Increased risk of amyotrophic lateral sclerosis (ALS) associated with herbicides, insecticides Men exposed to these chemicals may be twice as likely to develop ALS as unexposed men
Photo by Arjun Mj on Unsplash
Workplace exposure to pesticides (herbicides and insecticides) is linked to a 60-70% heightened risk of the most common form of motor neuron disease – amyotrophic lateral sclerosis, or ALS for short, finds a synthesis of the available evidence, published online in Occupational & Environmental Medicine.
Men who have been exposed to these chemicals may be twice as likely to develop the condition as those who haven’t been, the analysis indicates.
Although still relatively rare, the incidence of ALS – a progressive and rapidly fatal neurodegenerative disease for which there is no cure – has increased in recent years, note the researchers.
White the short term neurotoxic effects of pesticides, particularly insecticides, have been known for decades, there’s not a great deal of evidence on their potential long term neurotoxicity, they add.
In a bid to strengthen the evidence base, the researchers scrutinised research databases for relevant studies, including peer reviewed theses and scientific reports, on workplace exposure to pesticides and ALS, published between 1990 and 2025.
Eight case-control studies involving a total of 1734 cases of ALS, and 3 studies involving 457 cases of unspecified motor neuron disease, were retained for pooled data analysis from 767 initially screened articles.
This showed that compared with no exposure, any workplace exposure to pesticides was associated with a 60% heightened risk of ALS, based on the pooled data from 6 studies.
And based on the results of 3 studies, any exposure to high levels of pesticides was associated with a near tripling in risk compared with no pesticide exposure, whereas any exposure to lower levels was associated with a doubling in risk.
Compared with no exposure, exposure to herbicides was associated with a 70% heightened risk of developing the disease; exposure to either insecticides or fungicides was associated with a 60% heightened risk.
In studies that reported risk estimates stratified by sex, the pooled data analysis showed that exposed men were twice as likely as unexposed men (3 studies) to develop ALS.
But no increased risk was apparent in women who had been exposed to pesticides compared with those who hadn’t been.
The researchers highlight various limitations to their findings: the small number of available primary studies and their crude assessment of exposure, generally based on answers to a few limited questions.
“To strengthen the evidence on risk factors for ALS, primary studies particularly need methodological improvements on exposure assessment, on the selection of reference groups, and on adjustment for potential confounders, including analysis for interactions between risk factors,” they emphasise.
But they conclude: “The findings of this review add to the evidence that occupational exposure to pesticides may increase the risk of ALS and should encourage the implementation of interventions aimed at reducing exposure during occupational pesticide use.”
People who have survived intensive care unit admission with sepsis don’t respond to vaccines in the same way as those who haven’t had sepsis, according to new clinical trial results. The findings suggest that more work is needed to understand why the vaccine-related immune response is altered in sepsis survivors, so that vaccination programmes can be tailored to reduce sepsis survivors’ risk of infections and improve long-term health outcomes.
Sepsis survivors can have a weakened or altered immune system, which can increase the risk of new infections and death. Fifteen per cent of sepsis survivors die within a year of leaving hospital, with a further six to eight per cent dying every year over the next five years.
The VACIRiSS trial, led by King’s College London and Guy’s and St Thomas’ NHS Foundation Trust and funded by the National Institute for Health and Care Research (NIHR), found that a vaccine that helps protect against serious illnesses like pneumonia and meningitis in the general population did not reduce the risk of future infections or re-hospitalisations in adults who had survived sepsis.
The long-term health impacts of sepsis survivors may not be receiving enough attention in health care. In the UK, one in three sepsis survivors are re-hospitalised within 90 days, with the majority of these re-hospitalisations from infections, and one in six patients are no longer alive at the end of the first year after recovering from sepsis. Despite this, there is no routine long-term follow up care for sepsis survivors in the NHS.
Professor Manu Shankar-Hari, Professor of Critical Care Medicine at King’s College London and Principal Investigator on the trial
Sepsis, a misfiring of immune responses to infection, can cause failure of vital organs and death if not treated quickly. Globally, it’s estimated that there are about 166 million sepsis cases and 21 million deaths from sepsis each year. Those who survive (approximately 145 million patients globally every year) are at increased risk of long-term ill health, including from recurrent infections.
While sepsis survivors may receive vaccinations as part of established vaccination programmes (such as flu or pneumonia vaccinations for older adults), vaccinations are not part of standard of care for sepsis survivors.
In the trial, 214 sepsis survivors were randomly assigned to receive a vaccine, called PCV13, or a placebo injection. Participants were followed up for a year to see whether the vaccine reduced their risk of re-hospitalisation with infection or death.
Overall, the vaccine did not reduce re-hospitalisation with infection or death in sepsis survivors. While blood tests showed that many participants did produce immune responses to the vaccine, the responses varied widely from person to person. The differences in vaccine responses were linked to factors such as age, body weight, sex, and levels of altered immune system before vaccination.
