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What happens when I stop taking a drug like Ozempic or Mounjaro?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Drugs like Ozempic are very <a href="https://dom-pubs.pericles-prod.literatumonline.com/doi/10.1111/dom.12932">effective</a> at helping most people who take them lose weight. Semaglutide (sold as Wegovy and Ozempic) and tirzepatide (sold as Zepbound and Mounjaro) are the most well known in the class of drugs that mimic hormones to reduce feelings of hunger. But does weight come back when you stop using it? The short answer is yes. Stopping <a href="https://jamanetwork.com/journals/jama/fullarticle/2812936">tirzepatide</a> and <a href="https://doi.org/10.1111/dom.14725">semaglutide</a> will result in weight regain in most people. So are these medications simply another (expensive) form of yo-yo dieting? Let’s look at what the evidence shows so far. <h2>It’s a long-term treatment, not a short course</h2> If you have a bacterial infection, antibiotics will help your body fight off the germs causing your illness. You take the full course of medication, and the infection is gone. For obesity, taking tirzepatide or semaglutide can help your body get rid of fat. However it doesn’t fix the reasons you gained weight in the first place because obesity is a chronic, complex condition. When you stop the medications, the weight returns. Perhaps a more useful comparison is with high blood pressure, also known as hypertension. Treatment for hypertension is lifelong. It’s the same with obesity. Medications work, but only while you are taking them. (Though obesity is more complicated than hypertension, as many different factors both cause and perpetuate it.) Therefore, several concurrent approaches are needed; taking medication can be an important part of effective management but on its own, it’s often insufficient. And in an unwanted knock-on effect, stopping medication can undermine other strategies to lose weight, like eating less. <h2>Why do people stop?</h2> Research trials show anywhere from <a href="https://asean-endocrinejournal.org/index.php/JAFES/article/view/1771">6%</a> to <a href="https://pubmed.ncbi.nlm.nih.gov/35015037/">13.5%</a> of participants stop taking these drugs, primarily because of <a href="https://www.health.harvard.edu/staying-healthy/glp-1-diabetes-and-weight-loss-drug-side-effects-ozempic-face-and-more">side effects</a>. But these studies don’t account for those forced to stop because of cost or <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023">widespread supply issues</a>. We don’t know how many people have needed to stop this medication over the past few years for these reasons. Understanding what stopping does to the body is therefore important. <h2>So what happens when you stop?</h2> When you stop using tirzepatide or semaglutide, it takes several days (or even a couple of weeks) to <a href="https://pubmed.ncbi.nlm.nih.gov/30565096/">move out of your system</a>. As it does, a number of things happen: <ul> <li>you start feeling hungry again, because both <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4119845/">your brain and your gut</a> no longer have the medication working to make you feel full</li> </ul> <ul> <li> blood sugars increase, because the medication is no longer acting on the pancreas to help control this. If you have diabetes as well as obesity you may need to take other medications to keep these in an acceptable range. Whether you have diabetes or not, you may need to eat foods with a <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/carbohydrates-and-the-glycaemic-index">low glycemic index</a> to stabilise your blood sugars </li> <li> over the longer term, most people experience a return to their <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10092593/">previous blood pressure and cholesterol levels</a>, as the weight comes back </li> <li> weight regain will mostly be in the form of fat, because it will be gained faster than skeletal muscle. </li> </ul> While you were on the medication, you will have lost <a href="https://academic.oup.com/jes/article/5/Supplement_1/A16/6240360">proportionally less skeletal muscle than fat</a>, muscle loss is inevitable when you lose weight, no matter whether you use medications or not. The problem is, when you stop the medication, your body preferentially puts on fat. <h2>Is stopping and starting the medications a problem?</h2> People whose weight fluctuates with tirzepatide or semaglutide may experience some of the downsides of <a href="https://pubmed.ncbi.nlm.nih.gov/21829159/">yo-yo dieting</a>. When you keep going on and off diets, it’s like a rollercoaster ride for your body. Each time you regain weight, your body has to <a href="https://www.jomes.org/journal/view.html?doi=10.7570/jomes.2017.26.4.237">deal with</a> spikes in blood pressure, heart rate, and how your body handles sugars and fats. This can <a href="https://cardiab.biomedcentral.com/articles/10.1186/s12933-022-01735-x">stress</a> your heart and overall cardiovascular system, as it has to respond to greater fluctuations than usual. Interestingly, the risk to the body from weight fluctuations is greater for people who are <a href="https://jech.bmj.com/content/74/8/662">not obese</a>. This should be a caution to those who are not obese but still using tirzepatide or semaglutide to try to lose unwanted weight. <h2>How can you avoid gaining weight when you stop?</h2> Fear of regaining weight when stopping these medications is valid, and needs to be addressed directly. As obesity has many causes and perpetuating factors, many evidence-based approaches are needed to reduce weight regain. This might include: <ul> <li> getting quality <a href="https://www.hindawi.com/journals/ije/2010/270832/">sleep</a> </li> <li> exercising in a way that builds and maintains muscle. While on the medication, you will <a href="https://pubmed.ncbi.nlm.nih.gov/32628589/">likely have lost muscle</a> as well as fat, although this is not inevitable, especially if you <a href="https://www.europeanreview.org/article/34169">exercise regularly</a> while taking it </li> </ul> <ul> <li> addressing emotional and cultural aspects of life that contribute to over-eating and/or eating unhealthy foods, and how you view your body. Stigma and shame around body shape and size is not cured by taking this medication. Even if you have a healthy relationship with food, we live in a culture that is <a href="https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2009.159491">fat-phobic and discriminates</a> against people in larger bodies </li> <li> eating in a healthy way, hopefully continuing with habits that were formed while on the medication. Eating meals that have high nutrition and fibre, for example, and lower overall portion sizes. </li> </ul> Many people will stop taking tirzepatide or semaglutide at some point, given it is expensive and in short supply. When you do, it is important to understand what will happen and what you can do to help avoid the consequences. Regular reviews with your GP are also important. <hr /> Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/224972/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, General Practitioner, PhD Candidate, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-happens-when-i-stop-taking-a-drug-like-ozempic-or-mounjaro-224972">original article</a>. </div>

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No, taking drugs like Ozempic isn’t ‘cheating’ at weight loss or the ‘easy way out’

<a href="https://theconversation.com/profiles/clare-collins-7316">Clare Collins</a>, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Obesity medication that is effective has been a long time coming. Enter semaglutide (sold as Ozempic and Wegovy), which is helping people improve weight-related health, including <a href="https://pubmed.ncbi.nlm.nih.gov/37952131/">lowering the risk</a> of a having a heart attack or stroke, while also silencing “<a href="https://theconversation.com/some-ozempic-users-say-it-silences-food-noise-but-there-are-drug-free-ways-to-stop-thinking-about-food-so-much-208467">food noise</a>”. As demand for semaglutide increases, so are <a href="https://www.smh.com.au/lifestyle/health-and-wellness/in-a-fat-phobic-world-ozempic-is-hardly-the-easy-way-out-20240401-p5fgjd.html">claims</a> that taking it is “cheating” at weight loss or the “easy way out”. We don’t tell people who need statin medication to treat high cholesterol or drugs to manage high blood pressure they’re cheating or taking the easy way out. Nor should we shame people taking semaglutide. It’s a drug used to treat diabetes and obesity which needs to be taken long term and comes with risks and side effects, as well as benefits. When prescribed for obesity, it’s given alongside advice about diet and exercise. <h2>How does it work?</h2> Semaglutide is a <a href="https://en.wikipedia.org/wiki/GLP-1_receptor_agonist">glucagon-like peptide-1</a> receptor agonist (GLP-1RA). This means it makes your body’s own glucagon-like peptide-1 hormone, called <a href="https://en.wikipedia.org/wiki/Glucagon-like_peptide-1">GLP-1</a> for short, work better. GLP-1 gets secreted by cells in your gut when it <a href="https://pubmed.ncbi.nlm.nih.gov/38218319/">detects increased nutrient levels</a> after eating. This stimulates insulin production, which lowers blood sugars. GLP-1 also slows gastric emptying, which makes you feel full, and reduces hunger and feelings of reward after eating. <iframe id="tc-infographic-1031" class="tc-infographic" style="border: none;" src="https://cdn.theconversation.com/infographics/1031/c11b606581d4bc58a71f066492d7f740b52c04e1/site/index.html" width="100%" height="400px" frameborder="0"></iframe> GLP-1 receptor agonist (GLP-1RA) medications like Ozempic help the body’s own GLP-1 work better by mimicking and extending its action. Some studies have found less GLP-1 gets released after meals in <a href="https://pubmed.ncbi.nlm.nih.gov/38218319/">adults with obesity or type 2 diabetes mellitus</a> compared to adults with normal glucose tolerance. So having less GLP-1 circulating in your blood means you don’t feel as full after eating and get hungry again sooner compared to people who produce more. GLP-1 has a very short half-life of about <a href="https://pubmed.ncbi.nlm.nih.gov/28443255/">two minutes</a>. So GLP-1RA medications were designed to have a very long half-life of about <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">seven days</a>. That’s why semaglutide is given as a weekly injection. <h2>What can users expect? What does the research say?</h2> Higher doses of semaglutide are prescribed to treat obesity compared to type 2 diabetes management (up to 2.4mg versus 2.0mg weekly). A large group of <a href="https://pubmed.ncbi.nlm.nih.gov/36691309/">randomised controlled trials</a>, called STEP trials, all tested weekly 2.4mg semaglutide injections versus different interventions or placebo drugs. Trials lasting 1.3–2 years consistently found weekly 2.4 mg semaglutide injections <a href="https://pubmed.ncbi.nlm.nih.gov/36691309/">led to 6–12% greater weight loss</a> compared to placebo or alternative interventions. The average weight change depended on how long medication treatment lasted and length of follow-up. Weight reduction due to semaglutide also leads to a <a href="https://pubmed.ncbi.nlm.nih.gov/36769420/">reduction in systolic and diastolic blood pressure</a> of about 4.8 mmHg and 2.5 mmHg respectively, a reduction in <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/triglycerides">triglyceride levels</a> (a type of blood fat) and <a href="https://pubmed.ncbi.nlm.nih.gov/38041774/">improved physical function</a>. Another recent trial in adults with pre-existing heart disease and obesity, but without type 2 diabetes, found adults receiving weekly 2.4mg semaglutide injections had a <a href="https://pubmed.ncbi.nlm.nih.gov/37952131/">20% lower risk</a> of specific cardiovascular events, including having a non-fatal heart attack, a stroke or dying from cardiovascular disease, after three years follow-up. <h2>Who is eligible for semaglutide?</h2> Australia’s regulator, the Therapeutic Goods Administration (TGA), has <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023">approved</a> semaglutide, sold as Ozempic, for treating type 2 diabetes. However, due to shortages, the TGA had advised doctors not to start new Ozempic prescriptions for “off-label use” such as obesity treatment and the Pharmaceutical Benefits Scheme doesn’t currently subsidise off-label use. The TGA has <a href="https://www.tga.gov.au/resources/prescription-medicines-registrations/wegovy-novo-nordisk-pharmaceuticals-pty-ltd">approved Wegovy to treat obesity</a> but it’s not currently available in Australia. When it’s available, doctors will be able to prescribe <a href="https://pubmed.ncbi.nlm.nih.gov/36934408/">semaglutide to treat obesity</a> in conjunction with lifestyle interventions (including diet, physical activity and psychological support) in adults with obesity (a BMI of 30 or above) or those with a BMI of 27 or above who also have weight-related medical complications. <h2>What else do you need to do during Ozempic treatment?</h2> Checking details of the <a href="https://pubmed.ncbi.nlm.nih.gov/36691309/">STEP trial intervention components</a>, it’s clear participants invested a lot of time and effort. In addition to taking medication, people had brief lifestyle counselling sessions with dietitians or other health professionals every four weeks as a minimum in most trials. Support sessions were designed to help people stick with consuming 2,000 kilojoules (500 calories) less daily compared to their energy needs, and performing 150 minutes of <a href="https://www.healthdirect.gov.au/tips-for-getting-active">moderate-to-vigorous physical activity</a>, like brisk walking, dancing and gardening each week. STEP trials varied in other components, with follow-up time periods varying from 68 to 104 weeks. The aim of these trials was to show the effect of adding the medication on top of other lifestyle counselling. A <a href="https://pubmed.ncbi.nlm.nih.gov/38041774/">review of obesity medication trials</a> found people reported they needed less <a href="https://pubmed.ncbi.nlm.nih.gov/28652832/">cognitive behaviour training</a> to help them stick with the reduced energy intake. This is one aspect where drug treatment may make adherence a little easier. Not feeling as hungry and having environmental food cues “switched off” may mean less support is required for goal-setting, self-monitoring food intake and <a href="https://theconversation.com/9-ways-wont-power-is-better-than-willpower-for-resisting-temptation-and-helping-you-eat-better-71267">avoiding things that trigger eating</a>. <h2>But what are the side effects?</h2> Semaglutide’s side-effects <a href="https://pubmed.ncbi.nlm.nih.gov/38041774/">include</a> nausea, diarrhoea, vomiting, constipation, indigestion and abdominal pain. In one study these <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">led to</a> discontinuation of medication in 6% of people, but interestingly also in 3% of people taking placebos. More severe side-effects included gallbladder disease, acute pancreatitis, hypoglycaemia, acute kidney disease and injection site reactions. To reduce risk or severity of side-effects, <a href="https://pubmed.ncbi.nlm.nih.gov/36934408/">medication doses are increased very slowly</a> over months. Once the full dose and response are achieved, research indicates you need to take it long term. Given this long-term commitment, and associated <a href="https://www.health.gov.au/topics/private-health-insurance/what-private-health-insurance-covers/out-of-pocket-costs#:%7E:text=An%20out%20of%20pocket%20cost,called%20gap%20or%20patient%20payments">high out-of-pocket cost of medication</a>, when it comes to taking semaglutide to treat obesity, there is no way it can be considered “cheating”. <hr /> Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/219116/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/clare-collins-7316">Clare Collins</a>, Laureate Professor in Nutrition and Dietetics, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/no-taking-drugs-like-ozempic-isnt-cheating-at-weight-loss-or-the-easy-way-out-219116">original article</a>.

