y-shaped proteins that help the immune system recognize and neutralize foreign invaders, including viruses, as well as other threats, like toxins. Each antibody contains two "heavy chains" and two "light chains," structures that work together to recognize and bind to specific features of viruses, bacteria or other targets.

The tips of the Y shape are responsible for recognizing the targets, while other parts of the antibody help determine how the immune system responds — by blocking pathogens from infecting cells or flagging them for destruction by other immune cells, for instance.

In humans and most other mammals, the genes that build antibody heavy chains are organized into a single region of the genome, called a locus. Cells create a wide range of antibodies by mixing and matching the proteins encoded in different segments of that locus.

But when Frank and her team examined 26 bat species, they found two complete heavy-chain loci located on different chromosomes. The team then showed that both sets of genes were functional and actively used by immune cells to build antibodies. The finding was initially surprising enough that the researchers considered whether it could be an error in how they'd assembled the bats' genomes after sequencing them.

However, Frank's collaborator and former graduate student Dr. Taylor Pursell thought the finding might be genuine, rather than an experimental fluke.

"She said, 'No, Hannah; this is really weird ‪—‬ like, this doesn't happen,'" Frank recalled. "And I said, 'Oh my God; you're right. This is not just an experimental annoyance. This is actually super cool.'"

Using genetic analysis, the team found that one of the two loci contained a larger and more varied collection of gene segments that could be used to create a broad, ready-made repertoire of antibodies. The other had fewer of these building blocks but appeared to rely more heavily on a process called somatic hypermutation, in which antibody-producing cells make small genetic changes after encountering a pathogen.

Those changes can help antibodies become more "customizable" to whatever threatens the immune system, Frank said.

She compared this system to the different layers of defense seen in the 1998 Disney movie "Mulan." Upon seeing invaders at the Great Wall of China, guards raised an alarm to alert others without yet knowing the specific threat; this is like the innate immune system, the body's first, broad line of defense. The adaptive immune system is more like the heroine Mulan: highly targeted and capable of responding to a specific enemy, but slower to develop.

These two layers of immune defense are not unique to bats, but bats' two antibody systems may provide an additional layer of protection.

From each loci, bats can create a "cache of trainable, customizable cells," Frank said. This degree of customization could help the bats immune system ward off a wider range of threats than other mammals can.

"This extra set of genes gives the animals more diversity in their antibodies," said Michael Letko, a molecular virologist at Washington State University who was not involved in the study. "This study suggests bats have more diversity to start with, which may allow for faster and more effective responses from the start of an infection," Letko told Live Science in an email.

Letko added that the genetic analysis in the study was impressive and lends credibility to the results. "It is hard to dispute the validity of information solidly founded on the genetic organization of these bats," he said.

That interpretation remains a hypothesis, though; Frank and her team will need to study how these two systems behave when bats are exposed to viruses before they can determine exactly what advantages they provide.

"We think this discovery is an important piece of the puzzle," Frank said in a statement. "It doesn't fully explain why bats are such effective viral reservoirs, but it reveals a level of immune variety we didn't know existed and gives us an entirely new direction to explore."

Past studies of bat immunity have found that hotter body temperatures and a larger number of virus-filled packages in stem cells could also help bats' tolerate viruses better.

Understanding how bats tolerate viruses could help scientists predict which kinds of bats are most likely to affect human health and how we can mitigate those risks, Becker noted. Separately, bats have a notably low incidence of tumors and cancer, Letko said, and he wonders if their unique immune systems might hold clues as to why.

While bats are often viewed through the lens of the infectious diseases they carry, their story is far more complex, Frank said.

"Let's learn from the guys who've been evolving with them [viruses] for millions and millions of years," Frank said. "But let's try not to villainize them for surviving for millions and millions of years."

Inflammation may be behind a mysterious phenomenon known as dissociation, a mental state that includes "out-of-body" experiences and the feeling that the world is "unreal," emerging research suggests.

Scientists have long known that this altered state of consciousness is often triggered by trauma. But new research hints at how: Trauma triggers a stress response, which dials up chronic inflammation. The findings are part of a broader shift in psychiatric research as experts increasingly examine how the immune system may play a role in mental health conditions.

The research, which has been accepted for publication and is currently under peer review, is still preliminary, and it is based on correlations between blood markers and symptoms, which cannot prove inflammation causes dissociation. But if follow-up work shows inflammation fuels dissociation, that raises the possibility that anti-inflammatory drugs could treat disorders in which people spend much of their time feeling detached from themselves or reality, experts told Live Science. Interventions that broadly target reducing inflammation could also be beneficial, the study suggests.

Research in this area could provide a "whole new avenue for potential treatment options," study lead author Evelyn Dilkes, a psychology researcher at the University of Essex in England, told Live Science.

A common experience, a rare disorder

Dissociation encompasses both out-of-body experiences, known as depersonalization, and the feeling that everything around you is unreal, called derealization, said Dr. Ruth Lanius, a psychiatry professor and Harris-Woodman chair of mind-body medicine at Western University in Ontario. Both of these experiences are related to a person's sense of self and embodiment.

As a short-term phenomenon, it is common; between a quarter and three-quarters of the population may experience dissociation at some point in their lives. It can also be a symptom of many conditions, such as schizophrenia, depression, anxiety, panic disorders and epilepsy.

In around 1% of the population, people may experience prolonged dissociation, in what's known as depersonalization-derealization disorder (DPDR). People with this condition may frequently feel detached from their body or from reality for hours, weeks, months or years at a stretch.

Research suggests DPDR is often associated with past trauma, such as a life-threatening event or childhood abuse. During a traumatic event, dissociation may be helpful because it may offer "a psychological escape when a physical escape is not possible," Lanius told Live Science. It may also help a person stay calm and focused on the threat at hand.

The problem arises when dissociation continues after the threat has passed.

"[Dissociation] helps you to survive, but in the aftermath of trauma, it leaves you detached from all of your emotions, positive and negative, and so often individuals lose the capacity to feel fully alive," Lanius said.

So why does dissociation linger long past the immediate trauma for some people?

From stress to inflammation and then dissociation

Past research showed that inflammation, which can be the immune system's response to infection or injury, seems to be dysregulated in individuals with dissociative conditions. So Dilkes wondered whether the link between trauma and prolonged dissociation runs through the body's response to stress as a kind of "biological embedding," in which life experiences alter a person's physiology. That hypothesis proposes that trauma initially triggers a stress response. When that stress response doesn't subside, the body's stress system stays activated, continually releasing the hormone cortisol from the adrenal glands.

Cortisol is typically anti-inflammatory in short exposures, but when it remains elevated over long periods, it can contribute to chronic inflammation. This can show up in blood levels of interleukin-6 and C-reactive protein.

So Dilkes' lab looked for those inflammatory markers in the blood of children in the U.K. who were followed, starting in the 1990s, as part of the Avon Longitudinal Study of Parents and Children. The study collected samples at age 9 and 12 and again at age 17 and 24. The study asked participants when they were adults whether they “ever felt that they were not a real person, not part of the living world,” or if they “ever felt that the world was unreal, that things around them were like a stage set.”

Early results suggest that high interleukin-6 levels at age 9 seem to be correlated with people experiencing depersonalization in adulthood, while elevated C-reactive protein levels in earlier childhood, but lower ones in adulthood, are linked with experiencing derealization as an adult.

In the latter case, the study authors suggest that chronic stressors could dampen the immune response, leading C-reactive protein levels to drop over time even as symptoms linger.

The researchers also speculated that interleukin-6 and C-reactive protein may differentially act on the different brain regions affected in depersonalization and derealization, respectively. These findings may reflect differences in how stress and immune activity shift across the lifespan following trauma. "It's suggestive of a very intricate system," Dilkes said.

Affected brain regions and networks

Dilkes' research can't answer which brain regions and networks are likely affected, but past research suggests dissociation involves emotional blunting in the brain. In this response, the prefrontal cortex, which is involved in planning and decision-making, acts as a brake on the limbic system, which helps people experience emotions, Lanius said.

According to this theory, dissociation occurs because circuits in the amygdala, the fear-processing part of the brain, hyperactivate the prefrontal cortex. The overactive prefrontal cortex then disrupts normal signaling to the limbic system. The overall result is a dampening of emotions, which may enable people to stay focused and rational during a scary event.

This brain activation pattern, which is characteristic of DPDR, is the opposite of that classically found in post-traumatic stress disorder (PTSD), in which the amygdala is hyperactive, while parts of the prefrontal cortex are underactive. (There is, however, a subtype of PTSD associated with dissociation.)

Some early research hints that the default mode network and the temporoparietal junction, which are thought to be involved in maintaining a sense of self, may be affected in dissociation.

In the new study, the researchers speculate that interleukin-6 exposure in youth may influence the development of the default mode network, which could result in depersonalization symptoms later in life.

Many unanswered questions

While Dilkes' findings are intriguing, outside experts cautioned against overinterpreting early results.

Extrapolating results from studies that investigate dissociative disorders is difficult because patient groups with different diagnoses differ a lot from each other, said Judith K. Daniels, a professor of clinical psychology at the University of Groningen in the Netherlands. What's more, many symptoms can overlap between different dissociative disorders. Dissociation fueled by childhood abuse may differ biologically from dissociation found in a panic disorder, but current research isn't able to distinguish these groups.