The findings suggest that established vaccination programmes may need to be modified to provide better protection to sepsis survivors. However, more needs to be done to understand the varied responses in sepsis survivors to inform what changes are needed.
In a thoughtfully designed, adaptive clinical trial, University of Pittsburgh School of Medicine physician-scientists demonstrated that the United States could triple to quadruple the supply of platelets available to help save bleeding patients of all ages and extend the life-saving therapy into rural regions and community hospitals. Platelets are the component of blood that encourage clotting, plugging cuts and tears in blood vessels and stemming blood loss.
Of the 2.5 million room-temperature platelet units collected per year in the United States, roughly 10% to 20% are wasted due to the short shelf life, costing hospitals $300 million, according to recent research in the journal Hematology.
“Our findings could result in major international public health benefits,” said lead author Philip Spinella, professor of surgery and of critical care medicine in Pitt’s School of Medicine and codirector of Pitt’s Trauma and Transfusion Medicine Research Center. “This is incredibly transformative and will dramatically improve the availability of platelets while also reducing waste, allowing hospitals that aren’t in major cities to afford to keep this life-saving blood product on hand for bleeding patients.”
Currently, donated platelets are conventionally stored at room temperature with a five- to seven-day shelf life. Early studies conducted half a century ago in healthy volunteers led regulators to believe that refrigerating platelets to extend their shelf life made them less effective.
Recent preclinical studies indicated the opposite, though, so Spinella and colleagues designed CHIPS to safely test using refrigerated platelets stored for increasing amounts of time up to 21 days. The trial enrolled 1000 paediatric and adult patients undergoing cardiac surgery at 27 sites in the United States and Australia from December 2021 to March 2025.
The patients were randomised to receive either standard, room-temperature platelets stored for less than seven days or chilled platelets. At every 200 participants treated, independent data analysts looked at the results. If the chilled platelets were performing just as well as room temperature, they’d add up to another five days to the age of the chilled platelets used and enrol another 200 participants, up to a maximum of 21 days.
The research team discovered that platelets refrigerated for up to three weeks were just as effective at treating bleeding as room-temperature platelets stored for up to one week. Since it can take two days for blood banks to process donations, the finding holds the potential to extend the lifespan of platelets for use in controlling bleeding by almost four-fold.
“Rural and community hospitals, for the most part, simply cannot justify keeping room temperature platelets in stock – they don’t see enough severely bleeding patients, so the waste would far exceed the benefit, something our nation’s fragile blood supply chain cannot accommodate,” said coauthor Michael Boisen, cardiothoracic anaesthesiologist and medical director of the UPMC Patient Blood Management Program, who served as principal investigator for UPMC’s CHIPS trial site. “So, if we can safely extend the shelf life of platelets and reduce the waste, imagine how many more people we could help.”
More than 97% of platelets are donated through apheresis, where a donor’s blood runs from a tube in their arm to a machine that collects the platelets and returns the rest of the blood back to the donor–a time-consuming process. The age of platelet donors has steadily increased over the past decade and younger donors are not replacing the aging donor base fast enough to keep up with demand, according to data from Vitalant, which supplied the platelets for the study and is one of the nation’s largest nonprofit blood and biotherapies services providers.
“About 15% of hospitals can experience one or more delayed platelet transfusions within any given month due to supply shortages,” said Ralph Vassallo, Vitalant’s chief medical and scientific officer. “A 21-day shelf life for cold-stored platelets will reduce outdate rates and ensure platelets are available on hospital shelves when a surge in need occurs.”
In addition to the civilian applications, the findings could also benefit military personnel by making it more feasible to have platelets available in conflict areas, said Spinella, who is also associate medical director of Pitt’s Center for Military Medicine Research.
A unique facet of the trial is that it included children and babies from the start. Usually, clinical trials that aren’t specific to paediatric populations will exclude children.
“I believe it is unethical not to include children in a trial when there isn’t a rational biological reason to exclude them,” Spinella said. “Of the 1,000 participants in our trial, roughly a third were children—which makes sense because it is the very young who bleed the most from cardiac surgery and most frequently benefit from platelets. Our trial will hopefully motivate others to include children in their trials.”
Additional authors are listed in the JAMA article.
Real-world study reveals the precise level associated with patient prognosis.
Credit: Darryl Leja National Human Genome Research Institute National Institutes Of Health
After treatment for metastatic prostate cancer, a drop in prostate-specific antigen (PSA) levels in the blood is an indicator that the treatment is working. A recent real-world study indicates that reaching a PSA level below 0.2 ng/mL is an indicator of improved patient survival. The study is published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.
Multiple phase 3 clinical trials have shown that a PSA level below 0.2 ng/mL is the best cut-off for determining a patient’s prognosis. Real-world data are lacking, however, and physicians often use other metrics, such as percentage of PSA decline, to assess treatment response. To determine whether there is a PSA response target associated with the most favourable outcome in community-dwelling adults with metastatic prostate cancer, investigators analysed Veterans Health Administration data on 4890 patients who received testosterone deprivation therapy with or without other treatments in 2018–2023 for metastatic hormone-sensitive prostate cancer.