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Drugs like Ozempic won’t ‘cure’ obesity but they might make us more fat-phobic

<a href="https://theconversation.com/profiles/emma-beckett-22673">Emma Beckett</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Many have <a href="https://www.economist.com/leaders/2023/03/02/new-drugs-could-spell-an-end-to-the-worlds-obesity-epidemic">declared</a> drugs like Ozempic could “end obesity” by reducing the appetite and waistlines of millions of people around the world. When we look past the hype, this isn’t just untrue – it can also be harmful. The focus on weight, as opposed to health, is a feature of <a href="https://www.sciencedirect.com/science/article/abs/pii/S0277539521001217">diet culture</a>. This frames the pursuit of thinness as more important than other aspects of physical and cultural wellbeing. The Ozempic buzz isn’t just rooted in health and medicine but plays into ideas of <a href="https://butterfly.org.au/weight-bias-fatphobia-diet-culture/#:%7E:text=Weight%20bias%2C%20sometimes%20also%20called,or%20being%20around%20fat%20people.">fat stigma and fat phobia</a>. This can perpetuate fears of fatness and fat people, and the behaviours that <a href="https://link.springer.com/article/10.1186/S12916-018-1116-5">harm people who live in larger bodies</a>. <h2>Not the first ‘miracle’ weight-loss drug</h2> This isn’t the first time we have heard that weight-loss drugs will change the world. Ozempic and <a href="https://www.ncbi.nlm.nih.gov/books/NBK551568/">its family</a> of GLP-1-mimicking drugs are the <a href="https://theconversation.com/ozempic-is-in-the-spotlight-but-its-just-the-latest-in-a-long-and-strange-history-of-weight-loss-drugs-209324">latest in a long line of weight loss drugs</a>. Each looked promising at the time. But none have lived up to the hype in the long term. Some have even been withdrawn from sale due to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5126837/">severe side effects</a>. Science does improve <a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(20)30028-8/fulltext">incrementally</a>, but diet culture also keeps us on a cycle of hope for the next <a href="https://sahrc.org/2022/04/diet-culture-a-brief-history/">miracle cure</a>. So drugs like Ozempic might not deliver the results individuals expect, continuing the cycle of hope and shame. <h2>Ozempic doesn’t work the same for everyone</h2> When we talk about the results of studies using Ozempic, we often <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719041/">focus on the average</a> (also known as the mean) results or the maximum (or peak) results. So, studies might <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">show</a> those using the drug lost an average of 10.9% of their body weight, but some lost more than 20% and others less than 5% What we don’t talk about as much is that responses are variable. Some people are “<a href="https://www.sciencedirect.com/science/article/pii/S2212877820301769">non-responders</a>”. This means not everyone loses as much weight as the average, and some don’t lose weight at all. For some people, the side-effects will outweigh the benefits. When people are on drugs like Ozempic, their blood sugar is better controlled by enhancing the release of insulin and reducing the levels of another hormone called glucagon. But there is greater variability in the amount of <a href="https://www.sciencedirect.com/science/article/pii/S2212877820301769#bib88">weight lost</a> than the variability in blood sugar control. It isn’t clear why, but is likely due to differences in genetics and lifestyles, and weight being more complex to regulate. <h2>Treatment needs to be ongoing. What will this mean?</h2> When weight-loss drugs do work, they are only effective while they’re being taken. This means that to keep the weight off people need to keep taking them long term. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9542252/">One study found</a> an average weight loss of more than 17% after a year on Ozempic became an average net weight loss of 5.6% more than two years after stopping treatment. Short-term side effects of drugs like Ozempic include dizziness, nausea, vomiting and other gastrointestinal upsets. But because these are new drugs, we simply don’t have data to tell us if side effects will increase as people take them for longer periods. Nor do we know if <a href="https://www.medicalnewstoday.com/articles/why-weight-loss-drugs-stop-working-how-to-break-past-ozempic-plateau#:%7E:text=A%20lifetime%20commitment%20to%20Ozempic&text=By%20these%20standards%2C%20such%20drugs,long%2Dterm%20risk%20is%20unknown.">effectiveness will be reduced</a> in the long term. This is called <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/drug-tolerance#:%7E:text=A%20condition%20that%20occurs%20when,or%20different%20medicine%20is%20needed.">drug tolerance</a> and is documented for other long-term treatments such as antidepressants and chemotherapies. <h2>Biology is only part of the story</h2> For some people, using GLP-1-mimicking drugs like Ozempic will be validating and empowering. They will feel like their biology has been “normalised” in the same way that blood pressure or cholesterol medication can return people to the “normal” range of measures. But biologically, obesity <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202176/#:%7E:text=Obesity%20behaves%20as%20complex%20polygenic,about%2080%25%20(3).">isn’t solely about GLP-1 activity</a> with <a href="https://www.worldobesity.org/what-we-do/our-policy-priorities/the-roots-of-obesity">many other</a> hormones, physical activity, and even our gut microbes involved. Overall, <a href="https://www.ncbi.nlm.nih.gov/books/NBK278977/">obesity is complex and multifaceted</a>. Obesity isn’t just driven by personal biology and choice; it has social, cultural, political, environmental and economic determinants. <h2>A weight-centred approach misses the rest of the story</h2> The weight-centred approach <a href="https://butterfly.org.au/body-image/health-not-weight/#:%7E:text=Health%20and%20wellbeing%20are%20multi,on%20their%20size%20or%20appearance.">suggests that leading with thinness means health will follow</a>. But changing appetite is only part of the story when it comes to health. Obesity often <a href="https://www.sciencedirect.com/science/article/pii/S2667368123000335#:%7E:text=Obesity%20related%20malnutrition%20can%20also,%5D%2C%20%5B7%5D%5D.">co-exists with malnutrition</a>. We try to separate the effects in research using statistics, but focusing on the benefits of weight-loss drugs without addressing the underlying malnutrition means we aren’t likely to see the <a href="https://www.wsj.com/articles/ozempic-diet-exercise-healthy-43eee86c">improved health outcomes in everyone who loses weight</a>. <h2>Obesity isn’t an issue detached from people</h2> Even when it is well-intentioned, the rhetoric around the joy of “ending the obesity epidemic” can <a href="https://theconversation.com/ozempic-the-miracle-drug-and-the-harmful-idea-of-a-future-without-fat-211661">harm people</a>. Obesity doesn’t occur in isolation. It is people who are obese. And the celebration and hype of these weight-loss drugs can reinforce harmful fat stigma. The framing of these drugs as a “cure” exacerbates the binary view of thin versus fat, and healthy versus unhealthy. These are not binary outcomes that are good or bad. Weight and health exist on a spectrum. Ironically, while fat people are told they need to lose weight for their health, they are also <a href="https://www.dailytelegraph.com.au/news/nsw/ozempic-shame-why-users-are-embarrassed-to-admit-using-weight-loss-wonder-drug/news-story/ee52a819c69459afe6576d25988f9bd6">shamed for “cheating” or taking shortcuts</a> by using medication. <h2>Drugs are tools, not silver bullets</h2> The creation of these drugs is a start, but they remain expensive, and the hype has been followed by <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023#:%7E:text=Consumer%20Medicine%20Information%20.-,Why%20the%20Ozempic%20shortage%20happened,label%20prescribing%20for%20weight%20loss.">shortages</a>. Ultimately, complex challenges aren’t addressed with simple solutions. This is particularly true when people are involved, and even more so when there isn’t even an agreement on what the challenge is. Many organisations and individuals see obesity is a disease and believe this framing helps people to seek treatment. Others think it’s unnecessary to attach medical labels to body types and <a href="https://www.forbes.com/sites/geoffreykabat/2013/07/09/why-labeling-obesity-as-a-disease-is-a-big-mistake/?sh=5ca95cc2103b">argue</a> it confuses risk factors (things that are linked to increased risk of illness) with illness itself. Regardless, two things will always remain true. Drugs can only ever be tools, and those tools need to be applied in a context. To use these tools ethically, we need to remain mindful of who this application harms along the way. <hr /> Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/219309/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/emma-beckett-22673">Emma Beckett</a>, Adjunct Senior Lecturer, Nutrition, Dietetics & Food Innovation - School of Health Sciences, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/drugs-like-ozempic-wont-cure-obesity-but-they-might-make-us-more-fat-phobic-219309">original article</a>.

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Astonishing drug and prostitute claims surface as Lehrmann case reopened

The ongoing defamation case involving Bruce Lehrmann, a central figure in the Brittany Higgins saga, has been thrust back into the spotlight with shocking new allegations. The reopening of the case stems from claims made by former Seven Network producer Taylor Auerbach, which seek to shed light on a series of dealings surrounding Lehrmann's interactions with various media outlets. The allegations put forth by Auerbach paint an astonishing picture of Lehrmann's recruitment by Seven Network for an exclusive tell-all interview. It's alleged that Lehrmann, in a bid to secure his cooperation, was lavishly reimbursed for expenses that included not only extravagant meals and travel but also expenditures on illicit drugs and prostitutes. The details emerged through affidavits filed by Auerbach with the Federal Court, just days before a judgment was expected in Lehrmann's defamation case against Network Ten and journalist Lisa Wilkinson. The case originated from a February 2021 report on The Project, where Brittany Higgins accused Lehrmann of rape within a Parliament House office in 2019. According to Auerbach's affidavits, Lehrmann breached a so-called Harman undertaking by leaking private and confidential texts from Higgins to Seven Network, violating an agreement that restricted the use of evidence from an abandoned criminal case against him. These texts allegedly facilitated Lehrmann's negotiations with Seven Network and formed a crucial part of his interview on the Spotlight program. The allegations take a darker turn with claims of financial reimbursement for illicit activities. Auerbach asserts that Seven Network reimbursed Lehrmann for expenses related to drug purchases and visits to brothels, implicating the network in what can only be described as deeply troubling conduct. "I recall that monies paid by (Lehrmann) for illicit drugs and prostitutes that evening at the Meriton and the following evening at a brothel in Surry Hills were reimbursed to (Lehrmann) by Seven," Auerbach states in his affidavit, according to <a href="https://au.news.yahoo.com/lehrmann-defamation-case-reopened-evidence-163000287.html" target="_blank" rel="noopener">Yahoo News</a>. The reopening of Lehrmann's defamation case underscores the gravity of these allegations and their potential implications. Justice Michael Lee's decision to admit fresh evidence indicates the seriousness with which the court regards these claims and the need for a thorough examination of the facts. In response to these allegations, both Lehrmann and Seven Network have vehemently denied any wrongdoing. Lehrmann maintains his innocence, asserting that he did not leak texts to Seven Network and denying any involvement in the misconduct alleged by Auerbach. Seven Network, for its part, denies authorising or condoning the alleged payments to Lehrmann and says that any unauthorised expenses were promptly rectified. Image: Getty

Legal

Considering taking a weight-loss drug like Ozempic? Here are some potential risks and benefits

<a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> and <a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> After weight-loss drugs like Ozempic exploded onto the market, celebrities and social media influencers were quick to spruik their benefits, leading to their rapid rise in use. In the last three months of 2022, clinicians in the United States alone wrote <a href="https://www.washingtonpost.com/business/2023/09/27/ozempic-prescriptions-data-analysis/">more than nine million prescriptions</a> for these drugs. As they’ve grown in popularity, we’ve also heard more about the potential side effects – from common gastrointestinal discomforts, to more serious mental health concerns. But what does the science say about how well Ozempic and Wegovy (which are both brand names of the drug semaglutide) work for weight loss? And what are the potential side effects? Here’s what to consider if you or a loved one are thinking of taking the drug. <h2>Potential benefits</h2> 1) It’s likely to help you lose weight The largest, well-conducted <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">research study</a> of semaglutide was from United Kingdom in 2021. Some 1,961 people who were classified as “overweight” or “obese” were randomly assigned to have either semaglutide or a placebo and followed for 68 weeks (about 1.3 years). All participants also had free access to advice about healthy eating and physical activity. The study found those taking semaglutide lost weight – significantly more than people who had the placebo (-14.9% of their body weight compared with -2.4% of body weight). In another <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">study</a> in the United States, one health-care clinic gave 408 people weekly injections of semaglutide. Over the first three months, those included in the final analysis (175 people) lost an average of 6.7kg. Over the first six months, they lost an average of 12.3kg. Large weight losses have been found in a more <a href="https://www.nature.com/articles/s41591-022-02026-4">recent trial</a> of semaglutide, suggesting weight loss is a very likely outcome of ongoing use of the medication. 2) It may reduce your chronic disease risk factors When people in the overweight or obese weight categories lose <a href="https://www.sciencedirect.com/science/article/pii/S1550413116300535">at least 5%</a> of their body weight, physiological changes often occur beyond a change in weight or shape. This <a href="https://www.nih.gov/news-events/nih-research-matters/research-context-obesity-metabolic-health">might include</a> lowered cholesterol levels, lowered blood pressure and lowered blood glucose levels, which all reduce the risk of chronic diseases. In one of the semaglutide <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">trials</a>, most people (87.3%) lost at least 5% of their body weight. Although most of the large studies of semaglutide excluded people with metabolic health conditions such as type 2 diabetes, metabolic health gains were <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">observed</a>, including lowered blood pressure, blood glucose levels and fasting blood lipid (fat) levels. In the UK <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">study</a> from 2021, people taking semaglutide had greater improvements in physical capabilities and risk factors for heart disease and diabetes, including reductions in waist circumference, markers of inflammation, blood pressure and blood glucose levels. 3) It might improve your quality of life, emotional wellbeing or sense of achievement The original trial of semaglutide did not focus on this bundle of benefits, but further follow-ups show additional benefits associated with the medication. Compared to the placebo, people taking semaglutide saw significant <a href="https://www.tandfonline.com/doi/full/10.1080/00325481.2022.2150006">improvements</a> in their physical functioning and perceptions of their general health, social functioning and mental health. Anecdotally (not based on scientific research), people using semaglutide, such as <a href="https://people.com/oprah-winfrey-reveals-weight-loss-medication-exclusive-8414552">Oprah Winfrey</a>, report a reclaiming or turning point of their life, social situation and body image. <h2>What about the risks?</h2> 1) You may experience gastrointestinal symptoms In the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">US clinical trial</a>, nearly half (48.6%) of people taking semaglutide reported experiencing adverse effects. Nausea and vomiting were the most frequently experienced (36.6%) followed by diarrhea (8.6%), fatigue (6.3%) and constipation (5.7%). In the UK study, nausea and diarrhoea were also commonly reported. In <a href="https://www.nejm.org/doi/10.1056/NEJMoa2032183?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">another trial</a>, many participants (74.2%) using semaglutide reported gastrointestinal symptoms. However, nearly half (47.9%) using the placebo also reported gastrointestinal symptoms, indicating that symptoms may be similar to those experienced during normal daily living. Most gastrointestinal symptoms were mild to moderate in severity, and resolved for most people without the need to stop participating in the study. 2) You might feel fatigued Fatigue was the second most common side effect for participants in the US <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">clinical trial</a>, affecting 6.3% of participants. 3) You might be among the minority who don’t tolerate the drug Australia’s Therapeutic Goods Administration (TGA) has <a href="https://www.tga.gov.au/news/safety-alerts/compounding-safety-information-semaglutide-products">approved</a> Ozempic as safe to use, for the treatment of type 2 diabetes but it has not yet been approved for weight loss. The TGA has also <a href="https://www.tga.gov.au/resources/prescription-medicines-registrations/wegovy-novo-nordisk-pharmaceuticals-pty-ltd">approved Wegovy</a> (a higher dose of semagtlutide) for weight loss, however it’s not yet available in Australia. In the US <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">clinical trial</a>, no unexpected safety issues were reported. However, five patients (2.9%) had to stop taking the medication because they could not tolerate the adverse effects. Fifteen (8.6%) had to either reduce the dose or remain on the same dose to avoid the adverse effects. In <a href="https://www.nejm.org/doi/10.1056/NEJMoa2032183?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">other studies</a>, some patients stopped the trial due to gastrointestinal symptoms being so severe they could not tolerate continuing. More severe safety concerns reported in <a href="https://www.nejm.org/doi/10.1056/NEJMoa2032183?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">studies</a> include gallbladder-related disorders (mostly cholelithiasis, also known as gallstones) in 34 patients (2.6%) and mild acute pancreatitis in three patients (0.2%). All people recovered during the trial period. A 2024 European <a href="https://link.springer.com/article/10.1007/s11096-023-01694-7">study</a> analysed psychiatric adverse events associated with semaglutide, liraglutide and tirzepatide (which work in a similar way to semaglutide). Between January 2021 and May 2023, the drug database recorded 481 psychiatric events (about 1.2% of the total reported) associated with these drugs. About half of these events were reported as depression, followed by anxiety (39%) and suicidal ideation (19.6%). Nine deaths and 11 life-threatening outcomes were reported during the study period. Due to the severity and fatal outcomes of some of these reports, <a href="https://www.fda.gov/drugs/drug-safety-and-availability/update-fdas-ongoing-evaluation-reports-suicidal-thoughts-or-actions-patients-taking-certain-type">the US Food and Drug Administration</a> investigated further but did not find evidence that use of these medicines caused suicidal thoughts or actions. 4) It might be difficult to access Despite being considered safe, the TGA has <a href="https://www.tga.gov.au/safety/shortages/medicine-shortage-alerts/update-prescribers-advised-not-start-new-patients-ozempic#:%7E:text=Ozempic%27s%20TGA%2Dapproved%20indication%20is,consult%20the%20appropriate%20prescribing%20guidelines.">warned</a> significant Ozempic access barriers are likely to continue throughout 2024. To manage the shortage, pharmacists are instructed to give preference to people with type 2 diabetes who are seeking the medication. 5) You might not always get clear information from vested interests Given the popularity of Ozempic and Wegovy, health organisations such as the World Obesity Federation have expressed <a href="https://www.theguardian.com/society/2023/mar/12/orchestrated-pr-campaign-how-skinny-jab-drug-firm-sought-to-shape-obesity-debate">concern</a> about the medication’s marketing, PR and strong <a href="https://www.theguardian.com/australia-news/2023/jan/06/tga-investigates-influencers-after-diabetes-drug-ozempic-promoted-as-weight-loss-treatment">social media presence</a>. Some journalists have <a href="https://www.theguardian.com/society/2023/mar/12/orchestrated-pr-campaign-how-skinny-jab-drug-firm-sought-to-shape-obesity-debate">raised conflict of interest concerns</a> about the relationship between some obesity researchers and Novo Nordrisk, Ozempic and Wegovy’s manufacturer. The worry is that researchers might be influenced by their relationship with Novo Nordrisk to produce study results that are more favourable to the medications. <h2>Bottom line</h2> Ozempic is a medication that should be used in conjunction with your health care provider. But remember, weight is only one aspect of your health and wellbeing. It’s important to take a holistic view of your health and prioritise eating well, moving more and getting enough sleep. <hr /> Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-132745">Ozempic series</a> here.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/219312/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, Professor of Community Health and Wellbeing, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> and <a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, Lecturer, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/considering-taking-a-weight-loss-drug-like-ozempic-here-are-some-potential-risks-and-benefits-219312">original article</a>.

