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What Are the Purple Dots on Michael Phelps? Cupping Has An Olympic Moment

Michael Phelps competed in the final of the men’s 4x100-meter freestyle relay during the 2016 Summer Olympics with some strange purple dots on his arm and back.

Michael Phelps competed in the final of the men’s 4×100-meter freestyle relay during the 2016 Summer Olympics with some strange purple dots on his arm and back. Matt Slocum/Associated Press

Have you been wondering why swimmer Michael Phelps and other Olympians are sporting deep-purple circles on their limbs and midsections?

While it may look like the athletes have been in a bar fight, the telltale purple dots actually are signs of “cupping,” an ancient Chinese healing practice that is experiencing an Olympic moment.

In cupping, practitioners of the healing technique — or sometimes the athletes themselves — place specialized, round circular cups on the skin. Then they use either heat or an air pump to create suction between the cup and the skin, pulling the skin slightly up and away from the underlying muscles.

The suction typically only lasts for a few minutes, but it’s enough time to cause the capillaries just beneath the surface to rupture, creating the circular, photogenic bruises that have been so visible on Mr. Phelps as well as members of the U.S. men’s gymnastics team. If the bruising effect looks oddly familiar, it’s because it’s the same thing that happens when someone sucks on your neck and leaves a hickey.

Thanks @arschmitty for my cupping today!!! #mpswim #mp @chasekalisz

A photo posted by Michael Phelps (@m_phelps00) on Sep 10, 2015 at 12:29pm PDT

Physiologically, cupping is thought to draw blood to the affected area, reducing soreness and speeding healing of overworked muscles. Athletes who use it swear by it, saying it keeps them injury free and speeds recovery. Mr. Phelps, whose shoulders were dotted with the purple marks as he powered his 4×100 freestyle relay team to a gold medal Sunday, featured a cupping treatment in a recent Under Armour video. He also posted an Instagram photo showing himself stretched on a table as his teammate, fellow Olympian swimmer Allison Schmitt, placed several pressurized cups along the back of his thighs. “Thanks for my cupping today!” he wrote.

While there’s no question athletes and many coaches and trainers believe in the treatment, there’s not much science to determine whether cupping offers a real physiological benefit or whether the athletes simply are enjoying a placebo effect.

One 2012 study of 61 people with chronic neck pain compared cupping to a technique called progressive muscle relaxation, or P.M.R., during which a patient deliberately tenses his muscles and then focuses on relaxing them. Half the patients used cupping while the other half used P.M.R. Both patient groups reported similar reductions in pain after 12 weeks of treatment. Notably, the patients who had used cupping scored higher on measurements of well-being and felt less pain when pressure was applied to the area. Even so, the researchers noted that more study is needed to determine the potential benefits of cupping.

Another experiment involving 40 patients who suffered from knee arthritis found that people who underwent cupping reported less pain after four months compared to arthritis sufferers in a control group who were not treated. But the cupped group knew they were being treated — it’s not easy to blind people about whether a suction cup is being attached to their leg or not — and so the benefits might have been due primarily to a placebo effect.

Still, a placebo effect can be beneficial, and for athletes at the Olympic level any legal edge, however tenuous, may be worth a few eye-catching bruises.

A few years ago Denver Broncos player DeMarcus Ware posted a photo on Instagram showing his back covered with 19 clear cups as a therapist held a flame used to heat the cup before placing it on the skin. Celebrities including Jennifer Aniston and Gwyneth Paltrow have also been photographed with cupping marks on their skin.

Last year, Swimming World magazine noted that some college programs had begun using cupping therapy as well as former Olympian Natalie Coughlin, who has posted a number of photos of herself undergoing the treatment.

U.S. gymnast Alexander Naddour was sporting the purple dots during the men’s qualifying rounds on Saturday in Rio. He told USA Today that he bought a do-it-yourself cupping kit from Amazon. “That’s been the secret that I have had through this year that keeps me healthy,” Mr. Naddour told USA Today. “It’s been better than any money I’ve spent on anything else.”

In a Hospital, Health Care Until the Clock Runs Out

Jordin Isip

A 37-year-old man was admitted to a hospital several months ago with seizures. His M.R.I. was frightening, showing a brain full of holes. Medication controlled the seizures, but the drugs were just Band-Aids on a big, undiagnosed problem.

The patient was not particularly alarmed (which in itself was fairly alarming). His brain was riddled with infection or tumor, but all he wanted to do was get out of the hospital and go back to his life.

By all accounts, it was a troubled, isolated, drug-ridden existence in a fleabag hotel, a life free from anything resembling regular medical care. Still, he was ready to be on his way.

The only way to diagnose his problem was a brain biopsy. “Anything to get out of here,” the patient said, and signed a consent form.

The biopsy was performed uneventfully, and small specimens of the abnormal tissue were sent to the lab for a diagnosis. That was on a Friday.

By Monday, everyone was ready for an answer. By Tuesday, it was hard to tell who was more impatient, the patient pacing the hallways or his doctors pestering the lab.

