TIME medicine

Who Should—And Who Shouldn’t—Take Vitamin D

Vitamins
Getty Images

Here's what experts say, based on the latest evidence

Does your diet need a little extra D? For researchers, it’s one of nutrition’s most vexing questions. “It’s the wild, wild west,” says Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School. “The issue has become murkier over time rather than clearer.” Research is mixed about whether doctors should routinely test for vitamin D levels, like they do for cholesterol, and whether people should be supplementing their diets with vitamin D pills.

Case in point: a study just released in JAMA Internal Medicine showed that vitamin D did not lower the risk of falls among an elderly population in Finland. The study, which compared the effects of exercise against vitamin D supplements on falls and resulting injuries, did find, however, that exercise cut the chances of more severe injury from falls in half compared to those who didn’t exercise.

MORE: Want to Stay Healthy? Don’t Rely on Vitamins

But that doesn’t mean that vitamin D isn’t worth taking at all. The Institute of Medicine (IOM), and the U.S. Preventive Services Task Force (USPSTF) both recently reviewed all of the evidence on vitamin D and its health effects and concluded that in many cases, D supplementation is beneficial—with some important caveats. The two groups say that 600 international units (IU) are generally enough for most healthy adults and that higher doses of vitamin D don’t necessarily produce more health benefits. They also stress that those benefits are limited to bone health; there isn’t enough evidence to support the idea that taking the vitamin can protect against heart disease, cancer, diabetes or cognitive decline, all benefits suggested by some smaller studies.

“More isn’t necessarily better,” says Manson, who served on the IOM committee. “In some cases, it can be worse.”

Overdoing vitamin D can lead to calcium in the urine, which can cause kidney stones. Extremely high doses—around 10,000 IU a day—can trigger calcium deposits in the blood vessels, which can lead to clots that cause heart attacks. The IOM panel recommended no more than 4,000 IU of vitamin D daily to avoid these potential problems.

MORE: Want to Build Endurance? Cut Back on Vitamin C and E Supplements

When people are tested for vitamin D deficiency and come up short, some researchers caution against treatment. In addition to the dosage risks, there’s also evidence that the lab tests for the type of vitamin D circulating in the blood, 25-hydroxyvitamin D, may not be the most reliable measure of a person’s D levels. Plus, not all labs use the same standard test for picking up 25 hydroxy D, and they set different standards for what are considered normal levels. “Clinicians are often left chasing a number, and trying to get patients’ blood levels up to a certain point,” says Manson. “But when you think about how many people are screened for vitamin D, and the concerns about the reliability in how it’s measured, and the differences in what is considered normal ranges across laboratories, it’s really concerning.”

Better data may be coming soon, however. Several large trials are underway in which people are randomly assigned to take different levels of vitamin D supplements so researchers can study their health outcomes, from bone problems to heart disease, cancer, diabetes and more. Manson is overseeing the largest of these, called VITAL, which has 26,000 participants. The results from these studies, which are being conducted in the U.S., Europe, Australia and New Zealand, should be available in 2017. “We should have conclusive answers in about three years,” Manson says.

The studies will also look specifically at whether vitamin D levels and metabolism differ across racial and ethnic groups. Some studies have hinted that disparities by race in heart disease and certain cancer risks may be due to vitamin D, and the randomized trials will hopefully provide more information on whether that’s true.

In the meantime, Manson says doctors and patients should follow the IOM and USPSTF guidelines: doctors should not order vitamin D blood tests for all of their patients, and people shouldn’t take more than 600 IU of the vitamin if they are otherwise healthy. The only people who may need regular testing for vitamin D deficiency, and possible supplementation, are those with malabsorption problems like Celiac disease, those who have had bypass surgery, or people who have already had fractures and have been diagnosed with osteoporosis. People taking certain medications, including treatment for tuberculosis, may also need to consider vitamin D pills.

For everyone else, however, universal screening isn’t necessary—and there isn’t any reason to take more than the recommended daily allowance of vitamin D.

TIME Infectious Disease

How an HIV Outbreak Hit the Heartland

TIME.com stock photos Health Syringe Needle
Elizabeth Renstrom—TIME

Drug abuse combined with a spotty public health system are to blame for Indiana's public health emergency

Indiana Governor Mike Pence on Thursday declared a public health emergency in a rural Indiana county after 79 cases of HIV were confirmed there in the last several months.