Body

West Side Story returns to Handa Opera on Sydney Harbour

Get ready to snap your fingers, tap your toes and experience the magic of Broadway in Sydney as Opera Australia presents the electrifying musical extravaganza West Side Story – making its triumphant return to the Handa Opera on Sydney Harbour stage in 2024. The 2019 production of West Side Story, if you were fortunate enough to grab seats, was an absolute smash hit. With record-breaking ticket sales and rave reviews, it's no wonder this show stole the hearts of over 65,000 theatre and musical buffs. Directed by the incomparable Francesca Zambello, West Side Story promises to once again whisk audiences away to the bustling streets of New York City, complete with iconic songs, heart-pounding dance numbers, and enough drama to fill the harbour twice over. Leonard Bernstein and Stephen Sondheim's musical masterpiece will once again take centre stage, accompanied by Jerome Robbins' legendary choreography – and this year, we were fortunate enough to be able to pose a few pre-performance questions to none other than Guy Simpson, the show’s musical director, and the all-singing, all-dancing Wayne Scott Kermond, who is playing “Doc” onstage. Let’s raise the curtain and see what they have to say! <img src="https://oversixtydev.blob.core.windows.net/media/2024/03/Guy-Simpson.jpg" alt="" width="1280" height="720" /> Guy Simpson Guy Simpson, a seasoned musical director with nearly 45 years of experience, boasts an illustrious career spanning global productions. Notably, his involvement with iconic shows like Miss Saigon and The Phantom of the Opera has taken him across continents, from Australia to Asia and beyond. Simpson's extensive repertoire includes serving as Musical Supervisor and Director for Opera Australia's acclaimed productions such as Evita, My Fair Lady, and of course West Side Story. Additionally, his contributions as an orchestrator and producer of cast recordings further solidify his stature in the musical theatre realm. With credits ranging from beloved classics like Les Misérables to contemporary hits like Muriel's Wedding, Simpson's versatile talent continues to enrich the world of musical theatre on an international scale. OverSixty: What memories do you have of your first time working on West Side Story – when was it and what was the experience like? Guy: “I was a rehearsal pianist for the 1983 production of West Side Story. The conductor was Dobbs Franks, who came from the US to conduct the first production of the show in 1960. So I was lucky to learn the show from him. I wasn’t in the orchestra and had tickets to watch opening night but during the afternoon of that day I received a call to play in the orchestra that night because the pianist was unwell. I’ll never forget that! Since then I have conducted three seasons of the show and learn more and more about it each time.” OverSixty: What were Bernstein’s influences and what impact did Bernstein’s score have when the musical first premiered? And why do you think it remains so recognised today? Guy: “Bernstein was influenced by many things. There is an <a href="https://www.wrti.org/arts-desk/2018-08-23/the-surprising-backstory-to-west-side-story" target="_blank" rel="noopener">excellent article by Debra Lew Harder</a> that outlines these influences. I love the combination of Jewish themes, Puerto Rican rhythm, Mexican dance music and of course American jazz. His classical roots also come in here – especially the music of Aaron Copland and George Gershwin. The genius is Bernstein's ability to blend all this into a score that tells the story so brilliantly." OverSixty: What’s your favourite moment in the music that audiences might not always notice but could listen out for? Guy: I like what is known as ‘THE BALCONY SCENE’. Most people will know it as the iconic love duet ‘TONIGHT’. In the show this scene moves between spoken dialogue (with underscoring), into the song and back into dialogue in a wonderfully cohesive way. It is so well crafted and is quite a challenge for the conductor to fit the music with the dialogue in a seamless way. I also love the scene in the bridal shop that includes the song ‘ONE HAND ONE HEART’. <img src="https://oversixtydev.blob.core.windows.net/media/2024/03/Wayne-Scott-Kermond-as-Doc.jpg" alt="" width="1280" height="720" /> Wayne Scott Kermond Wayne Scott Kermond, hailing from a rich lineage of Australian Vaudeville performers, epitomises the essence of musical theatre, comedy and cabaret. With a repertoire spanning from Anything Goes to Hairspray, including acclaimed performances in several productions of West Side Story, Kermond's versatility shines through. Additionally, he's showcased his creative prowess as the creator and star of captivating cabaret shows such as Candy Man and Jive Junkys. Beyond the stage, Kermond's talents extend to film, where he's contributed to projects like Happy Feet 1 & 2, and as a respected scriptwriter and director for various musicals, cabarets and corporate events. With accolades including a Green Room Award and Mo Award, alongside nominations for Helpmann Awards, Kermond's exceptional abilities and esteemed showbiz heritage solidify his status as an extraordinary Australian talent. OverSixty: You and Guy first worked on this musical 40 years ago, how does it feel to be coming back together on the Handa Opera version? Wayne: “I first performed in West Side Story at the old Her Majesty’s Theatre (Sydney), 40 years ago playing the youngest member of the Jets gang, ‘Baby John’, and then again in another fabulous production touring Australia / New Zealand in the mid-nineties playing Arab. And so it was lovely to be reminded by Guy on the first day of rehearsals for this season how special it is to us both, here we are, doing it again, just a little greyer." “We shared a few laughs about ‘where did that time go?’, and how ‘young’ we still look after all these years. It’s so great to work with Guy again, I think the last show we did together was Chicago, back in the late nineties. So with Guy's huge amount of expertise and experience at the helm as our Musical Director the show is in great hands. Wait till you hear the amazing Orchestra.” OverSixty: What about this musical’s story, lyrics, etc resonate with you and why do you think it keeps being seen on stage? Can it appeal to all ages? Wayne: “West Side Story is as iconic to music theatre as Swan Lake is to ballet. All great musicals such as West Side have to have a great love story; West Side certainly has that. And to add to that, also an incredible score, dynamic original choreography and a beautifully written book makes it a triple threat. That's why it stands the test of time – it's an inter-generational piece, whose story and message still stands today, which is the reason why I’m now getting the opportunity to play an adult character ‘Doc’ in this OA production 40 years later, as it will be for another artist, in another 40 years' time.” OverSixty: What’s your favourite moment in the show and why? Wayne: It is very difficult to say there is a favourite moment as there are so many. The whole journey of the show is something everyone who loves theatre should experience. The Prologue, Dance at the Gym, America, Cool, Tonight, Something's Comin, and not forgetting the Quintet powerhouse... Every part of this show is special, whether you're seeing the show for the first time or for the tenth time, it’s exhilarating, poignant and moving." “It’s especially wonderful for me to have been given the opportunity to revisit the show, after all these years later as a performer. And it’s very exciting to watch another generation of performers being given the opportunity to experience such an exceptional piece of theatre.” So, mark your calendars, Sydney-siders, because Handa Opera on Sydney Harbour is about to serve up a theatrical experience like no other. With world-class performances, breathtaking views of the harbour, and enough fireworks to make New Year's Eve jealous, this is one event you won't want to miss. So grab your tickets, grab your friends, and get ready to experience the magic of West Side Story like never before. See you at the opera! For more information and ticket sales, check out <a href="https://opera.org.au/productions/west-side-story-on-sydney-harbour/" target="_blank" rel="noopener">opera.org.au/harbour</a> All images: Supplied

Domestic Travel

Legendary Star Wars and James Bond actor passes away

The galaxy far, far away has dimmed a little with the passing of Michael Culver, a distinguished British actor whose name became etched in the annals of cinematic history, particularly for his role in the iconic 1980 film Star Wars: Episode V - The Empire Strikes Back. Culver, who portrayed Captain Needa, the unfortunate Imperial officer, met his demise in one of the franchise's most memorable scenes at the hands of Darth Vader. However, his legacy extends far beyond the realms of science fiction, encompassing a career spanning over five decades of stage, screen and political activism. Born in 1938 in Hempstead, North London, to esteemed parents within the theatre industry, Culver was destined for a life under the spotlight. His father, Roland Culver, was a notable West End stage actor, while his mother, Daphne Rye, served as a casting director in London-based theatre. Following in their footsteps, Culver honed his craft at the London Academy of Music and Dramatic Art, laying the foundation for a prolific acting career. Culver's journey in the performing arts began in the late 1950s, with appearances on Broadway in Shakespearean classics such as King Henry V, Hamlet, and Twelfth Night. His talent soon graced the West End stage in 1962, marking the start of a distinguished theatrical career. Transitioning to the small screen, Culver made his onscreen debut in 1961, captivating audiences with his versatile performances in British television series and movies. However, it was Culver's portrayal of Captain Needa in The Empire Strikes Back that solidified his status as a cultural icon. Despite his character's brief appearance, Culver left an indelible mark on audiences worldwide, immortalised in one of cinema's most unforgettable moments. His confrontation with Vader, culminating in a chilling demise, remains etched in the memories of countless fans, a testament to Culver's ability to captivate audiences with his presence. Beyond his intergalactic exploits, Culver's talents graced a multitude of productions, including notable roles in Sherlock Holmes, A Passage to India, Secret Army, and even appearing in two James Bond movies – From Russia With Love and Thunderball – in uncredited roles. His versatility and dedication to his craft earned him admiration and respect from peers and audiences alike. Yet, Culver's contributions extended beyond the realms of entertainment; in the early 2000s, he shifted his focus to political activism, leveraging his platform to advocate for causes close to his heart. Despite bidding farewell to the limelight, Culver's legacy endures through the countless lives he touched and the memories he forged on stage and screen. An extended message on the Alliance Agents Facebook page, who represented Culver, read as follows: "We are very sad to confirm the passing of our friend and client Michael Culver. A career spanning over 50 years with notable roles in Sherlock Holmes, A Passage to India, Secret Army and of course one of the most memorable death scenes in the Star Wars franchise. Michael largely gave up acting in the early 2000's to concentrate his efforts into his political activism. It's been an honor to have represented Michael for for the last decade and to have taken him to some of the best Star Wars events in the UK and Europe. A real highlight was taking Michael to Celebration in Chicago in 2019. He was lost for words when he saw his queue line with nearly 200 people waiting to see him. We worked with Michael just 3 weeks ago at his last home signing with our friends at Elite Signatures. Michel died on Tuesday 27th February at the age of 85." "We miss him." His passing leaves a void in the hearts of fans and colleagues, a reminder of the fleeting nature of life's curtain call. As we reflect on his remarkable journey, let us celebrate the life and legacy of Michael Culver, an actor whose talents transcended galaxies and whose spirit will continue to inspire generations to come. In his memory, let us heed the timeless words of Captain Needa himself: "We shall double our efforts." Rest in peace, Michael Culver. The force will always be with you. Images: IMDB / Wookiepedia

Caring

War in Ukraine affected wellbeing worldwide, but people’s speed of recovery depended on their personality

