human behavior

Your Baby Is a Racist—and Why You Can Live With That

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It don't come easy: bonding across racial lines requires overcoming some very old genetic programming Hero Images; Getty Images/Hero Images

From humanity's earliest era, we had evolved to distinguish in-groups from out-groups and to assign powerful value to those differences. Call it racism, but it helped us survive

You always suspected babies were no good, didn’t you? They’re loud, narcissistic, spoiled, volatile and not exactly possessed of good table manners. Now it turns out that they’re racists too.

The latest evidence for that decidedly unlovely trait comes from research out of the University of Washington that actually sought to explore one of babies’ more admirable characteristics: their basic sense of fairness. In the study, 15-month-old toddlers watched an experimenter with a collection of four small toys share them either evenly or unevenly with two other adult volunteers. When allowed to choose which experimenters the babies wanted to play with later, 70% of them preferred the ones who had divided the toys evenly.

Nice, but there was an exception: when the two adults who were receiving the evenly or unevenly divided toys were of different races and the race of the one who got more toys matched the babies’ own, the 70% preference for the fair distributor dropped and the share of babies wanting to play with the unfair one rose. The implication: unfairness is bad, unless someone from your clan is getting the extra goodies.

“If all babies care about is fairness, they would always pick the fair distributor,” said University of Washington associate professor psychology of Jessica Somerville, in a statement that accompanied the study. “But we’re also seeing that they’re interested in consequences for their own group members.”

OK, so that doesn’t speak well of human nature at even its sweetest and most ingenuous stage. But here’s the thing: if we weren’t rank racists when we were very little, the species probably never would have survived. The idea of in-group bias is well established in behavioral science, and it has its roots long ago, in humanity’s tribal era. The fact is, the people in your own band are more likely to nurture you, care for you and protect you from harm, while the people from the tribe over the hill are more likely to, well, eat you.

As soon as you become old enough to toddle away from the campfire and wander out on your own, it thus pays to recognize, at a glance, what an alien other looks like. Sometimes it’s dress or hairstyle that provides the telltale cue, but just as often it’s skin tone, hair texture and the shape of facial features. It was the human tendency to migrate and settle in parts of the world with varying climates that caused these physical differences to emerge in the first place.

“We didn’t start off as a multi-racial species,” psychologist Liz Phelps of New York University told me in my upcoming book about narcissism. “We have races simply because we dispersed.” Once we did disperse, however, those differences in appearance—skin tone especially—turbocharged our suspicion of the outsider.

A study by psychologist Yarrow Dunham, now at Yale University, showed that color is an especially salient feature for very young people to overlook. Children in a classroom experiment who were divided into two groups and given two different color t-shirts to wear were, later on, much likelier to remember good things about all of the children who wore their color shirt and bad things about the ones who wore the other. “Kids will begin to show these preferences right away, in the lab, on the spot,” Dunham told me. “It’s not just a preference, it’s also a learning bias—the children actually learn differentially about the in-group and the out-group.”

Sometimes, for small children, there can be a certain sweetness to the bias, since they may feel concern for the person of a different race, the assumption being that anyone who doesn’t look like them must be unhappy about that fact. When my older daughter was three or four years old, we approached an African American cashier in a store and she asked her, “Are you sad that you don’t have light skin?” I winced and began to splutter an apology, but the woman answered, “No, honey. Are you said that you don’t have dark skin?” When my daughter said no, the woman responded, “So you see? We’re both happy with who we are.”

The sweet phase of simply noticing racial differences fades, to be replaced either by a higher awareness of the meaningless of such matters or a toxic descent into assigning ugly, negative values to them. Which way any one baby goes depends on upbringing, community, era, temperament and a whole range of other variables. What we will never be, like it or not, is an entirely post-racial species. Our better impulses may wish that weren’t so, but our ancient impulses will always test us. They are tests we must, from babyhood, learn to pass.

