Dr Siya Mjwara, founder of the AskDrSiya Psychotherapy and Wellness Coaching Practice, has just launched the first online recovery school in South Africa. The Recovery School will support individuals in identifying and confronting their challenges and businesses in developing and implementing wellness solutions in order to reduce absenteeism and improve productivity, as well as overall workplace culture. Dr Mjwara will provide a supportive and transformative environment where healing and growth are possible for all.
She says, “We create a virtual sanctuary where individuals can find healing, empowerment and community support. We strive to cultivate a space where you can reclaim your life and thrive, no matter what you’ve been through.
“After 17 years of working with individuals, couples and families, I can say, without a doubt, that we South Africans are a traumatised nation. Unfortunately, many of us are completely unaware of how our traumas are negatively impacting our lives, as well as the decisions we take on a daily basis. Recently, I’ve been hearing people say, “avoid dating anyone who has never been to therapy”. This is an indication that more of us are recognising how unresolved trauma can negatively impact our relationships.
“Besides our personal experiences, such as childhood trauma, relationship, family and workplace traumas, many of us are still dealing with the effects of intergenerational trauma.
This is part of the background that informs the vision for The Recovery School. My wish is for individuals to not only cope with trauma, but also to be able to thrive and become the best version of themselves. It takes courage to face your fears and begin living authentically, and you don’t need to walk the journey alone.
The school’s programmes are primarily designed to enable individuals to
Rediscover themselves
Break free from limiting beliefs
Cultivate resilience
Forge meaningful connections
Live fully in the present
Achieve their goals
Dr Mjwara BSW Hons (UWC), MA FCS (UWC), Dphil (UNIZULU) can be contacted on Ask@DrSiya.co.za or 079 772 1950.
A new study finds that the modest weight loss from taking metformin is attributable to an appetite-suppressing molecule that is abundant after exercise
Photo by I Yunmai on Unsplash
An “anti-hunger” molecule produced after vigorous exercise is responsible for the moderate weight loss caused by the diabetes medication metformin, according to a new study in mice and humans. The anti-hunger molecule, lac-phe, was discovered by Stanford Medicine researchers in 2022.
The finding, made jointly by researchers at Stanford Medicine and at Harvard Medical School and published in Nature Metabolism, further cements the critical role the molecule, called lac-phe, plays in metabolism, exercise and appetite. It may pave the way to a new class of weight loss drugs.
“Until now, the way metformin, which is prescribed to control blood sugar levels, also brings about weight loss has been unclear,” said Jonathan Long, PhD, an assistant professor of pathology. “Now we know that it is acting through the same pathway as vigorous exercise to reduce hunger. Understanding how these pathways are controlled may lead to viable strategies to lower body mass and improve health in millions of people.”
Many people with diabetes who are prescribed metformin lose around 2% to 3% of their body weight within the first year of starting the drug. Although this amount of weight loss is modest when compared with the 15% or more often seen by people taking semaglutide, the discoveries that led to those drugs also grew from observations of relatively minor, but reproducible, weight loss in people taking first-generation versions of the medications.
Post-workout appetite loss
When Long and colleagues at Baylor University discovered lac-phe in 2022, they were on the hunt for small molecules responsible for curtailing hunger after vigorous exercise. What they found was a mishmash of lactate and an amino acid called phenylalanine. They dubbed the hybrid molecule lac-phe and went on to show that it’s not only more abundant after exercise but it also causes people (as well as mice and even racehorses) to feel less hungry immediately after a hard workout.
“There is an intimate connection between lac-phe production and lactate generation,” Long said. “Once we understood this relationship, we started to think about other aspects of lactate metabolism.”
Metformin was an obvious candidate because as it stimulates the breakdown of glucose (thus reducing blood sugar levels) it can trigger the generation of lactate.
The researchers found that obese laboratory mice given metformin had increased levels of lac-phe in their blood. They ate less than their peers and lost about 2 grams of body weight during the nine-day experiment.