On Wednesday, with the specimens still being processed and another weekend looming, the case had attracted the notice of the administrators known in hospital vernacular as the discharge police.

Within minutes, it seemed, the patient was out of that expensive acute-care bed and on his way to the subway, clutching a thick sheaf of instructions, appointment slips and prescriptions, still without a diagnosis, brain full of holes, but free at last.

Your reaction to this story will almost certainly depend on your understanding of the word “hospital.” The word has connotations of care and comfort dating to the Middle Ages, but its meaning is changing so quickly that even the people who work in one cannot agree on what it is.

Once hospitals were where you found a doctor when you suddenly needed one; now doctors are all over the place, from big-box stores to storefront clinics. Hospitals were where you were headed if you were very sick; now you can heed your insurer’s pleas and choose a cheaper emergency center instead.

Hospitals were where you stayed when you were too sick to survive at home; now you go home anyway, cobbling together your own nursing services from friends, relatives and drop-in professionals.

Once hospitals were where you were kept if you were a danger to yourself or others. They still serve this function — although, perhaps, the standards for predicting these dire outcomes have tightened up quite a bit.

These days, it may be easier to define hospitals by what they are not. They are not places for the sick to get well, not unless healing takes place in the brief interval of time that makes the stay a compensated expense.

Hospitals are definitely not places for unusual medical conditions to be figured out, not if the patient is well enough to leave.

Like the hospital, the patient with holes in his brain was also a puzzle of ill-defined words. He was very sick, yet not all that sick. Whether he could survive at home depended strongly on the meaning of “survive” and “home.”

He was well enough to be an outpatient, but he was far from well, and had never managed to be a successful outpatient. He was not suicidal, at least not in any immediate sense. The big holes in his brain made it even less likely that he would adhere to the complicated instructions for his new outpatient life.

But then again, a hospital is a place where hope reliably springs eternal.

The patient’s young doctors certainly hoped for the best for him. They gave him a slew of prescriptions, and expressed their hopes that he would take the pills and keep his far-flung appointments, at one of which his brain biopsy report would be retrieved and his medications adjusted accordingly.

Not so long ago, the multiple ambiguities of this patient’s case would have kept him in the hospital until at least some of the uncertainty had been resolved. In fact, it would have been considered close to malpractice to let a patient like him out the door. Now it is considered downright medieval to keep him in.

I’m sure you would like to know what happened to the patient. His doctors would, too, but he is missing. His phone goes unanswered. The name of an emergency contact is blank in his records — he refused to provide one.

It’s anyone’s guess if he filled his prescriptions. He kept none of the appointments made for him.

The results of his biopsy showed a perfectly treatable condition, an infection that the pills he was sent home with should have helped. Perhaps he got better, perhaps not.

The young doctors will never know if they managed his case correctly — that’s “manage” in its medical sense. In the word’s other senses (“succeed despite difficulty” among them), they now have a reasonably good sense of how they failed.

The ‘Intentional Summer’ Challenge: Name That Plant!

KJ Dell’Antonia

Challenge No. 5: Name a flower, plant or tree.

This week, as part of the Well Family Intentional Summer, we’re inviting you to renew a skill your grandparents (and maybe even your parents) probably had: putting a name to the flowers, bushes and trees that surround even urban dwellers daily.

The names — and what’s more, the uses — of the plants that grow around us were once common knowledge. But for most of us, the need to brew dandelion tea or pop dandelion leaves into a salad evaporated the moment one of our recent ancestors walked into a supermarket. A generation or so later, many of us can’t even identify a dandelion.

British researchers have found that few people can identify five common wildflowers or trees, and the younger we are, the less likely we are to be able to name names. Even biology teachers in Britain did poorly on similar questions — a third couldn’t name three or more wildflowers.

That lack of knowledge reflects our increasing disconnect from the natural world. The more time we spend in nature, the more we want to know it and name it. Identifying a single plant is an invitation to connect with the green spaces around us.

“There are lots of benefits to spending time in green surroundings,” whether it’s a local park or a national forest, says Jessica de Bloom, the author of many research studies on vacation and happiness. A little nature can reduce recent stress and improve our mood. Even if the plant in question is growing out of a crack in a city sidewalk, taking a moment to really look at it and find out more about its place in the world can offer a memorable break in our day (and maybe lead to more outdoor exploration).

How to identify your plant of choice? Technology can make that easier. My kids and I chose a blue wildflower we hadn’t noticed before, and posted its picture on Facebook to test the hive mind. Meanwhile, I found mywildflowers.com and chose a few simple characteristics of our flower from the menu of options offered there: It had seven or more petals, was blue, appeared individually rather than in clusters and bloomed in July. (Similar sites and apps exist for other plants and trees: Try Leafsnap, iPflanzen or NatureGate.)

We had an answer via the internet in three minutes, and from Facebook in four: Chicory, the root of which can be blended into coffee. In fact, it’s in the coffee I’m drinking as I write. The search led to a conversation about chicory and to a real desire to know more about the “weeds” that grow by the side of the road.

If you’d like to test your knowledge of some common North American plants, try our quiz.

