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

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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.Credit 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

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Credit 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!

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Credit 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

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Credit 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

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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.Credit 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.

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Pokémon Has Children on the Move

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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.Credit

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

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Credit 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!

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Credit 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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Credit iStock

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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How to Sell Kids on Vegetables

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Credit Damon Winter/The New York Times

The same marketing techniques used to convince children to eat junk food are highly effective in promoting fruits and vegetables, a new study has found.

Researchers assigned 10 elementary schools to one of four groups. In the first, they posted vinyl banners around the salad bar depicting cartoon vegetable characters with “super powers.” In the second, they showed television cartoons of the characters. The third got both cartoons and banners, and a control group got no intervention. The study, in Pediatrics, went on for six weeks in 2013.

Compared to control schools, TV segments alone produced a statistically insignificant increase in vegetable consumption. But in schools decorated with the banners alone, 90.5 percent more students took vegetables. And where both the banners and the TV advertisements were used, the number of students taking vegetables increased by 239.2 percent.

“A lot of people have pushed back on this, saying marketing is evil,” said one of the authors, David R. Just, a professor of applied economics at Cornell. “But I have to disagree. It’s possible to use marketing techniques to do some good things.”

Putting such programs into practice, Dr. Just said, presents problems. “Schools are left to do their own marketing, and that’s not cost effective. These need to be national programs. McDonald’s is effective because you see their marketing everywhere.”

Don’t Eat Raw Dough, F.D.A. Cautions

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Credit iStock

Maybe you’ve swiped a bite of raw cookie dough while preparing a batch to bake. Or perhaps you’ve let your children lick the batter from the cake bowl, or use homemade “play dough” to make crafts. But even if the dough is free of raw eggs, which you think might give you a pass, don’t eat it.

Yesterday, the Food and Drug Administration issued a message warning people not to eat raw dough because of a recent outbreak of E. coli linked to contaminated flour.

So far, a reported 38 people in 20 states have been infected by a strain of bacteria called Shiga toxin-producing E. coli O121 found in flour. The infections began last December, and 10 of those infected have been hospitalized.

Symptoms of the bacterial infection include severe stomach cramps, diarrhea (often bloody), and vomiting. Most people get better within a week, but in some cases, infections can lead to a type of kidney failure called hemolytic uremic syndrome. Those who are most vulnerable to severe illness include children under 5, older adults and people with weakened immune systems.

Investigations by the Centers for Disease Control and Prevention and the F.D.A. traced the source of the outbreak to flour that was produced in November 2015 at the General Mills facility in Kansas City, Mo. General Mills has issued a voluntary recall of 10 million pounds of flour produced between Nov. 14 and Dec. 4, sold under three brand names: Gold Medal, Signature Kitchens and Gold Medal Wondra. Flour that is part of the recall should be thrown away.

Unlike other raw foods, like eggs or meat — which many people recognize as contamination risks — “flour is not the type of thing that we commonly associate with pathogens,” said Jenny Scott, a senior adviser in the F.D.A.’s Center for Food Safety and Applied Nutrition.

In this case, investigators believe that the grain became contaminated in the field, where it is exposed to manure, cattle, birds and other bacteria. “E. coli is a gut bug that can spread from a cow doing its business in the field, or it could live in the soil for a period of time; and if you think about it, flour comes from the ground, so it could be a risk,” said Adam Karcz, an infection preventionist at Indiana University Health in Indianapolis.

Normally, flour is cooked before it is consumed, destroying any pathogens. “For the most part, the risk from flour is pretty low, and most use of flour involves a ‘kill step’ — people bake with it,” Ms. Scott said. In commercial uses like “raw” cookie-dough ice cream, companies generally heat-treat it to eliminate bacteria, she said.

Consumers, then, need to be aware that they should follow food safety guidelines for flour. That means washing your hands thoroughly before and after handling raw flour. And Ms. Scott warned against letting children play with homemade play dough. “Kids are going to handle it and touch their faces, and they’re going to lick their fingers; it’s hard to supervise that,” she said.

At home, Mr. Karcz suggests sealing your flour container and storing it in a cool, dry place to prevent contamination. And after using flour, be sure to clean up your countertops, cutting boards and utensils to prevent the spread of any bacteria.

If you do develop symptoms of infection, contact your health care practitioner for treatment and to report the illness, particularly if you suspect it’s connected to an outbreak.

“We want to encourage consumers to report their illnesses, even though it’s an imperfect system,” Ms. Scott said. “We’d like to have the tests done and get everything reported and identify these outbreaks so we can follow up, discover root causes and make changes in the system so that people don’t get sick in the future.”