Researchers Clone Cells From Two Adult Men

After years of failed attempts, researchers have successfully generated stem cells from adults. The process could provide a new way for scientists to generate healthy replacements for diseased or damaged cells in patients

After years of failed attempts, researchers have finally generated stem cells from adults using the same cloning technique that produced Dolly the sheep in 1996.

A previous claim that Korean investigators had succeeded in the feat turned out to be fraudulent. Then last year, a group at Oregon Health & Science University generated stem cells using the Dolly technique, but with cells from fetuses and infants.

MORE: Stem-Cell Research: The Quest Resumes

In this case, cells from a 35-year-old man and a 75-year-old man were used to generate two separate lines of stem cells. The process, known as nuclear transfer, involves taking the DNA from a donor and inserting it into an egg that has been stripped of its DNA. The resulting hybrid is stimulated to fuse and start dividing; after a few days the “embryo” creates a lining of stem cells that are destined to develop into all of the cells and tissues in the human body. Researchers extract these cells and grow them in the lab, where they are treated with the appropriate growth factors and other agents to develop into specific types of cells, like neurons, muscle, or insulin-producing cells.

Reporting in the journal Cell Stem Cell, Dr. Robert Lanza, chief scientific officer at biotechnology company Advanced Cell Technology, and his colleagues found that tweaking the Oregon team’s process was the key to success with reprogramming the older cells. Like the earlier team, Lanza’s group used caffeine to prevent the fused egg from dividing prematurely. Rather than leaving the egg with its newly introduced DNA for 30 minutes before activating the dividing stage, they let the eggs rest for about two hours. This gave the DNA enough time to acclimate to its new environment and interact with the egg’s development factors, which erased each of the donor cell’s existing history and reprogrammed it to act like a brand new cell in an embryo.

VIDEO: Breakthrough in Cloning Human Stem Cells: Explainer

The team, which included an international group of stem cell scientists, used 77 eggs from four different donors. They tested their new method by waiting for 30 minutes before activating 38 of the resulting embryos, and waiting two hours before triggering 39 of them. None of the 38 developed into the next stage, while two of the embryos getting extended time did. “There is a massive molecular change occurring. You are taking a fully differentiated cell, and you need to have the egg do its magic,” says Lanza. “You need to extend the reprogramming time before you can force the cell to divide.”

While a 5% efficiency may not seem laudable, Lanza says that it’s not so bad given that the stem cells appear to have had their genetic history completely erased and returned to that of a blank slate. “This procedure works well, and works with adult cells,” says Lanza.

The results also teach stem cell scientists some important lessons. First, that the nuclear transfer method that the Oregon team used is valid, and that with some changes it can be replicated using older adult cells. “It looks like the protocols we described are real, they are universal, they work in different hands, in different labs and with different cells,” says Shoukhrat Mitalopov, director of the center for embryonic cell and gene therapy at Oregon Health & Science University, and lead investigator of that study.

MORE: Stem Cell Miracle? New Therapies May Cure Chronic Conditions like Alzheimer’s

Second, the findings confirm that the key factor in making nuclear transfer work with human cells is not the age of the donor cell, as some experts have argued, but the quality of the donor egg. “No matter how much you tweak the protocols or optimize them, it looks like the major player in efficiency is the individual egg quality,” says Mitalipov. He notes that all of his stem cell lines came from the same egg donor. The two cell lines described by Lanza’s group also came from one egg donor.

This latest success should reignite the debate over which reprogramming method generates the most reliable, and potentially useful, stem cells for eventually treating patients. The nuclear transfer method may join two other ways of making stem cells: one, developed by James Thomson in 1998, relied on extracting them from days-old embryos left over from IVF, and another, developed by Japanese scientist Shinya Yamanaka in 2006 (and for which he was awarded the Nobel Prize), bypassed the egg and embryo completely, allowing researchers to make stem cells by modifying an adult’s cells using a mixture of just four genes.

MORE: Stem Cell Researcher Calls for Retraction of His Own Work

Each method has it advantages and risks, however. IVF embryos are difficult to come by, since they require permission from couples to be used for stem cells research, and they may not be genetically matched to patients who might benefit from cells they generate.

