Competition among companies that produce name-brand drugs won't lower prices, suggests new study, which found competition usually leads to higher prices for consumers. Policies to promote competition, such as accelerating approvals, will likely not result in lower prices without structural reforms.

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Those 5 Stages of Grief: Does Mourning Really Unfold Like That?

Sometimes a psychological phenomenon becomes so well-known that even people with no training whatsoever in psychology are familiar with it. That’s true for the five stages of grief, as described by the psychiatrist Elisabeth Kubler-Ross back in 1969. When someone dies, she suggested, the first reaction of the loved ones left behind is denial. Anger comes next, then bargaining, then depression. Finally, after all those stages have passed, mourners experience some acceptance of their loss. 

Originally, Kubler-Ross formulated the stages of grief to describe the reactions of patients who had terminal illnesses. But she never conducted a systematic study of people’s reactions to the death of a loved one, and whether those reactions change over time in the way she predicted. Over the years, researchers have stepped in to try to see whether Kubler-Ross was right. 

They found that, with regard to the order in which various reactions peak over time, Kubler-Ross was spot on. She was wrong, though, about the frequency with which the bereaved experience different emotions. The most important conclusion of research on stages of grief, though, is that there is no one way to grieve. Different people mourn in different ways. Their stages may be different than the ones Kubler-Ross described, or they may not go through different stages at all. 

The Unfolding of Grief for 2 Years After the Loss of a Loved One: A Test of the 5 Stages

In “An empirical examination of the stage theory of grief,” published in the prestigious Journal of the American Medical Association, Paul K. Maciejewski and his colleagues studied the bereavement process in 233 people from Connecticut who had recently experienced the death of a loved one. Beginning one month after the loss, and continuing for two years, the researchers asked the mourners about their experiences. 

Professor Maciejewski included in the study only those people whose loved one died of natural causes and not from violence or some other traumatic event. Most of the mourners who agreed to participate were white. On the average, they were 63 years old. Most often, the person who had died was a spouse, though some people in the study were mourning the loss of an adult child, a parent, or a sibling.

The researchers did not ask about one of Kubler-Ross’s five stages — bargaining. That’s the stage in which mourners are preoccupied with what they could have done differently (for example, “if only I had asked for a second opinion”). They asked instead about a different stage — yearning. People who are yearning experience “a sense of emptiness.” They are “preoccupied with the person who has been lost, seeking reminders and reliving memories.” 

If Maciejewski and his colleagues had studied Kubler-Ross’s stages, they would have looked at these reactions, and expected them to occur in this order:

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

Instead, they tested a slightly different sequence:

1. Disbelief (denial)
2. Yearning
3. Anger
4. Depression
5. Acceptance

The researchers found that if they looked at the frequency with which people experienced each of those reactions, Kubler-Ross got it wrong: 

• Mourners experienced acceptance more often than every other reaction. That was true at each of the three major periods of time — between 1 and 6 months after the loss; between 6 months and a year after the loss; and between 1 and 2 years after the loss. 
• Yearning was always experienced next-most-often.
• Depression was always the third most often experienced reaction of the five that were studied.
• Disbelief and anger were experienced least often.

However, there’s another way of thinking about this. For each reaction, when does it reach its peak? For example, even though mourners experienced acceptance more often than any other reaction during every time period, when did acceptance reach its peak? When was it most likely to be experienced? If Kubler-Ross is right, then acceptance should reach its peak at the last stage. 

That’s what the authors found. Acceptance increased over time, reaching its peak at the end of the study — two years after the loss. 

All of the other reactions also reached their peak in the predicted order:

1. Mourners were most likely to experience disbelief (denial) soon after the loss.
2. Yearning reached its peak next — about 4 months after the loss.
3. Anger reached its peak about 5 months after the loss.
4. Depression peaked 6 months after the loss.
5. Acceptance increased steadily over time, reaching its highest level when the study ended, 2 years after the loss.

These results offer a different answer to the question of whether reactions to grief unfold in the way that Kubler-Ross predicted: Yes, each reaction peaks exactly in the order that she predicted. One of the reactions she discussed, bargaining, was not assessed in the study, so we cannot know how often mourners really do experience that, or when it peaks. 

Mental health professionals learned something important from this study. In writings about grief, and in the Diagnostic and Statistical Manual (DSM), the official guide to diagnosing mental disorders, depression gets all the attention. Yearning is not even mentioned in the bereavement section of DSM. Yet, it is the most commonplace of all the negative reactions to the death of a loved one. 

The good news from this study is that, on the average, after 6 months, all of the negative reactions declined. A half year after the death of their loved one, mourners experienced disbelief, yearning, anger, and depression less often than they had before. The one positive reaction that was studied, acceptance, continued to increase over time. 

In this study, as in all research in the social sciences, the findings describe the average reactions across all the people in the study. Many people, though, have different experiences.