An outbreak of HIV may seem odd in such a remote part of the country. The dozens of confirmed cases, described as an epidemic, are centered in Scott County, about a half-hour north of Louisville with a population of about 25,000.

But the spike has been fueled by growing heroin and drug use in rural counties like this one. A number of Midwestern states have struggled with a recent uptick in drug and needle use, and Indiana specifically has seen an increase in the use of a powerful painkiller called Opana, which can be altered and injected. The number of deaths related to opioids like Opana rose from 200 a year in 2002 to 700 in 2012, according to the Indiana State Department of Health.

In this area of the state, there’s relatively weak public health infrastructure to prevent the infection from spreading. Scott County is just one of five counties serviced by a single HIV testing clinic, and the county’s relative isolation from a sufficient public health system can help explain the virus’s rapid growth, says Beth Meyerson, an Indiana University health professor and co-director of the Rural Center for AIDS/STD Prevention.

“The system isn’t working and isn’t strong enough from a public health perspective,” Meyerson says.

In a 2013 study by the non-partisan organization Trust for America’s Health, Indiana ranked last in federal funding per capita from the Centers for Disease Control. The national average spent per capita was $19.54. In Indiana, $13.72 was spent on each Hoosier.

Indiana has also seen an increase in Hepatitis C in many rural communities, says Meyerson, another warning sign that HIV may be spreading. According to the U.S. Department of Health & Human Services, about 25% of people who have HIV in the U.S. are co-infected with Hepatitis C.

On Thursday, state authorities stepped in. Gov. Pence allowed local officials to start a 30-day needle-exchange program in Scott County as a way to stop the outbreak. “I do not enter this lightly,” Pence said, according to the Indianapolis Star. “In response to a public health emergency, I’m prepared to make an exception to my long-standing opposition to needle exchange programs.”

MORE: This Contraceptive is Linked to a Higher Risk of HIV

While dozens of cases have been reported, it’s likely that there are many more still unconfirmed. “I don’t expect these counties will remain the center of the epidemic,” Meyerson says. “I’m sure it’s going to be in other parts of southern Indiana, wherever our system is the weakest. We don’t know what we don’t know right now.”

TIME health

What Experts Got Wrong About Viagra

Small blue Viagra pills, Pfizer's pharma
Suzanne Opton—The LIFE Images Collection/Getty Small blue Viagra pills, separated by machine, in 1998

March 27, 1998: Viagra is approved by the FDA

It was the miracle drug to beat all miracle drugs; an instant bestseller that topped the sales figures of Big Pharma’s other greatest hits: Prozac and Rogaine. After the FDA approved Viagra on this day, March 27, in 1998, sales of the drug rose quickly — pumped by an early rush that yielded at least 10,000 scripts a day, per a TIME cover story about the drug — and had staying power, as evidenced by Pfizer’s annual profit of about $1.8 billion as of 2013 and the fact that our email inboxes are still routinely barraged with spam offers for the drug.

It was a magic bullet for many men, but one that TIME initially feared would herald “the end of sex as we know it.”

“Could there be a product more tailored to the easy-solution-loving, sexually insecure American psyche than this one?” Bruce Handy wondered in the 1998 piece.

There were many who saw chemically-induced erection as a slippery slope to a Sleeper-style orgasmatron.

“People always want a quick fix,” one psychiatrist complained to TIME. “They think Viagra is magic, just like they thought the G spot worked like a garage-door opener.”

Seventeen years later, sex as we know it hasn’t ended — it’s still happening in more or less the usual ways, whether or not Viagra is a part of it. But what was a godsend for men hasn’t opened any doors for women with sexual dysfunction. That’s not for lack of trying: A drug hailed as “the female Viagra” has undergone extensive clinical trials and been submitted to the FDA three times so far, most recently last month, but has never been approved, as Cosmopolitan reports.

The two drugs operate differently, as one might expect: while Viagra stimulates blood flow to the genitals, it doesn’t act on the brain. The proposed drug for women, flibanserin, instead works on neurotransmitters to increase sexual desire.

The fact that there are now several drugs on the market for men’s sexual troubles and none for women constitutes sexism, some have argued, especially since an estimated 16 million women over the age of 50 suffer from some form of sexual dysfunction. A new campaign called “Even the Score” focuses on just this disparity, calling on the FDA to make “safe & effective treatments for low [female] desire” a priority.