<a href="https://theconversation.com/profiles/luke-smillie-7502">Luke Smillie</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> The war in Ukraine has had impacts around the world. <a href="https://mitsloan.mit.edu/ideas-made-to-matter/ripple-effects-russia-ukraine-war-test-global-economies">Supply chains</a> have been disrupted, the <a href="https://news.un.org/pages/wp-content/uploads/2022/06/GCRG_2nd-Brief_Jun8_2022_FINAL.pdf?utm_source=United+Nations&utm_medium=Brief&utm_campaign=Global+Crisis+Response">cost of living</a> has soared and we’ve seen the <a href="https://www.unhcr.org/hk/en/73141-ukraine-fastest-growing-refugee-crisis-in-europe-since-wwii.html">fastest-growing refugee crisis since World War II</a>. All of these are in addition to the devastating humanitarian and economic impacts within Ukraine. Our international team was conducting a global study on wellbeing in the lead up to and after the Russian invasion. This provided a unique opportunity to examine the psychological impact of the outbreak of war. As we explain in a new study published in <a href="https://www.nature.com/articles/s41467-024-44693-6">Nature Communications</a>, we learned the toll on people’s wellbeing was evident across nations, not just <a href="https://ijmhs.biomedcentral.com/articles/10.1186/s13033-023-00598-3">in Ukraine</a>. These effects appear to have been temporary – at least for the average person. But people with certain psychological vulnerabilities struggled to recover from the shock of the war. <h2>Tracking wellbeing during the outbreak of war</h2> People who took part in our study completed a rigorous “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2773515/">experience-sampling</a>” protocol. Specifically, we asked them to report their momentary wellbeing four times per day for a whole month. Data collection began in October 2021 and continued throughout 2022. So we had been tracking wellbeing around the world during the weeks surrounding the outbreak of war in February 2022. We also collected measures of personality, along with various sociodemographic variables (including age, gender, political views). This enabled us to assess whether different people responded differently to the crisis. We could also compare these effects across countries. Our analyses focused primarily on 1,341 participants living in 17 European countries, excluding Ukraine itself (44,894 experience-sampling reports in total). We also expanded these analyses to capture the experiences of 1,735 people living in 43 countries around the world (54,851 experience-sampling reports) – including in Australia. <h2>A global dip in wellbeing</h2> On February 24 2022, the day Russia invaded Ukraine, there was a sharp decline in wellbeing around the world. There was no decline in the month leading up to the outbreak of war, suggesting the change in wellbeing was not already occurring for some other reason. However, there was a gradual increase in wellbeing during the month after the Russian invasion, suggestive of a “return to baseline” effect. Such effects are commonly reported in psychological research: situations and events that impact our wellbeing often (<a href="https://www.researchgate.net/publication/237535630_Adaptation_and_the_Set-Point_Model_of_Subjective_Well-BeingDoes_Happiness_Change_After_Major_Life_Events">though not always</a>) do so <a href="https://www.researchgate.net/publication/7062343_Beyond_the_Hedonic_Treadmill_Revising_the_Adaptation_Theory_of_Well-Being">temporarily</a>. Unsurprisingly, people in Europe experienced a sharper dip in wellbeing compared to people living elsewhere around the world. Presumably the war was much more salient for those closest to the conflict, compared to those living on an entirely different continent. Interestingly, day-to-day fluctuations in wellbeing mirrored the salience of the war on social media as events unfolded. Specifically, wellbeing was lower on days when there were more tweets mentioning Ukraine on Twitter/X. Our results indicate that, on average, it took around two months for people to return to their baseline levels of wellbeing after the invasion. <h2>Different people, different recoveries</h2> There are <a href="https://pubmed.ncbi.nlm.nih.gov/31944795/">strong links</a> between our wellbeing and our individual personalities. However, the dip in wellbeing following the Russian invasion was fairly uniform across individuals. None of the individual factors assessed in our study, including personality and sociodemographic factors, predicted people’s response to the outbreak of war. On the other hand, personality did play a role in how quickly people recovered. Individual differences in people’s recovery were linked to a personality trait called “stability”. Stability is a broad dimension of personality that combines low neuroticism with high agreeableness and conscientiousness (three traits from the <a href="https://www.sciencedirect.com/topics/social-sciences/big-five">Big Five</a> personality framework). Stability is so named because it reflects the stability of one’s overall psychological functioning. This can be illustrated by breaking stability down into its three components: <ol> <li> low neuroticism describes <a href="https://www.pnas.org/doi/full/10.1073/pnas.2212154120">emotional stability</a>. People low in this trait experience less intense negative emotions such as anxiety, fear or anger, in response to negative events </li> <li> high agreeableness describes <a href="https://psycnet.apa.org/record/2018-63285-010">social stability</a>. People high in this trait are generally more cooperative, kind, and motivated to maintain social harmony </li> <li> high conscientiousness describes <a href="https://doi.org/10.1016/j.paid.2023.112331">motivational stability</a>. People high in this trait show more effective patterns of goal-directed self-regulation. </li> </ol> So, our data show that people with less stable personalities fared worse in terms of recovering from the impact the war in Ukraine had on wellbeing. In a supplementary analysis, we found the effect of stability was driven specifically by neuroticism and agreeableness. The fact that people higher in neuroticism recovered more slowly accords with a wealth of research linking this trait with <a href="https://pubmed.ncbi.nlm.nih.gov/10573882/">coping difficulties</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5428182/">poor mental health</a>. These effects of personality on recovery were stronger than those of sociodemographic factors, such as age, gender or political views, which were not statistically significant. Overall, our findings suggest that people with certain psychological vulnerabilities will often struggle to recover from the shock of global events such as the outbreak of war in Ukraine.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/224147/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/luke-smillie-7502">Luke Smillie</a>, Professor in Personality Psychology, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/war-in-ukraine-affected-wellbeing-worldwide-but-peoples-speed-of-recovery-depended-on-their-personality-224147">original article</a>.

Mind

War veteran loses $18,000 to Netflix scam

Shane Arnold, 71, was left with nothing after he fell for an elaborate Netflix scam, allegedly run by a teenager. The war veteran was robbed of $18,000 when he thought he was entitled to a refund after receiving a fake Netflix email. After he entered his personal banking details, the accused scammer allegedly used this information to call Arnold the following day claiming to be a security officer from Commonwealth Bank. "(It was) extremely convincing," Arnold told 9News. "He spoke in a posh English accent." Arnold was allegedly told by a 19-year-old, whose voice had been disguised with AI, that his account had been compromised and ordered to put his bank cards in a bag, to be collected by a driver. Hours later, the accused teen who is from Braybrook, Melbourne allegedly withdrew thousands of dollars from ATMs in Braybrook and West Footscray, and purchased dozens of gift cards from Kmart. He also allegedly filled up on fuel, bought a new iPhone, and some strawberry milk and ice cream. The teen has since been charged over the incident, but Arnold is still fighting hard to get his money back. "I've worked for 50-odd years to get that money," he told the publication, adding that he felt "like my heart had been ripped out". The senior also claimed that the bank was partly to blame, and has lodged a report to the Australian Financial Complaints Authority (AFCA) who are currently managing his case. Arnold added that Commonwealth Bank had only offered to reimburse him $1000, and said that everyone who'd been scammed deserved to have their money returned to them. "I hope all those people get their money back," he said. "None of them deserved to be scammed and none of them did anything wrong." Images: Nine News

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Aussie love story from WWII immortalised in the war memorial

An Australian couple's love story that defied the odds of time and distance has been immortalised in the war memorial. The Australian War Memorial is calling for volunteers to help transcribe thousands of love letters sent from soldiers in the war, to their loved ones back at home. Launching on Valentine's Day, the project will see the digital release of hundreds of thousands of personal letters, diaries and other handwritten documents kept safe for decades. Among those stories is the tale of Mac and Dot, two lovebirds separated by World War II. Their love story began in 1939, when Mac was 17 and Dorothy was 14. Dorothy - or as Mac referred to her, his Darling Dot - was forbidden to go on a date with Mac after her father refused to give his blessing. "He kept on asking me to go out but my father wouldn't let me," Dorothy laughed as she told Ally Langdon on A Current Affair. <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-permalink="https://www.instagram.com/reel/C3Rj4g9vjIS/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/reel/C3Rj4g9vjIS/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by A Current Affair (@acurrentaffair9)</a> </div> </blockquote> Mac was soon off to war, but his plan was always to return home to Dot. "He said to me, 'When I come back home...Will you come out with me then?'" Dorothy reminisced. "I said, 'Of course I will, Mac!' And then he gave me a kiss and went to war." The young couple then continued to write each other letters every week for five long years, until Mac was captured by the German army and held as a prisoner of war. Despite his capture, Mac held onto every letter Dot had ever written him, as he remained determined to get home to his beloved. "I hated him being away, and when the letters came back oh gee they were wonderful," Dorothy said. "A letter meant he was still alive, you see, so it was so exciting." In April 1945, Dot received the best letter of all: Mac had escaped and was coming home. "Hello my darling. What does one say in a moment such as this?" Dot wrote on April 30th 1945. "I have butterflies in my stomach, love in my heart and few words that make sense in my mind. Well Mac, it's really coming at last. You're almost home". And Mac wrote back to that, "Hello darling. I miss you more now than ever." "Unfortunately I can't find a boat to take me back to you. If they don't hurry I guess I'll just have to pinch a rowing boat and see what I can do!" When Mac returned home, he brought with him half a decade's worth of those love letters from Dot, as well as a portrait of himself painted by another prisoner of war. It hangs proudly at the end of Dorothy's bed and is the first thing she sees when she wakes. Now Robyn Van Dyke and Terrie-Anne Simmonds from the Australian War Memorial are sifting through thousands of donated love letters, including Mac's and Dorothy's. "He not only managed to escape, but he managed to take all her letters with him and that blows me away because it's not a small amount of letters," Robyn said. The team is looking for <a href="https://transcribe.awm.gov.au" target="_blank" rel="noopener">volunteers</a> to help ensure those stories, and all that love, live forever. Dorothy, who is now 101 years old, had more than 70 wonderful years with Mac before he died in 2014. "He was nearly 90, you know. And me I just kept on going and going and going!" she said. "He'd be up there watching every minute I bet. We had such fun. Oh dear we did have fun. We laughed a lot and we cried a lot." "But we lived - and that was the main thing." Image credits: A Current Affair <p style="box-sizing: border-box; margin: 24px 0px 0px; padding: 0px; border: 0px; font-stretch: inherit; font-size: 18px; line-height: 1.333; font-family: 'Proxima Nova', 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size-adjust: inherit; font-kerning: inherit; font-variant-alternates: inherit; font-variant-ligatures: inherit; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-position: inherit; font-feature-settings: inherit; font-optical-sizing: inherit; font-variation-settings: inherit; vertical-align: baseline; caret-color: #333333; color: #333333; letter-spacing: 0.25px;">

Relationships

Drug regulator investigates deaths tied to weight loss injections

Australia's drug regulator is investigating further into three different deaths possibly linked to the use of Ozempic and other weight loss injections. Tim Ramsay, 58, started using Saxenda because he wanted to lose weight so he could confidently walk his daughter down the aisle. But, he tragically passed away just 19-days after he started taking the injections, and now his family want answers, after a coroner ruled his cause of death as undetermined. "I don't believe that anybody should die without an explanation, you just don't expire, there has got to be a reason for Tim's death," Ramsay's wife, Sue, told 60 Minutes. "19 days between his first injection and the day he left us, alarm bells in our heads, in the TGA's heads, and the coroner's head should be ringing," his daughter Elyse said. Leonie Margetts is also looking for answers, and is angry at the ease in which the injections could be accessed, following her daughter's death after taking Ozempic injections she'd ordered online. Margetts' daughter Naomi wanted to be a mum, but was told she needed to lose weight to to have any chance of falling pregnant. "You just do not expect to find your daughter on her knees in front of the toilet bowl dead," Margetts said. "She was a week away from turning 40 and that's a big thing for any female, she was feeling very vulnerable," she added. The Therapeutic Goods Administration's Chief Medical Advisor, Professor Robyn Langham has responded, and told 60 minutes that the TGA has a responsibility to the families of the deceased. "It's a very serious and a very tragic problem for the families that are concerned and we don't wish to minimise that at all," Langham said. She added that they are carefully monitoring reports of severe gastrointestinal side effects caused by the medication, and will withdraw the drug if necessary. "If we do see that there is a need to change the messaging or the information that goes with the drug or even in some cases to withdraw the drug, then we have the power to do so," Langham said. Some people have been using Ozempic for weightloss, which has caused it to "explode" in popularity. "I liken this to when the [Model] T Ford was first invented and suddenly we had changes in transportation and the horse and cart went," Professor of medicine and endocrinologist Dr Katherine Samaras said. But, the professor has warned that Ozempic is only approved in Australia for diabetes, and should only be used when supervised by a doctor. "We don't leave matches in the hands of children," she said. "We shouldn't leave these drugs in the hands of people, it has to be supervised." Images: 60 minutes

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How dieting, weight suppression and even misuse of drugs like Ozempic can contribute to eating disorders