Long and his colleagues also analysed stored blood plasma samples from people with Type 2 diabetes before and 12 weeks after they had begun taking metformin to control their blood sugar. They saw significant increases in the levels of lac-phe in people after metformin compared with their levels before treatment. Finally, 79 participants in a large, multi-ethnic study of atherosclerosis who were also taking metformin had significantly higher levels of lac-phe circulating in their blood than those who were not taking the drug.
“It was nice to confirm our hunch experimentally,” Long said. “The magnitude of effect of metformin on lac-phe production in mice was as great as or greater than what we previously observed with exercise. If you give a mouse metformin at levels comparable to what we prescribe for humans, their lac-phe levels go through the roof and stay high for many hours.”
Further research revealed that lac-phe is produced by intestinal epithelial cells in the animals; blocking the ability of mice to make lac-phe erased the appetite suppression and weight loss previously observed.
Finally, a statistical analysis of the people in the atherosclerosis study who lost weight during the several-year study and follow-up period found a meaningful association between metformin use, lac-phe production and weight loss.
“The fact that metformin and sprint exercise affect your body weight through the same pathway is both weird and interesting,” Long said. “And the involvement of the intestinal epithelial cells suggests a layer of gut-to-brain communication that deserves further exploration. Are there other signals involved?”
Long noted that, while semaglutide drugs are injected into the bloodstream, metformin is an oral drug that is already prescribed to millions of people. “These findings suggest there may be a way to optimize oral medications to affect these hunger and energy balance pathways to control body weight, cholesterol and blood pressure. I think what we’re seeing now is just the beginning of new types of weight loss drugs.”
There is a surprising dearth of research about how breast cancer cells can go dormant, spread and then resurface years or even decades later, according to a new review of in vitro breast cancer studies conducted by researchers at the University of Massachusetts Amherst.
“[Our review found that] less than 1% of all these studies that combine cells with designer environments look at dormancy,” says Shelly Peyton, Provost Professor of Chemical Engineering. “It’s not enough. We just don’t understand what’s happening – and it’s killing patients.”
Breast cancer dormancy is a phenomenon in which breast cancer cells metastasise (typically to the liver, lungs, brain or bones) but don’t grow. “They’re not detectable or symptomatic tumours,” Peyton explains. “A patient will have their primary tumour removed and appear to be disease-free for months, years, even decades. And for reasons we don’t understand, something changes about the environment that causes those cells to start regrowing, and then you have a deadly metastasis.”
Patients with metastatic breast cancer have a 30% five-year survival rate, compared to a 99% survival rate for localised breast cancer. “Early detection is key, particularly in the Western world,” says Peyton. “You can have lumpectomies, radiation, small surgeries. And women can survive. It’s when that cancer has spread that it becomes much harder to treat.”
This relapse in distant organs impacts 40% of early-stage breast cancer patients, and breast cancer dormancy is a contributing factor. But while metastasis has known biomarkers, dormant cancer cells are very hard to identify.
“When you have a single dormant breast cancer cell that’s hiding in a distant tissue, it’s really hard to detect that,” says Nate Richbourg, lead author on the paper and postdoctoral researcher in the Peyton Lab. “And you don’t want to do an invasive biopsy or prescribe toxic chemotherapy for something that might not be a problem.”
With these challenges in mind, the review, published in Science Advances, aimed to identify gaps in the research, particularly focusing on in vitro studies, or research using benchtop-model environments instead of animal models or humans. In vitro studies allow for the precise control of the environment, which Peyton’s research group says may play a deciding role in whether a cell remains dormant or reactivates into a deadly metastatic tumor.
“What can we control in these artificial environments that will give us insight into how breast cancer dormancy happens, and what we can do to treat it as well?” Richbourg asks, describing the importance of in vitro modelling. “When we create this artificial dormancy, we can see how many of those cells could turn back into proliferating and potentially deadly cells.”