The Connections Between Spanking and Aggression

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Credit iStock

In the 1990s, in my first month in practice as a pediatrician, I asked the mother of a 4-year-old about discipline and she told me that her son was often out of line and wild, and spanking was the only thing that worked, though she was sure I was going to tell her not to, just as her previous pediatrician had done. Around the same time, my colleague in the same clinic walked into an exam room to find a cranky toddler who was acting out, and a frustrated father who was taking off his belt and threatening punishment. In each case, and in many others, we had to decide how to talk to the parents, and whether to bring up the issue of child abuse — which is definitely an issue when a child is being struck, or threatened, with a belt.

Corporal punishment, also known as “physical discipline,” has become illegal in recent decades in many countries, starting with Sweden in 1979. The United States is not one of those countries, and pediatricians regularly find ourselves talking with parents about why hitting children is a bad idea. The American Academy of Pediatrics officially recommends against physical discipline, saying that evidence shows it is ineffective and puts children at risk for abuse; pediatricians are mandated reporters, responsible for notifying the authorities if we think there is a possibility of abuse, though the boundaries are not clearly defined by law.

But many parents continue to spank, even when they don’t think it does much good. In a recent report by the nonprofit organization Zero to Three of a national sample of 2,200 parents of children birth to age 5, parents were asked which discipline strategies they used a few times a week or more. Twenty-six percent said they “pop or swat” their child, 21 percent spank, and 17 percent reported hitting with an object like a belt or a wooden spoon. (Parents could respond that they used more than one strategy.) Zero to Three reported that even those who used these strategies frequently did not rate them as effective, and 30 percent agreed with the statement, “I spank even though I don’t feel O.K. about it.”

One reason the A.A.P. opposes spanking is because of evidence that it is associated with aggressive behavior in children. But does that mean that hitting children produces aggressive behavior, or that aggressive behavior in children elicits more and sterner parental measures?

Michael MacKenzie, an associate professor of social work and pediatrics at Rutgers, called the association “bidirectional and transactional.” How you discipline your child shapes your child, but also shapes you as a parent. But if you control for the child’s behavior, comparing more aggressive young children with other children who behave in the same ways, those who are frequently hit or spanked are more likely to show aggressive behavior and rule-breaking later on.

In a study published last year, he and his colleagues looked at these bidirectional effects. Children who were spanked were more likely to show disruptive, aggressive behaviors later on. Those behaviors, in turn, made it more likely that those children would be spanked more in the future.

“It mattered for everybody, but it mattered more for these kids in riskier contexts, the families facing more stress,” Dr. MacKenzie said. Other research showed that spanking was associated with poorer cognitive outcomes for children, even when the researchers controlled for factors such as maternal intelligence, maternal depression and cognitive stimulation in the home.

Dr. MacKenzie suggested that some families get caught in a “feedback loop,” in which children who are spanked respond more aggressively, and become even more challenging, reinforcing parents’ sense that only harsh discipline will work, so parents find themselves escalating the discipline, which in turn evokes more intense behavior.

“We want to think about these cycles and how they amplify,” he said, and to think as well about how to support families early on so that they set up different patterns. “We’ve sort of suggested the removal of a tool that many parents use, most parents use, without discussion of what the alternatives might be.”

Michael Lorber, a research scientist in the Family Translational Research Group at New York University, has found that parents who interpret their children’s behavior more negatively than an objective observer tend to use more harsh discipline. These patterns begin younger than we think, he told me, with parents in their studies clearly identifying children as young as 8 months old as difficult and aggressive.

“We think the infancy period is probably the time when parents begin to develop their disciplinary practices,” Dr. Lorber said. “Call it difficult temperament or incipient externalizing behaviors or contentiousness, it’s definitely the case that infants’ behaviors influence their parents, including physical discipline.”

One complicated question that researchers raise about physically aggressive children and their physically aggressive parents is whether there may be a genetic component to this behavior, which would be shared across the generations.

Leslie Leve, a professor of counseling psychology and human services at the University of Oregon College of Education, said that it was possible there were genetic predispositions toward aggressive behavior, which might affect both parents and children. “There is a common misperception that when people think of a behavior as ‘genetic’ that it’s not changeable, and that is not true,” Dr. Leve said. “With A.D.H.D. or aggression we know there is a genetic component, but there is a lot we can do in a family or educational environment. Genetics does not mean immutable.”

Dr. Leve has participated in studies of adopted infants, which can help tease out these effects, but which also show how complex the interactions are, with harsh parental responses affected by the child’s characteristics but also by factors in their own temperaments and their marriage.

Zero to Three reported that 69 percent of the parents said that “if they knew more positive parenting strategies they would use them.” Pediatricians try to help parents develop such strategies, discussing what behavior is developmentally realistic for young children; helping them interpret behavior without regarding it as defiant; counseling them about setting limits; and helping them find positive behaviors to praise and enjoy.