Over a median follow-up of approximately 2 years, 896 patients died. Patients whose PSA levels dropped below 0.2 ng/mL within 9 months of starting treatment were 54% less likely to die than patients whose levels did not drop this low, whether their PSA levels also decreased by at least 90% or not. Patients who had at least a 90% PSA decline but did not achieve a PSA of less than 0.2 ng/ml had no improvement in survival. The findings suggest that patients who do not experience a PSA drop below 0.2 ng/mL could be candidates for more aggressive treatments. Also, patients who received testosterone deprivation therapy plus another drug to further block testosterone were more likely to reach a PSA below 0.2 ng/mL.
“These data show that we need to target a PSA below 0.2 ng/ml as our metric of success to optimize outcomes for our patients with metastatic prostate cancer,” said corresponding author Stephen J. Freedland, MD, professor of Urology at Cedars-Sinai and Staff Physician at the Durham VA Medical Center.
#InsideTheBox is a column by Dr Andy Gray, a pharmaceutical sciences expert at the University of KwaZulu-Natal and Co-Director of the WHO Collaborating Centre on Pharmaceutical Policy and Evidence Based Practice. (Photo: Supplied)
By Dr Andy Gray for Spotlight
The regulation of complementary and alternative medicines in South Africa has been hotly contested in recent decades, including in court rooms. In his latest column for Spotlight, Dr Andy Gray unpacks the legal background and the current state of this still unfolding regulatory saga.
Multivitamin and mineral supplements are commonly found in many South African retail outlets, from pharmacies to health shops and supermarkets. Some outlets will stock a wider range of medicines, perhaps on shelves marked as “complementary”, or among other non-prescription medicines available for self-service.
Are these medicines regulated in the same way as other medicines, including those available on prescription?
The concept of a “call-up notice”
When South Africa’s medicines legislation was first passed in 1965, there were already many medicines on the local market which had not been assessed for safety, efficacy or quality. As all such medicines could not be immediately “called up” for registration, a stepwise approach had to be followed.
Between 1967 and the mid-1980s, medicines were identified for registration by pharmacological classification. The remnant of that approach is still evident in section 14(1) and (2): of the Medicines and Related Substances Act, 1965:
(1) Save as provided in this section or sections 21 and 22A, no person shall sell any medicine, … which is subject to registration by virtue of a declaration published in terms of subsection (2) unless it is registered.
(2) (a) The Authority may from time to time determine that a medicine, …, or class or category of medicine, … or part of any class or category of medicine, … mentioned in the declaration, shall be subject to registration in terms of this Act.
(b) Any such declaration may also relate only to medicines, … which were available for sale in the Republic immediately prior to the date on which it comes into operation in terms of paragraph (c) or only to medicines, … which were not then so available.
The declaration that a category or class of medicine is subject to registration is referred to colloquially as a “call-up notice”. A notice could be applied to those medicines already marketed, or only to those not yet marketed. Medicines which were already marketed but exempted from a full registration process were then regulated as “old medicines”. They are still subject to control according to their scheduling status and their production still needs to be in accordance with Good Manufacturing Practice. In time, new brands of some of the “old medicines” have been registered.
By the mid-1980s, the process of working through the pharmacological classifications was concluded. Thereafter, every new medicine would need to be registered before being marketed. In other words, a manufacturer or importer would need to provide sufficient evidence of the medicine’s safety, efficacy and quality to justify registration.
However, an important exception was created in 1986, which exempted homeopathic medicines from the full registration process. Two important restrictions were included. Firstly, no medical claims could be made for the medicine. Secondly, the following wording was to be included on the label of such medicine: “Homeopathic Medicine” and “WARNING: Use only as directed by a medical practitioner, pharmacist or homeopath”. The provision applied to homeopathic mother substances and so-called “minute-dose forms” made in accordance with homeopathic principles.
Broadening the scope of complementary medicines
Homeopaths are one of several complementary and traditional health professions regulated by the Allied Health Professions Council of South Africa. Medicines legislation has been amended to accommodate this wider range of complementary and traditional medicines.
A separate South African Health Products Regulatory Authority (SAHPRA) web site is dedicated to what are termed Category D medicines, also known as complementary medicines.
The General Regulations issued in terms of the Medicines Act includes a definition of complementary medicines which has two components: health supplements and medicines used in accordance with a “discipline as determined by the Authority”. The pharmacological classifications listed in Annexures 1 (human) and 2 (veterinary) medicines list the “disciplines” as Aromatherapy, Homeopathy, Phytotherapy, Traditional Chinese Medicine, Unani Medicine, Western Herbal Medicine, Combination Products and Other Herbal. The Annexures also list the types of health supplements, including amino acids, mineral, probiotics and vitamins. Two elements are important here – the nature of the substance included in the complementary medicine and the claims made in relation to that medicine.
