TIME medicine

Science Says These Are the Best Ways to Swallow Pills

Human hand hold medicine
Yasser Chalid—Moment Open/Getty Images

Lean forward or lean back?

For anyone who has ever choked or spit water out while trying to swallow a pill (which, let’s face it, we all have), a new study finally has answers for you.

The study published in the Annals of Family Medicine sought to determine the effectiveness of swallowing pills with what it called the “pop-bottle method” and the “lean forward technique.” The pop-bottle method had participants place the pill on their tongue and swallow it in one motion with a drink from a plastic bottle, and the lean forward technique had subjects swallow the capsule in an upright position with their heads bent forward.

The study found that both techniques “substantially facilitated” swallowing pills, even in subjects who had previously reported difficulty. Between the two methods, people preferred the lean forward technique—88.5% of participants reported improvement with the pop-bottle technique, and 96.9% did with lean forward.

So next time you face the daunting task of swallowing a pill, try tipping your head forward.

TIME health

Refusing Quarantine: Why Typhoid Mary Did It

Typhoid Mary Cooking
Illustration of 'Typhoid Mary' also known as Mary Mallon breaking skulls into a skillet, circa 1909. Fotosearch / Getty Images

Nov. 11, 1938: Mary Mallon dies in isolation on a New York island after being blamed for giving 51 people typhoid fever

In the early 1900s, when typhoid fever was associated with slums and their dismal sanitation, epidemiologists — and everyone else — wanted to know why an outbreak of the deadly bacterial infection suddenly emerged in Long Island’s tony Oyster Bay, among the summer homes of wealthy New Yorkers.

The answer turned out to be a cook who trailed typhoid wherever she went. And while Mary Mallon responded by brandishing a meat fork whenever public officials tried to test her, she proved to be a carrier for the disease, which was fatal to about one in 10 people who acquired it, even though she herself was immune to its effects.

Her extreme contagiousness (the New York Times called her “a veritable peripatetic breeding ground for the bacilli”) coupled with her refusal to comply with health officials’ orders not to endanger the public — say, by cooking for them — led to her lengthy involuntary isolation and to her moniker: Typhoid Mary.

It’s a name that invariably crops up whenever the debate over treatment of potential disease-carriers reenters the public discourse, as it did last month when a nurse returning from Sierra Leone was quarantined in a tent for three days. Although the nurse — who tested negative for Ebola — later balked at a voluntary three-week quarantine at her home in Maine, she faced nothing close to what Mary endured: more than a quarter-century of isolation on a “pest island” in the East River that ended with her death on this day, Nov. 11, in 1938.

For officials who, then as now, walked a fine line between protecting the public and preserving the civil rights of individuals who might pose a health risk, Mary presented a complicated case. The picture of health, despite her habit of infecting her employers, she refused to believe that she could make others sick without being sick herself, and swore until the day she died that she wasn’t responsible for the epidemic that perpetually followed in her wake.

That key difference between typhoid and Ebola — the latter of which is only contagious when the infected person is symptomatic, whereas Mallon was extremely contagious but never symptomatic — is also why Typhoid Mary’s usefulness as a current-events talking point is limited. Her resistance to quarantine was not based on science, and her health made it particularly hard to hold her to her promises. For example, she swore not to take another job as a cook when she was released in 1910, after three years of isolation in Riverside Hospital on the now-abandoned North Brother Island. Health officials lost track of her for a few years, but found her again in the midst of another typhoid outbreak, this time at a Manhattan maternity hospital where 25 people, mostly doctors and nurses, were infected. Mary had been cooking there under a fake name, but fled before health officials could catch her. They traced her to a house in Queens, where they had to sneak in through a second-story window, using a ladder, to apprehend her, according to the Times report on the event.

From there, it was back to isolation — for 23 more years, the rest of her life. Her obituary in the Times blamed her for 51 cases of typhoid and three deaths. Putting her age at roughly 68, the obit noted that “while her system was loaded with typhoid germs to such an extent that some physicians referred to her as the human culture tube, it was not typhoid that caused her death,” but the effects of a stroke she’d suffered six years earlier.

Read a 1928 report on New York City’s isolation island, here in TIME’s archives: Public Health

TIME Innovation

Five Best Ideas of the Day: November 10

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. Food touches everything in our lives. Yet we have no national food policy. That must change.

By Mark Bittman, Michael Pollan, Ricardo Salvador and Olivier De Schutter in the Washington Post

2. Electronic Medical Records should focus more on patient care and less on meeting the needs of insurance companies and billing departments.