Disciplinary choices reflect parental stress, family circumstances and the whole complex cocktail of emotion and personal history and daily life at home. What parents do affects their children — their brains and their behavior — and the ways that children behave affects their parents. And the cycle of spanking and aggressive behavior seems to leave everyone worse off.

Related:

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Drug Company Lunches Have Big Payoffs

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A free lunch may be all it takes to persuade a doctor to prescribe a brand-name drug instead of a cheaper generic, a new study suggests.

Using Medicare’s Open Payments data, researchers collected information on 279,669 doctors who received 63,524 payments reported by drug companies. They concentrated on specific drugs in four categories: cholesterol lowering statins, two types of blood pressure drugs and antidepressants.

The study, in JAMA Internal Medicine, found that 95 percent of the payments were for meals sponsored by drug companies, worth about $12 to $18 each.

Doctors who were treated to a single meal, where drug companies present information about their medications, were 18 percent more likely to prescribe Crestor, a brand-name cholesterol-lowering medicine. They were 70 percent more likely to prescribe Bystolic, a brand-name beta blocker for high blood pressure, and 52 percent more likely to prescribe Benicar, also for hypertension.

The more meals doctors had, the more likely they were to prescribe the promoted drug.

For U.S. Parents, a Troubling Happiness Gap

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Credit Getty Images

For years, social scientists have known that nonparents are happier than parents. Study after study has confirmed the troubling finding that having kids makes you less happy than your child-free peers.

Now new research helps explain the parental happiness gap, suggesting it’s less about the children and more about family support in the country where you live.

Based on data from 22 countries and two international surveys of well-being, researchers found that American parents face the largest happiness shortfall compared to people who don’t have children. The happiness gap between parents and nonparents in the United States is significantly larger than the gap found in other industrialized nations, including Great Britain and Australia. And in other Western countries, the happiness gap is nonexistent or even reversed. Parents in Norway, Sweden and Finland — and Russia and Hungary — report even greater levels of happiness than their childless peers.

The researchers, led by the University of Texas sociology professor Jennifer Glass, looked for factors that might explain the international differences in parental happiness, and specifically why parents in the United States suffer a greater happiness penalty than their peers around the world.

They discovered the gap could be explained by differences in family-friendly social policies such as subsidized child care and paid vacation and sick leave. In countries that gave parents what researchers called “the tools to combine work and family,” the negative impact of parenting on happiness disappeared.

“We comprehensively tested every other alternative,” said Dr. Glass, the lead author of the study, which will be published in the American Journal of Sociology in September. “The two things that came out most strongly in explaining the variation were the cost of care for the average 2-year-old as a percent of wages and the total extent of paid sick and vacation days.”

Notably, the researchers found that economic differences, whether a parent was married or partnered and whether the pregnancy was planned or unintended had no impact on the happiness gap. They also considered the impact of other family-friendly social policies, such as extended maternity and paternity leaves, flexible schedules and even policies that gave money to parents in the form of a child allowance or monthly payments.

Paid parenting leave has “nowhere near as big an effect as these other two policies, “said Dr. Glass, while the other policies didn’t have a significant impact on the happiness gap. Policies that made it less stressful and less costly to combine child rearing with paid work “seem to be the ones that really matter.”

Those same two policies, she said, were also correlated with increased happiness among nonparents. That more paid sick leave and vacation time would make nonparents happier was no surprise, but “we were a little puzzled that lower child care costs would show an effect on nonparents,” Dr. Glass said. She and her colleagues speculate that the result is what economists call an indirect benefit: Everyone is better off when countries invest in the future of their labor force, and everyone suffers when they don’t.

But while there are certainly distinctions in family policy to be made between the United States and other developed countries, there are also substantial cultural differences in the ways children are raised here and in other countries. Those distinctions are hard to measure, but might also account for some of the relative difference between parental and nonparental happiness.

“There’s an incredible anxiety around parenting here that I just don’t feel in other countries,” said Christine Gross-Loh, the author of “Parenting Without Borders,” a comprehensive look at modern parent culture across the developed world, who is raising her children between the United States and Japan. She points to Americans’ anxiety around children’s college and future prospects, and also to our emphasis on keeping children physically safe, and the harsh judgment of parents who are perceived to be doing a poor job of it.

“In Japan, my 6-year-old and my 9-year-old can go out and take the 4-year-old neighbor, and that’s just normal,” she said, while in the United States that kind of freedom can draw criticism and even lead to interventions by Child Protective Services.