The Most Important Finding Across All Studies of Grief: Different People Grieve in Different Ways

The experience of grief is deeply personal. There is no one way, and certainly no one “right” way, to experience the death of a person you loved. As psychology professor Nick Haslam noted:

“Some of the stages may be absent, their order may be jumbled, certain experiences may rise to prominence more than once, and the progression of stages may stall. The age of the bereaved person and the cause of death may also shape the grief process.”

Not everyone will be fortunate enough to experience less pain over the loss after six months have passed. In his discussion, Haslam described another study of people who had recently been widowed. Some of them, he said, “fell into a long-lasting depression.” Others were depressed before their spouse died and recovered afterwards. Still others “were fairly resilient and had experienced low levels of depression throughout.”

Whatever form your journey through grief takes, be kind to yourself. Don’t judge yourself or try to meet someone else’s standards for how you should be doing. The death itself is hard enough without adding any other needless pressures. 

Planned Parenthood and the ACLU Sue Missouri Over Restrictive Abortion Law

Planned Parenthood’s Acting President Weighs in on 2020 Endorsements, Voting and Activism

What are heat shock proteins (HSPs)?

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Dear Mark: Safe Tick Repellant, Fish Intake on Mediterranean Diet, and Therapeutic Value of Wine

For today’s edition of Dear Mark, I’m answering a few questions from recent comment boards. First, with all the scary tick-related news coming out lately, are there any non-toxic tick repellents that actually work? Are there essential oils that repel and/or kill ticks? Is there a safer way to use insecticides? Next, were the people in the Mediterranean keto study actually eating a kilo of fish on their fish days? And is the wine an important part of the Mediterranean diet? Is the wine therapeutic or just for pleasure?

Let’s find out:

Non toxic effective tick repellents safe for children? Any suggestions? I live in NC so the tick thing scares the hell out of me. Found at parks in short grasses, like how am I supposed to avoid this???

If you want to avoid DEET and other pesticides, there are many essential oils that repel ticks. Let’s go through the various tick species.

The castor bean tick:

Repelled by miswak essential oil and killed by Libyan rosemary essential oil.

Repelled by rosemary and mint essential oils.

Repelled by Dorado azul, also known as pignut or bushmint and traditionally used as mosquito repellant. The terpene known as alpha-humulene was the most repellant terpene found in the oil; you can buy both the oil and the humelene.

Repelled by turmeric oil, even beating out DEET.

The cattle tick:

Repelled by French marigold essential oil.

Repelled by mastrante essential oil.

The deer tick:

Repelled by nootkatone (a grapefruit aromatic compound) and to a lesser degree ECOSMART organic insect repellent. Here’s a cool video showing ticks trying to climb a person’s finger that’s been dipped in nootkatone.

Nothing is 100% guaranteed to repel all ticks. In fact, many of these oils show 50-60% effectiveness in the field. But if you use a combination of relevant essential oils, frequent tick checking, smart clothing choices (long socks, shoes/boots, pants), and avoidance of tick-heavy landscapes (tall grass, oak leaves, etc, notwithstanding these new breeds that apparently love short grass), you’ll be in good hands—or at least better hands than the naked guy rolling around in piles of oak leaves.

And if you’re really worried, you could always tuck pants into your shoes, then spray the shoes and lower section of your pants with peremethrin, an insecticide that kills the ticks as they climb before they can reach your flesh. Use a dedicated pair of pants and shoes that you don’t use for anything else and reapply each time you go out. A light spray on the outside of reasonably-thick pants should provide tick protection without actually putting the pesticide into contact with your skin.

2.2 pounds of fish each day?!

I know, I was surprised to read that myself. But right there, according to the researchers:

We estimated during the first 4 weeks of this study that the average edible fish consumption per subject during the ‘‘fish block’’ day was approximately 1.12 0.41 kg=day.

So it wasn’t just an allowance of fish. They actually tracked their consumption and found they were eating over 2 pounds of fish on average on the days they ate fish.

The study said that they had “fish block” and “no fish block” days. With no mix of fish and other meats on the same day. What is the reason for this?

They offered no justification in the study write-up.

Maybe it was to increase variety.

Maybe it was to reduce their intake of omega-3s. I mean, a kilo of fish per day adds up to a lot of omega-3s, especially if you’re doing sardines and salmon. There is such a thing as too much a good thing, and excessive omega-3 can lead to blood thinning, excessive bleeding, and imbalanced omega-3:omega-6 ratios in the opposite direction.

Maybe it was to help people stick to the diet, to break up all that fish with some meat and chicken.

Great, but why the wine? Is it not a contradictory with ketosis? But is it for pleasure or is it for a therapeutic reason?

Wine is emphasized in Mediterranean diet studies (both keto and regular) because wine is considered an important part of the cuisines of most Mediterranean countries, at least on the European side. Italy, France, Spain, Portugal, and Greece all have an extensive history of wine production and consumption. Since researchers are casting a wide net to capture everything that might be contributing to the health effects, they’re including everything that appears in the “Mediterranean diet.”

But, yes, it’s good to keep in mind that ketosis and alcohol detoxification do utilize some of the same physiological pathways.