<a href="https://theconversation.com/profiles/samantha-withnell-1504436">Samantha Withnell</a>, <a href="https://theconversation.com/institutions/western-university-882">Western University</a> and <a href="https://theconversation.com/profiles/lindsay-bodell-1504260">Lindsay Bodell</a>, <a href="https://theconversation.com/institutions/western-university-882">Western University</a> Up to 72 per cent of women and 61 per cent of men are dissatisfied with their weight or <a href="https://doi.org/10.1016/j.eatbeh.2014.04.010">body image</a>, according to a U.S. study. Globally, millions of people <a href="https://doi.org/10.1111%2Fobr.12466">attempt to lose weight</a> every year with the hope that weight loss will have positive effects on their body image, health and quality of life. However, these motivated individuals often struggle to maintain new diets or exercise regimens. The rise of medications such as semaglutides, like <a href="https://dhpp.hpfb-dgpsa.ca/dhpp/resource/101298">Ozempic</a> or <a href="https://dhpp.hpfb-dgpsa.ca/dhpp/resource/101765">Wegovy</a>, <a href="https://www.cbc.ca/news/health/ozempic-weight-loss-1.6772021">might be viewed as an appealing “quick fix”</a> alternative to meet weight loss goals. Research led by our team and others suggests that such attempts to lose weight often do more harm than good, and even increase the risk of <a href="https://osf.io/9stq2">developing an eating disorder</a>. <h2>Weight loss and eating disorders</h2> Eating disorders are <a href="https://doi.org/10.1002/eat.20589">serious mental health conditions</a> primarily characterized by extreme patterns of under- or over-eating, concerns about one’s shape or body weight or other behaviours intended to influence body shape or weight such as exercising excessively or self-inducing vomiting. Although once thought to only affect young, white adolescent girls, eating disorders do not discriminate; eating disorders can develop in people of <a href="https://doi.org/10.1002/erv.2553">any age, sex, gender or racial/ethnic background</a>, with an estimated <a href="https://nedic.ca/general-information/">one million Canadians</a> suffering from an eating disorder at any given time. Feb. 1 to 7 is <a href="https://nedic.ca/edaw/">National Eating Disorders Awareness Week</a>. As a clinical psychologist and clinical psychology graduate student, our research has focused on how eating disorders develop and what keeps them going. Pertinent to society’s focus on weight-related goals, our research has examined associations between weight loss and eating disorder symptoms. <h2>Eating disorders and ‘weight suppression’</h2> In eating disorders research, the state of maintaining weight loss is referred to as “weight suppression.” Weight suppression is typically defined as the difference between a person’s current weight and their highest lifetime weight (excluding pregnancy). Despite the belief that weight loss will improve body satisfaction, we found that in a sample of over 600 men and women, weight loss had no impact on women’s negative body image and was associated with increased body dissatisfaction in <a href="https://doi.org/10.1016/j.bodyim.2023.01.011">men</a>. Importantly, being more weight suppressed has been associated with the <a href="https://doi.org/10.1093/ajcn/nqaa146">onset of eating disorders</a>, including anorexia nervosa and bulimia nervosa. <a href="https://doi.org/10.1007/s11920-018-0955-2">One proposed explanation</a> for the relationship between weight suppression and eating disorders is that maintaining weight loss becomes increasingly difficult as body systems that <a href="https://doi.org/10.3945/ajcn.110.010025">reduce metabolic rate and energy expenditure, and increase appetite</a>, are activated to promote weight gain. There is growing awareness that <a href="https://doi.org/10.1136/bmj.g2646">weight regain is highly likely following conventional diet programs</a>. This might lead people to engage in more and more extreme behaviours to control their weight, or they might shift between extreme restriction of food intake and episodes of overeating or binge eating, the characteristic symptoms of bulimia nervosa. <h2>Ozempic and other semaglutide drugs</h2> Semaglutide drugs like Ozempic and Wegovy are part of a class of drug called <a href="https://pdf.hres.ca/dpd_pm/00067924.PDF">glucagon-like peptide-1 agonists (GLP-1As)</a>. These drugs work by mimicking the hormone GLP-1 to interact with neural pathways that signal satiety (fullness) and slow stomach emptying, leading to reduced food intake. Although GLP-1As are indicated to treat Type 2 diabetes, <a href="https://www.cbc.ca/news/canada/london/ozempic-off-label-1.6884141">they are increasingly prescribed off-label</a> or being <a href="https://www.bbc.com/news/health-67414203">illegally purchased</a> without a prescription because of their observed effectiveness at inducing weight loss. Although medications like Ozempic do often lead to weight loss, the rate of weight loss may <a href="https://doi.org/10.1001/jama.2021.3224">slow down or stop over time</a>. Research by Lindsay Bodell, one of the authors of this story, and her colleagues on weight suppression may help explain why effects of semaglutides diminish over time, as <a href="https://doi.org/10.1016/j.physbeh.2019.112565">weight suppression is associated with reduced GLP-1 response</a>. This means those suppressing their weight could become less responsive to the satiety signals activated by GLP-1As. Additionally, weight loss effects are only seen for as long as the medication is taken, meaning those who take these drugs to achieve some weight loss goal are <a href="https://doi.org/10.1111/dom.14725">likely to regain most, if not all, weight lost</a> when they stop taking the medication. <h2>Risks of dieting and weight-loss drugs</h2> The growing market for off-label weight loss drugs is concerning, because of the exacerbation of <a href="https://theconversation.com/ozempic-the-miracle-drug-and-the-harmful-idea-of-a-future-without-fat-211661">weight stigma</a> and the serious <a href="https://doi.org/10.1016/j.jand.2022.01.004">health risks</a> associated with unsupervised weight loss, including developing eating disorders. Researchers and health professionals are already raising the alarm about the use of GLP-1As in children and adolescents, due to concerns about their possible <a href="https://doi.org/10.1017/cts.2023.612">impact on growth and development</a>. Moreover, popular weight-loss methods, whether they involve pills or “crash diets,” often mimic symptoms of eating disorders. For example, intermittent fasting diets that involve long periods of fasting followed by short periods of food consumption may mimic and <a href="https://doi.org/10.1016/j.eatbeh.2022.101681">increase the risk of developing binge eating problems</a>. The use of diet pills or laxatives to lose weight has been found to increase the risk of <a href="https://doi.org/10.2105/AJPH.2019.305390">being diagnosed with an eating disorder in the next one to three years</a>. Drugs like Ozempic may also be <a href="https://doi.org/10.1002/eat.24109">misused by individuals already struggling with an eating disorder</a> to suppress their appetite, compensate for binge eating episodes or manage fear of weight gain. Individuals who are already showing signs of an eating disorder, such as limiting their food intake and intense concerns about their weight, may be most at risk of spiralling from a weight loss diet or medication into an eating disorder, <a href="https://doi.org/10.1002/eat.24116">even if they only lose a moderate amount of weight</a>. People who are dissatisfied with their weight or have made multiple attempts to lose weight often feel pressured to try increasingly drastic methods. However, any diet, exercise program or weight-loss medication promising a quick fix for weight loss should be treated with extreme caution. At best, you may gain the weight back; at worst, you put yourself at risk for much more serious eating disorders and other health problems.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/221514/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/samantha-withnell-1504436">Samantha Withnell</a>, PhD Candidate, Clinical Psychology, <a href="https://theconversation.com/institutions/western-university-882">Western University</a> and <a href="https://theconversation.com/profiles/lindsay-bodell-1504260">Lindsay Bodell</a>, Assistant Professor of Psychology, <a href="https://theconversation.com/institutions/western-university-882">Western University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-dieting-weight-suppression-and-even-misuse-of-drugs-like-ozempic-can-contribute-to-eating-disorders-221514">original article</a>.

Body

After 3 months of devastation in the Israel-Hamas war, is anyone ‘winning’?

<a href="https://theconversation.com/profiles/ian-parmeter-932739">Ian Parmeter</a>, <a href="https://theconversation.com/institutions/australian-national-university-877">Australian National University</a> The 19th century German war strategist and field marshal Helmuth von Moltke famously <a href="https://global.oup.com/academic/product/strategy-9780199325153?cc=us&lang=en&">coined</a> the aphorism “No battle plan survives first contact with the enemy”. His observation might well be applied to the tragedy we are witnessing in Gaza. Three months after the current conflict began, civilians have borne the brunt of the violence on both sides, with the deaths of more than 22,000 Palestinians in Gaza and 1,200 Israelis. Some 85% of Gazans <a href="https://apnews.com/article/israel-hamas-war-news-01-03-2024-3b77b0c36bf2cd9922b7a484234bef5f">have also been displaced</a> and a quarter of the population is facing a famine, according to the United Nations. The conflict still has a long way to run and may be headed towards stalemate. From a geopolitical perspective, here’s where the main players stand at the start of the new year. <h2>Israel: limited success …</h2> Israel has so far failed to achieve either of its primary war aims: the destruction of Hamas and freedom for the remainder of the 240 Israelis taken hostage on October 7. Hamas fighters continue to use their tunnel network to ambush Israeli soldiers and are firing rockets at Israel, albeit in much lower volumes: 27 were <a href="https://www.timesofisrael.com/at-stroke-of-midnight-hamas-attacks-israel-with-heavy-new-year-rocket-barrage/">fired</a> at the start of the new year, <a href="https://www.timesofisrael.com/liveblog_entry/idf-9500-rockets-fired-at-israel-since-oct-7-including-3000-in-1st-hours-of-onslaught/">compared</a> with 3,000 in the first hours of the conflict on October 7. There are still around <a href="https://www.economist.com/middle-east-and-africa/2023/12/20/israel-isnt-sure-what-to-do-about-the-hostages-in-gaza">130 Israelis</a> being held hostage, and only <a href="https://www.rand.org/pubs/commentary/2023/12/five-potential-next-steps-for-the-hostage-situation.html">one hostage</a> has been freed by the Israeli Defence Forces (IDF), as opposed to releases arranged through Qatari and Egyptian mediators. Israeli society is divided between those who want to prioritise negotiations to release the hostages and those who want to prioritise the elimination of Hamas. Israel achieved an important symbolic success with the apparent targeted killing of Hamas deputy leader <a href="https://www.cbsnews.com/news/israel-lebanon-hamas-saleh-al-arouri-fears-widening-regional-conflict/">Saleh al-Arouri</a> in Beirut on January 2. Though Israel has not formally claimed responsibility, there is little doubt it was <a href="https://www.axios.com/2024/01/02/hamas-saleh-arouri-killed-beirut-hezbollah-israel-gaza">behind</a> the killing. But the two Gaza–based Hamas leaders Israel most wants to eliminate, political leader Yahya Sinwar and military leader Mohammed Deif, are still at large. Israel still has US support in the UN Security Council, which has <a href="https://www.cnn.com/2023/12/22/politics/un-security-council-resolution-israel-gaza-resolution/index.html">managed to pass</a> only one toothless resolution since the war began. But the Biden administration is <a href="https://apnews.com/article/biden-israel-hamas-oct-7-44c4229d4c1270d9cfa484b664a22071">publicly pressuring</a> Israel to change its tactics to minimise Palestinian casualties. <h2>…and facing a ‘day after’ conundrum</h2> The Israeli government is also divided on how Gaza should be run when the fighting stops. Prime Minister Benjamin Netanyahu has <a href="https://www.jpost.com/breaking-news/article-777731">said</a> he won’t accept Gaza remaining “Hamastan” (Hamas-controlled) or becoming “Fatahstan” (ruled by the Palestinian Authority, which is dominated by the secular Fatah party). US President Joe Biden <a href="https://www.reuters.com/world/middle-east/biden-says-palestinian-authority-should-ultimately-govern-gaza-west-bank-2023-11-18/">prefers</a> a Gaza government led by a reformed Palestinian Authority, but Netanyahu has rejected this and has not articulated an alternative plan. Defence Minister Yoav Gallant this week <a href="https://www.timesofisrael.com/gallants-post-war-gaza-plan-palestinians-to-run-civil-affairs-with-global-task-force/">outlined</a> what seems to be his own plan for Gaza, involving governance by unspecified Palestinian authorities. His plan did not immediately have Israeli cabinet approval and has been <a href="https://thehill.com/opinion/international/4391112-dangerous-ideas-about-the-day-after-in-gaza/">slammed</a> by hard-right ministers. Two of these, Finance Minister Bezalel Smotrich and National Security Minister Itamar Ben–Gvir, have <a href="https://www.timesofisrael.com/likud-minister-slams-smotrich-ben-gvirs-unrealistic-call-for-gazan-emigration/#:%7E:text=Ben%20Gvir%20hit%20back%20at,will%20protect%20the%20IDF%20soldiers.%E2%80%9D">called</a> for a solution that encourages the Palestinian population to emigrate and for Israeli settlers to return to the strip. That would be <a href="https://www.france24.com/en/middle-east/20240103-us-condemns-far-right-israeli-ministers-call-for-palestinians-to-emigrate-from-gaza">unacceptable</a> to the Biden administration. Israel’s massive bombing campaign has also slowly turned international opinion against it, as expressed in the UN General Assembly <a href="https://apnews.com/article/un-assembly-israel-palestinians-hamas-vote-resolution-bffc37b2ecc444d906492008cde0aaf6">vote</a> last month in which 153 of the 193 member states called for a ceasefire. Are Netanyahu’s days now numbered? The current issue of The Economist <a href="https://www.economist.com/leaders/2024/01/03/binyamin-netanyahu-is-botching-the-war-time-to-sack-him">features a headline</a> that reads “Binyamin Netanyahu is botching the war. Time to sack him”. Whether or not that’s a fair judgement, it’s clear that internal divisions and indecision within his government are hindering Israel’s prosecution of the war. <h2>Hamas – still standing</h2> The militant group has obviously been hurt. Israel claims to have <a href="https://news.sky.com/story/israel-gaza-latest-hamas-war-sky-news-blog-12978800?postid=6736630">killed or captured</a> between 8,000 and 9,000 of Hamas’ approximately 30,000–strong fighting force – though it has not explained how it calculates militant deaths. Hamas’ main achievement is that it is still standing. To win, the militant group does not have to defeat Israel – it needs merely to survive the IDF onslaught. Hamas can claim some positives. Its attack on October 7 has put the Palestinian issue at the top of the Middle East agenda. Citizens in the Arab states that have signed peace agreements with Israel are clearly angry. And an Israeli-Saudi agreement to normalise relations between the countries, which had been imminent before the conflict, is off the table for now. Opinion polling also <a href="https://apnews.com/article/israel-hamas-palestinians-opinion-poll-wartime-views-a0baade915619cd070b5393844bc4514">shows support</a> for Hamas has risen from 12% to 44% in the West Bank and from 38% to 42% in Gaza in the past three months. If it were possible to hold fair Palestinian elections now, they could produce results Israel and the US would not like. <h2>United States – weakness in dealing with Israel</h2> Biden embraced Netanyahu immediately after the Hamas attack, but US efforts since then to influence Israel’s war plans have not yielded any results. Secretary of State Antony Blinken failed in his effort to persuade Israel to end the war by the start of the new year. His <a href="https://apnews.com/article/us-turkey-israel-greece-gaza-hamas-jordan-36e5e1be205d5200916fd447c8c8e455">current visit</a> to the region is unlikely to yield any major changes. Moreover, divisions in the US may hurt Biden in the lead–up to the presidential election in November. Young, college–educated progressives, who tend to vote Democratic, have taken part in demonstrations against Biden’s public support for Israel’s right to defend itself, if not its way of doing so. These progressives won’t vote for the almost–certain Republican candidate, Donald Trump. But they could stay home on election day, handing the election to Trump. US support for Ukraine has also become a casualty of the war. Republicans, taking their cue from Trump, are prioritising support for Israel and stopping the flow of migrants across the US-Mexico border. They are losing interest in Ukraine – which clearly benefits Russian President Vladimir Putin. Those benefits will be reinforced if Trump wins the presidency again. <h2>United Nations – irrelevant</h2> The UN has also failed in its mission of maintaining world peace. The only Security Council resolution on the war meant nothing, as Russia was pleased to <a href="https://www.politico.com/news/2023/12/22/un-security-council-gaza-aid-00133112">point out</a>. The recent UN General Assembly resolution illustrated Israel’s growing isolation, but has done nothing to change the course of the war. UN Secretary–General Antonio Guterres has been powerless to influence either Israel or Hamas. <h2>Iran – watching for opportunities</h2> The Hezbollah militant group will do a lot of huffing and puffing over the killing of al-Arouri in a Hezbollah-controlled part of Beirut. But it takes its orders from Tehran, which still shows no sign of wanting to become directly involved in the war. That said, Iran appears to have no problem with its proxies – Hezbollah in Lebanon and the <a href="https://theconversation.com/why-yemens-houthis-are-getting-involved-in-the-israel-hamas-war-and-how-it-could-disrupt-global-shipping-219220">Houthis in Yemen</a> – providing token support for Hamas through limited rocket, drone and artillery attacks. Iran is likely to be reinforced in this approach by the bombings at the tomb of former Quds Force commander <a href="https://theconversation.com/iran-vows-revenge-for-soleimanis-killing-but-heres-why-it-wont-seek-direct-confrontation-with-the-us-129440">Qassem Soleimani</a> last week, which killed almost 100 Iranians. The bombings have been claimed by the Islamic State, which will likely make Iran more focused on its internal security than on assisting Hamas.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/220644/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/ian-parmeter-932739">Ian Parmeter</a>, Research Scholar, Centre for Arab and Islamic Studies, <a href="https://theconversation.com/institutions/australian-national-university-877">Australian National University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/after-3-months-of-devastation-in-the-israel-hamas-war-is-anyone-winning-220644">original article</a>.