By Scott Hensley at National Public Radio

3. Anonymous social media often hosts vicious harassment targeting women and minorities. A new plan to monitor threats online is working for a solution.

By Barbara Herman in International Business Times

4. “You can’t wear a Band-Aid for long, particularly when the wound keeps bleeding.” Two years after Hurricane Sandy, New York is far from stormproof.

By Lilah Raptopoulos in the Guardian

5. China and the U.S. should take aim at a new “grand bargain” to head off tensions and mistrust in their relationship.

By Wei Zongyou in the Diplomat

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME women

Did We Give the Pill Too Much Power?

birth control pills
Getty Images

Elizabeth Weingarten is the associate editor at New America and the associate director of its Global Gender Parity Initiative.

The answer to why we are still struggling with reproductive rights in this country may have to do with our original—and perhaps unrealistic—expectations of how much the pill could change things in the first place

This pill came with a promise: help extinguish sexism from public life by removing a key roadblock for women. If women could plan when and whether they became pregnant, they should be better able to develop careers and livelihoods, avoid a life of economic dependence on men, and form identities outside of motherhood.

In many ways, the birth control pill kept that promise by enabling women to enter the workforce, improving their health by helping them to space out pregnancies, and allowing them to have sex for pleasure. But more than 50 years after the pill first came to market, its promise of access and equality remains unfulfilled for millions of other women.

Think about the Hobby Lobby decision, which ruled that certain businesses can deny employees coverage for contraception on the basis of religious beliefs. The fact that many insurance plans still don’t cover contraception or infertility treatments. “Time passes and yet we’re still kind of stuck when it comes to reproductive rights,” said New York Times Health reporter Catherine Saint Louis at a recent New America NYC event. Cost and culture still prevent millions of low-income women here and abroad from obtaining the pill.

“The things we’re talking about [today] are the same things [Margaret Sanger, one of the pill’s bankrollers and the founder of Planned Parenthood] was talking about in 1914,” said Jonathan Eig, the author of the book, “The Birth of the Pill.” “I honestly believe she thought once the pill got out there, the genie would be out of the bottle, women would have all the power they needed and everything would be fine after that… I really think she’d be stunned.”

So how did we get here?

At least in part, the answer may lie in the scope of our expectations; we have asked a lot of one medical invention. After all, said Eig, the idea that the role of a woman is to be a vessel for a child is rooted in thousands of years of history. This biological difference is the foundation of gender inequality – the thing that for centuries kept them out of economic and professional competition with men, noted New Republic Senior Editor Rebecca Traister.

That’s a powerful dynamic and hard to reverse. The pill turned into a silver bullet, that single technological innovation that would allow us to avoid confronting the deeper, more impactful social structures that sustain gender discrimination. We can’t ask the pill and its users to fix a problem the rest of us choose to ignore.

Here in the U.S., the pill put “all of the onus and responsibility [of pregnancy] on individual women without a sense of accountability of community and government to support whole and healthy lives,” explained Tiloma Jayasinghe, the executive director of the anti-violence against women organization Sakhi for South Asian Women. But “we’re not in this by ourselves.”

It also sidelined men, taking their responsibility out of the equation and separating them from the reality of reproduction, Traister said. “That’s how you get Rush Limbaugh talking about, ‘how much sex are these women having that they have to pay this amount per pill?’ What it has done is further made reproduction ‘women’s territory’ in certain ways.”

“It was a double-edged sword,” said Eig.

Even when companies clumsily try to give agency to women, it illustrates how much society has put women in an untenable situation. Facebook and Apple announced recently that they would begin offering egg freezing as part of their healthcare benefit plans. Critics accused the tech companies of putting pressure on women to sacrifice life for work, and decried the use of egg freezing as dangerous. But that criticism is misguided, argued Traister. Rather than blame Facebook and Apple, why not fault a “system that repeatedly puts new possibilities on offer and keeps them from people who need them”? Everyone, not just tech companies, should offer these types of benefits because they’re part of women’s health, she said.

Improving women’s health is a major benefit of the pill. Before the pill, birth control was inefficient, inaccessible, and often completely controlled by men. Consequently, women were having more children than they wanted – often faster than their bodies could handle them. In many cases, this led to maternal and infant death, or economic instability and famine.

That’s still the case overseas, where Silver Bullet laziness may also be a factor. Though the pill has led to many health benefits, including a reduction in infant and maternal deaths around the world, its effects have been uneven and limited in certain developing countries. “The WHO and other organizations are promoting the use of the pill to space pregnancies, and yet they are doing so in countries where women don’t always have control of their bodies or access to the pill,” Jayasinghe said. She suggested that the pill’s success may lead to complacency in those regions: “We have it now, our work is done. But it’s not done.”

