Publisher Health

From condoms to IUDs to tubal ligation, experts weigh in on how to assess and obtain birth control options.Over the past few decades, the number of birth control methods available in the United States has grown sharply. Women today are faced with a dizzying array of new pills, implants, gels and patches.Despite these advances, experts say a birth control pill for men is unlikely to hit the shelves any time soon, and the maze of options for women can be particularly confusing because each contraceptive carries its own set of precautions and side effects. The recent leak of a draft Supreme Court opinion on Roe v. Wade has also raised questions about whether states might be able to tighten their regulation of contraceptives.The New York Times spoke with seven gynecologists and reproductive health experts, seeking to identify and explain the types of contraceptives currently available, how to get them and what side effects and risks they carry.Could overturning Roe v. Wade impact birth control access?The leaked draft of the Supreme Court opinion that would overturn Roe v. Wade does not indicate that the Court would revisit past decisions about birth control. “We emphasize that our decision concerns the constitutional right to abortion and no other right,” Justice Samuel Alito wrote. “Nothing in this opinion should be understood to cast doubt on precedents that do not concern abortion.”However, some legal experts have raised concerns that justices could apply the argument for overturning Roe to limiting access to contraceptives. As a result, advocates worry that legislators could use a ban on abortion to make birth control less available. The state legislature if Louisiana advanced a bill this week that would classify abortion as homicide. Opponents of the proposal raised flags, saying that legislation could technically criminalize some forms of birth control as well.“We’ve seen folks falsely equating emergency contraceptives and IUDs with abortion,” said Mara Gandal-Powers, director of birth control access and senior counsel at the National Women’s Law Center. “That’s certainly something I’m concerned about.”What birth control can you get quickly?Condoms are the most popular option for over-the-counter birth control, and don’t require a prescription or doctor’s visit. They can help prevent pregnancy and sexually transmitted infections, but not everyone knows how to use them correctly, said Dr. Melissa Simon, vice chair for research at the department of obstetrics and gynecology at the Northwestern University Feinberg School of Medicine. And condoms fail about 13 percent of the time, according to the Centers for Disease Control and Prevention.Spermicide, a sperm-killing chemical that comes in gels, foams and the like, is also sold over-the-counter but is not considered effective as other options at preventing pregnancy by itself, said Dr. Monica Woll Rosen, an OB-GYN at University of Michigan Medical School.Other options for short-term contraceptionTwo other short-acting contraceptives, diaphragms and cervical caps, don’t require a prescription. Women should typically speak to a doctor about using them, and they’ve largely fallen out of favor, experts said, with many long-term options for birth control on the market.PhexxiOne of the newest forms of birth control to hit the market, Phexxi, is a hormone-free option that requires a prescription. It was about 93 percent effective when used correctly in clinical trials reviewed by the Food and Drug Administration, and 86 percent effective in practice.But it’s a gel that the user inserts in the vagina before intercourse, not a long-acting form of contraception, and some reported side effects include vaginal burning and itching. Also, because Phexxi is so new, some insurance companies may not cover it.From Opinion: A Challenge to Roe v. WadeCommentary by Times Opinion writers and columnists on the Supreme Court’s upcoming decision in Dobbs v. Jackson Women’s Health Organization. Alison Block: Offering compassionate care is a core aspect of reproductive health. It might mean overcoming one’s own hesitation to provide procedures ike second-trimester abortions. Jamelle Bouie: The leak proves that the Supreme Court is a political body, where horse-trading and influence campaigns are as much a part of the process as legal reasoning.Emily Bazelon: By suggesting in the draft that the progress women have made is a reason to throw out Roe, Justice Samuel Alito has turned feminism against itself.Bret Stephens: Roe v. Wade was an ill-judged decision when it was handed down. But overturning it would do more to replicate its damage than to reverse it.Sway: In the latest episode of her podcast, Kara Swisher talks to an abortion rights advocate about the draft opinion and the future of abortion rights in America.What other birth control methods require a prescription?The PillHormonal birth control pills can be highly effective if taken at the same time every day. There are hundreds of birth control pills on the