While so-called induced pluripotent stem cells, or iPS cells, avoid the need for embryos and could be matched to patients, some studies suggest that the process may not completely reprogram cells, leaving populations of some partially reprogrammed ones in the mix. In addition, iPS cells aren’t useful for treating mitochondrial diseases, which result from mutations in the cell’s energy factories, which have their own DNA outside of the cell’s DNA in the nucleus. If a cell with a mitochondrial mutation is reprogrammed using the iPS technique, any mutations would be reprogrammed as well.

MORE: FDA Approves Second Trial of Stem-Cell Therapy

Nuclear transfer, however, could treat these disorders since it involves an egg that provides its own, healthy mitochondria. But the process requires a good supply of eggs, which have to be donated by healthy volunteers. That raises ethical concerns since the technique could produce human clones. That’s why research on nuclear transfer is not funded by the federal government, and scientists know less about these cells and their potential than they do about iPS cells. “They have become kind of like cursed cells,” says Mitalipov of the stem cells generated through nuclear transfer. “But we clearly need to understand more about them.”

For patients who might one day benefit from stem cell-based therapies, that understanding could mean the difference between life and death, which is why the latest findings are potentially significant. “We have another way to skin the cat,” Lanza says. “The hope is that iPS cells work out, but for the future application of stem cell therapies to treating disease, it’s good knowing there is another way to make stem cells should we need to.”

Formerly Conjoined Twins Leave Dallas Hospital

Dallas Conjoined Boys
In this Tuesday, April 15, 2014 photo provided by Medical City Children's Hospital in Dallas, Jenni and Dave Ezell visit their twin 9-month-old boys Owen, left, and Emmett, who were born joined at the abdomen. The conjoined twins, separated last summer, were released from the hospital Wednesday and are expected to spend the next three to four weeks in a local inpatient rehabilitation center before being able to go home.= Medical City Children's Hospital/AP

(DALLAS) — Twin boys who were born conjoined have been released from the Dallas hospital that’s been their home since birth.

Owen and Emmett Ezell were joined at the abdomen and shared a liver and intestines when born. They were separated at Medical City Children’s Hospital last August.

Mother Jenni Ezell says the now-9-month-old twins can sit up and that they try to coo over the trachea tubes that help them breathe. They are fed through tubes in their abdomens.

At a Wednesday news conference, she described them as “very interactive, very social little boys” who “flash smiles and wave” at visitors.

Neonatologist Dr. Clair Schwendeman says he is optimistic for the still “fragile” boys.

The twins will spend the next month in an inpatient rehabilitation center before being allowed home.

medicine

Cleveland Clinic’s New Medicine

At one Ohio hospital, patients get herbs as well as drugs

Lora Basch, 59, sometimes suffers from poor sleep and anxiety. She’s uncomfortable with the side effects of drugs, so she’s tried acupuncture and magnesium supplements, but with only minimal success. After years of low energy, she went a different route altogether: gui pi tang, a mix of licorice root, ginseng and ginger meant to rejuvenate the body. Three months later, the Cleveland native is finally falling asleep at night, and she has more energy during the day. “The remedy is a huge relief,” she says. “I have a more stable life.”

Though herbal therapy has been practiced in China for centuries, it is still an afterthought in the U.S., in part because pharmaceutical remedies are usually easier to obtain. Now that’s beginning to change: in January, the Cleveland Clinic opened a Chinese herbal-therapy ward. In the past three months, therapists at the clinic have seen patients suffering from chronic pain, fatigue, poor digestion, infertility and, in the case of Basch, sleep disorders. “Western medicine may not have all the answers,” says Daniel Neides, the clinic’s medical director.

A certified herbalist runs the unit under the supervision of multiple Western-trained M.D.s. Patients must be referred to the clinic by their physician, who in accordance with Ohio law must oversee their treatment for at least a year. Executives at Cleveland say the clinic is the first of its kind to be affiliated with a Western hospital. “We’re incorporating ancient knowledge into patient care,” says in-house herbalist Galina Roofener.