This week’s challenge: Name something in nature, and tell us how it goes by commenting here or emailing us at wellfamily@nytimes.com before next Tuesday, July 26. You can also share on Twitter, Instagram or Facebook (#intentionalsummer).

Be sure to sign up here for the Well Family email so you don’t miss anything.

We’ll share reader stories and post next week’s challenge on Thursday, July 28. The real goal: to savor the summer all season long.

A Pediatrician’s View on Gun Violence and Children

Getty Images

What does it mean to consider gun violence a public health problem, especially when it comes to children?

The American Academy of Pediatrics announced the development of a new initiative last week reacting to the violence in St. Paul, Baton Rouge and Dallas, an attempt as pediatricians to find ways to protect children, adolescents and young adults.

This isn’t a new issue for the academy; the existing policy on firearm injuries in children emphasizes the importance of sensible gun control, along with the importance of counseling parents about how to reduce risks. Pediatricians as a group have long been concerned about the psychological effects of exposure to violence and the culture of gun violence.

But how can pediatricians make a difference? “I would like us to think deeply about this being trauma for kids,” said Dr. Benard Dreyer, the president of the academy. He emphasized that the discussion must include the overlapping issues of race and the impact of racism on children and adolescents.

This past week, children, along with the rest of us, have seen a truck used as an assault weapon in Nice, France, reminding us that violence takes many forms. Many families worry about how to discuss with our children the disturbing images and stories that play out in the news media. There is an overarching sadness to this discussion. We would like to tell our children that they live in a better, safer country, that the world is getting safer, and that we are making some progress on racism and racial disparities.

Parents need to protect young children from repeated exposures to graphic images, and to be mindful with all children about just how much they’re seeing and hearing. Be there to watch with an older child, both so that you can monitor the exposure, and so that you can talk about disturbing stories and convey the message that it’s O.K. to have these conversations, even when there are no easy answers. The A.A.P. offers age-related guidelines for talking to children about tragedies and other news events on the Heathy Children website.

When children are very upset or worried, they may have nightmares or other sleep disturbances, or complain of physical problems which perhaps will keep their parents nearer, or otherwise, according to their ages, may signal depression or anxiety. Again, it can help to make it clear that you’re willing to talk about these events and the emotions they engender, and willing to get pediatric or mental health help for a child who is particularly distressed.

Beyond what we say in difficult conversations with our frightened or troubled children, adults face the challenge of really making the world safer.

Dr. William Begg, the emergency medical services medical director for the area of Connecticut that includes Newtown, was in the emergency room when the shooting happened at Sandy Hook Elementary School in 2012. He co-founded United Physicians of Newtown, a medical group working to keep children safe from guns.

“I’ve said at every opportunity we have to look at gun violence as a public health issue,” he said. “I think we have to do more as physicians.”

Parents who choose to own guns need to understand how dangerous an accessible gun can be, especially a gun kept in the home, often loaded and unlocked.

“Those are the guns that get used in suicides and unintentional killings and some of the intentional killings,” said Eric Fleegler, a pediatric emergency physician and health services researcher at Boston Children’s Hospital.

As sample safety measures, Dr. Fleegler brought up good safety locks, or even biometric safes, which can be opened only by the right person’s fingerprints, as well as the possibility of safe repositories where people could store guns outside their homes, either temporarily or permanently.

Dr. Begg said it’s important that pediatricians have the opportunity to talk to parents who are gun owners.

“I would never tell a parent, you can’t own a gun; what I would tell a parent is, you should make an informed choice knowing the facts, knowing your family situation,” he said. “I think if people understood the data, many people would make a different choice.”

But these conversations can be controversial; Florida, Montana and Missouri have laws that restrict doctors’ discussion of guns; eight other states have considered such legislation.

When you consider guns as a public health issue, the first thing you look for is data and research, but under pressure from the gun lobby, Congress has restricted the Centers for Disease Control and Prevention and the National Institutes of Health from doing or funding research on gun violence and how to prevent it.

Researchers look for associations between injury rates and possible interventions, safety measures and regulations. A study published in 2013 in the Journal of the American Medical Association by Dr. Fleegler and his colleagues showed that states with more firearm laws had fewer firearm-related fatalities; the association was true for both homicides and suicides.

As with so many public health issues, risks are greater for children in poverty and greater for minority children. “The numbers are staggering no matter who you are, but worse the poorer you are, the darker your skin, especially for violence and homicide,” Dr. Fleegler said.

According to the C.D.C., in 2014, homicide by firearm was the second leading cause of death among 15- to  24-year-olds in the United States, with suicide by firearm in fourth place. For those 10 to 14, where the numbers are much lower, the order was reversed, with suicide by firearm the third leading cause of death, and homicide by firearm fourth.

We lost more than 10,300 males from age 10 to age 19 to violence-related firearm deaths from 2010 to 2014; 63 percent of them by homicide, 36 percent by suicide, and 1 percent by legal intervention. The death rate for the black males was 26.3 per 100,000, compared with 6.6 per 100,000 for the white males.