Since 2013, the intention has been to progressively bring all complementary medicines under effective regulation, using a risk-based approach to identify those requiring registration and full assessment of safety, efficacy and quality data. The first pharmacological classifications identified were those claiming antiviral properties, and those intended to treat diabetes, cardiac conditions and cancer. However, no complementary medicines have yet been registered and the initial “call-up notices” have been repealed.
Like much of South Africa’s medicines regulatory space, this process has been affected by litigation. A challenge of the complementary medicines regulatory scheme by the Alliance of Natural Health Products (South Africa) was finally decided by the Supreme Court of Appeal in 2022. The court confirmed the finding that SAHPRA should have no regulatory power over substances and preparations that did not meet the definition of a medicine. A preparation that seeks to supplement a diet or provide a nutritional benefit is not a medicine, but a foodstuff. Draft amendments to the 2017 General Regulations, informed by the court judgment, were published for comment in March 2023, but have yet to be issued in final form.
Not a total lack of regulation
The hiatus in finalising regulations does not mean, however, that there is no regulatory control over complementary or Category D medicines. The initial “roadmap” outlined in the 2013 regulations has been replaced by a series of guidelines. The progressive, developmental approach to the regulation of complementary medicines remains in place, albeit delayed and as yet incomplete.
The overall roadmap was updated in 2021. All manufacturers, wholesalers or distributors of complementary medicines are required to be licensed by SAHPRA, but this process relies on an applicant’s “attestation of compliance with minimum requirements at the time of application and the payment of the required licence application, and desktop evaluation fees”, rather than the full Good Manufacturing Practice inspection applied to manufacturers of other medicines. However, SAHPRA reserves the right to conduct inspections where warranted. A similar approach is applied to the regulation of medical devices and diagnostic tests.
In the meantime, while no complementary or alternative medicines have been registered by SAHPRA, there is relatively strict regulation of what companies can say about the unregistered complementary medicines that they market in South Africa.
As with the 1986 exclusion for homeopathic products, all category D products which have not been registered have to include the following statement on the label: “This unregistered medicine has not been evaluated by the SAHPRA for its quality, safety or intended use”. The guideline also distinguishes between low risk and high-risk claims, in either labelling or advertising. Low risk claims are those for general health enhancement without any reference to specific diseases; health maintenance; or the relief of minor symptoms (not related to a disease or disorder).
The guideline is specific about a widely used wording: “Unregistered complementary medicines making use of the terms “Clinically proven” or any similar expression … shall also be considered to be HIGH RISK and may be subject to individual call-up in terms of section 14(2) of the Medicines Act.” Examples of acceptable low risk claims are provided, such as “Helps enhance/promote joint health”. Further guidance on the evidence to be relied upon for low risk and high-risk claims has been provided for the discipline-specific complementary medicines.
Manufacturers and importers of health supplements are only allowed to make low risk claims, and the relevant guideline provides Annexures (from Annexure A to O), showing the allowable levels and claims for each type of supplement. For example, a single component vitamin B3 (nicotinamide) product sold for adults may not contain more than 500mg per dose, and can only make a claim of “Helps to metabolise carbohydrates, fats and proteins”, “Contributes to normal growth and development” or “A factor in the maintenance of good health”.
A key document is the current guideline on the regulation of discipline-specific complementary medicines. An additional guideline was updated in 2022, which provides guidance on caffeine, menthol, camphor and cannabidiol. Low-dose cannabidiol can be sold as either a discipline-specific complementary medicine or a health supplement. At a dose not exceeding 20mg per day or 600mg per pack, it can be sold as a Schedule 0 product.
As no complementary medicines have yet been registered, none have as yet been specifically included in any of the Schedules, and they are therefore assumed to be controlled as Schedule 0 products, which can be sold in any retail outlet. One exception would be any injectable product, as those are automatically included in Schedule 3 and are prescription-only.
Important sources of information
The SAHPRA complementary medicines website provides a crucial resource which can be accessed by the public. The list of licensed complementary medicines manufacturers, importers and exporters is accessible here. There are currently 117 entries on the list. Each entry also provides a list of the products provided by that licensed entity, with details of ingredients, recommended doses and intended uses, whether discipline-specific or health supplement. The entire database is also searchable.
The site also enables anyone to lodge a complaint about a complementary medicine, including anonymous complaints.
Gaps in the system
While some progress has been made, the regulatory scheme for complementary medicines remains incomplete. Apart from finalising the regulations after the court challenge, a risk-based “call-up” process still needs to commence. Moving from an attestation process to confirmation that every manufacturer has met current Good Manufacturing Practice standards is still necessary.
Currently, the proprietary (brand) names used for complementary medicines are not pre-approved by SAHPRA, and many are in contravention of the naming guidelines applied to other medicines.
Effective oversight of advertising and marketing practices remains elusive, not only in respect of complementary medicines.
The dictum traditionally applied to consumer goods of “let the buyer beware” (in Latin, “caveat emptor”) is no longer considered appropriate. The Consumer Protection Act, 2008 seeks to protect the public against unsafe products and unfair marketing. Medicines are treated as a special category of goods, deserving closer regulatory control. The remaining gaps in the medicines regulatory system need to be plugged. One very particular gap, which has never been adequately addressed, is the regulation of African traditional medicines, which are not currently captured in the definition of Category D medicines.