What's more, biomarkers of inflammation like C-reactive protein and interleukin-6 are often elevated in other inflammatory and autoimmune conditions ‪—‬ such as rheumatoid arthritis, lupus and multiple sclerosis, while, most people who experience trauma do not develop a dissociative disorder, which suggests that additional genetic or environmental factors are likely involved, Lanius said.

The nonspecific nature of these blood markers would also make it challenging to use them to diagnose DPDR, though in the future they could potentially be used alongside traditional DPDR screening tools, experts told Live Science.

One big limitation is that scientists do not yet fully understand how the brain constructs conscious reality in the first place.

"In my opinion, if we don't understand altered states of consciousness and dissociation, we can't understand psychopathology fully," Lanius said.

For now, more research is needed to determine whether therapies targeting inflammation would benefit people with dissociative disorders. Conditions like DPDR are thought to be rare, but symptoms are often overlooked, which can make it hard to both determine how common it is and to find study participants. But Dilkes thinks dissociation is underdiagnosed.

"So many people experience this, but no one has the words or knowledge of what it is," Dilkes said.

Editor's Note: This article was produced as part of the Dalla Lana Fellowship in Journalism and Health Impact program at the University of Toronto.

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The patient: An 8-year-old girl in the U.S.

The symptoms: The girl arrived at an emergency department after waking up with sudden, severe pain in her upper back. Within hours of the pain emerging, she developed rapidly worsening weakness in all four limbs, making it impossible for her to stand or walk.

She also reported painful tingling and loss of sensation in her hands, and doctors discovered that she had diminished reflexes and sensory changes beginning at her upper chest and moving down her body. In multiple instances at the hospital, she lost control of her bladder and bowels.

The combination of acute paralysis, severe back pain and incontinence suggested damage to the spinal cord, but the cause wasn't immediately clear, her doctors wrote in a report of the case.

What happened next: The medical team launched an extensive search for the underlying cause. An MRI of her neck and torso showed evidence of extensive inflammation or injury that stretched from her lower neck to the middle of her back. The scan also showed a small tear in one of the disks in her lower neck, with a small amount of disk material pushing outward.

However, the girl and her parents did not report any recent falls or injuries, and the MRI alone couldn't determine what had caused this apparent damage.

The girl's medical team then performed blood tests, a spinal fluid analysis and more imaging to look for signs of infections, autoimmune diseases or other inflammatory conditions that can trigger acute paralysis in children. These tests all came back negative.

While clinicians continued investigating, the girl was treated with intravenous steroids and underwent a procedure called plasmapheresis, during which blood is drawn from the patient into a machine which separates blood plasma (the liquid portion of blood) from blood cells and then returns the blood cells to the patient mixed with fresh plasma from donors. This process helps to filter out harmful antibodies and abnormal proteins that can be present in people with autoimmune or blood disorders.

Over the following days, the girl gradually regained her ability to feel, walk and control her bladder. However, repeat MRI scans showed worsening inflammation, which didn't seem to match the girl's improving condition.

The diagnosis: Throughout her hospital stay, the medical team suspected a diagnosis of transverse myelitis, which is a rare neurological disorder that involves swelling in the spinal cord. However, as infectious and autoimmune causes became increasingly unlikely, the physicians changed their minds.

They instead concluded that the girl had experienced a spinal cord infarction, or essentially a stroke affecting the spinal cord. This blood-flow blockage was most likely caused by an exceptionally rare condition called fibrocartilaginous embolism (FCE).

In FCE, a small piece of jelly-like material from the soft center of an intervertebral disk breaks off, enters the bloodstream and blocks one of the arteries supplying the spinal cord. The resulting loss of blood flow can cause sudden paralysis, sensory loss and bowel and bladder dysfunction.

It's unknown exactly how many people experience FCE, as it's difficult to diagnose and frequently underreported. One literature review found only 30 suspected cases and 41 confirmed cases of FCE that had been documented in the U.S.

The case study notes that FCE is most common in children and young adults ages 10 to 20, and that rate also jumps up later in adulthood, around ages 40 to 60. It is slightly more common among female patients than male. While slightly younger than the most commonly affected demographic, the 8-year-old patient in this case otherwise fit this description.

FCE is difficult to diagnose because there is no definitive laboratory or imaging test for it. Instead, physicians must rule out more common causes of spinal cord injury while looking for imaging findings and clinical signs and symptoms that might fit the diagnosis of FCE.

The treatment: There isn't a specific treatment for FCE; instead, care focuses on managing the symptoms caused by the spinal stroke.

The patient was treated with corticosteroids to reduce inflammation, medications to manage pain and plasmapheresis. After a few weeks, and with extensive rehabilitation therapy, the girl regained nearly all of her strength and functional abilities. Her only lingering symptom was weakness in her hands.

What makes the case unique: The case study notes that FCE is often linked to minor trauma to the spine, such as that caused by heavy lifting or other activities that briefly increase pressure inside the spinal disks. In this case, however, the medical team was unable to identify a clear triggering event, and the girl was otherwise healthy and had no reported history of physical trauma. The girl simply woke up with symptoms, which made the diagnosis even more unexpected.

The case also highlights that, although FCE is rare and often carries a poor prognosis — as many patients experience long-term disability and some may even die from complications — meaningful recovery is also possible. The case report authors concluded that, with early recognition and supportive treatment, patients with FCE may achieve improved outcomes and a return to their normal activities.

For more intriguing medical cases, check out our Diagnostic Dilemma archives.

This article is for informational purposes only and is not meant to offer medical advice.

Kakadiya, J., Lakhani, D. A., Gaddamanugu, S., Goncalves, F. G., & Mullen, A. J. (2026). Presumed fibrocartilaginous embolism causing spinal cord infarct in 8-year-old female: A case report. Radiology Case Reports. https://doi.org/10.1016/j.radcr.2026.03.047

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Gun violence is a uniquely American epidemic, according to Dr. Selwyn Rogers Jr., the founding director of the University of Chicago Medicine Trauma Center.

Rogers helped found the trauma center in 2018 on Chicago's South Side, which had lacked a local adult trauma center since 1991. For nearly 30 years, people injured on the South Side had to endure long ambulance rides to access care elsewhere in the city, and lives were lost as a result.

Since founding the new trauma center, Rogers has cared for many victims of gun violence. In a new book — "Healing the Gun Violence Epidemic: Ending Violence, Rebuilding Communities, and a Trauma Surgeon's Vision for Restoring Hope" (North Atlantic Books, 2026) — he tells their stories, along with those of advocates and organizations working to confront the underlying factors that drive gun violence in the first place. The book unpacks how we got here, and what we must do next, drawing on Rogers' experience as a witness to gun violence's toll.

Live Science spoke to Rogers about his work, new book and vision for how Americans should tackle this epidemic.

Nicoletta Lanese: In the book, you trace this trajectory of how we arrived here and what the future could look like, when it seems that strong gun legislation is unlikely. To put it plainly, what gives you hope for the future as a person who sees the impacts of gun violence daily?

Dr. Selwyn Rogers Jr.: I'll start off by saying, I'm pathologically optimistic. Otherwise I couldn't do what I do as a trauma surgeon, where I see some of the worst things.

What makes me hopeful, despite the current political headwinds, are people. When I see a mother who is grieving her son, who just died from gun violence, who says to me, "I have to keep going for my other kids." That gives me hope. When I see someone who acknowledges that they used to hurt others with a firearm, who now is passionate about prevention of other people getting hurt. That brings me hope. When I see the bugged out eyes of a five-year-old Black boy looking at me in my white coat, going, "Are you a doctor?" I say, yes, I am. That brings me hope.

There are all of these moments of human connection. If we just look for them, they're all around us. That brings me hope every time.

NL: The book draws on your experience as a trauma surgeon and also highlights societal factors driving gun violence. When did you begin thinking about treatment that goes beyond the operating room?

SR: I trained in Boston at the time of the crack epidemic in the early 1990s, and Boston, like many cities in the United States, had a fair bit of penetrating trauma. (We separate trauma into "blunt" and "penetrating": "blunt" meaning events where there's no penetration of the skin by a missile or a projectile, and "penetrating" where there is some projectile that violates the skin and causes internal damage.)

During that time, I was particularly struck that those who suffered penetrating trauma disproportionately look like me. I happen to be African-American, they happened to be mostly African-American or Hispanic. They happened to be mostly male. Something about that connected with me as I wanted to be part of helping to solve that problem over the course of my career.

That brought me to Vanderbilt and Meharry Medical College in Nashville, which is where I took my first job. I earned a Master's in Public Health at Vanderbilt School of Medicine, and as part of that experience, I had to do a practicum that involved real-life work trying to understand healthcare outcome differences across a two-mile difference in space: I was at Vanderbilt, a traditional academic medical center, and Meharry Medical College's county hospital, Nashville General Hospital.

Two people could have the same exact diagnosis and have very disparate outcomes, and trying to understand those differences and how you can make a difference in that space was very informative.

NL: How do you think about those social drivers of health in relation to trauma surgery?