In the meantime, a North Carolina doctor has patented a spinal implant that can produce orgasms at the push of a button, although he’s had trouble securing the funding to perfect the device. He calls it the Orgasmatron.

Read the 1998 cover story, here in the TIME Vault: The Potency Pill

TIME Diet/Nutrition

5 Habits of Vegetarians You Should Steal

vegetable-bunches
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These habits can lead to weight loss, and lower risks of high blood pressure and diabetes

More and more of my clients consider themselves to be “part-time” vegetarians. While they may not want to give up meat altogether, they enjoy plenty of meatless meals or take part in ongoing movements, like Meatless Mondays. Today is another formal campaign focused on leaving meat off your plate: It’s the Great American Meat-Out, and getting on board can be a great opportunity to improve your health.

Even semi-vegetarians weigh less, and have lower risks of high blood pressure and diabetes. Plus, taking the focus off meat can be a simple way to boost your intake of plant-based foods you may not be eating enough of.

Here are five healthy veg-based habits you can adopt, even if you aren’t interested in embracing a total vegetarian lifestyle.

Make veggies the main attraction

When I ask most of my omnivore clients what they had for dinner last night, they typically reply with meat first (e.g. “I had chicken with…”). Veggies are often an afterthought. Obviously my vegetarian and vegan clients don’t eat meat, but I advise everyone—including omnivores—to think about veggies first and build the rest of their meals around them. It’s key, because eating more veggies is one of the most impactful dietary changes you can make, but about 75% of adults fall short of the minimum recommended three daily servings.

Fitting in just one additional portion per day can slash your risk of heart disease by as much as 11%, and making veggies the star of your plate can lead to a myriad of benefits. From today on, when choosing what’s for lunch or dinner, select your veggies to start, then add lean protein, good fat, and healthy starch to round out your meal.

Read more: 13 Ways to Make Veggies Taste Better

Choose plant-based fats over animal fats

My hubby, who’s from Texas, grew up eating not just plenty of meat, but also meals made with other animal-based fats, like butter, and bacon grease, as well as lots of dairy-based sauces. While he still eats these foods once in a while, he now prefers veggies sautéed in olive oil or dressed with EVOO and balsamic vinegar, as well as guacamole instead of sour cream, and sauces made from tahini (sesame seed paste) or nut butter—all staples for many vegetarians.

The switch has helped him lose weight, up his energy, and improve his health, and I see the same with many of my clients. Plant-based fats have been shown to reduce inflammation, a known trigger of premature aging and diseases, including obesity, and even help boost weight control and whittle waistlines—even without cutting calories (check out my previous post 5 Amazing Powers of Avocado). Make the switch more often yourself and monitor how you feel, as well as how your jeans fit.

Read more: 14 Best Vegetarian Protein Sources

Make “pulses” your protein

Pulses are my current obsession. Eating at least one serving a day is the cornerstone of my latest book Slim Down Now, and I truly believe that pulses are the most underrated superfoods on the planet. Pulses include beans, peas (e.g. chickpeas, black eyed peas), and lentils, and in numerous studies, eating more of them has been tied to weight loss, less belly fat, appetite suppression, a better overall nutrient intake, and a lowered risk of diabetes and heart disease. Vegetarians often opt for pulses as their protein source and there are plenty of delicious ways to enjoy them, including lentil or split pea soup, black bean tacos, and hummus.

Pea protein powder, also a pulse, is also becoming a hot plant-based protein. I love to whip it into smoothies, and use it as a protein-booster in oatmeal. In addition to providing protein, pulses are rich in filling, blood-sugar regulating fiber, as well as resistant starch, a unique kind of carb that’s been shown to naturally up your body’s fat-burning furnace. Pulses also pack antioxidant levels that rival berries, and they’re satisfying without making you feel sluggish. This Friday or any day, trade the meat in a meal for a serving of pulse, like cannellini beans, lentils, or oven-roasted chickpeas—they’ll fill you up while helping you slim down and stay healthy.