– Gray is a Senior Lecturer at the University of KwaZulu-Natal and Co-Director of the WHO Collaborating Centre on Pharmaceutical Policy and Evidence Based Practice.
Disclosure: Gray serves on three technical advisory committees at the South African Health Products Regulatory Authority.
Children are NOT small adults. They experience and express illness and injury very differently from adults. Which is why paediatric diagnostic imaging is a highly specialised field of medical imaging and is specifically designed for children, from birth to adolescence.
Dr Ebrahim Banderker, a paediatric radiologist at Red Cross War Memorial Children’s Hospital (RXCH), explains why children need a different approach to imaging and the role of radiology in children. He also talks about the success of a public-private initiative with SCP Radiology where he is a consulting radiologist.
Why is paediatric imaging so important?
Children are often unable to, or struggle to describe the nature of their discomfort, pain or symptoms clearly. Imaging helps doctors understand what is happening inside the body, when language and understanding are limited.
When we diagnose early, we are often preventing future pain, disability or developmental issues as well as reducing the anxiety of the family.
What should parents know or understand about paediatric radiology?
Paediatric imaging is designed with the needs, safety and the specific conditions of children in mind. It is a tool for clarity, reassurance and early care. Our goal is to care for the child in their imaging journey and provide their doctors and families with clear answers they can trust.
How is paediatric radiology different from adult radiology?
The choice of the method of imaging is primarily based on how safe it is. The effects of radiation from X-rays and CT scans have a greater risk for a child than an adult – so ultrasound and MRI are preferred where possible.
Children are often afraid, unsettled because of pain and anxiety and may require sedation or anaesthesia to make them comfortable during the imaging process.
Paediatric imaging equipment, anaesthetic apparatus, monitoring and emergency equipment have to be adapted to children of different ages.
Do paediatric radiologist work directly with children and their parents?
Paediatric radiologists interact with the child and their caregivers far more often than adult radiologists interact with their patients. It is one of the most rewarding aspects of our work. Parents are generally more involved and can help the radiologist by confirming the history and symptoms. The radiologist in turn can reduce parent anxiety, explain the procedure and obtain consent where needed.
Please can you talk about radiation and safety in children – we know that one of the issues both parents and other adults have is safety and radiation?
Children have rapidly developing cells and tissues, often tightly packed together in small bodies and are considered to be 10-15 times more sensitive to radiation.
The guiding principle of all radiation safety is ‘ALARA,’ which stands for ‘As Low As Reasonably Achievable’ or as we say, ‘when benefit clearly outweighs the risk.’ Ultrasound and MRI do not use radiation and these should be used where possible.
What injuries are commonly seen in children that require imaging?
Common injuries include those from motor vehicle accidents and particularly pedestrian accidents, fractures from falls or playing sport and unfortunately, increasingly from child abuse which is sometimes first identified by the radiologist.
Children’s bones are different from adults and have areas where the bone is still growing. These are called growth plates. Injuries to the growth plates require special care because they can affect how a bone develops and this impacts the overall growth of the child.
Outside of injuries, paediatric imaging also looks at chest infections, abdominal pain, appendicitis, urinary tract problems and hip development in infants. Brain imaging may be used for seizures, headaches or developmental concerns. In essence, imaging can help us rule out serious causes quickly, which brings enormous reassurance to families.
Even for adults, radiology can be stressful and frightening – for children it must be worse. How are children supported during scans?
Radiographers and radiologists are trained to work gently and calmly with children and parents are encouraged to be involved and ask questions. For example, when a child needs to be sedated for an MRI, the parent will stay with them until they are asleep. When children feel safe, the scan is quicker, easier and more accurate. The team ensures the child is warm and comfortable and the environment is child friendly with toys and reading material to distract patients and to keep them happy and engaged.
What developments in paediatric radiology do you feel are the most important – especially over the 5 years?
Digital radiography allows for digital manipulation of images improving image quality and accuracy. Retakes are reduced so there is less radiation involved
Ultrasound machines have improved in-depth visualisation of body parts, disease processes and blood vessels
CT scanners are faster and offer lower radiation dose options. There are scanners which can scan the entire body of a child in less than a second. There is not even time to wriggle…
MRI imaging is developing at a galloping pace with faster scanning techniques and finer image detail
Functional MRI and the ability to do tissue sampling in cancer imaging, is opening many exciting new avenues.
The scope of interventional radiology techniques (treating not just diagnosing) is expanding rapidly to make less invasive treatment possible, with less complications for patients and much shorter recovery times. Paediatric radiology increasingly includes minimally invasive procedures (image-guided drainages, biopsies, nephrostomies, angiography), which can shorten hospital stays and reduce surgical burden.