In countries where there is a strong agreement about the norms around parenting, parents may worry less about their own choices. Without a single overarching parenting tradition, American parents may feel like they have “too many choices” as compared to parents in more homogeneous cultures, says W. Bradford Wilcox, an associate professor of sociology and the director of the National Marriage Project at the University of Virginia. “A clear and well-defined script can be psychologically comforting,” he said, and its lack can leave parents feeling “unmoored.”

Dr. Glass agrees that cultural differences add to the greater relative parent and nonparent happiness gap — but she notes that those cultural differences are also reflected in our family policies. Much of our anxiety around our children in the United States, she said, is very clearly a reflection of our policy choices.

“We have to compete for good child care. We compete to live where there’s a good elementary school,” she said. “We compete for activities because a child’s entire fate seems to depend on where he goes to college, because there’s no guarantee — if we don’t, our child might be left behind.”

Those fears, Dr. Glass said, come in part from our country’s high tolerance for unequal access to the resources families need. In countries that offer policies supporting a parent’s ability to balance work and family, she sees a commitment to egalitarianism. “A crucial part of what’s going on is the idea that every child deserves an equal chance in life,” she said.

The good news is that the findings show that the happiness gap of parenting is not inevitable. Stephanie Coontz, who teaches history and family studies at The Evergreen State College in Olympia, Wash., and is co-chairwoman of the Council on Contemporary Families, said it was a pleasant surprise to see the researchers document the need for better family policies.

“Don’t just swoop in and give a longer maternity leave,” Dr. Coontz said. “It’s a lifetime investment in helping people combine work and family for the long haul.”


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With Our Father’s Death, a Chance for Me and ‘the Boys’ to Connect

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Credit Giselle Potter

When I was a small boy my dad used to ask me for show tunes. “Sing ‘Happiness!’” he’d say to me on the ferry to Shelter Island, and I’d happily comply, the wind blowing the notes out into the Peconic Bay. And he liked to call me into the living room when he and my mom had company and say, “Sing something for us, Artie!”

My two older brothers dealt with this by secretly teaching me the song “Sodomy” from the show “Hair,” telling their credulous little brother that this would be a big hit next time Dad asked for a party number. It was a big hit all right.

Dad loved us all equally, but that didn’t mean he saw us as the same. “The boys and Artie” was a phrase I heard a lot, despite my protestations that I, too, was a boy. Perhaps he’d just gotten used to my brothers as a duo because they were only two years apart, and there was nearly a four-year gap between the middle one and me. Perhaps they were just more boyish.

My brothers certainly were the smartest kids I knew. (The smartest kids, it seemed, that everyone knew; as I came up behind them in school, I could count on teachers to say, “Oh, you’re a Levine brother – I’m expecting a lot from you.”) They never got less than an “A” as a grade. Each one, in turn, became the captain of the wrestling team and the tennis team. I idolized them even as I struggled with a sense that I’d never truly measure up. I was diabetic and I struggled physically. I was less perfect in school.

Dad didn’t make these comparisons (at least out loud). He expressed his love by showing up. He came to the musicals I performed in and clapped loudly. He went to every wrestling match my brothers competed in, shouting advice and living every takedown and pin, as if it were happening to him.

He wasn’t a heart to-heart conversation guy. As a gastroenterologist, Dad was more interested in talking about organs in the digestive tract. But he proudly (some might say relentlessly) reported our accomplishments to his patients and friends.

My father may have passed his tendency to express love by proxy on to us. Once when I was in seventh grade, I overheard my middle brother, Dan, who was a high school junior, talking to the kid who was running the school variety show. “You should get my brother to sing,” he told her. “He has a beautiful voice.”

Forty years later, this small comment still sits on the open shelves of my brain like a trophy, for an accomplishment you’d think I’d have outgrown by now.

Of course, overhearing something requires being in earshot of one another. And for us, that kind of proximity was fleeting. As adults we lived too far apart for a spontaneous hamburger or a cup of coffee, or a guy-like sharing of a sports event.

Over time my brothers seemed to have become more and more like my dad and I less so. Both became doctors, like my father. Both married nice Jewish girls. I married an Italian guy (O.K., a doctor, but still… ) and became a children’s book publisher. We each found “success,” but were careful not to talk about it with each other too directly.

For my dad, however, I would save up facts to report. If I was getting a promotion at work, if a poem had been accepted for publication, if someone praised my son, I would enjoy the good news. And then I’d enjoy packing it up for my dad and unpacking it in our next phone conversation, after which he’d say, “Terrific!! Want to talk to your mother?”

If my father was satisfied by this, I think my brothers and I were less so. Certainly, over time, it seemed to serve our relationships less and less well. What fact exchange over the phone can convey the complications of a marriage? What fact can express the near-fatal vulnerability of parenthood? What fact can reveal the passage from youth to middle age, the glimpses of what comes next?