Their review highlights just how complex the role of the environment is. “If you have a [breast cancer] cell somewhere in the bone marrow, you’re going to have other cells there, the physical factors in your environment, and the biochemical factors,” Richbourg gives as an example. “We try to use reductive models to separate the thing that is influencing this behaviour. But what we’re seeing is that everything works together to create this breast cancer dormancy effect. The better we can create models that capture all that nuance, the better we’re going to be able to understand it.”
For Peyton, their work is also a call to action. “The paper is calling out to the field that we need to do more,” she says. This includes being more creative with the materials that already exist and developing new materials; identifying ways to model the decades-long progression of dormancy that is impossible to recreate in a single study; and expanding the diversity of cell lines used for research (Richbourg points out that many of the studies they reviewed used the same cell line, MDA-MB-231, derived from one 40-to-50-year-old white woman).
Finally, the researchers have an eye to the ultimate goal: better treatments to save patients. “We see that that there are some clinical trials that are happening that are derived from some of those in vitro models,” says Ninette Irakoze, graduate student in the Peyton Lab. “The paper gives hope that, with more development of these in vitro models, eventually we could find treatments to eradicate dormant cancer.”
One of the most touted promises of medical artificial intelligence tools is their ability to augment human clinicians’ performance by helping them interpret images such as X-rays and CT scans with greater precision to make more accurate diagnoses.
But the benefits of using AI tools on image interpretation appear to vary from clinician to clinician, according to new research led by investigators at Harvard Medical School, working with colleagues at MIT and Stanford.
The study findings suggest that individual clinician differences shape the interaction between human and machine in critical ways that researchers do not yet fully understand. The analysis, published in Nature Medicine, is based on data from an earlier working paper by the same research group released by the National Bureau of Economic Research.
In some instances, the research showed, use of AI can interfere with a radiologist’s performance and interfere with the accuracy of their interpretation.
“We find that different radiologists, indeed, react differently to AI assistance – some are helped while others are hurt by it,” said co-senior author Pranav Rajpurkar, assistant professor of biomedical informatics in the Blavatnik Institute at HMS.
“What this means is that we should not look at radiologists as a uniform population and consider just the ‘average’ effect of AI on their performance,” he said. “To maximize benefits and minimize harm, we need to personalize assistive AI systems.”
The findings underscore the importance of carefully calibrated implementation of AI into clinical practice, but they should in no way discourage the adoption of AI in radiologists’ offices and clinics, the researchers said.
Instead, the results should signal the need to better understand how humans and AI interact and to design carefully calibrated approaches that boost human performance rather than hurt it.
“Clinicians have different levels of expertise, experience, and decision-making styles, so ensuring that AI reflects this diversity is critical for targeted implementation,” said Feiyang “Kathy” Yu, who conducted the work while at the Rajpurkar lab with co-first author on the paper with Alex Moehring at the MIT Sloan School of Management.
“Individual factors and variation would be key in ensuring that AI advances rather than interferes with performance and, ultimately, with diagnosis,” Yu said.
AI tools affected different radiologists differently
While previous research has shown that AI assistants can, indeed, boost radiologists’ diagnostic performance, these studies have looked at radiologists as a whole without accounting for variability from radiologist to radiologist.
In contrast, the new study looks at how individual clinician factors – area of specialty, years of practice, prior use of AI tools – come into play in human-AI collaboration.
The researchers examined how AI tools affected the performance of 140 radiologists on 15 X-ray diagnostic tasks – how reliably the radiologists were able to spot telltale features on an image and make an accurate diagnosis. The analysis involved 324 patient cases with 15 pathologies: abnormal conditions captured on X-rays of the chest.
To determine how AI affected doctors’ ability to spot and correctly identify problems, the researchers used advanced computational methods that captured the magnitude of change in performance when using AI and when not using it.
The effect of AI assistance was inconsistent and varied across radiologists, with the performance of some radiologists improving with AI and worsening in others.