Travel Trouble

Do you really need antibiotics? Curbing our use helps fight drug-resistant bacteria

<a href="https://theconversation.com/profiles/minyon-avent-1486987">Minyon Avent</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>; <a href="https://theconversation.com/profiles/fiona-doukas-1157050">Fiona Doukas</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/kristin-xenos-1491653">Kristin Xenos</a>, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Antibiotic resistance occurs when a microorganism changes and no longer responds to an antibiotic that was previously effective. It’s <a href="https://thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00502-2/fulltext">associated with</a> poorer outcomes, a greater chance of death and higher health-care costs. In Australia, antibiotic resistance means some patients are admitted to hospital because oral antibiotics are <a href="https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance">no longer effective</a> and they need to receive intravenous therapy via a drip. Antibiotic resistance is rising to high levels in certain parts of the world. Some hospitals <a href="https://www.reactgroup.org/news-and-views/news-and-opinions/year-2022/the-impact-of-antibiotic-resistance-on-cancer-treatment-especially-in-low-and-middle-income-countries-and-the-way-forward/">have to consider</a> whether it’s even viable to treat cancers or perform surgery due to the risk of antibiotic-resistant infections. Australia is <a href="https://www.safetyandquality.gov.au/our-work/antimicrobial-resistance/antimicrobial-use-and-resistance-australia-aura/aura-2023-fifth-australian-report-antimicrobial-use-and-resistance-human-health">one of the highest users</a> of antibiotics in the developed world. We need to use this precious resource wisely, or we risk a future where a simple infection could kill you because there isn’t an effective antibiotic. <h2>When should antibiotics not be used?</h2> Antibiotics only work for some infections. They work against bacteria but <a href="https://www.safetyandquality.gov.au/publications-and-resources/resource-library/do-i-really-need-antibiotics">don’t treat</a> infections caused by viruses. Most community acquired infections, even those caused by bacteria, are likely to get better without antibiotics. Taking an antibiotic when you don’t need it won’t make you feel better or recover sooner. But it can increase your chance of side effects like nausea and diarrhoea. Some people think green mucus (or snot) is a sign of bacterial infection, requiring antibiotics. But it’s actually <a href="https://www.safetyandquality.gov.au/sites/default/files/2023-11/aura_2023_do_i_really_need_antibiotics.pdf">a sign</a> your immune system is working to fight your infection. <h2>If you wait, you’ll often get better</h2> <a href="https://www.tg.org.au/">Clinical practice guidelines</a> for antibiotic use aim to ensure patients receive antibiotics when appropriate. Yet 40% of GPs say they prescribe antibiotics <a href="https://doi.org/10.1071/HI13019">to meet patient expectations</a>. And <a href="https://pubmed.ncbi.nlm.nih.gov/35973750/">one in five</a> patients expect antibiotics for respiratory infections. It can be difficult for doctors to decide if a patient has a viral respiratory infection or are at an early stage of serious bacterial infection, particularly in children. One option is to “watch and wait” and ask patients to return if there is clinical deterioration. An alternative is to prescribe an antibiotic but advise the patient to not have it dispensed unless specific symptoms occur. This can <a href="https://doi.org/10.1002/14651858.CD004417.pub5">reduce antibiotic use by 50%</a> with no decrease in patient satisfaction, and no increase in complication rates. <h2>Sometimes antibiotics are life-savers</h2> For some people – particularly those with a weakened immune system – a simple infection can become more serious. Patients with life-threatening suspected infections should receive an appropriate antibiotic <a href="https://www.safetyandquality.gov.au/our-work/clinical-care-standards/antimicrobial-stewardship-clinical-care-standard">immediately</a>. This includes serious infections such as <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/bacterial-meningitis#:%7E:text=What%20is%20bacterial%20meningitis%3F,can%20cause%20life%2Dthreatening%20problems.">bacterial meningitis</a> (infection of the membranes surrounding the brain) and <a href="https://clinicalexcellence.qld.gov.au/priority-areas/safety-and-quality/sepsis/adult-sepsis#:%7E:text=Adult%20patients%20with%20sepsis%20also,adult%20emergency%20department%20sepsis%20pathway.">sepsis</a> (which can lead to organ failure and even death). <h2>When else might antibiotics be used?</h2> Antibiotics are sometimes used to prevent infections in patients who are undergoing surgery and are at significant risk of infection, such as those undergoing bowel resection. These patients will <a href="https://www.tg.org.au">generally receive</a> a single dose before the procedure. Antibiotics may also <a href="https://www.tg.org.au">be given</a> to patients undergoing chemotherapy for solid organ cancers (of the breast or prostate, for example), if they are at high risk of infection. While most sore throats are caused by a virus and usually resolve on their own, some high risk patients with a bacterial strep A infection which can cause “scarlet fever” are given antibiotics to prevent a more serious infection like <a href="https://www.rhdaustralia.org.au/">acute rheumatic fever</a>. <h2>How long is a course of antibiotics?</h2> The recommended duration of a course of antibiotics depends on the type of infection, the likely cause, where it is in your body and how effective the antibiotics are at killing the bacteria. In the past, courses were largely arbitrary and based on assumptions that antibiotics should be taken for long enough to eliminate the infecting bacteria. More recent research does not support this and shorter courses are <a href="https://www.acpjournals.org/doi/full/10.7326/M19-1509">nearly always as effective as longer ones</a>, particularly for community acquired respiratory infections. For <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736742/">community acquired pneumonia</a>, for example, research shows a three- to five-day course of antibiotics is at least as effective as a seven- to 14-day course. The “take until all finished” approach is no longer recommended, as the longer the antibiotic exposure, the greater the chance the bacteria will develop resistance. However, for infections where it is more difficult to eradicate the bacteria, such as tuberculosis and bone infections, a combination of antibiotics for many months is usually required. <h2>What if your infection is drug-resistant?</h2> You may have an antibiotic-resistant infection if you don’t get better after treatment with standard antibiotics. Your clinician will collect samples for lab testing if they suspect you have antibiotic-resistant infection, based on your travel history (especially if you’ve been hospitalised in a country with high rates of antibiotic resistance) and if you’ve had a recent course of antibiotics that hasn’t cleared your infection. Antibiotic-resistant infections are managed by prescribing broad-spectrum antibiotics. These are like a sledgehammer, wiping out many different species of bacteria. (Narrow-spectrum antibiotics conversely can be thought of as a scalpel, more targeted and only affecting one or two kinds of bacteria.) Broad-spectrum antibiotics are usually more expensive and come with more severe side effects. <h2>What can patients do?</h2> Decisions about antibiotic prescriptions should be made using <a href="https://www.safetyandquality.gov.au/our-work/partnering-consumers/shared-decision-making/decision-support-tools-specific-conditions">shared decision aids</a>, where patients and prescribers discuss the risks and benefits of antibiotics for conditions like a sore throat, middle ear infection or acute bronchitis. Consider asking your doctor questions such as: <ul> <li>do we need to test the cause of my infection?</li> <li>how long should my recovery take?</li> <li>what are the risks and benefits of me taking antibiotics?</li> <li>will the antibiotic affect my regular medicines?</li> <li>how should I take the antibiotic (how often, for how long)?</li> </ul> Other ways to fight antibiotic resistance include: <ul> <li>returning leftover antibiotics to a pharmacy for safe disposal</li> <li>never consuming leftover antibiotics or giving them to anyone else</li> <li>not keeping prescription repeats for antibiotics “in case” you become sick again</li> <li>asking your doctor or pharmacist what you can do to feel better and ease your symptoms rather than asking for antibiotics.</li> </ul> <a href="https://theconversation.com/profiles/minyon-avent-1486987">Minyon Avent</a>, Antimicrobial Stewardship Pharmacist, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>; <a href="https://theconversation.com/profiles/fiona-doukas-1157050">Fiona Doukas</a>, PhD candidate, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/kristin-xenos-1491653">Kristin Xenos</a>, Research Assistant, College of Health, Medicine and Wellbeing, School of Biomedical Science and Pharmacy, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/do-you-really-need-antibiotics-curbing-our-use-helps-fight-drug-resistant-bacteria-217920">original article</a>.

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COVID wave: what’s the latest on antiviral drugs, and who is eligible in Australia?

<a href="https://theconversation.com/profiles/jessica-pace-1401278">Jessica Pace</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/nial-wheate-96839">Nial Wheate</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Australia is experiencing a <a href="https://theconversation.com/were-in-a-new-covid-wave-what-can-we-expect-this-time-216820">fresh wave of COVID</a>, seeing increasing cases, more hospitalisations and a greater number of prescriptions for COVID antivirals dispensed over recent months. In the early days of the pandemic, the only medicines available were those that treated the symptoms of the virus. These included steroids and analgesics such as paracetamol and ibuprofen to treat pain and fever. We now have two drugs called <a href="https://www.health.wa.gov.au/%7E/media/Corp/Documents/Health-for/Infectious-disease/COVID19/Treatment/COVID19-PAXLOVID-Patient-information.pdf">Paxlovid</a> and <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/abefa4a4-ecaa-4c26-8713-d80c90388545/COVID-19+Treatment+Fact+Sheet+-+Molnupiravir+-+Prescribers+20220428.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-abefa4a4-ecaa-4c26-8713-d80c90388545-oIRWpvB">Lagevrio</a> that treat the virus itself. But are these drugs effective against current variants? And who is eligible to receive them? Here’s what to know about COVID antivirals as we navigate this <a href="https://www.smh.com.au/national/a-slightly-more-dangerous-place-australia-is-in-its-eighth-covid-wave-20231030-p5eg5k.html">eighth COVID wave</a>. <h2>What antivirals are available?</h2> <a href="https://www.tga.gov.au/resources/artg/389801">Paxlovid</a> is a combination of two different drug molecules, nirmatrelvir and ritonavir. The nirmatrelvir works by blocking an enzyme called a protease that the virus needs to replicate. The ritonavir is included in the medicine to protect the nirmatrelvir, stopping the body from breaking it down. Molnupiravir, marketed as <a href="https://www.tga.gov.au/resources/artg/372650">Lagevrio</a>, works by forcing errors into the RNA of SARS-CoV-2 (the virus that causes COVID) as it replicates. As these errors build up, the virus becomes less effective. This year in Australia, the <a href="https://theconversation.com/were-in-a-new-covid-wave-what-can-we-expect-this-time-216820">XBB COVID strains</a> have dominated, and acquired a couple of key mutations. When COVID mutates into new variants, it doesn’t affect the ability of either Paxlovid or Lagevrio to work because the parts of the virus that change from the mutations aren’t those targeted by these two drugs. This is different to the <a href="https://app.magicapp.org/#/guideline/L4Q5An/section/E8kMVn">monoclonal antibody-based medicines</a> that were developed against specific strains of the virus. These drugs are not thought to be effective for any variant of the virus <a href="https://www.who.int/activities/tracking-SARS-CoV-2-variants">from omicron XBB.1.5 onwards</a>, which includes the current wave. This is because these drugs recognise certain proteins expressed on the surface of SARS-CoV-2, which have changed over time. <h2>What does the evidence say?</h2> As Lagevrio and Paxlovid are relatively new medicines, we’re still learning how well they work and which patients should use them. The latest <a href="https://app.magicapp.org/#/guideline/L4Q5An/section/L0OPkj">evidence</a> suggests Paxlovid decreases the risk of hospitalisation if taken early by those at <a href="https://www.nsw.gov.au/covid-19/testing-managing/antivirals">highest risk of severe disease</a>. Results from <a href="https://www.nejm.org/doi/10.1056/NEJMoa2116044">a previous trial</a> suggested Lagevrio might reduce COVID deaths. But a more recent, <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4237902">larger trial</a> indicated Lagevrio doesn’t significantly reduce hospitalisations or deaths from the virus. However, few people at highest risk from COVID were included in this trial. So it could offer some benefit for patients in this group. In Australia, Lagevrio is not routinely <a href="https://app.magicapp.org/#/guideline/L4Q5An/section/L0OPkj">recommended</a> and Paxlovid is preferred. However, not all patients can take Paxlovid. For example, people with medical conditions such as <a href="https://www.paxlovidhcp.com/moderate-renal-impairment">severe kidney or liver impairment</a> shouldn’t take it because these issues can affect how well the body metabolises the medication, which increases the risk of side effects. Paxlovid also can’t be taken alongside some <a href="https://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0020/702821/Information-for-patients-family-and-carers-nirmatrelvir-and-ritonavir.PDF">other medications</a> such as those for certain heart conditions, mental health conditions and cancers. For high-risk patients in these cases, Lagevrio can be considered. Some people who take COVID antivirals will experience side effects. Mostly these are not serious and will go away with time. Both <a href="https://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0020/702821/Information-for-patients-family-and-carers-nirmatrelvir-and-ritonavir.PDF">Paxlovid</a> and <a href="https://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0008/702818/Information-for-patients-family-and-carers-molnupiravir.PDF">Lagevrio</a> can cause diarrhoea, nausea and dizziness. Paxlovid can also cause side effects including muscle aches and weakness, changes in taste, loss of appetite and abdominal pain. If you experience any of these, you should contact your doctor. More serious side effects of both medicines are allergic reactions, such as shortness of breath, swelling of the face, lips or tongue and a severe rash, itching or hives. If you experience any of these, call 000 immediately or go straight to the nearest emergency department. <h2>Be prepared</h2> Most people will be able to manage COVID safely at home without needing antivirals. However, those at higher risk of severe COVID and therefore <a href="https://www.nsw.gov.au/covid-19/testing-managing/antivirals#:%7E:text=Both%20are%20available%20in%20NSW,Lagevrio%C2%AE%20(molnupiravir)launch.">eligible for antivirals</a> should seek them. This includes people aged 70 or older, people aged 50 or older or Aboriginal people aged 30 or older with one additional risk factor for severe illness, and people 18 or older who are immunocompromised. If you are in any of these groups, it’s important you <a href="https://www.health.nsw.gov.au/Infectious/covid-19/Documents/translated/plan-ahead-covid-flu-english.pdf">plan ahead</a>. Speak to your health-care team now so you know what to do if you get COVID symptoms. If needed, this will ensure you can start treatment as soon as possible. It’s important antivirals are started within <a href="https://www.nsw.gov.au/covid-19/testing-managing/antivirals#:%7E:text=Both%20are%20available%20in%20NSW,Lagevrio%C2%AE%20(molnupiravir)launch.">five days of symptom onset</a>. If you’re a high-risk patient and you test positive, contact your doctor straight away. If you are eligible for antivirals, your doctor will organise a prescription (either an electronic or paper script). These medicines are available under the Pharmaceutical Benefits Scheme (PBS) and subsidised for people with a Medicare card. The cost for each course is the standard <a href="https://www.pbs.gov.au/info/about-the-pbs#:%7E:text=Patient%20co%2Dpayments,you%20have%20a%20concession%20card.">PBS co-payment</a> amount: A$30 for general patients and A$7.30 for people with a concession card. So you can rest and reduce the risk of spreading the virus to others, ask your pharmacy to deliver the medication to your home, or ask someone to collect it for you.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/218423/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/jessica-pace-1401278">Jessica Pace</a>, Associate Lecturer, Sydney Pharmacy School, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/nial-wheate-96839">Nial Wheate</a>, Associate Professor of the School of Pharmacy, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/covid-wave-whats-the-latest-on-antiviral-drugs-and-who-is-eligible-in-australia-218423">original article</a>.