Read more: 9 Reasons You Should Eat More Beans

Snack on plants

While there are “junk food vegetarians,” many veg-heads make whole, plant-based foods their focus, including at snack time. Great options anyone can reach for include raw veggies with hummus or guacamole, fresh fruit with nuts, seeds or nut/seed butter, or a smoothie made with a plant-based “milk” (like almond or coconut) with fruit, leafy greens, and a plant-derived protein powder, such as pea or hemp. Even choosing dark chocolate over milk chocolate ups your plant-based game and boosts your antioxidant intake!

Build plants into desserts

I love baking (check out this video for my 5 healthy baking swaps) and one of my favorite challenges is to find delicious ways to sneak more plants into my splurges. I’ve added puréed spinach to vegan brownies, and in Slim Down Now I incorporate pulses into several goodies, including whipping white beans into chocolate pudding, and using garbanzo bean flour to make pumpkin spice mini muffins. Nutritionists and chefs are incorporating produce into desserts in lots of interesting ways, from tomato sorbet and chocolate eggplant cake to mushroom meringue.

Cynthia Sass, MPH, RD, is Health’s contributing nutrition editor, and privately counsels clients in New York, Los Angeles, and long distance. Cynthia is currently the sports nutrition consultant to the New York Rangers NHL team and the Tampa Bay Rays MLB team, and is board certified as a specialist in sports dietetics.

This article originally appeared on Health.com.

Read next: How the Nation’s Nutrition Panel Thinks You Should Be Eating

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TIME Diet/Nutrition

12 Recalled Foods Not to Eat This Week

Frozen Vegetable Lasagna
FDA Frozen Vegetable Lasagna

There were 17 food recalls in total this week

Every week lots of foods are pulled from grocery shelves for contamination. There were over a dozen recalls just this week, but since not every recall reported by the Food and Drug Administration makes headlines, we’ve listed them for you.

MORE Organic Frozen Foods Recalled Over Listeria Scare

Spinach
Brands: Simply Balanced, La Terra Fina, Cadia, Meijer, Wild Harvest and Wegmans
Contaminated with: Listeria
Several companies had recalls related to listeria-contaminated spinach this week. Simply Balanced and Cadia, Meijer, Wild Harvest and Wegmans brands recalled organic spinach packages. Wegmans had to recall up to 12,540 packages. La Terra Fina recalled spinach artichoke & parmesan dips and organic spinach dip.

Frozen meals
Brands: Amy’s Kitchen
Contaminated with: Listeria
Amy’s Kitchen, the popular frozen organic dinner company, voluntarily recalled over 73,890 cases of products due to possible contamination with listeria. Foods ranged from tofu vegetable lasagna to spinach pizza.

Ice cream
Brands: Blue Bell
Contaminated with: Listeria
The company made headlines earlier in March when five people in a Kansas hospital became ill, and three people died, from consuming Blue Bell ice cream products contaminated with listeria. This week, three flavors of 3 oz. ice cream cups were also recalled for possible contamination with the same bacteria.

Chocolate covered raisins and almonds
Brands: Lindt, Essential Everyday
Contaminated with: Undeclared hazelnuts and undeclared peanut allergen
Lindt recalled some of its 6.4 oz chocolate covered raisin bags and 6.4 oz chocolate covered almond bags for having undeclared hazelnuts. The products were sold in nine Lindt Chocolate Shop locations in the U.S. In addition, Supervalu Inc. recalled Essential Everyday chocolate covered raisins due to the presence of undeclared peanuts. Having undeclared nut allergens in products can be a serious a risk for people with nuts allergies.

Cod filets
Brands: Giant Eagle
Contaminated with: Undeclared soy
Giant Eagle recalled all lots of its name-brand Japanese Breaded Cod Fillets due to having undeclared soy, which is a risk for people who have soy allergies.

Paninis
Brands: Giant Eagle
Contaminated with: Undeclared egg
Giant Eagle recalled all lots of its name-brand Little Italy Paninis sold in its supermarkets due to having undeclared egg allergen, which is a risk for people with egg allergies.

Frozen Ravioli
Brands: Rising Moon Organics
Contaminated with: Listeria
Carmel Food Group recalled some of its Rising Moon Organics frozen ravioli items after it was discovered spinach from its supplier was contaminated with the bacteria listeria.

Walnuts
Brands: Aurora, Martin Food Products, Stop&Shop, Giant Carlisle Food Store, Giant of Maryland, Whole Foods Market
Contaminated with: Salmonella
Aurora Products, Inc. recalled its Natural Walnuts and Trail Mixes Containing Walnuts sold through the above retailers due to possible contamination with the bacteria salmonella.