market, and the most common ones use a combination of estrogen and progestin, which are both hormones, to stop ovulation.Some people report mood changes related to the pill and other forms of hormonal birth control. One review of studies found that users of hormonal contraceptives were more likely than nonusers to have higher rates of depression, anxiety, fatigue and anger.The Progestin-Only PillSometimes called the “mini pill,” this form of birth control contains only progestin, a synthetic form of the progesterone hormone. The biggest advantage of the progestin-only pill is that is doesn’t contain estrogen, making it more accessible to people who are at risk of developing medical complications from the hormone, said Dr. Aparna Sridhar, an associate clinical professor in obstetrics and gynecology at UCLA Health.“For those who actually cannot tolerate estrogen for any reason, the progestin-only pill is a great option,” Dr. Sridhar said.The progestin-only pill is about as effective as the combination pill if it’s used correctly, she said.The PatchThe patch uses a combination of hormones similar to those found in the ring and many oral contraceptives — estrogen and progestin — but instead of taking a daily pill, the user places a patch on their skin once a week.Patches come in packs of three; the user puts on a new patch each week for three weeks, then has a patch-free week during which a period typically occurs. Patches can be worn when showering or swimming.“It’s great for people who can’t remember or don’t want to take a pill every single day,” said Dr. Julia Cron, vice chair of the department of obstetrics and gynecology at Weill Cornell Medicine/New York-Presbyterian. “It also gives you some of the other advantages that the pill gives, like cycle control, less bleeding, less pain.”Side effects include irregular bleeding, headaches, breast tenderness and, for some, nausea and mood changes, Dr. Cron said.The RingThere are two vaginal rings available: the NuvaRing, which lasts for about a month, and the Annovera ring, which lasts for about a year. For both rings, the user inserts the ring, leaves it in for about three weeks and then removes for a week; someone using the NuvaRing would insert a new ring each month, while someone using the Annovera ring will reuse the same ring. They use similar hormones as the pill and the patch, but because they can be worn for longer periods of time, some find them less bothersome than the pill, which has to be taken every day, and the patch, which has to be applied nearly every week.Because the ring contains estrogen, it can have similar side effects to the pill or patch, said Dr. Siripanth Nippita, a clinical assistant professor of obstetrics and gynecology at NYU Langone Health. These can include mood changes, nausea, breast tenderness and headaches.What birth control methods require a medical procedure?Whitney Curtis for The New York TimesIUDsWomen’s health experts consider intrauterine devices, or IUDs, to be among the most effective forms of birth control, in part because people using them don’t need to remember to take or apply them, like a pill or a patch. A doctor inserts one of the T-shaped devices into the uterus, a procedure that typically lasts five minutes. Depending on the type, the IUD can remain effective for three to 12 years. .There are two types of IUDs currently available:Hormonal, which secretes progestin. “Very little” of the hormone is absorbed into the bloodstream, compared with oral contraceptive pills, Dr. Rosen said, so patients tend to experience fewer mood-related side effects. People who receive hormonal IUDs can have abnormal bleeding or spotting during the first three to six months after insertion. Then the bleeding typically becomes lighter and more regular, or goes away completely.Copper, which doesn’t contain hormones. However, people with heavy or painful periods may want to avoid copper IUDs, Dr. Rosen said, because they can cause longer periods and heavier flows for some.Birth Control ImplantsNexplanon is a type of implant that is inserted under the skin of the upper arm and lasts for around three years. It also has the lowest failure rate of all birth control methods, according to Dr. Nippita.A doctor or nurse inserts the small rod, which is about the length of a matchstick, and the process takes only a few minutes. No pelvic exam is required.Side effects can vary from person to person. About a third of patients will experience “daily, abnormal, bothersome” spotting, said Dr. Rosen; another third will not experience bleeding at all; and the other third will simply have lighter, infrequent spotting. Some people with the implant also report mood swings, headaches, weight gain and acne.Understand the State of Roe v. WadeCard 1 of 4What is Roe v. Wade?

Pulmonary arterial hypertension (PAH) is a type of high blood pressure in the lungs, in which blood vessels are narrowed, blocked or destroyed, causing the heart to work harder and, in time, result in cardiac weakness and failure.