Cleveland is starting modestly: its clinic is a single room with bright pillows, a tapestry, candles and a cot reserved for procedures like acupuncture. The center doesn’t take walk-ins and primarily sees patients with conditions that Western medicine has, for whatever reason, failed to remedy. “For something like acute pneumonia, Western antibiotics may be faster and more cost-effective,” says Roofener. “But if someone has antibiotic resistance, we can strengthen their immune system.”

All herbal formulas at the clinic are encapsulated for easy consumption. (By contrast, in China, patients are usually sent home with raw herbs to brew themselves.) The FDA doesn’t regulate herbs and supplements, so finding pharmacies that can both supply them and still meet hospital safety standards was a top priority. After a lengthy search, the clinic tapped a Kaiser Pharmaceutical subsidiary out of Taiwan as well as a Chinese herb–specific compounding pharmacy in Massachusetts and California that specializes in custom blends.

The primary uncertainty in herbal medicine is the prospect of an unpleasant or dangerous herb-drug interaction, which is why the clinic requires herbalists and physicians to have joint access to patients’ electronic medical records. To become an herbal therapist requires three to four years of master’s-degree-level education in Chinese medicine and a series of certification exams in Oriental medicine, herbology and biomedicine.

As it happened, I was battling a cold when I visited the clinic, so I signed up for the $100 consultation. Roofener spent 30 minutes reviewing my medical history, sleep routine, diet and even my spirituality–I was asked about what I practice and whether I meditate. She took my pulse Chinese-style: holding my wrists, she measured what she said were the multiple “pulses” of my organ systems. “Did you eat breakfast?” she asked. “The pulse on your stomach position is very weak.” I had eaten half a slice of toast.

I left the clinic with my own herbal remedy: 80 capsules of a diverse mixture of ingredients ranging from Lonicera flower to mint leaf, with instructions to take two pills four times a day for 10 days. Though an over-the-counter drug usually does the trick for me, my symptoms were cleared on the herbs alone. Now if only I could find an herb to make me taller.

Exercise

The Workouts That Can Prevent The Flu

Study: Workouts Prevent Flu
Keith Bishop—Getty Images

Vigorous exercise is better than moderate exercise at boosting the immune system.

You know that vigorous exercise burns fat and builds muscle (and it may even help fight cravings)—and now you might be able to add “fight the flu” to its list of accomplishments, according to research recently released at National Science and Engineering Week.

Through an online survey, researchers at the London School of Hygiene and Tropical Medicine polled more than 4,800 people on their health habits and found that those who exercised vigorously for at least two and a half hours a week were about 10 percent less likely to come down with a flu-like illness. Meanwhile, moderate exercise didn’t seem to have any effect on the flu.

While all exercise is known to increase immunity, previous research in the European Journal of Preventative Cardiology shows that high-intensity exercise is better than moderate exercise at improving the body’s aerobic capacity, a marker of overall health and fitness. And the fitter you are, the more likely your immune system will be able to wipe out nasty cells like the flu bug.

Cold or Flu: Can you Tell

However, it’s important to remember that overdoing it on high-intensity exercise can actually wear down the immune system, per a 2014 study in the Journal of Strength & Conditioning Research. Luckily, two and a half hours of high-intensity exercise a week is all your need to reap the flu-fighting benefits of hardcore exercise.

Think you’ve already beaten this year’s flu? Not so fast. While we are nearing the end of the season, the nasty bug can strike any time of year, note the researchers.

So for good measure, we’ve rounded up 10 of our favorite high intensity workouts. Try them out, and fight the flu and weight gain at the same time!

30-Minute Workout: Get Total-Body Toned with this No-Equipment Circuit Workout

This article was written by K. Aleisha Fetters and originally appeared on Womenshealthmag.com.

 

Heart Attacks, Strokes Related to Type 2 Diabetes Drop Dramatically

In a new study, researchers found that the rates of heart attacks and deaths related to high blood sugar dropped 60% from 1990 to 2010. The rates of lower extremity amputations, as well as strokes, dropped by about 50%

The rates of type 2 diabetes-related complications, like heart attacks, kidney failure, strokes, and amputations, have significantly dropped in the last 20 years.