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Drug resistance may make common infections like thrush untreatable

<a href="https://theconversation.com/profiles/christine-carson-109004">Christine Carson</a>, <a href="https://theconversation.com/institutions/the-university-of-western-australia-1067">The University of Western Australia</a> We’ve all heard about antibiotic resistance. This happens when bacteria develop strategies to avoid being destroyed by an antibiotic. The consequences of antibiotic resistance mean an antibiotic previously used to cure bacterial infections no longer works effectively because the bacteria have become resistant to the drug. This means it’s getting harder to cure the infections some bacteria cause. But unfortunately, it’s only one part of the problem. The same phenomenon is also happening with other causes of infections in humans: fungi, viruses and parasites. “Antimicrobial resistance” means the drugs used to treat diseases caused by microbes (bugs that cause infection) no longer work. This occurs with antibacterial agents used against bacteria, antifungal agents used against fungi, anti-parasitic agents used against parasites and antiviral agents used against viruses. This means a wide range of previously controllable infections are becoming difficult to treat – and may become untreatable. <h2>Fighting fungi</h2> Fungi are responsible for a range of infections in humans. Tinea, ringworm and vulvovaginal candidiasis (thrush) are some of the more familiar and common superficial fungal infections. There are also life-threatening fungal infections such as aspergillosis, cryptococcosis and invasive fungal bloodstream infections including those caused by Candida albicans and Candida auris. Fungal resistance to antifungal agents is a problem for several reasons. First, the range of antifungal agents available to treat fungal infections is limited, especially compared to the range of antibiotics available to treat bacterial infections. There are only four broad families of antifungal agents, with a small number of drugs in each category. Antifungal resistance further restricts already limited options. Life-threatening fungal infections happen less frequently than life-threatening bacterial infections. But they’re rising in frequency, especially among people whose immune systems are compromised, including by <a href="https://7news.com.au/news/qld/first-heart-transplant-patient-to-die-from-fungal-infection-at-brisbanes-prince-charles-hospital-identified-as-mango-hill-gp-muhammad-hussain-c-12551559">organ transplants</a> and chemotherapy or immunotherapy for cancer. The threat of getting a drug-resistant fungal infection makes all of these health interventions riskier. The greatest <a href="https://www.frontiersin.org/articles/10.3389/fimmu.2017.00735/full">burden of serious fungal disease</a> occurs in places with limited health-care resources available for diagnosing and treating the infections. Even if infections are diagnosed and antifungal treatment is available, antifungal resistance reduces the treatment options that will work. But even in Australia, common fungal infections are impacted by resistance to antifungal agents. Vulvovaginal candidiasis, known as thrush and caused by Candida species and some closely related fungi, is usually reliably treated by a topical antifungal cream, sometimes supplemented with an oral tablet. However, instances of <a href="https://www.theage.com.au/national/victoria/they-can-t-sit-properly-doctors-treat-growing-number-of-women-with-chronic-thrush-20230913-p5e499.html">drug-resistant thrush</a> are increasing, and new treatments are needed. <h2>Targeting viruses</h2> Even <a href="https://theconversation.com/why-are-there-so-many-drugs-to-kill-bacteria-but-so-few-to-tackle-viruses-137480">fewer antivirals</a> are available than antibacterial and antifungal agents. Most antimicrobial treatments work by exploiting differences between the microbe causing the infection and the host (us) experiencing the infection. Since viruses use our cells to replicate and cause their infection, it’s difficult to find antiviral treatments that selectively target the virus without damaging us. With so few antiviral drugs available, any resistance that develops to one of them significantly reduces the treatment options available. Take COVID, for example. Two antiviral medicines are in widespread use to treat this viral infection: Paxlovid (containing nirmatrelvir and ritonavir) and Lagevrio (molnupiravir). So far, SARS-CoV-2, the virus that causes COVID, has not developed significant resistance to either of these <a href="https://www.cidrap.umn.edu/covid-19/low-levels-resistance-paxlovid-seen-sars-cov-2-isolates">treatments</a>. But if SARS-CoV-2 develops resistance to either one of them, it halves the treatment options. Subsequently relying on one would likely lead to its increased use, which may heighten the risk that resistance to the second agent will develop, leaving us with no antiviral agents to treat COVID. The threat of antimicrobial resistance makes our ability to treat serious COVID infections rather precarious. <h2>Stopping parasites</h2> Another group of microbes that cause infections in humans are single-celled microbes such as Plasmodium, Giardia, Leishmania, and Trypanosoma. These microbes are sometimes referred to as parasites, and they are becoming increasingly resistant to the very limited range of anti-parasitic agents used to treat the infections they cause. Several Plasmodium species cause malaria and anti-parasitic drugs have been the cornerstone of malaria treatment for decades. But their usefulness has been significantly reduced by the <a href="https://www.mmv.org/our-work/mmvs-pipeline-antimalarial-drugs/antimalarial-drug-resistance">development of resistance</a>. Giardia parasites cause an infection called giardiasis. This can resolve on its own, but it can also cause severe gastrointestinal symptoms such as diarrhea, nausea, and bloating. These microbes have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6207226/">developed resistance</a> to the main treatments and patients infected with drug-resistant parasites can have protracted, unpleasant infections. <h2>Resistance is a natural consequence</h2> Treating infections influences microbes’ evolutionary processes. Exposure to drugs that stop or kill them pushes microbes to either evolve or die. The exposure to antimicrobial agents provokes the evolutionary process, selecting for microbes that are resistant and can survive the exposure. The pressure to evolve, provoked by the antimicrobial treatment, is called “selection pressure”. While most microbes will die, a few will evolve in time to overcome the antimicrobial drugs used against them. The evolutionary process that leads to the emergence of resistance is inevitable. But some things can be done to minimise this and the problems it brings. Limiting the use of antimicrobial agents is one approach. This means reserving antimicrobial agents for when their use is known to be necessary, rather than using them “just in case”. Antimicrobial agents are precious resources, holding at bay many infectious diseases that would otherwise sicken and kill millions. It is imperative we do all we can to preserve the effectiveness of those that remain, and give ourselves more options by working to discover and develop new ones.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/213460/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/christine-carson-109004">Christine Carson</a>, Senior Research Fellow, School of Medicine, <a href="https://theconversation.com/institutions/the-university-of-western-australia-1067">The University of Western Australia</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/drug-resistance-may-make-common-infections-like-thrush-untreatable-213460">original article</a>.

Body

Radio stars reveal their worst on-air moments

In celebration of 100 years of Australian radio, the who's-who of the Aussie airwaves have shared their most awkward interview moments. Ben Fordham, Amanda Keller and Fifi Box were among the radio presenters who recalled their worst on-air moments to <a href="https://www.news.com.au/entertainment/tv/radio/celebrity-interview-derailed-by-radio-stars-bulge/news-story/056c130ab09f85c3c9e14a0fdeb5587b" target="_blank" rel="noopener">news.com.au</a>, with the memorable moments ranging from mispronouncing a guest's name, to announcing the death of a celebrity who was very much still alive. 2GB's Ben Fordham revealed one of the more outrageous moments from his radio show, recalling when a caller asked him about classic Aussie TV show Simon Townsend's Wonder World. "I said, 'yeah, that was a great show. Sadly we lost Simon Townsend recently,' and then people started calling in saying, 'are you sure Simon Townsend is dead?'" he said. It turned out that Fordham had made an error, as it was actually Townsend's dog Woodrow who had died. He said, "When I came out of the ad-break I had to do a mop up job. It was pretty ugly." Amanda Keller from WSFM's Jonesy and Amanda shared a story about accidentally mispronouncing Weird Al Yankovic's name, despite her co-host trying to help her. "Jonesy (my co-host) kept telling me to pronounce his surname 'Yankovick', and I said, 'no, excuse me, it's pronounced 'Yankovich'." During the entire interview with the musician, Keller introduced the singer with her mispronunciation, and was eventually corrected by the singer when the time came for him to record a promo for the radio network. "It was humiliating," she said. Fifi Box recalled an experience back in 2013 when her then co-host Jules Lund blindfolded her and took her to a secret location for their show's 'Blackout Challenge.' "I was pregnant at the time, and basically found myself lying on a bed in a dark room being serenaded by the one and only David Hasselhoff!" she said. "The Hoff then decided it was funnier to take his pants off for an added extra surprise. Also, being heavily pregnant made the whole scenario a lot more awkward." Rounding out the awkwardness was KIIS FM's Will and Woody who had an uncomfortable interview with pop star Jennifer Lopez. "We overheard Jennifer Lopez screaming at her publicist about needing to do an interview with us. We were both dressed as Santa and had to go through the whole interview knowing that she really didn't want to be there," Will said. "Suffice to say that the interview wasn't one of our best." Image credits: Getty Images

Music

5 reasons why climate change may see more of us turn to alcohol and other drugs

<a href="https://theconversation.com/profiles/helen-louise-berry-8608">Helen Louise Berry</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> and <a href="https://theconversation.com/profiles/francis-vergunst-230743">Francis Vergunst</a>, <a href="https://theconversation.com/institutions/university-of-oslo-934">University of Oslo</a> Climate change will affect every aspect of our <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01859-7/fulltext">health and wellbeing</a>. But its potential harms go beyond the body’s ability to handle extreme heat, important as this is. Extreme weather events, such as floods, droughts, storms and wildfires, are becoming more frequent and severe. These affect our <a href="https://pubmed.ncbi.nlm.nih.gov/36165756/">mental health</a> in a multitude of <a href="https://www.nature.com/articles/s41558-018-0102-4">ways</a>. Coping with climate change can be overwhelming. Sometimes, the best someone can do is to seek refuge in alcohol, tobacco, over-the-counter and prescription drugs, or other psychoactive substances. This is understandable, but dangerous, and can have serious consequences. We outline <a href="https://journals.sagepub.com/doi/full/10.1177/17456916221132739">five ways</a> climate change could increase the risk of harmful substance use. <h2>1. Mental health is harmed</h2> Perhaps the most obvious way climate change can be linked to harmful substance use is by damaging mental health. This <a href="https://onlinelibrary.wiley.com/doi/10.1111/dar.12448">increases the risk</a> of new or worsened substance use. People with a mental disorder are <a href="https://www.hindawi.com/journals/psychiatry/2018/5697103/">at high risk</a> of also having a <a href="https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-11-25#:%7E:text=Prevalence%20of%20comorbidity%20in%20epidemiological%20studies&text=Among%20subjects%20with%20an%20alcohol,a%20comorbid%20SUD%20%5B39%5D.">substance-use disorder</a>. This often precedes their mental health problems. Climate change-related increases in the number and nature of extreme events, in turn, are escalating risks to mental health. For example, extreme heat is linked to increased <a href="https://pubmed.ncbi.nlm.nih.gov/27727320/">distress</a> across the whole population. In extreme heat, more people go to the <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2789481">emergency department</a> for psychiatric problems, including for <a href="https://www.sciencedirect.com/science/article/abs/pii/S0048969720338249">alcohol</a> and <a href="https://www.nature.com/articles/s43856-023-00346-1">substance use</a> generally. This is even true for <a href="https://www.sciencedirect.com/science/article/pii/S0048969720325572">a single very hot day</a>. Post-traumatic stress disorder, depression, anxiety and <a href="https://onlinelibrary.wiley.com/doi/abs/10.5694/mja13.10307">other mental health</a> problems are <a href="https://www.frontiersin.org/articles/10.3389/fpubh.2019.00367/full">common</a> at the time of extreme weather events and can persist for months, even years afterwards, especially if people are exposed to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9116266/">multiple events</a>. This can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6101235/">increase</a> the likelihood of using substances as a way to cope. <h2>2. Worry increases</h2> With <a href="https://climatecommunication.yale.edu/publications/climate-change-in-the-american-mind-beliefs-attitudes-december-2022/">increasing public awareness</a> of how climate change is endangering wellbeing, people are <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/articles/worriesaboutclimatechangegreatbritain/septembertooctober2022#:%7E:text=The%20level%20of%20worry%20about,lives%20right%20now%20(29%25).">increasingly worried</a> about what will happen if it remains unchecked. Worrying isn’t the same as meeting the criteria for a mental disorder. But <a href="https://www.undp.org/publications/peoples-climate-vote">surveys</a> show climate change generates complex emotional responses, <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(21)00278-3/fulltext">especially in children</a>. As well as feelings of worry, there is anxiety, fear, guilt, anger, grief and helplessness. Some <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904966/">emotional states</a>, such as <a href="https://www.pnas.org/doi/full/10.1073/pnas.1909888116">sadness</a>, are linked with long-term tobacco use and also make substance use <a href="https://pubmed.ncbi.nlm.nih.gov/16011392/">relapse</a> more likely. <h2>3. Physical injuries hurt us in many ways</h2> Physical injuries caused by extreme weather events – such as smoke inhalation, burns and flood-related cuts and infections – increase the risk of harmful substance use. That’s partly because they <a href="https://pubmed.ncbi.nlm.nih.gov/20033251/">increase</a> the risk of psychological distress. If injuries cause long-term illness or disability, consequent feelings of hopelessness and depression can dispose some people to self-medicate with alcohol or other drugs. Substance use itself can also generate long-term physiological harm, disabilities or other chronic health problems. These are <a href="https://www.tandfonline.com/doi/abs/10.3109/00952999609001655">linked with</a> higher rates of harmful substance use. <h2>4. Our day-to-day lives change</h2> A single catastrophic event, such as a storm or flood, can devastate lives overnight and change the way we live. So, too, can the more subtle changes in climate and day-to-day weather. Both can disrupt behaviour and routines in ways that risk new or worsened substance use, for example, using stimulants to cope with fatigue. Take, for example, hotter temperatures, which disrupt <a href="https://www.cell.com/one-earth/fulltext/S2590-3322(22)00209-3?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS2590332222002093%3Fshowall%3Dtrue">sleep</a>, undermine <a href="https://jhr.uwpress.org/content/57/2/400">academic performance</a>, <a href="https://www.nature.com/articles/s41562-017-0097">reduce physical activity</a>, and promote <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(22)00173-5/fulltext">hostile language</a> and <a href="https://www.cambridge.org/core/elements/abs/climate-change-and-human-behavior/F64471FA47B8A6F5524E7DDDDE571D57">violent behaviour</a>. <h2>5. It destabilises communities</h2> Finally, climate change is destabilising the socioeconomic, natural, built and geopolitical <a href="https://www.nature.com/articles/s41558-018-0102-4">systems</a> on which human wellbeing – <a href="https://theconversation.com/climate-change-and-health-ipcc-reports-emerging-risks-emerging-consensus-24213">indeed survival</a> – depends. Damaged infrastructure, agricultural losses, school closures, homelessness and displacement are significant <a href="https://www.nature.com/articles/s41558-018-0102-4">sources of psychosocial distress</a> that prompt acute (short-term) and chronic (long-term) stress responses. <a href="https://doi.org/10.1196/annals.1441.030">Stress</a>, in turn, can <a href="https://doi.org/10.1007/s002130100917">increase</a> the risk of <a href="https://link.springer.com/article/10.1007/s002130100917">harmful substance use</a> and make people more likely to relapse. <h2>Why are we so concerned?</h2> Substance-use disorders are economically and socially <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30337-7/fulltext">very costly</a>. Risky substance use that doesn’t meet the criteria for a formal diagnosis <a href="https://digitalcommons.fiu.edu/srhreports/health/health/32/">can also harm</a>. Aside from its direct physical harm, harmful substance use disrupts <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3843305/">education</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3234116/">employment</a>. It increases the risk of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676144/">accidents</a> and <a href="https://www.tandfonline.com/doi/abs/10.1080/09595230600944479">crime</a>, and it undermines social relationships, intimate <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795906/#:%7E:text=Results%20indicated%20that%20alcohol%20use,drinkers%20with%20low%20relationship%20satisfaction.">partnerships</a> and <a href="https://www.cambridge.org/core/journals/development-and-psychopathology/article/abs/longitudinal-relations-between-parental-drinking-problems-family-functioning-and-child-adjustment/CE508589A9E799FD6DC9E23DF364FB8F">family functioning</a>. <h2>Politicians take note</h2> As we head towards the <a href="https://www.cop28.com">COP28 global climate talks</a> in Dubai, climate change is set to hit the headlines once more. Politicians know climate change is undermining human health and wellbeing. It’s well past time to insist they act. As we have seen for populations as a whole, there are multiple possible ways for climate change to cause a rise in harmful substance use. This means multidimensional <a href="https://www.nature.com/articles/s41558-018-0102-4">prevention strategies</a> are needed. As well as addressing climate change more broadly, we need strategies including: <ul> <li> supporting vulnerable individuals, especially <a href="https://journals.sagepub.com/doi/full/10.1177/21677026211040787">young people</a>, and marginalised commmunities, who are <a href="https://www.nature.com/articles/s41558-018-0102-4">hit hardest</a> by extreme weather-related events </li> <li> focusing health-related policies more on broadscale health promotion, for example, healthier eating, active transport and community-led mental health support </li> <li> investing in climate-resilient infrastructure, such as heat-proofing buildings and greening cities, to prevent more of the destabilising effects and stress we know contributes to mental health problems and harmful substance use. </li> </ul> There is now <a href="https://news.un.org/en/story/2022/10/1129912">no credible pathway</a> to avoiding dangerous climate change. However, if <a href="https://carnegieendowment.org/2023/01/12/climate-protests-tracking-growing-unrest-pub-88778#:%7E:text=These%20are%20just%20a%20few,even%20more%20numerous%20and%20influential.">increasing rates</a> of climate protests are anything to go by, the world may finally be ready for radical change – and perhaps for reduced harmful substance use.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/217894/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/helen-louise-berry-8608">Helen Louise Berry</a>, Honorary Professor, Centre for Health Systems and Safety Research, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> and <a href="https://theconversation.com/profiles/francis-vergunst-230743">Francis Vergunst</a>, Associate Professor, Psychosocial Difficulties, <a href="https://theconversation.com/institutions/university-of-oslo-934">University of Oslo</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/5-reasons-why-climate-change-may-see-more-of-us-turn-to-alcohol-and-other-drugs-217894">original article</a>.