The disease is relatively rare, but affects an estimated 100,000 persons in the United States, and results in 20,000 deaths annually. There is no cure.
In a study published May 4, 2022 in Science Translational Medicine, researchers at the University of California San Diego School of Medicine describe the underlying signaling pathway that results in PAH — and a novel monoclonal antibody therapy that blocks the abnormal blood vessel formation characterizing the disease.
At the cellular level, PAH progresses with proliferation of vascular smooth muscle cells (vSMC) that cause small arteries in the lungs to become narrowed, leading to progressively less oxygen in the blood. A research team, led by senior author Patricia A. Thistlethwaite, MD, PhD, professor of surgery in at UC San Diego School of Medicine and a cardiothoracic surgeon at UC San Diego Health, focused on overexpression of the NOTCH ligand JAGGED-1, a binding protein involved in cell signaling and, in this case, the development of small pulmonary vSMCs.
They found that overexpression of the NOTCH3 ligand, JAGGED-1, spurs vSMC proliferation, but the NOTCH3 ligand DELTA-LIKE 4 inhibits it. The researchers then developed a therapeutic monoclonal antibody that selectively blocks JAGGED-1-induced NOTCH3 signaling, effectively reversing pulmonary hypertension in two rodent models of the disease, without toxic side effects.
“These findings reveal two opposing roles of NOTCH ligands,” said Thistlethwaite. “Importantly, it opens the door to a potentially new, safe treatment for PAH, using a monoclonal antibody that selectively inhibits NOTCH3 activation in the lung vasculature.”
Co-authors include: Yu Zhang, Moises Hernandez, Jonathan Gower, Nolan Winicki, Xena Morataya, Sebastian Alvarez, Jason X.-J. Yuan and John Shyy, all at UC San Diego.
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Materials provided by University of California – San Diego. Original written by Scott La Fee. Note: Content may be edited for style and length.

In April 2021, during the Leaders Summit on Climate, President Biden announced his goal to drastically reduce the United States’ greenhouse gas emissions by 2030.
Victor Agbafe was watching the address on TV. The University of Michigan Medical School student, who is also studying law at Yale, immediately texted a few mentors, including Michigan Medicine integrated plastic surgery resident Nicholas Berlin, M.D., M.P.H., M.S.
The question that emerged from their messages was a crucial one: What role can the medical community, which accounts for about 8.5% of America’s greenhouse gas emissions, play in these climate change reduction efforts?
A year later, research that Agbafe and Berlin led outlines some answers. Their paper describes how surgery, particularly cancer surgery, contributes to climate change and suggests some solutions to combat the problem, from reducing waste to rethinking how surgical care is delivered.
“In general, these ideas are good for our planet,” Agbafe said. “But also, surgery unfortunately plays a disproportionate role in the carbon output and the waste we produce in medicine.”
Operating rooms are a massive source of greenhouse gas production for hospitals, representing 70% of their waste and generating three to six times as much carbon as the rest of health systems.

Researchers have identified distinct differences among the cells comprising a tissue in the retina that is vital to human visual perception. The scientists from the National Eye Institute (NEI) discovered five subpopulations of retinal pigment epithelium (RPE) — a layer of tissue that nourishes and supports the retina’s light-sensing photoreceptors. Using artificial intelligence, the researchers analyzed images of RPE at single-cell resolution to create a reference map that locates each subpopulation within the eye. A report on the research published in Proceedings of the National Academy of Sciences.
“These results provide a first-of-its-kind framework for understanding different RPE cell subpopulations and their vulnerability to retinal diseases, and for developing targeted therapies to treat them,” said Michael F. Chiang, M.D., director of the NEI, part of the National Institutes of Health.
“The findings will help us develop more precise cell and gene therapies for specific degenerative eye diseases,” said the study’s lead investigator, Kapil Bharti, Ph.D., who directs the NEI Ocular and Stem Cell Translational Research Section.
Vision begins when light hits the rod and cone photoreceptors that line the retina in the back of the eye. Once activated, photoreceptors send signals through a complex network of other retinal neurons that converge at the optic nerve before traveling to various centers in the brain. The RPE sits beneath the photoreceptors as a monolayer, one cell deep.