And so we actually communicated less. It was nothing dramatic. We still loved one another. But we didn’t see one another more than once or twice a year. I’d drive past my brother’s town and think about stopping, but wouldn’t. We’d each visit our parents. Separately.

As my dad got older and developed cancer and heart problems, my brothers’ roles as medical consultants became more prominent, but we didn’t truly draw together. To spare my feelings they sometimes spoke with my husband about my dad’s problems, but in our concern we were still siloed, even as age began to make us all look more like each other … and more like him. And even as age began to take my father away from us all.

We started talking more during Dad’s long, slow, torturous decline from Alzheimer’s disease, but in some ways this just meant that the facts we had to report were not vacations, business news or our kids’ activities, but sad, tactical communiqués from a losing battle.

Then, after my dad died, a strange thing happened. My brothers began to call me just to check in. My oldest brother took to texting cartoon strips with fart jokes in them that he thought my dad would have loved. (And it’s true, the phrase “break wind” was a real favorite of his.) They asked to visit. They meant it.

I realized that the most powerful, tangible reminders of my father resided in my brothers, and in me, too. I reminded them of him. And I was one of the very few people on earth who could remember him as a father, if not exactly as they did, well, then as closely as almost anyone could.

My dad, whose affections had been a (sometimes sore) point of comparison in my head, was becoming the person who might now draw us close.

The other day I got a starred review for a picture book I’d written based on my dad, and I so wanted to call him up to share that perfect, shiny fact.

Maybe I’ll send it to my brothers.

Arthur Levine is the publisher of Arthur A. Levine Books at Scholastic, whose books include the Harry Potter series. He is the author, most recently, of the picture book “What a Beautiful Morning,” about a family dealing with Alzheimer’s disease.

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Parents Should Avoid Comments on a Child’s Weight

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Credit Stuart Bradford

Should parents talk to an overweight child about weight? Or should they just keep their mouths shut?

Parents in this situation are understandably torn. Say something, and they risk shaming a child or worse, triggering an eating disorder. Say nothing, and they worry they’re missing an opportunity to help their child with what could become a serious long-term health problem.

Now a new study offers some guidance: Don’t make comments about a child’s weight.

The study, published in the journal Eating & Weight Disorders, is one of many finding that parents’ careless — though usually well-meaning — comments about a child’s weight are often predictors of unhealthy dieting behaviors, binge eating and other eating disorders, and may inadvertently reinforce negative stereotypes about weight that children internalize. A parent’s comments on a daughter’s weight can have repercussions for years afterward, contributing to a young woman’s chronic dissatisfaction with her body – even if she is not overweight.

“Parents who have a child who’s identified as having obesity may be worried, but the way those concerns are discussed and communicated can be really damaging,” said Rebecca Puhl, deputy director of the Rudd Center for Food Policy and Obesity at the University of Connecticut. “The longitudinal research shows it can have a lasting impact.”

The impact on girls may be especially destructive, she said, because “girls are exposed to so many messages about thinness and body weight, and oftentimes women’s value is closely linked to their appearance. If parents don’t challenge those messages, they can be internalized.”

The new study included over 500 women in their 20s and early 30s who were asked questions about their body image and also asked to recall how often their parents commented about their weight. Whether the young women were overweight or not, those who recalled parents’ comments were much more likely to think they needed to lose 10 or 20 pounds, even when they weren’t overweight.

The study’s lead author, Dr. Brian Wansink, a professor and the director of Cornell University’s Food and Brand Lab, characterized the parents’ critical comments as having a “scarring influence.”

“We asked the women to recall how frequently parents commented, but the telling thing was that if they recalled it happening at all, it had as bad an influence as if it happened all the time,” said Dr. Wansink, author of the book “Slim by Design.” “A few comments were the same as commenting all the time. It seems to make a profound impression.”

Some studies have actually linked parents’ critical comments to an increased risk of obesity. One large government-funded study that followed thousands of 10-year-old girls found that, at the start of the study, nearly 60 percent of the girls said someone — a parent, sibling, teacher or peer – had told them they were “too fat.” By age 19, those who had been labeled “too fat” were more likely to be obese, regardless of whether they were heavy at age 10 or not.

Comments made by family members had even stronger effects than comments made by unrelated people.

Several studies have found that when parents encourage overweight teenagers to diet, the teenagers are at higher risk of lower self-esteem and depression and of being overweight five years later.

Research by Dianne Neumark-Sztainer, a professor at the University of Minnesota, found that when parents talked to their teens about losing weight, teenagers were more likely to diet, use unhealthy weight-control behaviors and binge eat. Those behaviors are less likely to develop when conversations with parents focused on healthy eating behaviors, rather than weight per se.