As cosmetic procedures surge worldwide and beauty content increasingly dominates social media platforms, a new study from the Hebrew University of Jerusalem, suggests that for some women, cosmetic treatments may begin to resemble compulsive or addiction-like behaviour. The study, led by Dr Vera Skvirsky alongside Dr Uri Lifshin, Dr Dvora Shmulewitz, and Prof Mario Mikulincer from the Department of Psychology at Hebrew University of Jerusalem and the Israel Center for Addiction and Mental Health (ICAMH), examined what the researchers describe as “addictive cosmetic procedures use,” or ACPU, among women.
Published in the Journal of Health Psychology, the study surveyed 1614 women between the ages of 25 and 71, making it one of the larger investigations to date into the psychological patterns associated with repeated cosmetic treatments. The findings point to a phenomenon that researchers say deserves greater attention from both clinicians and the public. Among women who had undergone cosmetic procedures, 20% met the threshold for moderate to severe risk of addictive cosmetic procedure use during their lifetime.
More than 15% reported symptoms that were active within the past year.
Across the full sample, nearly 9% of women showed moderate to severe signs of problematic cosmetic procedure use. The researchers adapted an assessment tool originally based on the Diagnostic and Statistical Manual of Mental Disorders criteria for substance-related disorders. Participants were asked questions typically associated with addiction, including whether they had unsuccessfully tried to stop undergoing cosmetic procedures, felt compelled to continue despite negative consequences, or experienced cravings related to treatments.
While previous research has linked cosmetic procedures to body image concerns and body dysmorphic disorder, this study goes further by examining whether repeated cosmetic treatments can, in some cases, resemble a behavioural addiction. Unlike earlier studies, which often focused on patients at cosmetic clinics, this research surveyed more than 1600 women from the general population and found that addiction-like patterns were most strongly associated with the combination of low body esteem and problematic social media use.
While cosmetic procedures are often associated with confidence and self-expression, the researchers found that repeated engagement may also intersect with vulnerabilities tied to body image and digital behaviour. Women with lower body esteem were significantly more likely to report addictive patterns of cosmetic procedure use, particularly when paired with high levels of problematic social media use. Participants who reported problematic or excessive social media behaviour were especially vulnerable if they also struggled with dissatisfaction about their appearance.
The researchers also observed smaller associations between addictive cosmetic procedure use and lower feminist attitudes, lower attachment security, and more negative attitudes toward aging, though those relationships were less consistent once multiple factors were analysed together.
The findings arrive amid a sharp global increase in cosmetic procedures. According to international estimates cited in the paper, cosmetic interventions worldwide rose by roughly 40% between 2019 and 2023.
The researchers stressed that the study does not argue cosmetic procedures are inherently harmful. Rather, they say the results suggest that in some cases, repeated engagement may take on characteristics similar to behavioral addictions already recognized in mental health research.
“Cosmetic procedures have become deeply normalised in many societies, and for many people they may be a positive experience,” said the researchers. “But our findings suggest that for a meaningful minority, the behaviour may begin to resemble other compulsive patterns we see in addiction research, especially when low body esteem and problematic social media use are involved.”
The researchers cautioned that the study was cross-sectional, meaning it cannot determine cause and effect. It remains unclear whether problematic social media use contributes to addictive cosmetic behaviour, whether cosmetic procedures themselves influence body image and online engagement, or whether other psychological factors drive both.
“Always finish your antibiotics” is no longer considered medical best practice for all conditions. This may come as a surprise for many patients.
A new study has found that almost 90% of Americans believe that it’s always best to take the full course of antibiotics, even when you feel better – consistent with long-running but now outdated health campaigns. The reality is more complicated. Sometimes shorter courses are safer, and sometimes longer courses are best.
The survey demonstrates a need for better communication between doctors and patients about what’s healthiest.
“Historically, there was very strong guidance by major health organisations and clinicians that you must always finish the course,” says Alistair Thorpe, PhD, research assistant professor of population health sciences at University of Utah Health and first author on the study. “Now, we’re seeing a growing body of evidence saying that that is not always the case. And oftentimes, shorter durations of antibiotics are as effective and safe as longer alternatives.”
The research team surveyed 1475 people across the country on their attitudes about antibiotic course length. They asked participants whether they’d feel more comfortable taking a three- to five-day course of antibiotics if they had pneumonia, as is recommended by current guidelines, or if they’d prefer an antibiotic course of a week or more, which is recommended by outdated guidelines. While shorter courses of antibiotics are as effective and safer for pneumonia than longer ones, about 60% of people said they’d rather take the longer course.
One of the main reasons people gave for preferring longer antibiotic courses was that they had been told to “always finish their antibiotic course” – 88% of respondents had heard of, and agreed with, this common mantra. Most had been told this by their clinician, and many had also heard it via a public health campaign.
A strong body of scientific evidence shows that, for many common infections, shorter courses of antibiotics work as well as longer courses and are less likely to cause side effects. Still, there are some cases, like tuberculosis, where longer courses are most effective.