SR: When I was in training early on, as well as when I was a junior faculty, it was really striking to me that there were some patients who would come back again and again after traumatic injury. Thinking about how we treat other conditions that are not trauma — for example, heart disease — if I had a heart attack, blockage of my coronary blood vessels supplying my heart, I would today get a stent and get antithrombotic, antiplatelet therapy to reopen my heart. But if at the same time it was discovered that I had high cholesterol, I was overweight, I had a sedentary lifestyle, I smoked, those risk factors would also be addressed as part of my holistic recovery.

For trauma, we don't treat it that way; for the most part, we treat it as an event. Something happened, and we will take care of you.

But we don't look at all the other factors that put you at risk in the first place. And because we often don't do that, when people leave the hospital, the four walls of the emergency department or the trauma center, their risk factors haven't changed. Why would we think that they're not going to be re-injured again? So bringing that framing has been a very fundamental part of my both professional journey and my academic journey.

NL: And those paired interests eventually brought you to your role in Chicago?

SR: In many ways, I've been preparing my entire career to be in Chicago. My current role combines both my technical interest in helping people using my skills and training as a surgeon, but also the social drivers of health and healthcare disparities.

All of those things culminated in a knock on the door where the chair of the Department of Surgery at University of Chicago, said, "Hey, we have an opportunity to open a brand-new adult trauma center on the South Side of Chicago." Before that call in 2016, I did not know that there was no adult trauma center on the South Side of Chicago since 1991.

I've been here nine years now, and I love the city of Chicago. I love what I do; I love the patients I take care of; I love the community. I can't imagine doing anything else.

NL: Can you clarify what services a trauma center offers, as opposed to an emergency room?

SR: The distinction is that the emergency room, emergency ward, emergency department is a place. It's a place where people who are the most severely ill go to seek care. Now, in our healthcare system, people also seek care in the emergency department because they don't know where else to go. They may not have a primary care doctor, they may not have health insurance, so the ED becomes a place where they go.

A trauma center is not that. A trauma center is a system of care incorporating operating rooms, interventional radiology, social workers, anesthesiologists, trauma surgeons, orthopedic — basically a whole team of people that surround the individual and their injuries and try to restore them to health.

For traumatically injured patients, time is critical and minutes mean life or loss of function. Let's say you fell off your bicycle and you lacerated, or cut, your brachial artery, the artery that supplies your arm. If you don't go to a trauma center within a short period of time — minutes, maybe an hour max — you will likely die from that relatively straightforward injury.

The two things that trauma centers are very good at is stopping bleeding that will lead to death, and controlling complications of trauma. Those require a coordinated set of team members to do all those things in a short period of time.

In 1991, when there was no adult trauma center on the South Side, people who were injured on the South Side of Chicago would go to other adult trauma centers throughout the city. Chicago, as you know, is a pretty big city. You can drive for an hour and still be in Chicago. It's hard for me to calculate the number of lives lost [because of the time it took to reach a trauma center].

That's exactly what happened to a kid by the name of Damien Turner. He was an 18-year-old community activist advocating for rent control and other social issues on the South Side, and unfortunately, he was shot on August 15, 2010, literally four blocks from the University of Chicago. He was transported to Northwestern, where he arrived dead. His mother said that, "If the South Side had an adult trauma center, my son would still be alive."

You can debate whether or not that may be true, but it's hard to debate the reality that time matters if you're shot and actively bleeding to death. Because Damien Turner led a youth group called Fearless Leading by the Youth, in his honor, that organization mobilized around a simple slogan: Trauma center now.

NL: What do you think people often get wrong about gun violence in Chicago?

SR: Chicago has an outsized influence in this country, for better or for worse, right? It's in the middle of the Midwest. It has very high visibility as the third largest city. We've had mayors and governors and presidential candidates and presidents of the United States. All those things have put a lot of spotlight on Chicago.

With this framing that Chicago has all this violence, this is all a Democratic city problem — urban blight became synonymous with Chicago, which is far from the truth. One of the things that made me write the book is to dispel those myths. But also to bring the stories to change the narrative that this problem of gun violence in America is not unsolvable, it's not intractable.

If we bring a public health lens, we can solve this problem, just like we've solved so many others.

NL: What would it mean to bring a public health lens?

SR: Going back to 2005, when I was in training in Boston, I was very struck by people who came back over and over again, injured. So we developed a violence recovery program that was hospital-based. The number of these programs have grown over the past 20 years to basically embed people with lived experiences — some of whom have been shot themselves, some of whom have been justice-involved — as credible messengers to help connect people with services, provide psychological support, and change the arc or trajectory of people's lives.

That's what I would call secondary prevention. Something has already happened; how can we lower the risk? It's no different than someone who has an opiate addiction, and we make sure that they have access to naloxone so that they don't overdose and die. That's a public health risk mitigation strategy. Having a team of credible, trusted messengers to help transition that person from injured to recovered is something that every hospital should invest in.

Ideally, we would also invest in programs to prevent people from being injured in the first place. Those are harder because they're not constrained within the four walls of an emergency department or the many, many walls of a health system. They're, if you will, societal.

I think that there is an important opportunity for surgeons in particular, plus emergency medicine, physicians, nurses, and other healthcare providers, to bring voice to the voiceless. Oftentimes, people who are injured who come into our emergency departments, they don't have the agency that a physician or nurse or other healthcare provider has. How can we bring their voice to the forefront, often realizing that people who are the closest to the problem can often be the source of some of those solutions?

Our opportunity for primary prevention that I see is that we could approach gun violence not as a criminal problem, but as a public health one, for which we need to determine risk factors, protective factors, mitigation factors to lower people's risk.

NL: What do secondary prevention programs look like for the patients?

SR: There are probably 80 or so hospital-based violence intervention programs across the country with a blueprint that's been coordinated by a nonprofit called the Health Alliance for Violence Intervention. It hires individuals who are not necessarily social workers or pastoral care (though they can be), but often people with lived experience from the community that can relate to and can connect with the person because they've either been in the situation themselves, or they're from the neighborhood, from the community.

That's the first thing, to create that trusted relationship. The next thing that happens is you're getting out of the hospital. What's your life look like afterwards? If you were on the margin and living paycheck to paycheck, and now you're not working, now you can't pay your rent. Where's the next meal gonna come from?

Turns out there's a whole host of community-based organizations that are doing great secondary prevention work. Our violence recovery team can be the connector.

It's not like we're creating new services; there is the Supplemental Nutrition Assistance Program, there is the Victims of Crime Act, which is a fund, but people don't know about it and don't know how to access it. A violence recovery team serves as a connective tissue or bridge to those services to get people access to things that they need to keep on progressing and recovering.

There are also a number of more established secondary prevention efforts. Oftentimes, street outreach organizations like Institute for Nonviolence Chicago have credibility to interrupt those cycles of violence. And there are others, like Cure Violence, that take people with lived experience, who are justice-involved, have spent time in prison or jail, and want to do something positive.

Those people are incredibly strong proponents; they don't want their son, their brother to be injured like they were injured. Those people can be important interrupters to the cycle of violence. They know many of the people in the community that are involved, and sometimes, it's literally a conversation to prevent a retaliatory shooting.

With that framing, you take folks who have been injured, shot themselves or [who have] shot others, and you wrap around a set of services to take them from the illegal economy into the legal economy. That might involve trauma-informed care, cognitive behavioral therapy, and skills development. I think those are all things that have evolved very intentionally in the city of Chicago over the past decade.

NL: We're currently seeing social support being weakened at the federal level. Do you see that as a place for cities to step up in new ways?

SR: In Chicago, I'll give a specific example for the community violence intervention ecosystem. The civic business community have put their money where their mouth is. They've put in $100 million over the past several years; that's new funding that wasn't there before.

Holistically, no matter what's going on at the federal, state, municipal, local level, at the end of the day, it is about the human connection, right? It's about what we do for the person next to us. It's what we do for our neighbor. If your neighbor is sick and shut in, do we actually show up for our neighbor and say, "Hey, can I bring you a cup of soup?" How much does that really cost?

You don't need the federal government to do that.

This interview has been condensed and edited lightly for clarity.

Science word of the day: Allele

Pronunciation: Ah-LEEL'

What it means: Genes contain the instructions for the various proteins that determine traits, such as eye color or blood type. An allele is a specific variant of a gene. Alleles come in pairs, one from each parent. Some are dominant, meaning that copy will override any instruction from the other allele in the pair, and some are recessive, meaning there have to be two copies of that particular allele for those instructions to translate into an observable feature. Of course, not all inheritance is as simple as dominant and recessive patterns, particularly for traits that arise from combinations of hundreds of genes.

How to use it in a sentence: We learned in grade school that alleles for brown eyes are dominant over alleles for blue eyes, leaving the kids with hazel eyes feeling lost and confused.

Can you crack our science word of the day puzzle, Chain Word?

Scientists may have found a way to rejuvenate key cells that help rebuild muscle in the body and thus preserve muscle into old age, they report in a new mouse study.

It is "really exciting stuff," Matthew Krause, a muscle physiologist at the University of Windsor in Ontario, said of the results. It could have clinical applications down the road if shown to work in humans, as well, added Krause, who was not involved in the research.