In the new study, published in The New England Journal of Medicine, researchers at the Centers for Disease Control and Prevention looked at four major data sets and found that the rates of heart attacks and deaths related to high blood sugar dropped 60% from 1990 to 2010. The rates of lower extremity amputations, as well as strokes, dropped by about 50%, and end-stage kidney failure by 30%.

“We were a bit surprised by magnitude of the decrease in heart attack and stroke,” lead study author Edward W. Gregg, a senior epidemiologist at the Centers for Disease Control and Prevention, told The New York Times.

Still, over the same study period, the number of Americans with diabetes tripled, rising to 26 million. While the sharp decline in compilations is reassuring, it’s likely because the medical community has gotten better at diagnosis and treatment.

[The New York Times]

What Your Sleeping Position Says About Your Relationship

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Andi Singer--Getty Images

Whether you spoon or sleep back-to-back is an indicator of how happy and satisfied you and your partner are

According to a new study, spooning with your partner really does say something about your relationship.

Researchers from the University of Hertfordshire surveyed 1,000 people and found that couples who maintained physical contact while they slept were more likely to report being happy in their relationship. An overwhelming 94% of couples who touch while sleeping said they were happy, while only 68% of couples who didn’t touch while snoozing expressed being satisfied with their relationship.

Not only that, physical distance while sleeping seemed to translate into emotional distance. Of the 12% of couples who slept with less than an inch separation from their partner, 86% of them said they were happy. For couples who slept more than 30 inches apart (a mere 2%), only 66% said they were happy.

“This is the first survey to examine couples’ sleeping positions, and the results allow people to gain an insight into someone’s personality and relationship by simply asking them about their favorite sleeping position,” said Professor Richard Wiseman, a psychologist at the University of Hertfordshire and study lead. The research was presented at the Edinburgh International Science Festival.

The most popular sleeping position for couples was back to back, with 42% doing so. Thirty one percent slept facing the same direction, and 4% slept facing one another.

Interestingly, the more outgoing one is, the more likely that person is to sleep closer to to his or her partner. And creative types tended to sleep on their left.

So the next time you want to add some satisfaction to your relationship, consider scooting a little closer. You can always do the “Hug ‘n’ Roll” later.

[Science Daily]

Pregnancy

The Problem With America’s Twin Epidemic

Americans undergoing fertility treatments have gotten used to the prospect of the 'instant family'—but it may carry unnecessary risks.

Remember the days when getting pregnant with twins was a surprise? Now if you’re undergoing fertility treatment, you actually have to decide in advance whether you’re up for double trouble by authorizing how many embryos to have implanted in your uterus. But a new study commissioned by the March of Dimes urges doctors to reduce the health problems caused by multiple births by encouraging patients to get pregnant one embryo at a time.

You don’t have to get mowed down by a double-wide stroller on a city sidewalk to know we’re in the middle of a twin epidemic. Twins account for more than 20 to 30 percent of babies conceived via in-vitro fertilization (IVF), which reached an all-time high with more than 165,000 cycles performed in the U.S. in 2012, according to the latest statistics by the Society for Assisted Reproductive Technology. National data show twin births nearly doubled over the last three decades to 1 in 30 babies born in the United States in 2009, from 1 in every 53 babies in 1980.

“In the old days of IVF, we had such low pregnancy rates that we had to transfer multiple embryos at a time just to have a good chance of creating a successful pregnancy,” explains Robert Anderson, MD, a fertility doctor from Newport Beach, California. Yet as fertility medicine improved over the past few decades, rates of multiples eventually spiked until the American Society for Reproductive Medicine tightened guidelines in 2012 about how many embryos could be transferred at a time to prevent another “Octomom,” whose doctor’s license was revoked after he implanted eight embryos into Nadya Suleman’s uterus. The current rule of thumb: one to two for women under 35 and three to five for women in their early 40s, depending on the quality of the embryos.