The study authors suggest that doctors and public health campaigns use several evidence-informed strategies to better communicate the complex reality of antibiotic course length – for instance, avoiding overly simplistic claims that either shorter or longer courses are universally better, and acknowledging that as scientific evidence accumulates over time, health recommendations can change.
To patients who have been prescribed antibiotics, Thorpe recommends having an open conversation with your doctor about the appropriate course length and adherence plan to get health advice that’s specific to your situation.
“Discuss with your clinician what the right duration is for you and when the right time is to stop your course,” Thorpe says. “Getting advice directly from a clinician on a one-to-one basis about what is most appropriate for you in that situation is the right way to go.”
Thorpe emphasises that the changing recommendations are a positive outcome of increasing knowledge.
“Evidence is growing and guidance is evolving on antibiotic use, which is a normal process and a good sign that we are working to improve how we provide care,” he says. “Our knowledge about how best to use antibiotics has changed, but it has changed because we’re learning more, and it’s important that we make sure we are communicating this well to the public.”
This illustration depicts a 3D computer-generated image of a group of Gram-positive, Streptococcus pneumoniae bacteria. The artistic recreation was based upon scanning electron microscopic (SEM) imagery. Credit: CDC on Unsplash
Exposure to a mild or symptom-free strain of Streptococcus pyogenes (Strep A) can trigger the body’s immune response and naturally build protection, potentially solving a nearly 100-year-old mystery of immunity.
New Griffith University research, with the help of clinical scientists from the Murdoch Children’s Research Institute (MCRI), investigated how immunity developed over time as infection rates declined with age, suggesting progressive immune protection.
Strep A is a common bug which can cause painful tonsillitis and school sores in young children and teenagers.
If untreated, it can lead to rheumatic fever, rheumatic heart disease and kidney disease, conditions for which First Nations peoples in Australia suffer some of the highest reported rates in the world.
It is estimated 10-20% of children across Australia develop Strep A tonsillitis each year, with some getting the disease multiple times and requiring surgical removal of the tonsils.
By adulthood, most people have developed immunity to Strep A even though most will have only had a few bouts of tonsillitis in their life.
Senior author Associate Professor Manisha Pandey from Griffith’s Institute for Biomedicine and Glycomics said: “How this might happen has never been adequately explained as there are more than 250 distinct strains of Strep A, and immunity to one strain does not provide protection against the others.”
“To address this question, the team investigated the development of immunity using samples collected through a controlled human infection study conducted by MCRI researchers who administered a dose of Strep A which was high enough to cause tonsillitis in most, but not all.
“All participants were treated with antibiotics, regardless.
“Surprisingly, antibodies from the asymptomatic participants not only bound strongly to the exposed strain of bacteria but were able to kill the Strep A germ in a murine model of tonsillitis.”
The findings demonstrated both symptomatic and asymptomatic participants developed robust immune responses to the Strep A strain they were exposed to.
Dr Ailin Lepletier, said it had been known for many years that multiple strains of Strep A were circulating in the community and up to 30% of people had Strep A in their throats without getting sick.
“But we didn’t know this may be providing immunity to these strains, causing silent infections so that by adulthood, we have accumulated antibodies to fight most strains,” she said.
“While a person may not feel sick, their body can still learn how to fight the bacteria and remember it from childhood into adulthood.”
Professor Michael Good AO, said this mechanism of natural immunity may also apply to other common infections.
“While highly intriguing for Strep A, it is unlikely to provide a strategy for a vaccine as it would be necessary to vaccinate against each of the 250 strains,” he said.
Dr Anna Calkin, National Manager of Research at the Heart Foundation, said the findings came from research made possible through approximately $2.79 million in Heart Foundation funding.
“The findings highlight the importance of investing in research that addresses conditions disproportionately affecting First Nations peoples,” Dr Calkin said.
“By improving our understanding of how natural immunity to Strep A develops, this work may contribute to future efforts to prevent rheumatic heart disease and close longstanding health gaps.”
The research team included Griffith University Professor Daniel Kolarich, plus MCRI researchers Associate Professor Joshua Osowicki and Professor Andrew Streer.
The paper ‘Subclinical exposure to Streptococcus pyogenes drives the development of long-lived homologous immunity’ has been published in Nature Communications.
Study shows that combining the two compounds with conventional treatment may be a promising alternative, reducing the need for antibiotics.
Photo by Caroline Lm on Unsplash
By Fernanda Bassette | Agência FAPESP – A combination of omega-3 and low-dose acetylsalicylic acid (ASA) produced results comparable to antibiotics in treating severe periodontitis. This conclusion is based on a study conducted by researchers affiliated with Albert Einstein Israelite Hospital, Guarulhos University (UNG), the University of Taubaté (UNITAU), and the Ribeirão Preto School of Dentistry at USP (FORP-USP) in Brazil, as well as Harvard University in the United States. The findings were published in May in the Journal of Periodontology and suggest a promising therapeutic alternative for some patients by reducing the need for antibiotics. These findings are particularly relevant in the context of growing global concern about bacterial resistance.