Harsh comments about weight can send the message that parents are “tying weight to some kind of perception about how the child is valued,” Dr. Puhl said, and that can trigger negative feelings. “The children are internalizing that, and thinking they’re not O.K. as a person. And that is what’s leading to other outcomes, like disordered eating.”

So what’s a parent to do? Do they just stand by while their child gains weight?

Dr. Neumark-Sztainer was besieged by parents asking her this question, and wondering, “How do I prevent them from getting overweight and still feel good about themselves?”

In her book, called “I’m, Like, SO Fat: Helping Your Teen Make Health Choices About Eating and Exercise in a Weight-Obsessed World,” she notes that parents can influence a child’s eating habits without talking about them. “I try to promote the idea of talking less and doing more — doing more to make your home a place where it’s easy to make healthy eating and physical activity choices, and talking less about weight.”

For parents, that means keeping healthy food in the house and not buying soda. It means sitting down to enjoy family dinners together, and also setting an example by being physically active and rallying the family to go for walks or bike rides together. Modeling also means not carping about your own weight. “Those actions speak louder than words,” Dr. Puhl said.

While your children are young, “there doesn’t need to be a conversation at all – it really is just about what’s being done at home,” Dr. Neumark-Sztainer said.

If an older child is overweight, “wait for your child to bring it up, and be there to support them when they do,” she said. “Say, ‘Look, I love you no matter what size you are, but if you would like, I will support you. I suggest we focus not so much on your weight but on your eating patterns and behaviors. What would be helpful for you?’”

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Coffee May Protect Against Cancer, W.H.O. Concludes

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Credit Fred R. Conrad for The New York Times

An influential panel of experts convened by the World Health Organization concluded on Wednesday that regularly drinking coffee could help protect against some types of cancer, a decision that followed decades of research pointing to the beverage’s many health benefits.

The announcement marked a rare reversal for the panel, which had previously described coffee as “possibly carcinogenic” in 1991 and linked it to bladder cancer. But since then a large body of research has portrayed coffee as a surprising elixir, finding lower rates of heart disease, Type 2 diabetes, neurological disorders and several cancers in those who drink it regularly.

Much of the evidence for coffee’s health benefits stems from observational studies, which cannot prove cause and effect. But the favorable findings on coffee consumption have been so consistent across so many studies that numerous health authorities have endorsed it as part of a healthy diet.

Last year, the panel of scientists that shaped the federal government’s 2015 dietary guidelines said there was “strong evidence” that 3 to 5 cups of coffee daily was not harmful, and that “moderate” consumption might reduce chronic disease. The World Cancer Research Fund International reported in recent years that coffee protects against multiple cancers. And the authors of one systematic review said that coffee consumption should be encouraged in people with chronic liver disease because it seems to lower their mortality.

The World Health Organization is the latest group to suggest a daily cuppa Joe might be good for health. The organization’s International Agency for Research on Cancer, also known as IARC, said it assembled a team of 23 scientists who reviewed more than 1,000 studies which showed no conclusive proof that coffee causes cancer. But the studies did suggest it was protective against some types of cancer, such as liver and uterine.

It is not entirely clear why. But scientists say coffee contains many antioxidants and other compounds that are being studied for their anti-cancer properties. Studies have linked decaffeinated coffee consumption to lower rates of chronic disease too, suggesting coffee’s benefits are not simply due to caffeine.

Whatever the mechanism, the news is sure to be welcomed by many Americans – about half of whom drink coffee every day. Around the world, more than 1.6 billion cups of coffee are consumed daily, making it one of the world’s most popular drinks behind tea.

In their report issued Wednesday, the IARC scientists did identify one surprising risk for coffee and tea drinkers. They said that drinking “very hot” beverages was “probably carcinogenic” because the practice was linked to esophageal cancer in some studies. But researchers say that may be caused by excessively hot beverages inflaming the lining of the throat – something that people could easily avoid by letting their hot tea or coffee cool off for a few minutes before drinking them.

Overcoming the Shame of a Suicide Attempt

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Credit Jordin Isip

I don’t remember much about the first time I tried to kill myself, 21 years ago, because any time the memory popped up I deleted it from my mind like an unflattering photo on Facebook. Despite being open and public about my second attempt, in 2006, which I revealed in a memoir about my alcoholism, I’ve never told anyone else about that first one – not my partner of 25 years, my therapist of 10 years, family, nor friends – until now.