The body loses muscle with age and with chronic conditions that compromise people's mobility. To find a potential treatment for this muscle atrophy, the scientists behind the new study looked to "satellite cells." These stem cells are located around skeletal muscle fibers and play an important role in muscle regeneration.

Muscles incur microscopic damage with use, and this damage calls satellite cells into action. They proliferate to rebuild muscle fibers, by either merging into the torn muscle cells or forming new muscle cells. With age, satellite cells activate less efficiently and muscles become weak. But the new study, published July 24 in the journal Scientific Reports, suggests that it may be possible to rescue satellite cells from dormancy.

When muscles tear during exercise, a protein called hepatocyte growth factor (HGF) gets released. This is the signal that binds to receptors on satellite cells and activates them. Previously, studies from the same team showed that HGF works less well in old lab mice because its structure is chemically altered by a compound called peroxynitrite, and this makes it harder for HGF to plug into its receptor on satellite cells. This chemical alteration is known as nitration.

Peroxynitrite is produced through the reaction of unstable nitrogen and oxygen molecules, called radicals, said study co-author Ryuichi Tatsumi, a muscle physiologist at Kyushu University in Japan. These radicals are produced during normal metabolism, but their levels increase with age, he explained.

As a result, satellite cells cannot be activated efficiently to trigger muscle growth, even if the amount of HGF itself does not decline. Tatsumi and colleagues showed this in a previous study in rats.

In the new study, the scientists tested two compounds to see if they could counter this effect in lab mice. They used an experimental setup in which mice couldn't use their muscles as normal, so they weakened; such muscle disuse is known to increase HGF nitration around muscle cells.

Both of the tested compounds are known to protect proteins from damage caused by highly reactive chemicals by intercepting the reaction before it can take place. In experiments, the team treated HGF with each compound before exposing it to peroxynitrite. They found that, compared with untreated HGF, HGF treated with either compound showed substantially lower levels of nitration. This preserved its ability to activate satellite cells grown in lab dishes.

At high concentrations, one of the compounds — lipoic acid trisulfide (LASSS) — not only prevented nitration but also markedly increased HGF's ability to plug into its receptor. That suggests LASSS may chemically modify HGF in a way that could boost its effects.

To see if these observations carried over to living animals, the researchers gave lab mice LASSS in their drinking water. Although these were young mice, they were prevented from bearing weight on their hind limbs for five days, so they experienced short-term muscle disuse. Compared with untreated animals, the mice given LASSS had substantially lower HGF nitration around their muscle cells.

It's "pretty remarkable" that providing LASSS by mouth was sufficient to produce this effect, Krause said. He noted, however, that the researchers did not measure muscle atrophy or try administering LASSS to old mice to see the effects on the muscle. Longer experiments would be needed to observe those changes, he told Live Science.

The compound could also be tested in other forms of muscle wasting, Krause suggested. For example, severe chronic diseases like cancer can cause cachexia, a wasting syndrome marked by dramatic weight and muscle loss.

In general, protein nitration has been linked to several age-related disorders, including Alzheimer's disease, in which nitrated proteins accumulate in the brain. Understanding how to protect proteins from this kind of chemical damage could have implications beyond muscle biology, Tatsumi said.

However, further studies are still needed to assess the effectiveness and safety of LASSS in older animals. Experiments involving aging animals are expensive and can take a lot of time, Tatsumi said, but he is optimistic that this understanding will help address a range of age-related disorders with this same underlying biology.

"That is our big wish," he told Live Science. "I think, in the near future, we can do that."

As recently as 2019, U.S. military health researchers had concerns about testosterone levels among the troops. Their worries were not that male service members didn't have enough of the hormone, as current Defense Secretary Pete Hegseth fears. Instead, experts worried about the troops' inappropriate use of testosterone replacement therapy (TRT), the practice of using injectables or gels to increase a person's circulating testosterone.

"Out of every 1,000 male service members, almost 3 are inappropriately receiving TRT," researchers wrote in a report published on Health.mil, the military's health system website. (That report is available on the Wayback Machine.)

This could lead to harmful side effects, the report authors noted.

"Those being inappropriately treated may experience adverse effects of the medication," including obstructive sleep apnea and edema, the report continued. TRT may worsen sleep apnea and cause swelling in the limbs from water retention. "These adverse effects have the potential to impact deployability and medical readiness."

In short, supplementing testosterone unnecessarily could reduce military readiness, rather than boost it, per the report authors. Now, in a reversal of these concerns, more service members might find themselves offered TRT in the wake of a new military policy announced July 15 by the Department of Defense. It states that all active-duty and reserve service members' testosterone levels will be tested annually starting at age 30.

It is unclear how the policy might affect female service members. Live Science contacted the Department of Defense, which declined to answer questions about the expected testing protocol or criteria for offering service members TRT.

Such an initiative goes well beyond what medical organizations recommend regarding hormone screening for men, experts told Live Science. And while the screening could catch some service members who actually need treatment, the policy might also lead to overtreatment and, in turn, unwanted side effects.

"One of my big, big concerns around this is, how are these tests going to be conducted?" said Luke Cox, a lecturer in sport and exercise science at Swansea University in the U.K. who studies performance-enhancing drugs, including steroidal hormones like testosterone.

Testosterone and military readiness

Testosterone has strong cultural connections with hypermasculinity. As the primary hormone responsible for the development of male sexual characteristics, it's been associated with concepts of strength, aggression and virility. Hegseth continued this pattern by tying the hormone to military readiness in a video announcing the policy change.

"[I]t's about restoring and optimizing your natural capabilities, projecting your longevity and ensuring you have the biological foundation required to sustain the fight," Hegseth said.

That rhetoric aligns with promises made in advertisements for TRT, which pitch testosterone as a tool to "attain that higher level of living," Cox told Live Science. The clinical trial data is more circumspect, however.

In men with genuinely low circulating testosterone levels — often defined as lower than 300 nanograms per deciliter (ng/dL) — TRT does have benefits. (This 300 ng/dL threshold isn't the universal definition for "low testosterone," as not everyone below that line has troubling symptoms. We'll unpack that later.)

Much of the clearest evidence of benefit is for sexual symptoms: In a large clinical trial, men with low testosterone saw increased sexual desire and sexual activity, such as masturbating or having sex, after TRT. For men whose levels are not low, additional supplementation hasn't been shown to have a clear benefit in the bedroom.

TRT has been shown to improve mood and reduce depressive symptoms in men with low testosterone, and in older men, it's also been shown to improve bone density. Boosting testosterone also boosts muscle mass in middle-aged and older men.

Most of this research has been done on men over age 40, because testosterone naturally declines with age. Low testosterone is rarer in younger men, although exact estimates of its prevalence vary. Estimates also vary among older age groups, but a large study called the European Male Ageing Study found that 0.1% of 40- to 49 year-olds had low testosterone, along with symptoms such as fatigue or low sexual desire. That number rose to 5.1% among those in their 70s.

In 2024, 42.8% of active-duty military members, including men and women, were 25 and younger. Only 8.3% were 41 or older. But the prevalence of low testosterone is generally on the rise, said Dr. Joshua Halpern, chief scientific officer and regional medical director at Posterity Health and a reproductive urologist at Northwestern University's Feinberg School of Medicine.

Studies suggest that testosterone levels are lower, on average, in young men today than they were in the year 2000. Scientists have theorized that this trend may stem from increases in body mass index, as well as other factors, such as sedentary lifestyles, changing diets and exposure to environmental toxins, according to a 2020 article in Urology Times.

"While active service members are typically among the healthiest of men, and therefore at lower risk for testosterone deficiency, a significant proportion of service members could have a low testosterone number," Halpern told Live Science. "But that doesn't necessarily mean they should receive treatment."

Treating with testosterone

There is no universal testosterone level that is definitively "too low." The cutoff of 300 ng/dL is based on the point at which symptoms of low testosterone ‪—‬ such as fatigue, low libido and poor mood ‪—‬ tend to present themselves. However, some men have no problems associated with low or low-to-normal numbers.

Plus, testosterone doesn't act in isolation. In fact, some symptoms of "low T" in aging men may actually arise from low estrogen, which stems from these individuals' declining testosterone levels. That's because the male body converts a portion of its total testosterone into estrogen. The two hormones normally work together to regulate sexual desire and erectile function, while estrogen specifically regulates fat accumulation, studies suggest.

There is also a broad range of "normal," running from around 300 to 1,000 ng/dL. For that reason, the American Urological Association recommends testing only if a man is experiencing symptoms that point to low testosterone.

"Making a diagnosis of testosterone deficiency in the absence of signs and/or symptoms increases the likelihood of making a false diagnosis and reduces the potential benefit of testosterone therapy," the association's guidelines state.

Testosterone also has a complicated role in the body. It can affect mood, energy and bone health, but the hormone itself can also be affected by health conditions and lifestyle factors. Studies suggest that intense periods of physical training can temporarily suppress testosterone in military members. That finding tracks with civilian studies that have found that levels can shift dramatically based on people's recent sleep and exercise.

That's why doctors recommend two separate blood tests, both taken in the morning, before diagnosing low testosterone. This helps to ensure that a person's levels are consistently in a low range.