Still, wine does appear to have therapeutic effects, especially in people with metabolic syndrome—the subjects of this study.

Red wine is very high in polyphenols, due to both the polyphenols in grapes themselves and the unique polyphenols that form during fermentation. One study compared grape extract to red wine made with the same types of grapes, finding that red wine provided benefits the grape extract did not.

Drinking wine with a fast food meal can reduce postprandial oxidative stress and inflammatory gene expression; it can actually make an otherwise unhealthy meal full of refined, rancid fats less damaging (though still not advisable).

Blood pressure: In people with (but not without) a genetic propensity toward efficient or “fast” alcohol metabolism, drinking red wine at dinner seems to lower blood pressure.

Type 2 diabetics: Type 2 diabetics who initiate red wine drinking at dinner see reduced signs of metabolic syndrome, including moderately improved glycemic control and blood lipids.

Inflammation: A study found that non-drinkers who begin regularly drinking moderate amounts of Sicilian red wine enjoy reduced inflammatory markers and improved blood lipids.

I’d say the wine is a therapeutic addition to the Mediterranean keto diet. Don’t let that override your own experience, however. Wine might have therapeutic effects for many people, but not everyone feels better including it. It’s an option, but it’s hardly a necessary one for a healthy diet.

If you have any more questions, feel free to ask away down below. Thanks for reading, everyone.

References:

El-seedi HR, Khalil NS, Azeem M, et al. Chemical composition and repellency of essential oils from four medicinal plants against Ixodes ricinus nymphs (Acari: Ixodidae). J Med Entomol. 2012;49(5):1067-75.

Ashitani T, Garboui SS, Schubert F, et al. Activity studies of sesquiterpene oxides and sulfides from the plant Hyptis suaveolens (Lamiaceae) and its repellency on Ixodes ricinus (Acari: Ixodidae). Exp Appl Acarol. 2015;67(4):595-606.

Goode P, Ellse L, Wall R. Preventing tick attachment to dogs using essential oils. Ticks Tick Borne Dis. 2018;9(4):921-926.

Politi FAS, Fantatto RR, Da silva AA, et al. Evaluation of Tagetes patula (Asteraceae) as an ecological alternative in the search for natural control of the cattle tick Rhipicephalus (Boophilus) microplus (Acari: Ixodidae). Exp Appl Acarol. 2019;77(4):601-618.

Lima Ada S, Carvalho JF, Peixoto MG, Blank AF, Borges LM, Costa junior LM. Assessment of the repellent effect of Lippia alba essential oil and major monoterpenes on the cattle tick Rhipicephalus microplus. Med Vet Entomol. 2016;30(1):73-7.

Schulze TL, Jordan RA, Dolan MC. Experimental use of two standard tick collection methods to evaluate the relative effectiveness of several plant-derived and synthetic repellents against Ixodes scapularis and Amblyomma americanum (Acari: Ixodidae). J Econ Entomol. 2011;104(6):2062-7.

Hansen AS, Marckmann P, Dragsted LO, Finné nielsen IL, Nielsen SE, Grønbaek M. Effect of red wine and red grape extract on blood lipids, haemostatic factors, and other risk factors for cardiovascular disease. Eur J Clin Nutr. 2005;59(3):449-55.

Di renzo L, Carraro A, Valente R, Iacopino L, Colica C, De lorenzo A. Intake of red wine in different meals modulates oxidized LDL level, oxidative and inflammatory gene expression in healthy people: a randomized crossover trial. Oxid Med Cell Longev. 2014;2014:681318.

Gepner Y, Henkin Y, Schwarzfuchs D, et al. Differential Effect of Initiating Moderate Red Wine Consumption on 24-h Blood Pressure by Alcohol Dehydrogenase Genotypes: Randomized Trial in Type 2 Diabetes. Am J Hypertens. 2016;29(4):476-83.

Gepner Y, Golan R, Harman-boehm I, et al. Effects of Initiating Moderate Alcohol Intake on Cardiometabolic Risk in Adults With Type 2 Diabetes: A 2-Year Randomized, Controlled Trial. Ann Intern Med. 2015;163(8):569-79.

Avellone G, Di garbo V, Campisi D, et al. Effects of moderate Sicilian red wine consumption on inflammatory biomarkers of atherosclerosis. Eur J Clin Nutr. 2006;60(1):41-7.

The post Dear Mark: Safe Tick Repellant, Fish Intake on Mediterranean Diet, and Therapeutic Value of Wine appeared first on Mark's Daily Apple.

RHR: A New Study on Hashimoto’s Disease, Diet, and Lifestyle

A new study from Angie Alt and Dr. Rob Abbott shows promising results for the autoimmune protocol (AIP) diet as a way to treat Hashimoto’s disease. In this episode of Revolution Health Radio, I talk with Angie and Dr. Abbott about their findings, and we discuss how behavior and lifestyle interventions impacted their results.

The post RHR: A New Study on Hashimoto’s Disease, Diet, and Lifestyle appeared first on Chris Kresser.