Here’s what I remember about that first time, in 1995. I felt hopeless, that my 27 years of life were done (27!). I’d come home drunk from a glamorous Manhattan book event, which I had organized as the publicist. The wattage of successful artists in literature, fashion and theater was blinding. I felt like a failure, that I would never be more than the hired help, that my own dreams were just thin air. When I came home and poured another drink and remembered the leftover painkillers in my medicine cabinet – prescribed for a sprained ankle earned by a drunken fall — I thought, “Why not?”

My attempt was impulsive, not premeditated. Had it been successful, I’d classify it as suicidal manslaughter. I climbed into the antique wrought iron bed I shared with my partner and passed out. The next morning, I woke up next to him and he was none the wiser. I got up in a daze and went to work feeling like I was moving under water, so heavy was my triple hangover from booze, pills and shame. I kept moving, kept drinking (I was blind then to the cause and effect of booze and depression) and kept silent.

My silence nearly killed me. Eleven years later, I tried again. I had been fantasizing about suicide every day for months. I was more hopeless. I was drunker. That time I did it with sleeping pills I’d been taking to prevent me from drinking as much at night. Booze, pills, suicide attempts: it was all one big happy “Valley of the Dolls” family. That time I took the pills in the morning after my partner left for work, and I didn’t wake up on my own. My partner found me in that antique bed when he came home from work. The jig was up, and my winding path to recovery began.

Why bother talking about the first one? Now that I’ve been sober for almost eight years and my artistic dreams are coming true, the secret made me feel like a house rebuilt on a foundation still riddled with termites. I knew I would have to own the attempt eventually, so when the Centers for Disease Control and Prevention recently released a report that suicides had surged to the highest levels in 30 years, I knew it was time for me to come clean. With two attempts on my score card, I forever remain in a suicide high risk group. According to the Harvard T.H. Chan School of Public Health, a history of suicide attempt is one of the strongest risk factors for suicide, and the American Foundation for Suicide Prevention reports that approximately 40 percent of those who have died by suicide have made a previous suicide attempt at some point in their lives. I don’t want the third time to be the charm.

The further away from that first attempt, the deeper the secret grew and the less real it became. I didn’t really do that. I didn’t think a few painkillers would kill me. I didn’t mean it. But I did do it and I did mean it. I’m mortified by that. It was reckless, rash, stupid, selfish, pathetic.

As a recovering alcoholic I know that admitting to my behavior and owning my story is the only way it can no longer own me. I’m not ashamed of being an alcoholic, but I’m still ashamed of trying to kill myself, even though I know I did it under the temporary insanity of alcohol. According to the A.F.S.P., approximately 30 percent of those who die by suicide have blood alcohol levels in the range of intoxication at the time of their deaths.

After my second attempt, I went to rehab and then to sober meetings. The focus quickly shifted from my suicide attempt to my alcoholism, and rightfully so. Once my alcoholism was treated, the depression lifted. It was alcohol that brought on my depression and thoughts of suicide, and ultimately twice gave me the courage to try it. Since I’ve been sober, I no longer suffer from depression, do not take antidepressants and no longer think about killing myself.

I’m fortunate to live in New York City, where there are almost as many sober meetings as there are bars. These are peer-led meetings of alcoholics helping other alcoholics, free of judgment and condescension. These meetings keep me sober, hence nonsuicidal.

But what about the nonalcoholics and nonaddicts who’ve attempted suicide? Where are their meetings? I could find only a few peer-led suicide attempt survivor support groups via Google, and none in New York City. When I called the National Suicide Hotline requesting local suicide attempt survivor support groups, the operator suggested just one option: a Safe Place Meeting hosted by the Samaritans, a suicide prevention network. But those meetings are for those who have lost loved ones to suicide, and they have no meetings for attempt survivors.

I admitted my second suicide attempt because I was found out, and had to. But shame kept me quiet about my first attempt. I admit it now, and I throw out a call for other closeted suicide attempt survivors to do the same: Own it, and find – or create — a safe group where you can talk about it.

Today I own my story, so that my story doesn’t kill me.

Jamie Brickhouse is the author of “Dangerous When Wet: A Memoir of Booze, Sex, and My Mother.

What Should You Pay for a Child’s Guitar (Or Any Musical Instrument)?

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Credit iStock

It should have been a simple enough request. My 10-year-old, after several years of piano and voice lessons, had asked for a guitar.

But what to buy? I posed the question to my Facebook friends. Full-size or smaller? Acoustic or electric?

A couple of guys from the best campus band from my college days suggested the Baby Taylor, a three-quarter size (also known as parlor-size) acoustic guitar made by the El Cajon, Calif., company that the likes of Taylor Swift and Jason Mraz count on for instruments. A new one generally sells for around $329.