Age and disease can cause metabolic changes in RPE cells that can lead to photoreceptor degeneration. The impact on vision from these RPE changes varies dramatically by severity and where the RPE cells reside within the retina. For example, late-onset retinal degeneration (L-ORD) affects mostly peripheral retina and, therefore, peripheral vision. Age-related macular degeneration (AMD), a leading cause of vision loss, primarily affects RPE cells in the macula, which is crucial for central vision.
Bharti and colleagues sought to determine if there are different RPE subpopulations that might explain the wide spectrum of retinal disease phenotypes.

While most of us were baking sourdough bread and watching “Tiger King” to stay sane during the pandemic shutdown, UC Riverside bioengineering professor William Grover kept busy counting the colorful candy sprinkles perched on top of chocolate drops. In the process, he discovered a simple way to prevent pharmaceutical fraud.
The technique, which he calls CandyCode and uses tiny multicolored candy nonpareils or “hundreds and thousands” as a uniquely identifiable coating for pharmaceutical capsules and pills, is published in Scientific Reports.
Counterfeit or substandard medicines harm millions of people and cost an estimated $200 billion annually. In the developing world, the World Health Organization estimates that one in 10 medical products is fake.
Grover’s lab has previously worked on simple, low-cost ways to ensure the authenticity of pharmaceuticals. Other researchers have been interested in putting unique codes on pills that can be used to verify their authenticity, but all of those schemes have practical limitations.
“The inspiration for this came from the little colorful chocolate candies. Each candy has an average of 92 nonpareils attached randomly, and the nonpareils have eight different colors. I started wondering how many different patterns of colored nonpareils were possible on these candies,” said Grover. “It turns out that the odds of a randomly generated candy pattern ever repeating itself are basically zero, so each of these candies is unique and will never be duplicated by chance.”
This gave Grover the idea that the nonpareils could be applied as a coating to each pill, giving it a unique pattern that could be stored by the manufacturer in a database. Consumers could upload a smartphone photograph of a pill and if its CandyCode matches one in the database, the consumer could be confident that the pill is genuine. If not, it is potentially fraudulent.
To test this idea, Grover used edible cake decorating glue to coat Tylenol capsules with nonpareils and developed an algorithm that converts a photo of a CandyCoded pill into a set of text strings suitable for storing in a computer database and querying by consumers. He used this algorithm to analyze a set of CandyCode photos and found they function as universally unique identifiers, even after subjecting the CandyCoded pills to physical abuse that simulates the wear-and-tear of shipping.
“Using a computer simulation of even larger CandyCode libraries, I found that a company could produce 10^17 CandyCoded pills — enough for 41 million pills for each person on earth — and still be able to uniquely identify each CandyCoded pill,” Grover said.
Even more unique CandyCodes could be created with the introduction of more colors or combining different sizes or shapes of candy nonpareils. CandyCodes could also be used to ensure the authenticity of other products that are often counterfeited. Bottle caps, for example, could be coated with adhesive and dipped in nonpareils to ensure the integrity of perfume or wine and garment or handbag hang tags could be coated with glitter.
CandyCoded capsules or tablets have an unexpected benefit for the consumer as well.
“Anecdotally, I found that CandyCoded caplets were more pleasant to swallow than plain caplets, confirming Mary Poppins’ classic observation about the relationship between sugar and medicine,” said Grover.
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Materials provided by University of California – Riverside. Original written by Holly Ober. Note: Content may be edited for style and length.

Every species, from bacteria to humans, is capable of regeneration. Regeneration is mediated by the molecular processes that regulate gene expression to control tissue renewal, restoration and growth.
A collaboration between researchers in the Department of Biomedical Engineering and the College of Medicine at Texas A&M University identifies the crucial role of minerals in regulating gene expression, thus controlling the number of proteins that a cell should make, thereby encouraging tissue regeneration and redefining cellular identity.
This research paves the way for future studies to identify the role of specific minerals, as well as how they can be assembled to design the next generation of mineral medicine to heal damaged tissue.
This study was recently published in Science Advances.