So how do we change the system here and abroad?

For many countries, harnessing the power of the pill will require a major culture shift. It needs to become okay for mothers to talk to daughters and fathers to talk to sons about contraception, which won’t be an easy fix, Jayasinghe said. (And critically, contraception is much more than just the pill. There are other forms of more reliable contraception – like IUD and hormonal implants – that in some cases are even preferred by women, but may be pricier or harder to access).

Here in the U.S., “we need to broaden our discussions to beyond fighting about abortion to a fuller scope of what do rights mean – the full scope of contraception,” Jayasinghe said. Abortion is just one issue in a women’s life – and making it a nitpicky focal point of reproductive conversations is limiting, she suggested. Ideally, legislators would introduce – and pass – some kind of comprehensive women’s reproductive rights and healthcare bill. That also means recognizing infertility as a real health problem, Saint Louis noted. Right now – in many circles – it’s an “I’m so sorry you waited until you were 35 [to have kids] problem, rather than recognizing that it affects 19-year-olds.”

It’s also critical to include men in conversations – both personal and public – around reproductive issues. Research shows that when men and women are required to take sexual education classes together, for example, birth rates drop dramatically, Eig pointed out. And after all, the scientific mastermind behind the pill was a man – Gregory (Goody) Pincus.

“There’s still a long way to go,” Eig said. “If there were more people like Goody [Pincus] fighting today, we’d see more innovation and more attention still being brought to this cause.”

This piece was originally published in New America’s digital magazine, The Weekly Wonk. Sign up to get it delivered to your inbox each Thursday here, and follow @New America on Twitter.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME medicine

9 Things to Know Before Buying Another Supplement

pills
Getty Images

A guide to avoiding sketchy ingredients and choosing the most trusted brands

The supplement aisle at the drugstore is lined with products that promise to prevent illness, improve energy, boost metabolism, even brighten your skin. You probably already know these capsules aren’t necessarily silver bullets to perfect health. (Whatever benefits your multivitamin or omega-3 supplements offer, you still have to exercise and eat right, for example.) But you do expect them to be safe to swallow, at the very least.

Sadly, a new study in the Journal of the American Medical Association suggests otherwise. After analyzing supplements that had been recalled by the FDA for containing banned substances—such as steroids or powerful prescription medications like Viagra and Prozac—researchers found that roughly two-thirds of the tainted products were back on store shelves with the same illicit ingredients at least six months later.

HEALTH.COM: 6 Myths (and Facts) About Weight Loss Supplements

Because supplement makers are subject to little regulatory oversight from the U.S. Food & Drug Administration, they aren’t required to prove a product’s safety (or efficacy) before it goes to market. And as this study shows, some fail at accurately providing the most basic safety information.

That said, the supplement industry is vast; Americans are expected to spend $32.4 billion on vitamins and dietary supplements in 2014, according to a Euromonitor International report. And there are reputable, safe supplement-makers out there.

Our buyer’s guide can help you avoid sketchy ingredients and choose the most established, trusted brands.

Be wary of certain types of pills

Namely exercise, weight-loss, and sexual-enhancement supplements. The products analyzed in the JAMA study fell into these three categories. Several of the weight-loss supplements actually contained an amphetamine-like drug called sibutramine, which is banned in the U.S., Asia, and Europe.

HEALTH.COM: Warning: Do Not Mix These Supplements

Shop selectively

Big-chain drugstores, pharmacies, and supplement stores like GNC or the Vitamin Shoppe may act faster to pull recalled items.

Don’t bargain-hunt

A University of Minnesota analysis found that for six types of herbal products, the more expensive the supplement was, the more likely it was that the recommended dosage would be consistent with established standards.

Steer clear of supplements made in China

Lack of regulation and poor manufacturing practices in China mean their goods may be more likely to be contaminated with substances like lead.

HEALTH.COM: Probiotic Foods and Supplements That Really Work

Check for a USP Verified Mark

It means that the nonprofit US Pharmacopeia has verified that a product contains the ingredients on the label in the amounts specified and doesn’t contain unacceptable levels of contaminants.

Do research at reputable sites

You can read supplement fact sheets from National Institutes of Health Office of Dietary Supplements to get all the info you need on everything from the recommended daily amount (RDA) to the latest on the health benefits of a certain supplement. It’s also a good idea to stay on top of warnings or recall alerts from the FDA. When you’re ready to buy, the USP website has a store directory and list of all the participating supplement companies if you want to check before you head to the store.