Yet doctors like Anderson are making the case that we should rethink the trend of buying our babies in bulk, since a singleton pregnancy is better for the health of the mother and baby. The latest numbers show that nearly 15 percent of women under 35 opted for a single embryo transfer in 2012, which is double the number from three years earlier. “Over the years, we grew to accept a certain percentage of twins, but it’s a big problem,” says Anderson. “They’re born three to four weeks premature on average, and there’s an increased risk of birth defects, not to mention the mother suffering from getting gestational diabetes or preeclampsia. A study last year found that medical costs associated with care for the mother during pregnancy and immediately after birth and for the infants up to one year cost on average about $105,000 for twins, compared to $21,000 for a single baby.

Despite the increasing acceptance of the technique known as elective single embryo transfer,the rates are still low compared to some European countries, where IVF is often covered by national health insurance and doctors prefer to implant just one embryo in the vast majority of cases. The concept has been a hard sell on American patients, since many can’t afford multiple IVF cycles and are thrilled at the idea of getting “two for the price of one.” Or they’re older patients who worry they’ll have a harder time getting pregnant the second time around a few years later. “When I talk to my patients about single embryo transfer, the vast majority of their eyes glaze over,” explains Fady Sharara, M.D., a reproductive endocrinologist in Reston, Virginia. “They’ve already made up their minds. They say, ‘Doctor, I’d rather have twins, and then we’re done.’” This twin mindset has become so entrenched among patients that even in a recent study in which they were offered financial incentives to go for a singleton pregnancy, 40 percent still declined.

Yet the math of “more is more” is misleading, and proponents say success rates can be similar. Anderson’s team at the Southern California Institute for Reproductive Sciences published a study last fall in Fertility & Sterility showing that pregnancy rates involving single embryos that had been genetically tested were equivalent to those with a double transfer. Here’s how it works: Although a woman undergoing IVF might produce enough eggs to create a half-dozen embryos, only a certain percentage will be chromosomally normal and likely to lead to a pregnancy. So doctors boost a patient’s chances of success by transferring one of those good embryos, which has a pregnancy rate of up to nearly 60 percent. (National IVF pregnancy rates involving untested embryos, on the other hand, range from 47 percent in women under 35 and 20 percent for women in their early 40s.) She’ll freeze the extra embryos and come back for another pregnancy attempt later, if they first one fails or she wants another child. “You don’t have to have the whole family at the same time,” explains Sharara, pointing out that even though the first cycle might cost around $20,000, including genetic testing, subsequent transfers of frozen embryos will cost a couple thousand each.

Doctors claim they can boost success rates even more by tinkering with the timing of transfers. During conventional IVF, a woman undergoes weeks of hormone stimulation after which her eggs are retrieved, fertilized with sperm, grown into embryos and implanted into her uterus immediately afterwards. But if a woman chooses genetic testing, her embryos will be frozen while she waits for results, and Anderson says she has a better shot of pregnancy if the embryo is transferred during a later month when her reproductive system isn’t flooded with so many hormones.

Fertility medicine has come a long way from throwing a bunch of embryos into a womb and seeing what sticks. Still, the piecemeal approach may not be for everyone, especially older women who want a ready-made family as soon as possible. Also, the insurance companies who do cover IVF, may not cover genetic testing or embryo freezing, which can cost thousands extra. But the growing popularity of the singleton method is a good trend for patients who want more control in shaping the size of their families.

Health Care

Arizona Approves Surprise Inspections of Abortion Clinics

Arizona Governor Jan Brewer makes a statement saying she vetoed the controversial SB1062 bill at the Arizona State Capitol in Phoenix
Arizona Governor Jan Brewer. On Tuesday, she signed a bill allowing snap inspections of the state's abortion clinics Samantha Sais —Reuters

A new piece of legislation signed by Arizona’s Republican Governor will allow health officials to conduct surprise inspections of the state’s nine abortion clinics

Health officials will be able to inspect Arizona’s abortion clinics without warrants after Arizona Governor Jan Brewer signed a bill into law Tuesday.