Mind

What exactly is a ceasefire, and why is it so difficult to agree on one in Gaza?

<a href="https://theconversation.com/profiles/marika-sosnowski-1415833">Marika Sosnowski</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Barely a week after Hamas’ attack on Israeli soldiers and civilians on October 7 and the subsequent airstrikes by the Israeli Defence Force on the Gaza Strip, talk of a ceasefire had already begun. More than five weeks into the war, calls for a ceasefire have only grown louder. Visiting the White House this week, Indonesian President Joko Widodo <a href="https://www.aljazeera.com/news/2023/11/14/indonesian-president-joko-widodo-urges-biden-to-help-end-gaza-atrocities">said</a>, a “ceasefire is a must for the sake of humanity.” Israel has thus far <a href="https://apnews.com/article/israel-hamas-war-news-11-11-2023-d4d272416107c02e63dabd9548395026">refused</a> to discuss a ceasefire without the release of the 240 hostages being held by Hamas. But what exactly is a ceasefire, and how do they work? And what sort of arrangement would be most effective in Gaza? <h2>Different terms, different meanings</h2> Virtually as old as conflict itself, a ceasefire is an ancient way of formalising a halt to armed violence between warring parties for a certain period of time. Historically, the terms truce and armistice were used as synonyms. Perhaps surprisingly, international humanitarian law has <a href="https://www.chathamhouse.org/2023/11/humanitarian-pauses-and-ceasefires-what-are-differences">no provisions</a> relating specifically to when ceasefires should be negotiated, what they need to contain or how they need to be applied. It is only in the last 50 years or so that a range of new terminology has become commonplace to describe the phenomenon of a “<a href="https://beyondintractability.org/essay/cease-fire">ceasefire</a>”. These include: <ul> <li> <a href="https://ru.usembassy.gov/joint-statement-russian-federation-united-states-syria/">cessation of hostilities</a> </li> <li> <a href="https://www.thenewhumanitarian.org/news/2017/12/04/un-calls-humanitarian-pause-yemen-conditions-capital-deteriorate">humanitarian pauses</a> </li> <li> <a href="https://www.peaceagreements.org/viewmasterdocument/2093">de-escalation areas</a> </li> <li> <a href="https://reliefweb.int/report/sudan/un-call-days-tranquility-bears-fruit-more-five-million-children-have-been-vaccinated">days of tranquility</a> (pauses in fighting to allow for immunisation of children) </li> <li> <a href="https://kaldorcentre.unsw.edu.au/sites/kaldorcentre.unsw.edu.au/files/Policy_brief_Creating_safe_zones_and_safe_corridors.pdf">safe zones</a> and safe corridors </li> <li> <a href="https://osce.org/stories/osce-mirror-patrols-windows-of-hope-eastern-ukraine">windows of silence</a> (one name given to the 2014 ceasefire in Ukraine). </li> </ul> Many of these terms have been used in the Gaza conflict. For instance, in late October, the UN General Assembly <a href="https://press.un.org/en/2023/ga12548.doc.htm">adopted</a> a resolution calling for an “immediate, durable and sustained humanitarian truce leading to cessation of hostilities”. In the Security Council, the US has <a href="https://www.bbc.com/news/world-middle-east-67320520">called</a> for “humanitarian pauses”, but not a “ceasefire”. Russia, meanwhile, has <a href="https://news.un.org/en/story/2023/10/1142427">demanded</a> a “humanitarian ceasefire”, but is unhappy with a “truce” or “pauses”. This week, Hamas said it is willing to <a href="https://www.france24.com/en/middle-east/20231113-%F0%9F%94%B4-live-more-gaza-hospitals-halt-operations-as-israeli-assault-continues">release</a> 70 hostages in exchange for a five-day “truce”. Israeli Prime Minister Benjamin Netanyahu has previously <a href="https://www.theguardian.com/world/2023/nov/04/gaza-ceasefire-talks-ongoing-despite-israeli-pm-rejecting-pause-says-us">rejected</a> a “temporary truce”, but under pressure from the US, has agreed this week to <a href="https://www.aljazeera.com/features/2023/11/10/will-israels-humanitarian-pauses-mean-much-for-gaza-no-say-experts">implement</a> daily four-hour “humanitarian pauses”. While there have been <a href="https://ukraine.un.org/en/174777-glossary-humanitarian-terms-pauses-during-conflict">attempts</a> to differentiate between these terms, states continue to place different emphasis or apply different meanings to them in ad hoc ways. This makes finding common ground difficult. <h2>What could be achieved in Gaza instead</h2> So, if we have no common definitions as a starting point, how do parties come to any useful or enforceable agreement on a ceasefire? Thus far in Gaza, the answer has mostly been they don’t. It may be simplistic to say that words are what we use as humans to make sense of and order the world, but in this context, specifics matter. Arguably, in focusing so squarely on getting to a halt in fighting (whatever we want to call that), we lose sight of many other important factors and actions that may or may not fall under the broad and open-to-interpretation umbrella term of “ceasefire”. For example, Israel and Hamas might find agreement if negotiators focused on more specific details or issues, such as: <ul> <li> the amount of ordnance being used by both sides on a daily basis, and what kind of ordnance </li> <li> where or what is targeted by both sides </li> <li> the number of aid convoys allowed into Gaza, where they would come from, where they would go and what they would be carrying </li> <li> the number and/or nationality of hostages to be released and at what regularity. </li> </ul> I am not a negotiator and this is not an exhaustive list. What it hopes to illustrate is that efforts for a grand-bargain-type ceasefire should not be prioritised over more nuanced, and perhaps tangible, efforts for other types of lulls in fighting. <h2>How ceasefires can be problematic</h2> At the same time, it should not be forgotten that ceasefires can have unintended consequences. Often these consequences are far from beneficial, positive or humanitarian – the kinds of things we expect from a ceasefire. For example, in Syria, local <a href="https://www.washingtonpost.com/politics/2021/06/18/do-ceasefires-syria-work-we-checked-data/">ceasefires</a> and reconciliation agreements have been used during the civil war to allow for the evacuation of citizens from their homes in places like <a href="https://paxforpeace.nl/publications/no-return-to-homs/#:%7E:text=The%2520report%2520'No%2520Return%2520to,cities%2520and%2520neighbourhoods%2520in%2520Syria.">Old Homs</a> and <a href="https://www.middleeasteye.net/opinion/besiege-bombard-retake-reconciliation-agreements-syria">Daraya</a>. Subsequently, a raft of presidential decrees were enacted that enabled the Syrian regime to permanently reappropriate their properties. State-backed <a href="https://www.brookings.edu/articles/beyond-fragility-syria-and-the-challenges-of-reconstruction-in-fierce-states/">reconstruction</a> and development projects such as Basila City (which ironically means “Peace City” in old Aramaic), Marouta and Homs Dream were then built on the land acquired via the ceasefire agreements. Likewise, during the Russian invasion of Ukraine, <a href="https://www.newsweek.com/evacuation-route-offered-fleeing-ukrainians-mined-1685418">humanitarian corridors</a> were implemented that allowed people from the besieged city of Mariupol to evacuate. Shortly afterwards, however, Ukrainian President Volodymyr Zelensky <a href="https://www.novinite.com/articles/214156/Zelensky+accused+Russia+of+Mining+Humanitarian+Corridors">accused</a> Russia of laying landmines within the corridors to thwart civilians’ ability to flee. In another example, humanitarian corridors that Russia <a href="https://www.reuters.com/markets/asia/top-wrap-1-ukrainians-trapped-besieged-city-fighting-blocks-evacuation-efforts-2022-03-07/">proposed</a> setting up would not lead civilians to safety, but rather into Russia or its close ally Belarus. Israel has similarly announced “<a href="https://www.bloomberg.com/news/articles/2023-10-16/israel-announces-another-safe-passage-for-gazans-to-move-south">safe corridors</a>” enabling <a href="https://www.aljazeera.com/features/2023/11/10/will-israels-humanitarian-pauses-mean-much-for-gaza-no-say-experts">mass displacement</a> of civilians from the north to the south of the country. The relocation is <a href="https://www.theguardian.com/world/2023/oct/13/israel-hamas-war-latest-gaza-residents-told-move-ground-assault">supposedly</a> for civilians’ own safety, despite the fact airstrikes are killing civilians there, too. Many also <a href="https://www.newarab.com/news/egypt-israeli-safe-zones-gaza-prelude-displacement">fear</a> the supposed “safe corridors” could lead to a permanent displacement of Gazans. Israel has reportedly also canvassed support for a <a href="https://www.nytimes.com/2023/11/05/world/middleeast/israel-egypt-gaza.html#:%7E:text=Israeli%2520leaders%2520and%2520diplomats%2520have,the%2520border%2520in%2520neighboring%2520Egypt.">humanitarian corridor</a> that would direct Palestinians towards the Sinai peninsula in Egypt, in effect making them an Egyptian problem with little possibility of return. The idea has unsurprisingly been rejected by both the Palestinians and Egypt. <h2>A ceasefire is only the beginning</h2> Despite all this, ceasefires are perhaps the best-formalised tools humans have so far devised to halt the violence of armed conflict for a time. Therefore, given the suffering of civilians on both sides in the Israel-Hamas conflict, it is imperative some form of ceasefire happens. However, we should not be blinded by calls for a ceasefire (whatever terms are used), but stay alert to the hazards that ceasefires can themselves create. In any case, a ceasefire that stops violence for four hours, four days or four months will only be the beginning of the more challenging work that needs to be done to bring meaningful and long-term security and stablity to both Palestinians and Israelis.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/217683/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/marika-sosnowski-1415833">Marika Sosnowski</a>, Postdoctoral research fellow, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-exactly-is-a-ceasefire-and-why-is-it-so-difficult-to-agree-on-one-in-gaza-217683">original article</a>.

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Foul play suspected in tragic death of TV star's 15-year-old niece

Police are investigating the death of TV star Audrina Patridge’s 15-year-old niece, after her cause of death was revealed to be a drug overdose. Young Sadie passed away in February just nine days after her 15th birthday. Police are still looking into the exact manner of how the teenager died, as they are investigating different avenues of how the drugs entered her system. Sources have been trying to figure out how the teenager got her hands on narcotics, adding that police have learned that she allegedly used Snapchat to procure Percocet that was laced with fentanyl. Fentanyl is a synthetic opioid drug, which can be up to 100x stronger than typical opioid drugs like morphine. Fentanyl, a very fast acting medication, is a prescription drug used during surgeries and prescribed for very severe pain, often in late-stage cancers. Despite being an effective pain reliever, Fentanyl is also manufactured illegally and may be sold as powder, fake pills or mixed in with other illicit drugs, like heroin, with this combination being especially deadly. Audrina, known for her role on The Hills, shared the heartbreaking news in February that her niece had passed away in a 10-slide Instagram tribute. “My heart hurts to even write this. My beautiful niece is now in heaven,” she captioned the slide show that looked back on cherished memories. “I know it’s not goodbye forever, but it is the hardest to say goodbye for now. We will miss you and cherish every single moment we had with you. Rest in peace Say Say!! We love you forever & ever!” Image credits: Instagram

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