AI tools influenced human performance unpredictably
AI’s effects on human radiologists’ performance varied in often surprising ways.
For instance, contrary to what the researchers expected, factors such how many years of experience a radiologist had, whether they specialised in thoracic, or chest, radiology, and whether they’d used AI readers before, did not reliably predict how an AI tool would affect a doctor’s performance.
Another finding that challenged the prevailing wisdom: Clinicians who had low performance at baseline did not benefit consistently from AI assistance. Some benefited more, some less, and some none at all. Overall, however, lower-performing radiologists at baseline had lower performance with or without AI. The same was true among radiologists who performed better at baseline. They performed consistently well, overall, with or without AI.
Then came a not-so-surprising finding: More accurate AI tools boosted radiologists’ performance, while poorly performing AI tools diminished the diagnostic accuracy of human clinicians.
While the analysis was not done in a way that allowed researchers to determine why this happened, the finding points to the importance of testing and validating AI tool performance before clinical deployment, the researchers said. Such pre-testing could ensure that inferior AI doesn’t interfere with human clinicians’ performance and, therefore, patient care.
What do these findings mean for the future of AI in the clinic?
The researchers cautioned that their findings do not provide an explanation for why and how AI tools seem to affect performance across human clinicians differently, but note that understanding why would be critical to ensuring that AI radiology tools augment human performance rather than hurt it.
To that end, the team noted, AI developers should work with physicians who use their tools to understand and define the precise factors that come into play in the human-AI interaction.
And, the researchers added, the radiologist-AI interaction should be tested in experimental settings that mimic real-world scenarios and reflect the actual patient population for which the tools are designed.
Apart from improving the accuracy of the AI tools, it’s also important to train radiologists to detect inaccurate AI predictions and to question an AI tool’s diagnostic call, the research team said. To achieve that, AI developers should ensure that they design AI models that can “explain” their decisions.
“Our research reveals the nuanced and complex nature of machine-human interaction,” said study co-senior author Nikhil Agarwal, professor of economics at MIT. “It highlights the need to understand the multitude of factors involved in this interplay and how they influence the ultimate diagnosis and care of patients.”
People with low income or education levels may benefit from screening for alcohol-related conditions
Photo from Pixabay CC0
Men and women with lower income or education levels are more likely to develop medical conditions related to alcohol abuse compared to similar individuals with a higher socioeconomic status. Alexis Edwards of Virginia Commonwealth University, US, and colleagues report these findings in a new study published March 19th in the open access journal PLOS Medicine.
The World Health Organization estimates that harmful alcohol use accounts for 5.1% of the global burden of disease and injury worldwide, and results in three million deaths each year. Excessive alcohol consumption can also take an economic toll. Previous studies have identified links between a person’s socioeconomic status and alcohol use, but currently it is unclear how an individual’s social class impacts their future risk of acquiring alcohol-related medical conditions, like alcoholic liver disease.
In the new study, researchers used a model that follows people over time to estimate their risk of developing medical conditions from alcohol abuse using two indicators for socioeconomic status: income and education level. The researchers analysed data from more than 2.3 million individuals in a Swedish database to show that both men and women with a lower income or education level were more likely to develop these conditions. The associations held true, even when researchers controlled for other relevant factors, such as marital status, history of psychiatric illness and having a genetic predisposition to abuse alcohol.
The new findings are important for understanding which populations are most likely to suffer from medical conditions resulting from alcohol abuse, and contribute to a growing body of literature on health disparities that stem from socioeconomic factors. The researchers recommend that individuals with lower income or education levels might warrant additional screening by clinicians to evaluate their alcohol consumption and identify related conditions.
The authors add, “Among individuals with an alcohol use disorder, those with lower levels of education or lower incomes are at higher risk for developing an alcohol-related medical condition, such as cirrhosis or alcoholic cardiomyopathy. Additional screening and prevention efforts may be warranted to reduce health disparities.”