The new law nullifies previous measures that required judges to approve any potential inspection of the state’s nine registered abortion clinics.

“This legislation will ensure that the Arizona Department of Health Services has the authority to appropriately protect the health and safety of all patients,” said the Governor’s spokesman Andrew Wilder, according to Reuters.

Pro-choice advocates said the Republican Governor’s decision as part of her sustained attack on women’s health.

“[Brewer] has been hostile to women’s health care, including abortion and family planning, since the day she took office,” the president of Planned Parenthood Advocates of Arizona, Bryan Howard, said in a statement following the passage of the bill.

Arizona joins ten other states that allow for similar snap inspections of abortion facilities.

[Reuters]

How Eldercare Handicaps Women

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Older woman refusing medication at home Monkey Business Images—Getty Images

On Health Care Decisions Day, leading healthcare advocate Jennifer Brokaw, daughter of Tom, points to the burden of medical-decision making, for which wives and daughters bear the brunt.

As a 48-year-old physician, wife, and daughter of aging parents, I am increasingly aware of my role as a medical decision-maker on both sides of the equation. In my work as a medical advocate, I have noticed that this role is played largely by women.

While I am proud that women are still fighting for sexual and reproductive freedoms, that child-rearing has become more of a team sport, and that women’s health issues such as breast cancer and heart disease are on everyone’s radar, the important role of women as medical decision-makers has not yet been given its due.

Almost half of hospitalized patients 65 or older needed a surrogate to help with at least one major decision, according to a recent study in the Journal of the American Medical Association. Almost a quarter of those patients needed a surrogate to make all of the decisions.

And who are the surrogates? According to JAMA, 58% were daughters, 20% were sons, and 20% were spouses, wives included.

It’s now estimated more than 60% of adults 65 and older will need some form of long-term care, many of them for the devastating onset of Alzheimer’s disease or dementia. Alzheimer’s is also one of the key reasons elderly patients require assistance with providing consent or refusal for medical treatment.

It’s not easy being a healthcare surrogate. This is especially true when the decisions center on end-of-life questions, a weighty decision when you consider that in California 77% of unpaid in-home caregivers are women. Where should mom live after a stroke? Would dad want to spend his last days on a ventilator, heavily sedated and paralyzed? Contrary to what many people assume about what happens in the hospital today, it is often the appointed surrogate, not the treating physicians, that make the final decisions about extent of treatment at the end of life.

Research has shown that surrogate decision-makers experience a lot of stress when decisions need to be made, and after the fact as well. However, a well-known study in the British Medical Journal showed that surrogates that had discussed advance directives and wishes with their loved one had significantly less stress, shorter grieving periods, and less substance use after their loved one’s death than those who had not had those conversations.

Nevertheless, only 30% of Americans have created an Advance Health Care Directive or Living Will. In the JAMA study, 25% had a designated surrogate on the chart, but a mere 7% had left any guidelines about their wishes. To be sure, these issues are difficult to contemplate in advance and still carry a lot of stigma in our optimistic never-say-die culture. It’s time for that to change.

I encourage all families to start creating an Advance Health Care Directive or Living Will now with all family members at the table. Clarifying the goals a person has for his or her life, including its end, can ease the burdens of decision-making when a crisis arrives. This process is known as advance care planning.

Furthermore, it’s time for doctors to get formal training about how to discuss decisions that need to be made with the surrogate decision-maker in a way that focuses on the overall goals of care and not just the immediate crisis. Doctors also need to circle back to taking more responsibility for decisions, keeping the patient’s and surrogate’s goals into account, and avoiding the old paternalistic attitude.

Everyone admires the woman who can “have it all,” be a mother, wife, and have a career and a full personal life. When we talk about what derails women’s careers, the conversation focuses on having children. The truth is that “sandwich generation” women have a lot more on their plate. It’s time to give advance care planning and healthcare decision-making the attention it deserves. It’s a woman’s prerogative.

Watch Jennifer and Tom Brokaw’s TED talk on healthcare surrogacy:

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