Supported by FAPESP (projects 20/05874-2 and 20/05875-9), the study followed 109 patients with advanced periodontitis over the course of one year. Advanced periodontitis is a chronic inflammatory disease caused by the accumulation of bacteria beneath the gums, affecting the tissues that support the teeth. If left untreated, it can lead to tooth mobility, bone loss, and even tooth loss.
“Patients with severe disease have very deep pockets, which act as reservoirs for bacteria associated with the disease. It’s a very challenging condition to treat,” says dental surgeon Nídia Cristina Castro dos Santos, the first author of the study and a professor and researcher at Einstein.
For the study, participants were randomly assigned to one of four groups. All underwent subgingival instrumentation – popularly known as scaling – which is considered the standard treatment for periodontitis. However, they received different complementary therapies.
The control group received placebos of the antibiotics, omega-3, and ASA in capsules identical to those used for the active treatments. A second group received a combination of the antibiotics metronidazole and amoxicillin, considered the therapy with the strongest scientific evidence for severe cases of the disease, administered three times a day for 14 days. The third group took three grams per day of omega-3, in addition to a daily dose of aspirin for six months. The fourth group received a combination of the two strategies simultaneously: antibiotics for two weeks and the omega-3 and ASA protocol for six months. Participants were reevaluated after three, six, and twelve months.
By the end of the follow-up period, about 58% of patients who were treated with antibiotics had met the researchers’ established clinical goal of having no more than four remaining deep periodontal pockets. Among those who received omega-3 and ASA, the percentage was virtually the same: 57.7%. In contrast, in the group that received only scaling and a placebo, the rate was 23.1%. Combining the two strategies, antibiotics and supplementation, didn’t provide any additional benefits.
“The use of antibiotics isn’t considered the gold standard of treatment. Although metronidazole and amoxicillin yield good results in the most severe cases, their use should be evaluated on a case-by-case basis due to risks related to bacterial resistance and possible adverse effects,” says Castro dos Santos.
These results reinforce a line of research that has been underway for some time. In a previous study also supported by FAPESP and published in the journal Scientific Reports, the researchers observed that omega-3 supplementation reduced inflammation and bone loss caused by periodontal disease in rats, especially when combined with physical exercise. Although the study was conducted in an animal model, it already indicated the nutrient’s potential in inflammatory processes related to oral health (read more at agencia.fapesp.br/54990).
According to Castro, omega-3 differs from traditional anti-inflammatory drugs in that it contributes to the production of molecules involved in the natural resolution of inflammation and tissue repair, rather than blocking certain inflammatory pathways. Low-dose ASA, on the other hand, was used because it enhances the formation of these mediators. The researchers hypothesised that this strategy would help the body better control the chronic inflammatory process characteristic of periodontitis.
“We imagined that the combination of antibiotics and omega-3 would be most effective in controlling periodontitis in these patients. We also believed that the results for the group that used omega-3 with ASA would be slightly lower than those for the antibiotic group. The result was surprising because the two therapies performed very similarly, paving the way for it to become a treatment option for these patients,” says Castro.
Another finding that caught the researchers’ attention was the persistence of the observed benefits. Even six months after supplementation ended, patients continued to show results similar to those recorded at the end of treatment. According to Castro, this suggests that modulating the inflammatory response may produce lasting effects, although the mechanisms involved are still being investigated.
For dental surgeon Magda Feres, the lead author of the study and a full professor at the Harvard School of Dental Medicine and the Graduate Program in Dentistry at UNG, the results suggest that modulating the inflammatory response may represent a viable alternative for selected patients. “The combination of omega-3 and low-dose aspirin achieved clinical benefits comparable to those of the metronidazole and amoxicillin protocol, opening up a real alternative for those who can’t take antibiotics, especially patients with allergies or intolerance to these medications,” she says.
The researcher adds that the results are especially significant in light of growing concerns about antibiotic resistance, which is considered one of the main threats to global public health. “Demonstrating that it’s possible to treat severe periodontitis by modulating the body’s own response is new and relevant information that helps preserve antibiotics for when they are truly indispensable,” says Feres.
However, the authors emphasise that the results do not imply an immediate change in clinical practice. The study was conducted on patients without significant systemic or oral diseases. Further research is needed to confirm the findings in different populations and to identify which groups can truly benefit from each approach.
According to Feres, some of the answers may come from microbiological analyses currently underway. These analyses are investigating how these therapies influence the composition of bacteria in periodontal pockets. Preliminary data suggest a reduction in disease-associated species and an increase in microorganisms related to gum health. “It’s an important step forward, but not the end of the story. Therefore, the message is one of cautious optimism: we have a promising, scientifically plausible alternative to antibiotics in select cases. Routine replacement will require more evidence,” she concludes.
The article “Immunomodulators, associated or not with systemic antibiotics, to treat periodontitis: A 1-year multicenter, placebo-controlled, double-blind, randomized clinical trial” can be read at aap.onlinelibrary.wiley.com/doi/10.1002/jper.70081.