The public health approach means talking to parents about how to keep their children safe, and looking for strategies—technological, behavioral, and legal—to make everyone safer.

Think about what it has meant to bring down the numbers of children dying in car crashes. We don’t look at collisions as unavoidable twists of fate. We look for strategies — technological, behavioral, and legal — to reduce the incidence of collisions and minimize the damage that they do to small bodies.

“We need to take away the notion that we shouldn’t regulate the safety of firearms,” Dr. Fleegler said. “We take pride in our cars, but the idea of removing safety regulations makes no sense.”

Dr. Begg said that for the first 25 years of his career, while practicing in different emergency rooms around the country, he saw patients harmed by gun violence and took care of them, but did nothing to address the larger problem.

“After the Sandy Hook tragedy where I saw the children of my friends and the children of my community, I didn’t know if my children were going to be affected — they were in lockdown also in school,” he said. “I decided I was going to devote the next 25 years of my career to promoting gun violence safety. There’s a lot more change to come.”

Talking to Kids About Racial Violence

The daughter of Diamond Reynolds, whose boyfriend, Philando Castile, was shot by the police in Minnesota last week.

The daughter of Diamond Reynolds, whose boyfriend, Philando Castile, was shot by the police in Minnesota last week. Eric Miller/Reuters

My husband is white; as an Armenian man, I am a hue darker, and our 10-year-old daughter is biracial, with brown skin. We’ve tried to shield her from some of the recent painful news stories related to bias. But after last week’s killings of two African-American men by police officers, and then the killings of five Dallas police officers, we need to be ready to talk with her about the terrors of prejudice.

I reached out to some experts who help teenagers and parents make sense of violent racism, and work toward something better. Here is some of the wisdom they offered:

  1. Don’t avoid it. “As moms and dads, we can be scared to talk about something so raw, and ugly,” said Tamara Buckley, an associate professor of counseling and psychology at Hunter College and the co-author of “The Color Bind: Talking (and Not Talking) About Race at Work.” “But not bringing it up doesn’t protect your family. It only puts the conversation in others’ hands.”
  2. All kids — not just minorities — need to talk. “Every youth needs to be nurtured to practice empathy, not judgment,” said Renée Watson, who has worked with high school students struggling to process the Black Lives Matter movement and whose work includes the young adult novel “This Side of Home.” “It’s time for us to get out of our own worlds. To be critical thinkers, young people must be exposed to news about every demographic.”
  3. It’s O.K. not to have answers. “Don’t be afraid to be vulnerable in front of your child,” said Ms. Watson. “Even as a teacher I don’t know everything. It’s not about me trying to get students to think how I do, but to create room for dialogue.”
  4. Ask open-ended questions. Buckley suggested asking: “How are you feeling about what you’re seeing in the news? What are your friends saying? What bothers you the most?”
  5. Notice changes in behavior. “Your son might answer, ‘It’s not bothering me,’” Dr. Buckley said. “Some young people may be in such shock they can’t take in the news. Keep a close eye on them. Do they seem stressed? Isolated? Watch for changes in demeanor, which can suggest they’re upset even if they’re telling you otherwise.”
  6. Turn to art. “If things get tense, music, painting, and dance are great ways to express yourself,” said Ms. Watson, who was a 2013 NAACP Image Award nominee. She said multicultural publishers like Lee & Low “know we need a mix of ‘mirror’ books — in which we see ourselves reflected — and ‘window’ books — in which we see others.” She offered a checklist to measure the diversity in your home library: Do all the titles featuring black characters focus only on slavery? Do all the ones about Latinos emphasize immigration? Are all your L.G.B.T.Q. books coming out stories? If so, you could consider books that examine broader issues in these communities.
  7. Educate yourself about social justice. “Know the difference between equality and equity,” said Shuber Naranjo, a diversity educator at Bank Street School for Children in Manhattan. “It’s like in a Broadway theater, there are the same number of stalls in the women’s and men’s bathrooms. It’s equal, but not equitable, because you see a longer line for women.”
  8. Don’t go it alone. Racism is a tough subject for one person to tackle. “Seek out other dads and moms,” Dr. Buckley suggested, “and find ways to support one another. I’ve noticed all this racial violence has been a real point of connection between black and white parents.”


How do you talk to your kids about race, policing and violence? Join six New York Times journalists for a live chat at 2 p.m. Eastern time, Tuesday, July 12.

Related:

Pokémon Has Children on the Move

The author’s son and daughter, both 10, sneak up on a virtual Pokémon.

The author’s son and daughter, both 10, sneak up on a virtual Pokémon.

Parents looking for a way to get children moving and off the couch this summer have found a surprising new ally: Pokémon.

Unlike most video and smartphone games, the phenomenally popular Pokémon Go, which has been downloaded by millions in the past week, requires the player to be active. The game uses map technology and local landmarks to make it seem as if mythical cartoon creatures are lurking in the real world all around you.

As my two 10-year-olds and I quickly found, playing Pokémon Go is not sedentary. Pokémon “trainers” must search for the virtual creatures; finding more of them requires getting up and heading outside.