HEALTH.COM: Vitamins: What to Take, What to Skip

Consult the experts

Namely, the store pharmacist and your doctor. The former can alert you to any potential adverse events or drug interactions, and your doc can advise you on which supplements are safe and effective.

Skip dubious ingredients

These four have been linked to serious side effects, and aren’t worth the risk.

  1. Kava. It has been reported to cause liver damage.
    2. Bitter orange. It contains the chemical syndephrine, which has been linked to heart attacks and strokes in healthy people when taken alone or combined with caffeine.
    3. Contaminated L-tryptophan. It’s associated with neurotoxic reactions.
    4. Chromium. When overused, it’s been linked to anemia—even kidney failure.

HEALTH.COM: Best Foods For Every Vitamin and Mineral

With additional reporting by Hallie Levine

This article originally appeared on Health.com

TIME health

Pilot Sully Sullenberger on Ebola: Medicine Needs a Higher Authority

Chesley "Sully" Sullenberger in New York City, on Jan. 15, 2014.
Chesley "Sully" Sullenberger in New York City, on Jan. 15, 2014. Andrew Burton—Getty Images

Sully Sullenberger is an expert in the fields of aviation and patient safety.

Quality and safety oversight of the medical field is too fractured, and could benefit from an FAA-like agency

For the last several weeks, I have been watching the haphazard response to the appearance of Ebola in the U.S. through the eyes of a professional pilot. With limited federal control over matters related to public health, elected officials around the country are rushing to enact emergency measures to prevent Ebola’s spread, resulting in major disagreements about how best to do that. We saw the limits of that approach in New Jersey, and then in Maine, when the first person subjected to forced isolation called her treatment “inhumane” and defied quarantine orders, setting off a debate among public health experts, civil liberties groups and even the White House.

I have devoted my entire professional life to the pursuit of the safety of the public. Aviation and medicine are both high-stakes endeavors with little margin for error. All complex systems are different, but they all abide by similar rules and need a coordinated system of protocols and uniformity to bring into play under situations that can be very different. Over many decades, aviation has developed a systems approach to manage the complexity and interrelatedness of an endeavor that involves inherent risk, and an effective culture of safety that can, in substantive ways, be transferred to medicine.

When an accident occurs in aviation – often resulting in mass casualties and widespread media attention – the National Transportation Safety Board (NTSB) immediately conducts a thorough investigation into the accident or incident as the U.S. body responsible for recommending systemic changes and making sure that the right lessons are drawn and disseminated widely to all in the industry. In medicine there are too many entities that have a hand in quality and safety and whose efforts are not effectively coordinated. The Centers for Disease Control and Prevention (CDC) lacks the high degree of regulatory authority of an agency like the Federal Aviation Administration (FAA), so there is no single domestic agency that oversees all of medicine and promotes and mandates agreed upon best practices uniformly. And Ebola aside, in medicine, accidents and incidents tend to occur singly, largely without getting much attention.

Without a systems approach, medicine is fragmented. Without sufficient widespread implementation of best practices and effective training, medical personnel and government leaders are forced to scramble, making critical decisions and developing protocols in real time to respond to an evolving crisis. With states and hospitals left to their own devices, no one consistent policy emerges, causing gaps in execution. The result, as we have seen, can lead to chaos and confusion among medical professionals and a loss of confidence by the public.

In aviation we also face complexity, ambiguity and situations we have never specifically trained for, but airline pilots train for the unknown. It is our job to anticipate potential issues and, when faced with the unexpected, to adapt, and to respond calmly, quickly and effectively. The ability to make split-second decisions becomes infinitely easier when the effective protocols, training, equipment and human team skills are already in place as part of the robust and resilient safety system and culture in which we operate. Every day pilots and flight attendants face new situations for the first time at 35,000 feet, but they perform successfully because they know how to execute after years of preparedness training. They’re not trying to use duct tape to solve the problem.

Medical professionals are as dedicated as any. They grapple with imperfect information, highly complex systems and ambiguities that far outweigh those of a Boeing 747. But that’s all the more reason to create a culture of consistent application of best practices and effective communication. In order to establish and maintain public confidence, officials have to handle uncertainty well, acknowledge the limits of their knowledge and have the courage to level with people. Every time I made an announcement from the cockpit, whether it was about a delay or an in-flight emergency, I told my passengers everything that I knew and that I would keep them updated. That kind of transparency is the only way to maintain the public’s trust.