In some cases, it may be that the best treatment isn't TRT but rather an approach that addresses the underlying health conditions that are affecting testosterone levels. This might include assessing whether a patient has sleep apnea and treating it if they do, for example.

Meanwhile, pushing testosterone levels too high can lead to erythrocytosis, an overconcentration of red blood cells that can bring a risk of blood clots and stroke. What constitutes "too much" varies person to person. Due to some testosterone being converted into estrogen, too-high levels can also lead to unwanted side effects like breast growth in some men on TRT.

The other major side effect of TRT is that testosterone replacement shuts off the body's own production of testosterone in the testes. TRT only raises the level of testosterone circulating in the blood, not in the testes where sperm production takes place. Sensing the testosterone in the bloodstream, the brain suppresses its production in the testes, thus diminishing or stopping sperm production. This can cause infertility, and sperm production may take several years to recover after a person stops TRT.

"[F]or young service members who are found to have low testosterone, it will be very important for them and their physicians to understand the risks of treatment and the alternatives that may be more appropriate for preserving their fertility," Halpern said.

Meanwhile, a federal judge has questioned the treatment program. An ongoing lawsuit against the federal government's ban on transgender troops states that "the Armed Forces must adhere to high mental and physical health standards ... without the benefit of routine medical treatment or special provisions." The judge raised questions about how the TRT that will be offered to cis men differs from that which transgender men would use.

This article is for informational purposes only and is not meant to offer medical advice.

Redheads are a rare breed, with people who sport ginger locks making up less than 2% of the global population. With such low numbers, would it be possible for red hair to go "extinct," leaving people with natural hair hues ranging from black to blond, with nary a hint of red?

In a word, no. Experts told Live Science about how the genetics of red hair means the trait is sticking around.

"There is no evidence that redheads are going extinct," said Katerina Zorina-Lichtenwalter, a research associate at the University of Colorado Boulder's Institute for Behavioral Genetics who has studied red hair inheritance. She told Live Science that the genes responsible for red hair "are harmless, they do not interfere with reproduction and they are not linked to a disease that would prevent people from reaching reproductive age."

Nevertheless, the myth of an impending red hair extinction isn't a new one.

"The 'Is red hair becoming extinct?' question has been around for decades," Ian Jackson, a professor emeritus at the University of Edinburgh's Institute of Genetics and Cancer, told Live Science. "There have also been extinction stories about blond hair that go back to the mid-19th century."

The logic behind the supposed redhead extinction usually goes something like this: Red hair is rare; in the world's redhead hotspots in the United Kingdom and Ireland, only about 10% of the population is categorized as redheads. And red hair is a recessive trait, meaning two redhead carriers have to have get together to have redheaded children.

There's even the question of whether potentially deadly conditions, such as melanoma, might wipe out redheads, who are especially susceptible to sunburn. While there are people of color with red hair (Malcolm X famously had reddish hair), red hair is often linked with pale skin and, therefore, elevated skin-cancer risk. Redheads' higher melanoma risk isn't only because they burn more easily. It's also due to harmful chemistry from pheomelanin, the pigment that helps create the reddish hair hue, and reduced DNA‑repair protection, which is linked to variants of the gene that causes red hair.

Keeping the flame alive

But these issues won't doom redheads to extinction, experts said.

First, let's look at genetics. A person needs to inherit the recessive version of MC1R — a gene involved in pigment production — from both parents. Someone with only one copy may not have red hair at all, but they can still pass the variant to their children. So, the role of carrying red hair genes through the generations is shared by people of all hair colors, not just redheads.

This hidden-carrier effect is why a recessive trait can remain in a population even when it is uncommon to see. Jackson gave a simple example: If a variant is carried by half the population, only about a quarter of couples would both carry it. Among those couples, roughly one-quarter of children would inherit two copies.

For red hair to truly disappear, the relevant variants would have to be steadily removed from the gene pool. In evolutionary terms, that would usually mean people carrying these variants — or people with red hair — were having fewer children than everyone else.

"The only reason things go extinct in large populations is because you don't produce as many kids as the others, to put it in blunt terms, and I don't know that there's any evidence for that," Jonathan Rees, professor emeritus of dermatology at the University of Edinburgh, told Live Science.

Second, let's look at skin cancer risk. Rees said people with MC1R variants have a greater skin-cancer risk "somewhere in the region of two to four fold."

But skin cancer risk does not automatically equal evolutionary decline. Many skin cancers occur after people have already had children. Mortality rates for melanoma in the U.K. are the highest in people aged 90 and older, according to Cancer Research UK, after they've had more than enough time to pass on their genes.

Theoretically, before the invention of sunscreen and modern medicine, it may have been more likely for redheads to have died of skin cancer before they had children. Given that the trait has persisted, though, are there any evolutionary benefits to having red hair?

Red hair may carry surprising health advantages. For instance, recent research suggested the red‑hair pigment pheomelanin can help regulate excess cellular cysteine, which can be harmful at high concentrations.

"The vitamin D story is the one that people most often peddle," Rees said. The idea being that lighter pigmentation of the skin (and red hair being linked to lighter skin) increases the amount of vitamin D that people can make during the gloomy winters. But he added that the evidence there is lacking, especially because it can be hard to define who, exactly, is a redhead. It's a spectrum: where does red hair end and strawberry blond hair begin? That makes it hard to study without sequencing the genomes of large swathes of the population.

However, the frequency of red hair could still fluctuate. Jackson said the frequency may "go down somewhat as people become more mobile" and have children with partners from regions where MC1R variants are less common. But that would be a change in frequency, not extinction.

As long as MC1R variants persist silently in carriers — and as long as redheads are not having significantly fewer children than everyone else — the world's redheads are not about to disappear.

An outbreak of parasitic illness linked to iceberg lettuce is affecting nine U.S. states, federal health officials have announced. That's up from the five affected states that were identified in earlier stages of the officials' investigation.

This lettuce-related outbreak is one of several in the U.S. that are being caused by the parasite Cyclospora cayetanensis, which can enter the body when someone consumes food or water contaminated with the organism. The federal government has not officially identified a source of contamination in the other Cyclospora outbreaks yet, although some state officials have mentioned potential culprits. (North Carolina officials have pointed to cilantro and parsley, for example.)

The nine-state outbreak linked to iceberg lettuce includes cases in Illinois, Indiana, Kansas, Kentucky, Michigan, Ohio, Oklahoma, Pennsylvania and West Virginia, according to the Food and Drug Administration (FDA). To date, 1,947 people have been infected across these states and reported eating Taco Bell before they got sick. There have been 98 hospitalizations and no deaths.

Data collected by federal officials had previously pointed to shredded lettuce served at Taco Bell as a common source of exposure, and from there, they identified the supplier as Taylor Farms de Mexico. "Taco Bell has indicated they are no longer using lettuce from Taylor Farms de Mexico as of July 17, 2026," the FDA noted.

Specifically, the infections have been linked to lettuce sourced from central Mexico, prompting Taylor Farms to remove all of its iceberg lettuce from that region from the U.S. market. The company has also issued a recall. A complete list of recalled products can be found on the FDA's website.

The recall affects products that were distributed in the nine states listed above, as well as additional states, all of which are listed on the FDA's website. Consumers, restaurants and retailers that purchased or received recalled lettuce are advised to discard it immediately and not consume it.

"We also expect to continue to see the number of confirmed cases rise, despite the recall, due to the fact that it can take as long as six weeks for CDC [Centers for Disease Control and Prevention] and state officials to determine if a sick person is part of this outbreak," the FDA's latest update notes. "FDA will continue to work with federal and state partners to investigate this multistate outbreak and ensure products implicated in this outbreak have been removed from the market."

This article is for informational purposes only and is not meant to offer medical advice.

A 6-year-old girl was given a first-of-its-kind gene therapy in a hospital in China for a nonlethal condition. Within a week, she was dead.

Her death was never publicly disclosed by the scientists who developed and administered her experimental gene therapy. But now, more than a year after her death, her parents are telling her story in the hope that others will be spared the same fate.

A new joint investigation from Science and Retraction Watch, published July 23, details the case of "Mei," a young girl given gene therapy in March 2025 at Xinhua Hospital, which is affiliated with the Shanghai Jiao Tong University School of Medicine. (Mei's parents asked that the family's names be changed for the report. Her name was changed to Mei, which is Chinese for "beautiful," and they are referred to as "Jason" and "Linda.")

Mei's trial was led by Zilong Qiu, a neuroscientist at the university's brain center. Live Science has contacted Qiu for comment.

Mei had a rare genetic disorder called Snijders Blok-Campeau syndrome, which is caused by mutations in the gene CHD3. The gene carries instructions for a protein that helps control how DNA is packaged in cells, which in turn, affects how genes can be switched on and off. The gene plays an important role in early brain development. In people with the syndrome, this process is disrupted, leading to brain changes that can cause speech problems and intellectual disability.

Mei's parents had sought further tests after their daughter was diagnosed with global developmental delay in 2023; this broad diagnosis is given to young children who show delays in several areas, such as speech and motor skills. Genetic sequencing following her diagnosis revealed she had the syndrome.

People with the condition typically have normal life expectancy, although symptoms can range in severity, with severe cases coming with seizures and heart problems. Mei's case was mild, and her parents secured her speech and occupational therapy alongside special education support to help manage her symptoms.