Other parents are reporting a similar effect.

“My 18-year-old and his friends walked and biked 25 plus miles in two days, outside, in the heat and rain,” said Lisa Romeo, a mother of two who lives in Cedar Grove, N.J.

Phil LeClare of Salem, Mass., said that after three days of Pokémon Go while on vacation in Maine, his 11-year-old son proudly said that he’d walked 30 miles.

Along with the stories of calories burned come the benefits of unexpected family time. The real-world component of walking and hunting for the creatures seems to make playing Pokémon Go alone unappealing. Instead, even teenagers are inviting siblings and parents along. Add in the likelihood of meeting other players at Poké-stops, and the game begins to feel like a social event.

“Event” is a good characterization, said Jeffrey Rohrs, a father of two and the chief marketing officer of Yext, a location data management platform. The app, he said, appears to have struck a perfect chord in our culture, making fresh use of smartphone technology while offering a way around our collective fears that smartphones make us more sedentary and connect us better to the cloud than to one another. “There’s just this euphoria around it,” he said. “It’s unique.”

But for families that have been pleasantly surprised by the action and interaction of Pokémon Go, the game has created a quandary: Do our usual screen time limits apply? Do miles logged and family togetherness really make Pokémon Go different from other screen-based distractions?

The average American child already spends more time consuming media via a screen than at school. Adults aren’t doing much better. Many of us say we spend too much time on our smartphones and the internet, and our kids think so too: In one study, about 70 percent of children under 18 said their parents spent too much time glued to the phone.

“I’m wary of promises that more technology is the answer to problems caused by the overuse of technology,” said Richard Freed, a psychologist and author of “Wired Child: Reclaiming Childhood in a Digital Age.” We’ve been hopeful in the past that certain games, like the Wii system, would promote family time or get kids moving, he said, but those games ultimately failed to live up to the hype.

When it comes to Pokémon Go, Dr. Freed says he is in “wait and see” mode, but dubious. His family loves to walk together outdoors. “Now you add this new wrinkle,” in the form of a game that may be more compelling than the conversation that forges bonds among them. “You have to ask,” said Dr. Freed, “will this facilitate that connection?”

As a replacement for other forms of gaming, Pokémon Go offers plenty of advantages. My two 10-year-olds and I did enjoy connecting while roaming the streets in search of creatures — but part of the pleasure, for me, was that I’d lured them away from their usual Sunday afternoon game-fest with the Wii.

For some families, the hunt has already begun to take over their travels — encouraging kids to walk and hike further, yes, but will they remember seeing the White House, or the Pokémon at its gates? On a positive note, Mr. Rohrs sees a future where the technology could be used to enhance our destinations “It’s easy to imagine a hunt for the great authors of London,” he said, rather than Pokémon.

But for now, it’s even easier to imagine getting just a little tired of children who’d rather hunt Zubats than enjoy a zoo.

Which can only mean one thing. “Part of parenting is establishing boundaries,” said Mr. Rohrs, who spent his weekend exploring New York City with his wife, two children and Pokémon Go. Although he was mostly enthusiastic about the unexpected places the game led them, “We quickly realized we needed to declare some ‘phone in pocket’ time.”

For now, many parents seem to be relishing the good in Pokémon Go, while recognizing that they will need to create limits. For some of us, Pokémon Go brings up unexpected summer memories of twilight freeze-tag and hide-and-seek. Laurel Snyder had to set a curfew for her kids, ages 9 and 10, who spent the day wandering their neighborhood in Atlanta.

“I told them they had to be home by 8, and they dashed in sweaty-faced at 7:53. It really felt more like my own childhood experience than I’d have imagined,“ she said. That early hour might even relax a little, with so much community to be found in the initial excitement surrounding the game. It’s likely that for many children, and adults too, the summer of 2016 just became the summer of Pokémon.

For Coffee Drinkers, the Buzz May Be in Your Genes

Andrew Scrivani for The New York Times

Like most of my work, this article would not have been possible without coffee.

I’m never fully awake until I have had my morning cup of espresso. It makes me productive, energized and what I can only describe as mildly euphoric. But as one of the millions of caffeine-loving Americans who can measure out my life with coffee spoons, (to paraphrase T.S. Eliot), I have often wondered: How does my coffee habit impact my health?

The health community can’t quite agree on whether coffee is more potion or poison. The American Heart Association says the research on whether coffee causes heart disease is conflicting. The World Health Organization, which for years classified coffee as “possibly” carcinogenic, recently reversed itself, saying the evidence for a coffee-cancer link is “inadequate.” National dietary guidelines say that moderate coffee consumption may actually be good for you – even reducing chronic disease.

Why is there so much conflicting evidence about coffee? The answer may be in our genes.

About a decade ago, Ahmed El-Sohemy, a professor in the department of nutritional sciences at the University of Toronto, noticed the conflicting research on coffee and the widespread variation in how people respond to it. Some people avoid it because just one cup makes them jittery and anxious. Others can drink four cups of coffee and barely keep their eyes open. Some people thrive on it.