Minerals are inorganic elements that play many vital roles, working interactively with vitamins, enzymes, hormones and other nutrient cofactors to regulate thousands of the body’s biological functions. Although several minerals have been shown to regulate gene expression and cellular activity, very little work has focused on understanding underlying molecular mechanisms.
This engineering research group is led by Dr. Akhilesh Gaharwar, associate professor of biomedical engineering and Presidential Impact Fellow, in collaboration with Dr. Irtisha Singh, assistant professor in the Department of Molecular and Cellular Medicine at Texas A&M and the co-corresponding author of the study where a new class of mineral-based nanoparticles has been introduced to direct human stem cells toward bone cells. These nanoparticles are known specifically as nanosilicates, and with them, the team is able to determine the role of minerals in regulating gene expression profiles to direct stem cell differentiation.

A coaching program aimed at decreasing burnout among female resident physicians significantly reduced emotional exhaustion and imposter syndrome while increasing self-compassion over a six month period, according to researchers at the University of Colorado Anschutz Medical Campus.
“Physician burnout is linked to increased errors, higher patient mortality rates, depression, suicidal ideation and high job turnover,” the study said. “The culture leading to burnout begins in medical school and worsens throughout training.”
The study was published today in JAMA Network Open.
Currently, between 40-80% of residents and physicians experience burnout with surveys showing females feel it most acutely.
“When it comes to physician burnout people tend to either blame the system or the individual and miss the physician culture,” said study co-author Tyra Fainstad, MD, visiting associate professor at the University of Colorado School of Medicine. “Right now, the physician culture is toxic.”
Fainstad and fellow co-author Adrienne Mann, MD, assistant professor at the CU School of Medicine, are both certified life coaches who were alarmed at burnout rates among female residents.

Our DNA acts like a blueprint for the cellular machinery that lets cells, organs, and whole organisms function. Mutations in the DNA can result in genetic diseases. Such genetic variation can include point mutations at a single site, as well as deletions, duplications, and inversions.
The term ‘inversion’ describes a piece of DNA flipping its orientation in the genome. Inversions are poorly understood because they are more difficult to analyse than other types of mutations. Scientists at EMBL Heidelberg, in collaboration with scientists at the University of Washington, USA, and Heinrich Heine University Düsseldorf, Germany, have now shown that inversions are one of the most common mutational processes in humans.
The researchers uncovered how inversions are formed and investigated in detail a set of 40 inversions that form recurrently in the genome, where the DNA sequence flips back and forth. These ‘flip-flopping’ inversions typically lie in regions linked to the development of certain human diseases called genomic disorders.
“We found that inversions form at a much higher rate than previously thought. In humans, at least 0.6% of the genome repeatedly changes direction, making inversion one of the fastest mutational processes in humans,” said Jan Korbel, EMBL Senior Scientist and Head of Data Science. “At these sites, the genome is not stable – the direction of the DNA code continues to switch back and forth.”
Many important human genes lie within these unstable regions. For scientists, this means they must consider this flipping behaviour of genomic regions when they study aspects such as long-distance gene regulation or epigenetics.
Inversions are also relevant for the development of human diseases, such as developmental delays in children or neuropsychiatric disorders in adults. “Despite their importance, these regions have been very difficult to study before because of their complexity. Showing that these inversions indeed flip-flop back and forth required a new set of computational methods,” said Tobias Marschall, Director of the Institute of Medical Biometry and Bioinformatics and the Heinrich Heine University Düsseldorf. “We can now provide human geneticists with a new tool to understand the origin of disease in their patients.”
Evan Eichler, group leader at the University of Washington, said: “We showed for the first time that inversions can be associated with rare genomic rearrangements found in paediatric autism, developmental delay and epilepsy. The question now is why? We hypothesize that certain configurations at the flanks of the inversions either predispose or protect individuals and their offspring from disease-associated rearrangements. This could have a practical application in the clinic, where it could be used to identify families at risk for developing these disorders.”
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Materials provided by European Molecular Biology Laboratory. Original written by Annika Grandison. Note: Content may be edited for style and length.

For some sports such as tennis, the wrist is frequently under stress, and an injury to the wrist can prevent an athlete from competing. To aid in the early detection of wrist injuries, researchers at the University of Tsukuba have developed a portable MRI system that enables athletes to be screened for injuries before they exhibit any symptoms.