Jason worried about her future, though, anticipating that she'd continue to trail behind in school and may never live independently. On WeChat (the instant messaging, social media and mobile payment app), Jason and Linda joined a group of parents of kids with autism and similar disorders. There, they learned about Qiu, the neuroscientist, who has a gene-therapy company called Lanqi Xintu Gene Technology. Qiu had been developing a gene therapy for Rett syndrome, another genetic disorder that disrupts brain development.

Jason contacted Qiu about possibly creating a gene therapy for Mei, and Qiu immediately arranged a meeting. He explained that such a therapy would require delivering viruses into Mei's spinal fluid; modified viruses are often used as vehicles to deliver gene therapies into the body. The viruses would then travel to her brain, where they'd make the desired edits. To get a big enough dose into the brain, hundreds of trillions of viruses would be needed.

Qiu planned to use a base editor, a CRISPR-based approach that swaps out just one letter in DNA's code for another. (The technique was famously used in the case of a U.S.-based baby, called KJ, whose life-threatening genetic disease was successfully treated.)

Because Mei's condition was not life-threatening, the approach would need to clear a high bar to pass the university's ethics board, Qi said. It would need to be trialed in mouse and monkey experiments first. Qiu insisted, though, that the university could ensure Mei's safety, although it couldn't guarantee the treatment would work. The possibility of death wasn't discussed — and it would not be in the years to come.

Jason and Linda agreed to the plan. They would ultimately put the equivalent of $860,000 toward the cost of developing, testing and deploying the therapy; those costs included informal payments made directly to various members of the research team. Charging for an unproven therapy is forbidden under Chinese law, but Qiu explained this away by saying the parents were paying into his gene-therapy company, which then paid for the procedure.

In January 2025, Qiu submitted a manuscript describing the team's lab-animal experiments to the journal Nature. (A revised version of the manuscript was published in February 2026 and contains no mention of the family nor its financial contributions.) Science had several experts review the manuscript, who expressed concerns about how well the monkey study was conducted.

Live Science contacted Nature for comment, and a spokesperson said "We are looking into the matter carefully following an established process. We are unable to provide further information at this time."

The next month, a toxicology study conducted by the team found that four monkeys given the treatment developed moderate to severe liver damage, and one also had kidney damage. This should have prompted additional safety studies, experts told Science, and hinted that the therapy was triggering a dangerous inflammatory response — a known risk of virus-based gene therapies.

The hospital's ethics committee did not review this data before giving the OK for Mei's procedure. Her parents were told about the results of the animal studies, but they said the scientists seemed unconcerned about them. Under China's regulatory system, the trial did not need to be cleared by the country's equivalent of the Food and Drug Administration before proceeding.

On March 24, 2025, after giving her a steroid to dampen potential immune reactions, Dr. Yongguo Yu injected gene therapy-laden viruses into Mei's spinal fluid. Although some virus-based gene therapies in the U.S. can be given with steroids, as of late, doctors often opt for more aggressive immune-suppressing drugs for safety.

Within days, Mei developed a range of symptoms; she got a fever, wasn't urinating, and her platelet levels plummeted. She was taken into an intensive care unit for treatment, but she died seven days after receiving the injection.

The hospital determined her death was directly related to the treatment and caused by thrombotic microangiopathy. This is an immune reaction that causes blood clots and can arise from virus-based gene therapies.

The hospital was later fined the equivalent of about $3,600 for failing to properly oversee the trial and not registering it as commercially sponsored research in China's national database. The hospital required that the doctor involved receive verbal counseling.

The family asked Qiu to withdraw his Nature paper, worried that other families might be tempted to try the same therapy, and he initially agreed, although it was later published. The paper was covered positively in the press at the time, and parents in the WeChat group began expressing interest. Seeing that, Jason and Linda submitted a complaint to Shanghai Jiao Tong University School of Medicine, calling for a retraction and investigation. The university took no action.

They also sent a letter to Nature after the publication; at the time, the journal said that the ethical issues raised "fall outside our purview in terms of data integrity" and that the matter should be handled by the university.

Regarding the investigation, neither Qiu, Lu, the university or the hospital responded to Science's requests for comment. Nature told Science that it was not aware of the issues surrounding the clinical trial before it published the group's paper.

You can read the full investigation by Brendan Borrell at Science, along with a breakdown of the top four takeaways from the case. In particular, Mei's death raises questions about China's regulations around experimental therapies and human clinical trials, especially in the wake of the infamous "CRISPR baby" cases that purportedly prompted the country to tighten its restrictions around gene editing.

Editor's note: This story was updated at 3:00 p.m. on July 24, 2026, with new comments from Nature. It was first published at 2:00 p.m. the same day.

There has been talk of "rescheduling" cannabis for years, a regulatory move that would significantly ease federal restrictions on the drug. Now, with a recent push from the White House to expedite the rescheduling process, we may see that change come to pass.

Moving cannabis to Schedule III — a less-restrictive classification for drugs — would represent a very important shift in how the federal government treats cannabis research, in that it would officially state that cannabis has medical use. This landmark decision would encourage some of the largest scientific investment in cannabis research to date and help build some of the strongest evidence of the value of cannabis-based therapies.

However, the move to Schedule III should be viewed as a transition rather than an endpoint.

How cannabis is regulated, today

Cannabis has existed in a complicated space in medicine, policy and public perception for decades.

More than 6 million Americans are registered to use cannabis through state medical programs. Clinicians participating in state medical cannabis programs generally "certify" and "recommend" specific cannabis products to certain patients, rather than write traditional prescriptions. Additionally, a handful of cannabis-derived and cannabinoid-based medications have received formal Food and Drug Administration (FDA) approval.

However, since the Controlled Substances Act was enacted in 1970, cannabis has been classified as a Schedule I substance. This category is associated with the highest level of restriction, including substances such as heroin, MDMA, and LSD.

Under federal law, Schedule I drugs are defined as having a high potential for abuse and no currently accepted medical use. Given some cannabis-derived drugs are FDA approved, it may seem contradictory that cannabis remains a Schedule I substance. The key is that federal drug scheduling, FDA drug approval and state cannabis laws are separate legal and regulatory systems.

Federal law classifies cannabis as a Schedule I drug. Separately, the FDA evaluates and approves individual cannabinoid medications for specific medical conditions. Independently, states can authorize cannabis for medical or adult use under their own laws, even though cannabis remains illegal under federal law.

This three-tiered regulatory landscape can be confusing for patients, clinicians and the general public alike.

Rescheduling would be a boon for research

For a few years, federal officials have recommended moving cannabis to Schedule III, which includes drugs with accepted medical uses that are subject to fewer federal restrictions. Ketamine and anabolic steroids, like testosterone, are examples. Compared with Schedule I substances, Schedule III drugs are considered to have a lower potential for abuse and can be prescribed for accepted medical uses under federal law.

Rescheduling cannabis would thus create a regulatory environment that's more favorable to research, which could support the development of future FDA-approved cannabis-based medicines. Researchers are already exploring cannabinoids as potential treatments for conditions including chronic pain, post-traumatic stress disorder, inflammatory bowel disease and sleep disorders, but the available evidence remains limited for many uses.

Evidence is limited, in part, because for decades researchers studying cannabis have faced regulatory hurdles that extend beyond those encountered with many other controlled substances.

Studies using cannabis often require additional federal, institutional and local approvals, compared to research with less-restricted drugs. They have extra requirements around securely storing and handling cannabis. They require detailed record-keeping to document how research materials are received, stored and used, as well as Drug Enforcement Administration registration for the principal investigator conducting Schedule I research.

Additionally, federal restrictions have historically limited researchers' access to cannabis products that reflect those people regularly use, such as commercially available flower, vape products and edible formulations.

This regulatory burden has historically discouraged some universities, healthcare systems and funding organizations from investing in cannabis research. These hurdles have made cannabis studies slower, more costly and smaller in scale than those conducted with more loosely controlled drugs.

Shifting cannabis to Schedule III would help to reduce these barriers, opening opportunities for more universities and healthcare systems to conduct much-needed clinical studies for medical cannabis. It could help researchers conduct the larger, more rigorous clinical trials needed to determine which therapies are truly safe and effective — and which are not.

Such gold-standard studies would better evaluate cannabis' potential benefits and risks, as well its effects in specific medical conditions and appropriate dosing for each. This evidence could, in turn, help reduce the stigma associated with cannabis use.

What rescheduling won't accomplish

Rescheduling cannabis will not automatically make cannabis more accessible to patients or immediately establish where cannabis is beneficial, what doses are most appropriate or which patients are most likely to benefit.

It would not automatically convert existing state cannabis programs into the conventional prescription model used for most Schedule III drugs. And it would not immediately resolve the complexities surrounding state medical cannabis programs, which operate outside the traditional FDA-approved medication pathway.

Unlike most prescription drugs, medical cannabis is an umbrella term that includes hundreds of products that differ in cannabinoid content, formulation, dose and route of administration. Most of those products have not been approved by the FDA, so rescheduling would not automatically place them into the traditional prescription drug system or immediately resolve many of the financial and access barriers patients face when trying to use them.