Dr. El-Sohemy suspected that the relationship between coffee and heart disease might also vary from one individual to the next. And he zeroed in on one gene in particular, CYP1A2, which controls an enzyme – also called CYP1A2 – that determines how quickly our bodies break down caffeine.

One variant of the gene causes the liver to metabolize caffeine very quickly. People who inherit two copies of the “fast” variant – one from each parent – are generally referred to as fast metabolizers. Their bodies metabolize caffeine about four times more quickly than people who inherit one or more copies of the slow variant of the gene. These people are called slow metabolizers.

With funding from the National Institutes of Health, Dr. El-Sohemy and his colleagues recruited 4,000 adults, including about 2,000 who had previously had a heart attack. Then they analyzed their genes and their coffee consumption. When they looked at the entire study population, they found that consuming four or more cups of coffee per day was associated with a 36 percent increased risk of a heart attack.

But when they split the subjects into two groups – fast and slow caffeine metabolizers – they found something striking: Heavy coffee consumption only seemed to be linked to a higher likelihood of heart attacks in the slow metabolizers.

“The increased risk that we saw among the entire population was driven entirely by the people that were slow metabolizers,” said Dr. El-Sohemy, who is also on the science advisory board at Nutrigenomix, a personalized nutrition company. “When you look at the fast metabolizers, there was absolutely no increased risk.”

The trend among fast metabolizers was quite the opposite. Those who drank one to three cups of coffee daily had a significantly reduced risk of heart attacks – suggesting that for them coffee was protective.

Dr. El-Sohemy suspects that because caffeine hangs around longer in a slow metabolizer, it has more time to act as a trigger of heart attacks. But fast metabolizers clear caffeine from their systems rapidly, allowing the antioxidants, polyphenols and coffee’s other healthful compounds to kick in without the side effects of caffeine, he said.

Other more recent research seems to point in the same direction. In Italy, a team of scientists looked at hypertension in 553 fast and slow caffeine metabolizers. Once again, the subjects’ genetic profiles predicted whether coffee was potentially harmful or healthful. Heavy and even moderate coffee drinkers were significantly more likely to have hypertension if they were slow metabolizers. But fast metabolizers saw their risk of hypertension fall as their coffee intake rose.

That is not to say that every coffee drinker should run out and have their CYP1A2 genes analyzed by one of the many direct-to-consumer genetic testing companies. Dr. Marilyn Cornelis, an assistant professor at the Northwestern University Feinberg School of Medicine, said her research had identified many genes involved in caffeine metabolism, and that relying on only one or two genetic factors could provide people with a false sense of reassurance.

“There are clearly other genetic and environmental factors contributing to differences in caffeine metabolism,” she said. “And these are not captured by existing tests.”

Nonetheless, this greater understanding of the link between coffee and genetics has opened up a wide new area of research. Scientists are now studying whether the CYP1A2 gene and others might mediate coffee’s influence on breast and ovarian cancer, Type 2 diabetes and even Parkinson’s disease.

It has also prompted a closer look at the effects of caffeine on exercise. Though it has long been accepted that caffeine enhances sports performance, research by Christopher J. Womack, a professor of kinesiology at James Madison University, suggests that endurance athletes who are fast caffeine metabolizers may benefit more than others.

In one study in 2012, Dr. Womack and his colleagues studied the effect of caffeine pills and placebos on the performance of male cyclists. Dr. Womack found that the slow metabolizers completed a 40-kilometer race on a stationary bike one minute faster on caffeine. But the fast metabolizers improved their time by four minutes.

Dr. Womack suspects that the fast metabolizers saw greater benefits because the rapid metabolism of caffeine further heightened their sympathetic nervous systems — which control the so-called fight or flight response.

“In the broad sense, the average person is going to perform better with caffeine,” he said. “Some people have a huge effect. Not surprisingly, it has something to do with our genetics.”

As an avid coffee consumer, I was curious about my own genes. Through a company called FitnessGenes, which analyzes 41 different genes related to diet and exercise – including CYP1A2 – I learned that I was a so-called fast caffeine metabolizer. The company says that 40 percent of people are fast metabolizers. About 45 percent have both a slow and a fast copy, and 15 percent carry two copies of the slow allele.

Dan Reardon, a medical doctor who founded FitnessGenes, said that, anecdotally, slow metabolizers who drink coffee tend to report a very gradual wakefulness, sometimes lasting hours. But fast metabolizers often experience something very different with coffee: an immediate spike in alertness followed at times by a relatively quick dip in energy.

While my DNA results suggested that my twice-daily espresso habit might be for the best, researchers have only just begun to understand how our genes and coffee habits interact. In a 2015 study, Dr. Cornelis and a team of international scientists identified eight genetic variants that appear to make people more likely to seek out coffee, including at least two variants that are involved in the psychologically rewarding effects of caffeine.

The research could help to explain why some people see little or no appeal in a freshly brewed cup of coffee – while others, like me, can hardly fathom a morning without it.

Eat Well is a new weekly column on the science and culture of eating.