Macadamia nuts
Brands: Nature’s Eats
Contaminated with: Salmonella
Texas Star Nut and Food Co. Inc. recalled Nature’s Eats macadamia nuts due to the detection of salmonella.

Kale and quinoa salad
Brands: Wawa
Contaminated with: Undeclared soy
Taylor Farms Florida Inc. recalled some of its Wawa brand Kale and Quinoa Salad due to undeclared soy in the dressing packet in the salad which could put people with soy allergies at risk.

Cookies
Brands: Giant Eagle
Contaminated with: Undeclared milk
Giant Eagle is recalling its Raisin Filled and Apricot Filled cookies which are sold in its supermarkets due to having undisclosed milk allergen, a risk for people with milk allergies.

O’Coconut products
Brands: Nutiva
Contaminated with:
Salmonella
Organic company, Nutiva, recalled O’Coconut products after learning they may be contaminated with salmonella.

Read next: Here’s the Terrifying Truth About Metal Shards in Your Food

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TIME Diet/Nutrition

A High-Fat Diet Could Be Altering Your Behavior and Not Just Your Waistline

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Study finds that heart disease and obesity aren't the only effects of eating too many fatty foods

Obesity, heart disease and other physical afflictions may not be the only negative impacts of consuming fatty foods. According to a recent study on mice, high-fat foods could be affecting behavior, increasing the risk of depression and related psychological disorders.

The study, published in the journal Biological Psychiatry, suggests that a high-fat diet alters the mix of bacteria in the gut known as the gut microbiome. These changes, researchers from Louisiana State University believe, might be affecting one’s susceptibility to mental illness.

The researchers tested their hypothesis by taking organisms from the gut microbiome of mice that had been fed a high-fat diet and transplanting them into non-obese mice. They found that the microbiome associated with greater levels of fat led to problems such as increased anxiety and impaired memory.

“This paper suggests that high-fat diets impair brain health, in part, by disrupting the symbiotic relationship between humans and the microorganisms that occupy our gastrointestinal tracks,” Dr. John Krystal, Editor of Biological Psychiatry, told Science Daily.

Although there is still a lot of research to be done in this field, the study highlights mental issues associated with a high-fat diet regardless of obesity.

[Science Daily]

Read next: 10 Reasons Your Belly Fat Isn’t Going Away

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TIME Diet/Nutrition

Why We Like Food That Makes Noise

TIME.com stock photos Food Snacks Potato Chips
Elizabeth Renstrom for TIME

What your food 'sounds' like affects how good it tastes, a new study says

The crunch of a chip, the snap of a carrot, or the fizz of a freshly opened beverage may greatly influence just how good we think those foods taste, according to new flavor research.

Flavor perception is multi-sensory. “The flavor of food is reduced to a mere whisper when its scent is lost,” chef Molly Birnbaum once said. In a new report published in the journal Flavour, researcher Charles Spence, a professor of experimental psychology at Oxford University reviews a wide variety of research related to sound and flavor perception, and comes to the conclusion that what a food sounds like is incredibly important to the experience of eating it. That sound, he says, is the “forgotten flavor sense.”

“Our brains are all the time trying to pick up correlations in the environment,” says Spence. According to his research, people use sounds to assess how tasty food is, even if they don’t realize it. In one of the studies he highlights, consumers used the word “crisp” more than any other descriptor when they were asked to evaluate 79 foods. Another study completed in 2007 by University of Leeds researchers to determine just how important bacon crispiness is to a BLT, the lead researcher concluded: “We often think it’s the taste and smell of bacon that consumers find most attractive. But our research proves that texture and the crunching sound is just—if not more—important.”

Science has also shown that changing the sounds a food makes can influence a person’s perception of it. In his own prior research, Spence showed that people give carbonated beverages higher ratings when the sound of the bubbles popping becomes louder and more frequent.

But why is the way food sounds important to us? For one, Spence says it could be that sound is an indicator for texture and therefore quality. Texture can reveal how fresh food is. If an apple cracks crisply when it’s bitten into, instead of yielding without a snap, you know that’s a good sign.

Even soft foods, like bread, bananas or mousse can make subtle sounds when they’re bitten, sliced or plunged into with a spoon, and Spence says he believes the commercialization of sounds in the food industry may soon be growing in a big way.