Athletes have a risk of sports injuries, which can influence their ability to continue training and competing. For injuries such as cartilage tears, early detection and treatment are important for enabling athletes to continue playing sports, because a lack of treatment may affect their ability to compete. Whole-body MRI scanners can identify cartilage injuries; moreover, MRI scans of asymptomatic patients have shown a high rate of cartilage damage, meaning that MRI scans can identify injuries before athletes are even aware of them. When an injury is detected early, treatment can be started before the injury becomes more problematic. Unfortunately, using a whole-body MRI scanner, which is large and expensive, is not realistic for screening athletes outside of healthcare settings.
To address this problem, the research team at the University of Tsukuba recently developed a portable MRI system for baseball elbow injuries. “Because this system is portable, athletes can be quickly screened at a remote location, such as their practice field,” explains Professor Yasuhiko Terada. “Thus, this device can eliminate the need for players to go to a hospital for diagnosis.”
Now, the research team has improved upon their previous device and specifically developed a system to diagnose wrist injuries. Their improvements include an effective shielding method for obtaining high-quality images and an outlet-free power system, so there is no need for a commercial power supply.
The investigators employed their MRI scanner at a tennis school, where they imaged the wrists of male and female tennis players aged 8-18 years old. Among the athletes screened, several were found to have cartilage damage, even though some of these athletes had no other symptoms of an injury. Thus, this device can provide an early screening tool that is convenient for athletes and can help to prevent further injury or damage.
“As future work, further devices can be developed for other joints, such as the ankle or knee,” says Professor Terada. Owing to its convenience, this newly developed device may lead to the development of similar systems for preventing and treating injuries among athletes in all types of sports.
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Materials provided by University of Tsukuba. Note: Content may be edited for style and length.

Mailed opioid disposal kits led to 60 percent of patients who had leftover opioid pain pills properly disposing of them after surgeries, according to a new study by researchers at the Perelman School of Medicine at the University of Pennsylvania. Just 43 percent of patients in this study who didn’t receive the kits disposed of their opioids, but when compared to national studies, the mailed kit group in this research appeared to double or even triple the previously seen rates of safe disposal. Pointing to a potentially effective method for cutting down on a source of illicit opioids, this study was published today in JAMA Network Open.
“I was pleased to see that such a simple, ‘snail mail’ approach could change behavior and promote self-reported disposal,” said the study’s lead author, Anish Agarwal, MD, an assistant professor of Emergency Medicine and chief wellness officer of the Department of Emergency Medicine at Penn Medicine. “The opioid epidemic clearly continues to be front and center for patients, and the concerns with opioid use and misuse are becoming a real part of the conversation between physicians and patients. I think patients are more aware of the risks and consequences of using opioids and storing them in their homes.”
Leftover opioid medications are a concern for their potential to be misused, either by the person they were prescribed to or someone else taking them. But just throwing leftover pills into the trash may not be the best option.
“Throwing them in the trash can be dangerous if tabs are ingested by kids or animals, and there are environmental concerns,” said the study’s senior author, M. Kit Delgado, MD,an assistant professor of Emergency Medicine and Epidemiology and deputy director of the Penn Medicine Nudge Unit. “When safe disposal site are not available, the FDA recommends that certain high-risk medications, including opioids, be flushed down the toilet due to their high-risk nature. However, there are also environmental concerns with doing this.”
While safe disposal sites, like certain pharmacies, are the best option, patients often don’t use them because they may not be easily accessible or it takes extra effort. So Agarwal, Delgado, and colleagues decided to test whether an added layer of convenience — mailing safe disposal kits — might make a difference.
Taking place between April 19 and June 1, 2021, the study consisted of 235 patients who completed it. All these participants had an orthopaedic or urologic procedure and were prescribed opioid pain medication for their recovery. Split roughly in half, the usual procedure was applied to one group: They were texted instructions to dispose of their unused opioids along with a link detailing the locations of local safe disposal points to drop off their unused opioid tablets. The second group received the same text message instructions but also received mailed disposal kits four to seven days after their procedures.