Think Like a Doctor: A Cough That Won’t Stop Solved!

Andreas Samuelsson

On Thursday we asked Well readers to unravel the case of a middle-aged man who had a cough for over a year. He was just about to give up on finding a cause or cure when he started coughing up blood. A CT scan done at that point revealed a strange hole near the base of the right lung. Your challenge was to figure out what was going on.

The correct diagnosis is:

An aspiration of a foreign body

Over 400 of you wrote in and a handful of you figured it out. Anne Hartley was the first to suggest that the man inhaled a foreign object. She’s a general internist at Rush Medical College in Chicago. When I asked her how she figured it out she said it was easy. She has two small children and so, she told me, “foreign bodies are always on my mind.” Reading how healthy the patient appeared made it seem even more likely that he had accidentally inhaled something that was now lodged in his lungs. Strong work, Anne!

So he had inhaled something – but what? A couple of you even figured that out. A shout out to Toni Brisby of Britain, who was the first to suspect that the patient had inhaled a seed. Well done, Toni!

The Diagnosis:

The first successful removal of an aspirated object was published in 1897. A small bone was retrieved from the airways of a German farmer using a long metal tube and a set of tweezers. At that time, half of all people who accidentally aspirated objects into their lungs died. That changed dramatically over the next decades when an American ear, nose and throat specialist developed early versions of the tools used to remove such objects. That doctor, Chevalier Jackson, devoted his life to putting these tools to use. A collection of the several thousands objects he retrieved from airways of the children and adults who needed him is on display at the Mütter Museum in Philadelphia.

These days foreign body aspiration is most common in boys between the ages of 1 and 2. The mortality rate is 7 percent in children younger than 4. Only a tiny fraction of aspirations (well under 1 percent) occur in adults, and most of those adults are either elderly or have some underlying condition that makes swallowing difficult – because of some neurological problem, like having a stroke, or because they are impaired by alcohol or drugs. What is aspirated also varies with age. In children, most of the aspirated objects are nuts or seeds.

In adults the most common objects fished out of the lungs were pins or small plastic objects. Foods were a distant second. Most adults sought medical care within 24 hours but some didn’t remember aspirating at all and others remembered only once the object was found, when a bronchoscopy was done to evaluate symptoms – as was the case here. Persistent cough was the most common symptom but recurrent infections were also seen. Presence of the object was often suspected from chest X-rays, which sometimes showed air trapping in the lung beyond the obstruction.

How the Diagnosis Was Made:

Dr. Karen Schmitz was the doctor caring for the 43-year-old man, who went to the hospital after two weeks of coughing up blood (hemoptysis) – the newest development in a cough that had lasted a year and a half. A CT scan showed a strange hole in the lower part of his right lung. Because tuberculosis could cause such holes as well as hemoptysis, he was in an isolation room until the doctors were sure he didn’t have it.

Still, TB seemed an unlikely diagnosis. He had never been exposed to TB and had no real risk factors. And even though he had an impressive cough, none of the usual symptoms of TB were present. He had no fever or night sweats, hadn’t lost weight, and he didn’t feel sick. So even before the tests came back the question became, if it wasn’t TB, what was causing this cough?

He was seen by an infectious disease specialist and Dr. Timothy Clark, a lung specialist. They agreed on the most likely culprits. It could be some kind of fungus – chronic fungal infections can cause few or even no symptoms. He had traveled in Southern California and Arizona, both places where a fungus called Coccidioides often caused asymptomatic disease. Blood tests were ordered to look for common fungi. There was also the possibility that it might be something worse – a lung cancer. Again he had no risk factors – he’d never smoked – but it was a possibility. So doctor and patient decided that the best course of action would be for the pulmonologist to look directly into the patient’s lungs. The test, called a bronchoscopy, was scheduled for the following morning.

The Doctor Is Surprised:

Early the next day the patient was taken to a procedure room to have his bronchoscopy. In this test a tiny camera is threaded into the lungs to look at the lesion using the CT scan to help navigate to the right spot.

The patient was lightly sedated, and moments later Dr. Clark inserted the scope. The lung specialist guided the instrument down the narrow pink corridors of the airways. The goal was to get as close as possible to the hole seen on the scan and take samples of the surrounding tissues. Suddenly the doctor stopped. He saw something – was it a tiny piece of metal? – sitting where the airway forked. He edged the scope a little closer. It was black and smooth with a shape that was strangely familiar. He threaded a tiny gripper through the scope, onto the end next to the camera, and pulled the object out.

“Is that a seed?” he asked. Suddenly the patient said in a slurred voice, “It’s a sunflower seed.” Dr. Clark dropped the tiny object into a specimen cup. “You’re right! It is a sunflower seed!”