World Water Day 2024 resonates deeply in South Africa, where access to clean water remains a significant struggle for many. Recent protests sparked by water scarcity highlight the urgency of this issue, reminding us that water is not just a resource, but a fundamental human right.
This year’s theme, “Leveraging Water for Peace,” calls for unity and recognition of water’s universal significance. As we face the reality of inequality, it is important for us to renew our commitment to equitable water access for all, by fostering dialogue and taking action that is deeply rooted in empathy and ubuntu. Every drop should bring not only sustenance, but also the promise of peace and prosperity.
Connecting local struggles to global issues
South Africa’s water challenges mirror broader global concerns. Ranked a worrying fifth in global water risk, we share these strained resources with our neighbours. This interconnectedness cannot be ignored, and neglecting this truth is likely to fuel regional tensions. Instead, by highlighting our shared challenge, we can strengthen our position and emphasise the need for collaborative solutions. The depth of South Africa’s water scarcity isn’t just a domestic issue – it’s a regional one. Our ranking among the world’s worst puts us alongside stressed neighbours, suggesting the potential for cross-border conflict over shared resources.
Internally, competition between formal and informal users already creates friction, amplified by seasonal rainfall and inadequate infrastructure. To make matters worse, poor sanitation further contaminates water sources, escalating the crisis. The Institute for Security Studies’ Public Violence and Protest Monitor shows that in South Africa, community frustrations with water and sanitation delivery failures resulted in 585 cases of public protest between January 2013 and April 2021, of which incidents, 65% escalated into violent protests.
Aligning with the water rights framework
Although South Africa boasts a progressive water rights framework, our efforts must align with this framework, ensuring that the fight for water equity remains central to our pursuit of peace. Empowering communities with access to clean drinking water and sanitation and upholding water rights are essential steps toward conflict prevention.
Raising awareness is essential, but tangible action holds the key to progress. Businesses can play an important role in acknowledging South Africa’s water scarcity and investing in corporate social responsibility (CSR) projects that focus on addressing sanitation and water quality in the communities in which they operate. From an individual perspective, it is important that each citizen does their part to conserve water, while supporting organisations that work on improving water access, and raising awareness of related issues within their communities. At a government level, it is critical to prioritise infrastructure maintenance, address sewage contamination, and collaborate with regional partners and industries on sustainable water management strategies, to prevent civil unrest by addressing water equity issues.
Tapping into Ubuntu and empathy
Ubuntu, the South African philosophy of shared humanity, encourages us to understand and share the experiences of others. Cultivating empathy across communities, businesses, and government fosters inclusive dialogue and collaborative solutions. With the principles of ubuntu in mind, it is critical to address sewage contamination to preserve our scarce water resources. It is essential for municipalities and provincial governments to invest in infrastructure upgrades to reduce water loss and improve delivery. Businesses operating within the sanitation and water treatment sectors have the potential to empower communities by providing filtration and treatment solutions for local water sources. Moreover, the broader private sector can contribute to corporate social responsibility (CSR) initiatives aimed at enhancing sanitation and water quality in vulnerable communities.
Amplifying voices through collaborative communication
Empowering community voices is vitally important. This can be achieved through increased awareness on water scarcity and its impact, as well as by supporting local initiatives that improve water access and quality. Based on the principles of ubuntu, we must advocate for the facilitation of open communication between communities, businesses, and government. Water advocacy groups such as South African Water Caucus (SAWC), and water project NGOs such as the Mvula Trust must continue to advocate for increased funding for water and sanitation projects, by holding the government accountable for meeting water rights and supporting regional cooperation on water management.
Uniting for peace and prosperity
In this way, individuals, organisations, and governments can turn the promise of World Water Day into tangible progress by working together. In prioritising equitable water access, addressing underlying challenges, and fostering collaboration, we can build a future where every drop flows towards peace, not conflict. Remember, water scarcity and strife does not have to be our inevitable future. Through collective action and commitment, we can ensure that this precious resource serves as a bridge to peace and prosperity for all.