Without robust follow-up research, rescheduling alone would do little to resolve the uncertainty surrounding many cannabis products.

In short, the greatest benefit of moving cannabis to Schedule III would not be the policy change itself; it would be the opportunity to build a stronger evidence base for cannabis science and medicine. Policymakers may open the door to Schedule III, but researchers, clinicians and regulatory agencies will determine whether this opportunity will actually lead to the appropriate and meaningful advances in cannabis science and medicine.

The value of rescheduling will be measured not by how quickly it changes patients' access to cannabis, but by whether it helps create the scientific foundation needed to guide responsible medical use.

This article is for informational purposes only and is not meant to offer medical advice.

Opinion on Live Science gives you insight on the most important issues in science that affect you and the world around you today, written by experts and leading scientists in their field.

It's a Tuesday morning, and you're getting your toddler ready for daycare. But as you brush her hair into a ponytail, you notice that her cheeks are flushed, her nose is runny and her breathing is phlegmy. Instead of daycare, you head to your pediatrician, who offers a solution: a prescription for antibiotics.

This scenario has played out many times in clinics around the world. The problem is that most common childhood infections are caused by viruses, which antibiotics don't treat. In the long term, unnecessary antibiotic prescriptions can foster resistance in bacteria, thereby reducing the drugs' potency and fueling the rise of dangerous superbugs.

That's why, in recent years, there's been a huge push in many countries to raise awareness of antibiotic misuse among doctors and to reduce the overprescription of these drugs. In Japan, the government noticed that the country's pediatricians were prescribing too many antibiotics, especially to young children, and offered them a financial incentive to break the habit.

It's been working remarkably well. Among young kids directly affected by the incentive, it slashed antibiotic prescriptions by 20%; it also contributed to a spillover effect in older kids and teens, as under-20s have seen a 50% reduction in prescriptions in recent years. I went to Japan to examine why the program has been so effective and to learn whether similar approaches could work in the U.S.

Understanding why a fairly modest incentive of 800 yen (about $5) a visit is so effective requires unpacking why Japanese doctors overused antibiotics in the first place. If doctors face similar pressures stateside, maybe the same strategy could work here too.

A culture of overprescription

Japan started out with a big problem of antibiotic misuse, especially among prescriptions for kids. From 2013 to 2016, over 30% of children with respiratory tract infections were given antibiotics, despite most of those infections being viral. (The U.S. started at a slightly better baseline regarding antibiotics given for respiratory conditions, with about 23% of outpatient prescriptions being unnecessary.)

For decades, it was common in Japan to routinely prescribe antibiotics for sniffles and tummy bugs, Dr. Takemi Murai, deputy head of the Infectious Diseases Division at Nagano Children's Hospital in Azumino, told me. That's in part because medical education there didn't emphasize the risk of "superbugs," meaning bacteria that can withstand many antibiotics.

"When I trained, antimicrobial stewardship wasn't yet a formalized part of the curriculum in the way it is now," said Murai, who finished medical school in 2006.

There also may be a generational divide, Dr. Tatsuki Ikuse, a pediatric infectious disease specialist at the National Center for Child Health and Development in Tokyo, told me. Ikuse, who finished medical school in 2013, suspects that older doctors "experienced many cases of bacterial infections when there was no vaccination."

Now that vaccines for whooping cough, diphtheria and pneumococcal disease are routine, children face a lower risk from the bacteria that cause those illnesses. But those early experiences treating children with serious bacterial infections may still be shaping doctors' prescribing patterns, even decades later, Ikuse thinks.

Surveys conducted in Japan suggest that doctors under 50 are more likely than doctors over 50 to see antimicrobial resistance as an urgent issue. Clinic doctors — those likeliest to see kids as outpatients for acute illnesses — also skew older than doctors in hospitals; in 2024, clinic doctors averaged about 60 years old, while those in academic and nonacademic hospitals averaged 40 and 48 years old, respectively.

Historically, Japanese doctors also had a strong bias toward prescribing antibiotics for "feverish" diseases, noted Dr. Norio Ohmagari, director of disease control and prevention at Japan's National Center for Global Health and Medicine.

Murai agreed with that sentiment. "If doctors saw a fever and a high CRP level [a sign of inflammation], they prescribed antibiotics," Murai said. "Doctors were following such a practice for a long time, so they didn't question it."

Concerns over secondary infections were also a big driver of unnecessary antibiotic use, said Dr. Masahiko Sakamoto, a hospital pediatrician in Saku, a highland city about an hour northwest of Tokyo by bullet train. Even if doctors suspected a viral infection, like the common cold, they worried that the illness could open the door for secondary bacterial infections, such as bacterial pneumonia. However, recent studies suggest this scenario is uncommon and shouldn't prompt doctors to use antibiotics preventatively.

Is antibiotic misuse still a problem in the U.S.?

Young children in the U.S. were once the most likely group to receive unneeded antibiotics, but now, those unnecessary prescriptions have "dropped dramatically," Dr. Sarah Kabbani, director of the U.S. Centers for Disease Control and Prevention's (CDC) Office of Antibiotic Stewardship, told me in an email.

Between 2011 and 2016, children's antibiotic prescriptions decreased 13% overall. "Overall declines in antibiotic use over the past decade have been driven in large part by reductions in prescribing for children," Kabbani noted.

Japan has also decreased its overall antibiotic use in younger populations, halving its outpatient prescription rates for patients under 20 between 2011 and 2022, Dr. Yusuke Okubo, division chief of clinical epidemiology and health services research at the National Center for Child Health and Development in Tokyo, told me.

The decrease in antibiotics overuse syncs with parents' lived experiences in both countries.

"I was taking antibiotics quite often" as a kid, Tatsuya Kanno, a software engineer and father of two in Tokyo, told me. "Nowadays, we don't get really prescribed those antibiotics easily."

"It has definitely been different from my childhood," said Gabby Brown, an apparel consultant and mother of two in Littleton, Colorado. "There was always a bottle of pink stuff in the fridge, you know? And now they're very hesitant to give it out."

Brown's pediatrician actually has an explicit policy on their website stating that they don't overprescribe antibiotics and instead follow evidence-based guidelines to determine when the drugs are truly necessary. I've found a number of other U.S. pediatric clinics that do the same.

One reason U.S. pediatricians have been able to improve several key metrics of antibiotic use is that the issue has been on their radar for a while.

"Antibiotic stewardship was a core tenet of my residency training 20 years ago," Dr. Morgan Leafe, a U.S.-based pediatrician who worked in inpatient and outpatient settings for 11 years after residency, told me in a direct message. "So I would say it's not new in pediatrics."

But there remains room for improvement.

Prescription rates vary widely among states and among different types of outpatient facilities, such as community practices versus those affiliated with academic medical centers. Rural communities often use antibiotics at higher rates and log more inappropriate use, compared with urban areas. These regional variations are "not explained by clinical factors," said Julia Szymczak, a medical sociologist and associate professor in the Division of Epidemiology at the University of Utah School of Medicine.

Nowadays in the U.S., urgent care clinics might be a hotspot for antibiotic misuse. These and other walk-in clinics serve an increasing number of pediatric patients, with an estimated 26% of children visiting one in the past 12 months. Urgent cares may prescribe antibiotics to children at a higher rate than other ambulatory settings do; in one study, 42% of the children seen at urgent cares were prescribed antibiotics at their visit, while the national average across all pediatric ambulatory visits is 21%.

It may be that urgent cares are more likely to prescribe antibiotics for conditions that they're explicitly not recommended for. One national analysis found that urgent cares prescribed antibiotics for 20% of allergy cases, 42% of viral upper respiratory infections and 52% of uncomplicated ear infections, while doctor's offices wrote far fewer of these inappropriate prescriptions. Other studies highlight similar patterns.

Among children, inappropriate prescriptions are less likely at urgent cares that specialize in pediatrics, highlighting doctors at general clinics as a potential population to target. Additionally, research has found that visits with nurses or physician assistants are more likely to end in an antibiotic prescription than those with doctors. (Only licensed doctors can write prescriptions in Japan, so this factor is more unique to the U.S.)

Different systems, similar pressures

Japan's nationalized healthcare provides a staggering degree of choice, because insurance coverage doesn't tie you to specific clinics or require you to get referrals to access certain care. Young children's care is virtually free thanks to national and local subsidies. So on paper, parents can easily shop around for a pediatrician that best suits their family's needs, as well as pop into any healthcare facility with flexibility should the need arise.

While this system is convenient, it has its downsides, some parents told me.

"In the U.S. and in Switzerland, they try to get to know you and know your child," said Reid, a fundraiser and father of two based in Okinawa, who recently moved to Japan with his sons and husband. "They don't at all in Japan."

In contrast, about 9 in 10 children in the U.S. have a primary care provider, although that percentage has fallen in recent years as the use of urgent care has increased. Primary care providers can be a go-to for sick visits as well as an ongoing monitor of kids' health via annual check-ups. (Annual check-ups in Japan are handled by local municipalities, not by children's regular doctors, Reid noted.)

In some ways, pediatric clinics in Japan can be considered more analogous to urgent care in the U.S., in that they're intended to address acute cases of illness as they emerge. For more serious illnesses, caregivers bring their children to hospitals, parents in Japan told me.