Even under the influence of the sedative, the patient was able to remember when he’d inhaled the seed. It was at a baseball game he’d gone to with his older son. He’d bought a bag of sunflower seeds – his favorite snack — and was cracking them open with his teeth when suddenly one seed escaped and went down the wrong pipe. He started coughing immediately as his body fought to expel the foreign object. He coughed for what seemed to be a long time and while he never felt the seed come up, the spasm finally subsided. And he felt fine. He didn’t really think about it again until a couple of weeks later when he started coughing again. He told his first couple of doctors about it, but they pooh-poohed the notion. The interval between the choking event and the onset of the cough made aspiration much less likely. Besides, it’s usually only a problem for the very young or the very old — rarely for the perfectly healthy middle-aged guy.

Did the doctor think that this little seed could account for the coughing that had been killing him for the past 18 months? The doctor nodded. And if it was, he should get better within a couple of days.

The patient was ecstatic. Maybe it was just the relief of knowing that his 18 months of coughing were over or maybe it was the drugs they’d given him for the procedure, but the exuberant man found himself calling out as he was wheeled out the elevator to his hospital room: “Yay, I don’t have cancer. Yay, it was a seed.” He shook the cup with the retrieved seed in time with his chant.

As they watched the man roll out of the procedure room Dr. Clark turned to Dr. Schmitz. “You know I’ve seen this one other time. And it’s funny – we always forget to think of it.”

That was last December. After a couple of days, the cough was completely gone. And once baseball season started this spring, the man was able to enjoy his sunflower seeds just as he always had.

When a Child Thinks Life is Unfair, Use Game Theory

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As soon as Kristina Dooley’s 5-year-old triplets see an elevator, they race to be the one who gets there first.

“When they get to the buttons, elbows start flying,” she says. Almost immediately, she hears the complaint “That’s not fair!” from the child who doesn’t get to hit a button.

A child’s list of things that are “not fair” is seemingly endless. Whether it’s elevator buttons, equal piles of goldfish crackers, who gets the first bedtime kiss or who gets to use the precious purple cup, children demand precision equality that seems impossible to achieve most of the time.

But research suggests that humans evolved to want fair treatment — an expectation that other social animals share. In a now famous study, a capuchin monkey rewarded for a task with a piece of tasty cucumber was pleased, until she saw one of her peers rewarded for the same task with a tasty grape. The reaction may be familiar to parents. The monkey throws the cucumber at her handler and rattles the cage in anger.

In humans, the desire to be treated fairly starts early. Researchers have found that children as young as 19 months seem to understand the concept of fairness, and appear surprised by scenes of blatant favoritism – such as when one puppet is given toys and another puppet goes without. By age 7, some children will choose to forgo candy rather than get a significantly larger share than others.

“The question of jealousy is easy — in any kind of group living, you have to be careful that somebody else isn’t getting more than you,” said Paul Raeburn, a co-author of “The Game Theorist’s Guide to Parenting.”

The desire not to have more than others can also be explained. In a hunter-gatherer society where conditions of scarcity arise frequently, sharing food when you have more increases the likelihood that others will share when you have less. “The presumption is that it gave some ancestor an evolutionary advantage,” he said.

Given that a child’s desire for life to be fair seems to be hard wired, it’s better not to fight it, says Mr. Raeburn. Instead, he suggests applying classic game theory strategies to help children make “fair” decisions and stop the squabbling. They include:

I Cut, You Pick: This classic strategy for dividing simple things, like cake, allows each child to make a choice: One divides the desired good, and the other chooses. I Cut, You Pick has limits, says Mr. Raeburn, if the thing to be divided has a different value to each child, or if there are more than two children with an interest. But if nothing else, it works well for cake.

Tit for Tat:When children are faced with the job of cleaning up a joint mess, suggest “you pick up one, then he picks up one,” said Mr. Raeburn. “We had mixed results with Tit for Tat,” he admits. His 9-year-old son was able to manipulate his 6-year-old brother into doing more. “This probably works better with children who are closer in age, or at least both over 7.”

Random Dictator: In Random Dictator, a family faced with a choice that affects every family member (what movie to watch, what cereal to buy, which restaurant to go to) has each family member write down a selection, then draws a single one from a hat. One person ultimately chooses — but who “wins” is random.

Auction: How to decide who chooses the one show that will be watched tonight or gets first play on the iPad on a road trip? Try auctioning the desired reward to the highest bidder, using chores, other privileges or even Halloween candy as currency. “This involves some learning,” said Mr. Raeburn. “It’s easy for a child to overvalue something in the moment and get stuck doing way too many chores.” At first, he says, parents might have to monitor the fairness of the auction process itself — but children who like it may end up running auctions on their own.

Even if you adopt these strategies, chances are that some things will always feel “not fair” to kids.

“Don’t react defensively,” says Laura Markham, author of “Peaceful Parent, Happy Siblings.” Parents have to recognize that sometimes, no matter how logical the division of everything from elevator buttons to our time and attention seems to us, one child feels less loved. Even grown-ups know it’s hard when someone else gets a gift you wanted, or more ice cream on their cone. Find words that acknowledge the child’s perspective.

“Try focusing on whether you’re meeting their individual needs instead of worrying whether each one is getting the exact same thing at the exact same time,” Dr. Markham said. “When we’re always busy with the baby, or something like that, it really rankles.”

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