The aviation industry has made great strides in safety over the past 40 years by teaching critical skills some call “soft” skills, which are really human skills, giving crews the tools they need to take a team of experts and make them an expert team. In an overall systems approach, there are real incentives aligned with the public good, and we’ve found that a long-term approach to safety pays for itself by avoiding accidents and bad outcomes.

In medicine, there is so much uncoordinated individual effort on the part of thousands of entities, it is hard to align public health incentives and take the long-term approach. There were candidate Ebola vaccines ready to go to human trial almost 10 years ago. As we’ve learned in aviation, safety is cost-effective in the long term, and for that reason we have for decades used government-industry partnerships to do the hard work and proactively mitigate risks.

Adopting some of these practices may help avoid the systemic gaps we’ve seen over the last few weeks, resulting in better alternatives for those tasked with the heavy burden of managing the Ebola response – and for the public at large.

Sully Sullenberger is an expert in the fields of aviation and patient safety; he is an author, speaker and consultant, and serves as the CBS News Aviation and Safety Expert. He is also the founder and chief executive officer of Safety Reliability Methods, Inc., a company dedicated to management, safety, performance and reliability consulting.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME medicine

Scientists Develop Drug to Replace Antibiotics

New medicine effective against superbugs

Scientists have created the first antibiotic-free drug to treat bacterial infections in a major development in combatting drug-resistance, according to The Times.

A small patient trial showed that the new treatment was effective at eradicating the MRSA superbug which is resistant to most antibiotics. The drug is already available as a cream for skin infections and researchers hope to create a pill or an injectable version of it in the next five years.

Antibiotics have been one of the most important drugs since the invention of penicillin almost 90 years ago. But the World Health Organization has repeatedly warned of the threat of antimicrobial resistance, saying “a post-antibiotic era – in which common infections and minor injuries can kill” is a very real possibility in the 21st century.

But scientists say this new technology is less prone to resistance than antibiotics because the treatment attacks infections in a completely different way. The treatment uses enzymes called endolysins — naturally occurring viruses that attack certain bacterial species but leave beneficial microbes alone.

Mark Offerhaus, the Chief Executive of the Dutch biotech firm Micreos which is leading the research, said the development of the new drug marks “a new era in the fight against antibiotic-resistant bacteria”, adding that millions of people stand to benefit from this.

[The Times]

 

TIME Innovation

Five Best Ideas of the Day: November 5

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. Beyond PTSD: Returning soldiers struggle to recover from the ‘moral injury’ of war.

By Jeff Severns Guntzel in On Being

2. On climate and so many other scientific issues, the way we communicate polarizes audiences. We can do better.

By Paul Voosen in the Chronicle of Higher Education

3. Entrepreneurs and educators need to observe students in school if they want to make real change.

By Alex Hernandez in EdSurge

4. Lifesaving ultrasound technology may soon come to a device the size of an iPhone. The applications for medicine in the developing world are massive.

By Antonio Regalado in MIT Technology Review

5. Many Arab governments are fueling the very extremism they purport to fight and are looking for U.S. cover. Washington should play the long game.

By Michele Dunne and Frederic Wehrey at the Carnegie Endowment for International Peace

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Innovation

Five Best Ideas of the Day: November 4

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. Peer-to-peer sharing of experiences could transform health care.

By Susannah Fox in Iodine

2. A technological and analytical arms race is producing the best athletes in history. Can those advances be applied to education?

By James Surowiecki in the New Yorker

3. In South Bronx, startups are ‘onshoring’ technology jobs and trying to spark a revolution.

By Issie Lapowsky in Wired

4. ‘Sister City’ relationships foster cross-border collaboration and spur economic development.

By Nehemiah Rolle in Next City

5. Colleges and universities should focus on student success beyond graduation.

By Karen Gross and Ivan Figueroa at Inside Higher Ed

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Innovation

Five Best Ideas of the Day: November 3

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. “Ultimately, gender equality is a vital part of humanity’s progress. ” Read the 2014 Gender Gap Report.

By the World Economic Forum

2. Shopping for Water: Markets just might save the American West from its water crisis.

By Peter Culp, Robert Glennon, and Gary Libecap at the Hamilton Project

3. With Ebola in the spotlight, Liberia’s nurses take to the streets to care for the sick crowded out of the overwhelmed health care system.

By Jina Moore at BuzzFeed News

4. Humanitarians are preparing for a future with autonomous weapons, which are unlikely to understand mercy, proportionality or the difference between combatants and civilians.

By Malcolm Lucard in Red Cross Red Crescent

5. Markets in everything: Can letting the rich buy into clinical trials produce cures for rare diseases faster?

By Alexander Masters in Mosaic Science

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

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