Diagnostic uncertainty

For a typical respiratory or tummy bug, doctors in both the U.S. and Japan make diagnoses based largely on a patient's symptoms and timeline of illness. In the U.S., most minor infections are "generally assumed to be viral unless certain criteria are present," Leafe said. These criteria are spelled out in manuals used by pediatricians.

The criteria enable doctors to "feel reassured" that they've correctly classified an infection as viral or bacterial, even in the absence of a highly sensitive diagnostic test, said Dr. Ilan Shapiro, a community pediatrician at AltaMed Health Services, a nonprofit health network in Southern California.

Rapid tests are available for only a handful of bacteria, including Streptococcus pyogenes (also called group A strep), a common culprit behind strep throat and scarlet fever. These tests are "definitely underutilized" by Japanese clinics, Ohmagari noted, while U.S. clinicians are encouraged to use them more widely.

"For strep throat, we never treat [give antibiotics], now, without a positive test," said Dr. Jennifer Shu, a pediatrician with Children's Medical Group, a group of pediatric offices in the Atlanta metropolitan area. (That said, electronic medical records suggest that not all doctors' offices use these tests before prescribing antibiotics, despite these recommendations.)

In both countries, doctors can use rapid tests to diagnose common viral infections, such as influenza and RSV. But those tests don't always catch every case. And even if they come back positive, they can't rule out the possibility of simultaneous infections with viruses and bacteria, Shu noted.

Shu's practice also uses a 20-minute test that looks for multiple viruses and bacteria in the nose and throat, including the bacteria behind whooping cough and Mycoplasma, which causes "walking pneumonia." Not all clinics use this type of test, though, because they require a special certification and equipment to run on-site, Shu said.

Such panel tests can be helpful but also tricky to interpret. Bacteria can sometimes be detected in a patient's nose without being the cause of their symptoms. "That's where clinical judgment comes in," Shu said, emphasizing that a doctor must combine test results with the timeline of a patient's symptoms.

Time crunches

The lack of quick, surefire diagnostic tests for bacterial infections can leave doctors with a degree of uncertainty, which can sometimes prompt unnecessary prescriptions, Szymczak said.

"Our number one motivation is to not harm somebody; that's the main thing," said Dr. Shruti Gohil, an infectious-disease specialist at UCI Health who designs interventions to improve doctors' antibiotics use. Worries about potential missed diagnoses can prompt doctors to reach for an antibiotic now "in exchange for a potential future, untoward consequence," such as a greater chance of resistant infections, she said.

In both countries, doctors must make diagnoses and treatment plans in a limited amount of time. "Pediatric outpatients in Japan are very busy and can only secure a few minutes for each patient," Ikuse told me.

Such time crunches are common in the U.S., too.

"I had a pediatrician who said they had — I can't remember the figure — but it was like 800 seconds for a sick visit," said Szymczak, who studies the factors that drive clinicians to misuse antibiotics. "They broke it down into seconds."

Given that antibiotics are generally very safe drugs, pediatricians can be tempted to prescribe them "just in case" in these situations, even if the need isn't certain, a 2019 review found. In these scenarios, patients end up taking courses of antibiotics they likely don't need.

Doctor shopping and bad reviews

One factor driving antibiotic misuse that might be unique to Japan is the competition between clinics and the customer service culture it motivates.

Japan's mandatory national health insurance makes it easy to "doctor shop." Depending on where a family is based, there may be a glut of pediatric specialists to choose from — as in metropolitan centers like Tokyo — or very few. For instance, in Okinawa, general family doctors are easier to come by than pediatricians, said Sandra Miller*, a researcher and mother of one based in the prefecture.

But across all settings, families can still flexibly choose which clinic they go to. Meanwhile, pediatricians in Japan, who make less than their peers who care for adults, can worry about losing clients to nearby practices.

Japanese clinicians used to worry that, after being denied antibiotics for their sick kids, dissatisfied parents would leave poor reviews online — particularly in Google Reviews — and thus drive away business, Okubo said. "They feared such clinic reviews."

Parents frequently used to demand antibiotics from their children's pediatricians, Okubo added. "Ten years ago, it was a common situation," he told me.

Among the clientele of Shu's Atlanta clinic, she's "seeing a trend where people aren't asking for antibiotics as much." But still, parents sometimes request the drugs when she's determined they're not needed. These requests often stem from the parents' past experiences.

"They'll say, 'Well, last time they took an antibiotic they got better faster, the next day,'" Shu said. Because mild viral infections often go away on their own in a few days, that timing could have just been a coincidence, but it leaves an impression on the caregiver nonetheless.

A parent in Japan told me about the other side of this conversation.

Kanno once brought his daughter into a clinic after she developed a bad cough after catching the flu. Their doctor prescribed antibiotics, and the cough resolved within days. Later, Kanno's son had similar symptoms, but the doctor didn't recommend an antibiotic in his case. When his son's coughing and wheezing persisted, "I asked him to prescribe that antibiotic, the same one that my daughter took," Kanno said.

The pediatrician said it likely wouldn't help but didn't explain why. The doctor said he would provide the antibiotic if the family wanted it. He ultimately prescribed it, and it didn't help. "He got my trust after that," Kanno said.

Szymczak's research has identified this "it-helped-last-time" bias as a common driver of patients' antibiotic requests that can be difficult for doctors to negotiate.

Parents' understanding of antibiotic resistance

In Japan, parents' awareness of antibiotic resistance has grown in recent years, Japanese doctors told me, but research suggests many still don't know much about it.

"I don't think parents generally understand that antibiotics don't work for colds, much less [understand] antibiotic resistance," said Dr. Yusuke Shibata of the Shibata Pediatric Clinic in Tokyo. "Explaining antibiotic resistance to parents is difficult," though he still tries to do so, he told me in an email after I visited his clinic.

Studies of U.S. parents suggest that many don't understand resistance or proper antibiotic use and that a misunderstanding of the purpose of antibiotics can drive requests for the drugs. In my interviews, I found that parents in both countries had some grasp of the concept of antibiotic resistance, but the depth of that understanding varied.

Tomomi Sato*, a New York City-based teacher and mother of two who lived in Japan as a child, said she'd heard that taking antibiotics too often could make it so your body didn't respond to them well in the future. She likened it to an urban legend about roaches that she heard from her mother and others from her hometown of Tokyo.

"You know how they talk about, in Japan, roaches are getting bigger and bigger?" she said. "They just build immunity … they don't respond to the old type of roach spray, so you have to get a new version."

Some parents are cautious about overusing medications in general but don't worry about antibiotic resistance, specifically.

"I want them to recover by trusting their own immunity, rather than relying on medication," said Risa, an HR representative and mother of two in Saku, Japan. But that said, "if it's something that's difficult to heal naturally, I think professional judgment and a prescription are necessary," she added.

Risa told me she thinks antibiotics may be medically appropriate when an illness is particularly severe or prolonged. She doesn't weigh whether the cause is likely viral or bacterial, even though antibiotics don't treat viral illnesses.

"I think that's probably the general mindset," said Fumie Kuchiba, a mother of one in Saitama, Japan, who previously worked as a registered pharmaceutical salesperson.

Other parents have a clear sense of the threat resistance poses.

"Resistance is a threat because if something is powerful enough to beat our current modern medicine, then it can wreak real havoc," said Malcolm, an editor and father of one in Atlanta. On the individual scale, he knows that resistance can emerge within an individual, potentially raising their personal risk of resistant infections. But on a global scale, he thinks of resistance as a threat as formidable as that posed by viral pandemics, such as COVID-19.

Difficult conversations

When parents seek an antibiotic that isn't medically needed, that can prompt difficult conversations with their children's doctors.

A Philadelphia-based doctor summed up the dynamic in an interview with researchers: "If patients feel like they need an antibiotic, it's very, very hard to talk them down from that. So, antibiotics are definitely overprescribed. And, you know, it's easier to say yes rather than taking time and, like, so much time to say no." This doctor and several other participants in that study felt they had "little autonomy to stand up to patient demand."

Some studies find that, when a pediatrician withholds antibiotics and a parent questions them, doctors can perceive that as negative pushback and give the drug against their initial judgment. But if a pediatrician denies antibiotics while also providing guidance for symptom relief, that conflict can be avoided and prescription becomes less likely.

Shapiro, the pediatrician in California, told me he handles such requests by walking parents through his diagnostic process and explaining the downsides of using unnecessary prescriptions. He also offers options for seeking further care — via phone, telehealth or an in-person visit — should the infection not improve as expected.

These conversations take time, and they can stir up conflict, which Shapiro said he's grown more comfortable navigating over his career. Early on, "you don't want conflict; you feel that conflict is bad, and you want everybody to be happy," he said. But ultimately, "the objective is for them to be healthy."

Multiple parents in Japan told me their doctors don't usually talk through their reasoning for checking for a given symptom or prescribing X drug over Y. "If we don't ask, he won't explain," Kanno said of their current pediatrician; but if prompted, their doctor provides good explanations, he said.

Similarly, Japanese parents told me their doctors don't often say whether or why they suspect an infection is viral or bacterial — a clarification that might help caregivers feel more comfortable forgoing an antibiotic.