“It’s going to start out with modernist chefs,” Spence predicts. Food modifications could also be used to help make food more pleasurable for the elderly whose overall senses may be decreasing, he adds.

Outside sound can also influence perception, and it doesn’t require much effort. “If I’m having Italian food and I’m hearing music of that region, it may make me perceive the food as more authentic,” he says. Even the ice cream company Häagen-Dazs launched an app where customers can scan their ice cream carton and listen to a violin concerto timed to allow the ice cream to soften.

Still, Spence says he largely feels like sound isn’t being considered in the food industry as often as it could be. A 2003 survey of 14o food scientists showed they rated sound as the least important attribute contributing to flavor. But as research continues to emerge and the industry continues to experiment, we may be listening to our food more often.

TIME Depression

How Pilots Are Screened for Depression and Suicide

While it’s not clear exactly why Germanwings Flight 9525 crashed into a French mountainside, the black box from the cockpit raises questions about whether mental health issues were involved, and how aviation officials identify and monitor the mental health of pilots.

Prosecutor Brice Robin said that the cockpit recordings suggest the lead pilot was locked out of the flight deck after leaving for the restroom, and that co-pilot Andreas Lubitz “voluntarily allowed the aircraft to lose altitude. He had no reason to do this. He had no reason to stop the captain coming back into the cockpit.” As investigators search for a second black box, experts are trying to piece together the reasons why Lubitz acted the way he did. His mental state remains a possible cause.

If the investigation reveals that mental health played a role, it wouldn’t be without precedent. In a 2014 study in the journal Aviation, Space and Environmental Medicine, researchers looked at 20 years of data for what they called “aircraft assisted suicide.” From 1993-2012, 24 of 7,244 plane crashes were thought to be deliberately caused by a pilot. That’s less than 1% of the total, but it’s still enough to raise questions about the mental health stressors of pilots.

“I really wish that we had some kind of deeper thinking about this issue, because it’s one of the most difficult in aviation medicine,” says Alpo Vuorio, MD, PhD, the study author and an aviation specialist in occupational medicine at the Mehiläinen Airport Health Centre in Finland. He screens pilots and cabin crew of commercial airlines for health issues—including mental health issues—and says he sees any given commercial pilot once a year for a short visit.

Commercial pilots have to pass a physical and mental evaluation every six months (for those over 40) or once a year (for those under 40) in order to be certified to fly a passenger plane. The emphasis, however, is on the physical and less on the mental, mainly because mental health is harder to quantify.

“You somehow try to see if the pilot is well, and it’s not the easiest thing,” Vuorio says. Pilots answer yes-or-no questions about their mental health, Vuorio says, like if they’ve ever tried to attempt suicide or visited a psychiatrist. “You speak yes or no, but it’s up to you, what you tell,” he says. Pilots can visit several different locations for these examinations, he says, and if they don’t occur in house, past data don’t appear on the screen.

And pilots aren’t likely to divulge any potential mental health problems, including signs of depression or anxiety, because that would take them out of the sky. “Pilots aren’t going to tell you anything, any more than a medical doctor would about their mental health,” says Scott Shappell, professor of the Human Factors Department at Embry-Riddle Aeronautics University who is a former pilot and crash scene investigator.

Pilots, like doctors and policemen and others with high-stress jobs, tend to be good at compartmentalizing — walling off difficult or emotional experiences so they don’t interfere with their ability to function day-to-day. Medical examiners who evaluate pilots for their recertification also aren’t always trained in mental health, so they may not recognize subtle signs of conditions such as depression or alcoholism.

According to Dr. William Sledge, medical director of the Yale-New Haven Psychiatric Hospital who has evaluated pilots for the Federal Aviation Administration, about 40% of pilots he saw were for alcohol related problems, and a third for depression or anxiety. Only about half of the latter group reported their problems themselves, however. The other half were referred to Sledge only after incidents required their superiors to intervene.

“The problem is there is no incentive” to report mental health issues, says Shappell. “They know that if they self report, the way the system is designed, it will be a black mark.”

In a statement, the FAA said: “Pilots must disclose all existing physical and psychological conditions and medications or face significant fines of up to $250,000 if they are found to have falsified information.”

In the case of mental health evaluations, pilots are taken off the flight schedule while they are treated or begin antidepressant medications. Until 2010, even these drugs were banned, and pilots required them could no longer fly.

When the U.S. Air Force began requiring annual suicide prevention and awareness training in 1995, including screening for mental illness, the suicide rate plummeted from about 16 suicides per 100,000 members to about 9.

Even for experts, however, judging whether a pilot is suicidal is one of the hardest parts of the job. That’s no surprise, since the struggles of spotting and talking about suicide plague our entire society, says Barbara Van Dahlen, a licensed clinical psychologist and the founder and president of Give an Hour, a network of volunteer therapists. “In our society we are so quick to try to make it ok, to say it will pass and to say suck it up,” she says. “We really don’t listen to ourselves and we don’t listen to others very effectively.”

But pilots and others in high-pressure occupations face several unique stressors, she says, like having a physically demanding job and being responsible for other lives. “In a lot of positions of authority and leadership, those people are supposed to be capable and on top of things,” she says. “They don’t have a lot of people to share with and talk to, to be less than perfect and less than OK. That adds to the stress.”

One study of suicides among general aviation pilots—civilians who aren’t leading scheduled commercial flights—published in the journal Aviation, Space and Environmental Medicine, looked at 21-years’ worth of general aviation accidents as reported by the National Transportation Safety Board between 1983-2003. During that time, 37 pilots either committed or attempted suicide by aircraft, and nearly all resulted in a fatality. 38% of the pilots had psychiatric problems, 40% of the suicides or attempts were linked to legal troubles, and almost half, 46%, were linked to domestic and social problems. 24% of the cases involved alcohol and 14% involved illicit drugs.

Having ready access to a plane also seemed to be a contributing factor, too; 24% of the crashed planes in the study were used illicitly.

Read next: German Pilots Cast Doubt on Blaming of Co-Pilot for Crash

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TIME ebola

American Patient With Ebola Has Condition Upgraded

The patient is now in serious, rather than critical, condition

The American patient being treated for Ebola is improving, according to the National Institutes of Health (NIH).

The NIH announced on Thursday that the patient has had her condition upgraded from critical to serious. The patient, who was working to combat Ebola in Sierra Leone, arrived at the NIH in Bethesda, Md. on March 13 for treatment.

The patient is one of 17 volunteers for Partners in Health who were brought to the United States for precautionary monitoring. The NIH has not released any further details about the patient.

The American patient is the second to be treated by the NIH for Ebola. The team also treated Dallas nurse Nina Pham who was infected after treating Thomas Eric Duncan, the first person to be diagnosed with Ebola in the United States.

The current Ebola outbreak reached one year this week. So far 24,927 people have been infected and 10,338 people have died from the disease.

TIME Addiction

A New Government Anti-Smoking Campaign Includes E-Cigs

Past campaigns have increased calls to quitlines by 80%

A new federal ad campaign against smoking features e-cigarettes for the first time.

The U.S. Centers for Disease Control and Prevention (CDC) released its latest ad in its ongoing “Tips From Former Smokers” campaign. The campaign features real Americans who have experienced serious health or social consequences from smoking. Often the ads are explicit. On March 30, the first ad about e-cigarettes, as opposed to traditional tobacco, will air.

The ad features a 35-year-old woman named Kristy who picked up e-cigarettes as a way to quit smoking. She ended up using both products. Eventually she had a collapsed lung and was diagnosed with lung disease. She’s a married mother of three who works as a truck driver.

Kristy's Tip Print Full Page Ad
CDC

“Nationally, about 3 in 4 adult e-cigarette users also smoke cigarettes,” the CDC says in a statement. “If you only cut down the number of cigarettes you smoke by adding another tobacco product, like e-cigarettes, you still face serious health risks.”

Other ads focus on side effects like vision loss and colorectal cancer.

In 2014, the CDC says the national quit line received 80% more calls when the ads were on the air, and since 2012 the ads have generated more than 500,000 additional calls. The ads will run for 20 weeks on TV, radio, online, billboards, in theaters and in magazines and newspapers. Kristy’s ads will be on the radio and in print.

The ads encourage smokers to call 1-800-QUIT-NOW or visit www.cdc.gov/tips.

Read next: These 4D Ultrasound Photos Show How Fetuses Respond to Their Mothers’ Smoking

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