But then I heard from my friend Craig Bromberg, the father of 11-year-old guitar-playing twins and a serious musician himself. He let me have it for even considering buying a brand-new guitar. “I for one can’t stand the idea of kids with fancy instruments before they have even taken a single lesson,” he wrote.

He had a point. I’ve devoted a decent chunk of my professional life of late to trying to talk parents who have more money than average out of overindulging their kids. When it comes to cars, a shiny used one is generally the best choice. As for fancy mobile phones, get a dumb phone with basic voice and text service or let them pay the difference between that and the roving Internet access and shiny hardware they crave.

But musical instruments (of all sorts – not just guitars) are tools for learning, and that makes them different from cars or phones. Many forms of athletic gear for older children – tennis rackets, lacrosse sticks, gloves for baseball or softball – are similar. Even so, I realized that in considering my child’s request for a guitar, I got caught up in all the usual aspirations we have for our children, as well as my own memories and regrets about my musical training.

The lesson: We ought to put every object of child desire through its own wants-versus-needs test, one that inevitably ends with a question about how much is enough.

When I called up the people at Taylor Guitars to ask them how much guitar a 10-year-old truly needs, they put me in touch with Andy Powers, who is in charge of guitar design for the company. A parent and former guitar teacher himself, he does not necessarily default to his own company’s instruments when recommending a first guitar to other parents.

“I say that the first thing we want to do is get the kids an electric guitar,” he said, because electric guitars are often easier for beginners to play. His company doesn’t make very many of them and none at the entry level.

And he offered advice for helping a child stick with the instrument. “The first thing you want to teach them is their very favorite song,” he advised.

But how much should you actually spend? Mr. Powers outlined the two approaches he hears about most often. The delayed gratification theory has children doing the hard things first. You study, practice and bear with it, and then you get the nice guitar. The other is instant gratification – buy the nice guitar to start to make learning the guitar enjoyable as soon as possible.

Mr. Powers advised against the delayed gratification approach because it could sabotage the child’s learning. “The least enjoyable part is the moment you first pick it up,” he said. “You’re physically struggling with an instrument that you don’t know much about.”

And for a child like mine who wants to play acoustic, he couldn’t help but wax eloquent on the virtues of the Baby Taylor’s function over form: its intonation, seasoning and repairability. I know a bit about music and caught his drift, but I wasn’t sure his arguments would pass muster with every parent.

I took his comments back to my friend Craig. He reminded me that most famous musicians did not learn to play on top-of-the-line equipment. And while the Baby Taylor is portable (which is why many adults love owning it too), he wondered whether we’d be inclined to tote it around given its price and the possibility of damaging it.

My wife asked another question that I hadn’t thought of: Why not buy our daughter the cheap guitar (or at least a decent but lower-priced used one), and spend more on a really great teacher or a larger number of initial lessons? It’s an excellent question, if only we knew which style of teaching would be best for her. Picking out an instrument seems easier somehow.

One of Craig’s most recent musical purchases for one of his sons was a used instrument. Indeed, buying someone else’s Baby Taylor would set us back only $200 to $250. Older ones seem to hold their value reasonably well, which means we could hock ours if my daughter doesn’t take to playing or graduates to a bigger guitar within a few years. Craig said he did not find this approach overly indulgent.

And to Mr. Powers at Taylor, who has made music his life’s work, the choice of instrument is one with the highest of stakes, as he’s not sure he would have stuck with it if he had been learning on a glorified toy. “The difference between that person who says ‘Oh yes, I took lessons when I was a kid’ and someone who engages forever is when they cross over from studying to doing an instrument,” he said.

I do want my daughter to play on a guitar that gives her the best chance of crossing that chasm. But my hunch is this: It wouldn’t have taken $329 to get me to “do guitar,” had anyone thought to suggest it when I quit classical piano lessons after 10 years.

And perhaps that’s one more reason I find the used Taylor — which we’re now in the process of hunting down, at $100 or so off the new price — so enticing. If my daughter doesn’t stick with guitar, I just may keep her instrument for myself.

Ron Lieber is the Your Money columnist for The New York Times and the author of “The Opposite of Spoiled,” about parenting, money and values.

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Where Does the Time Go? How to Keep Track

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Credit iStock

How busy are we, exactly?

The author and time management expert Laura Vanderkam decided to answer that question for herself. She tracked her time for an entire year (8,784 hours in a leap year), and in doing so learned her life was a bit less hectic than she thought. Ms. Vanderkam, a working mother of four young children, recently wrote in The Times about her experience.

The article, “The Busy Person’s Lies,” was widely viewed and shared and generated hundreds of comments. But it also left some of us with questions for Ms. Vanderkam, whose latest book is “I Know How She Does It: How Successful Women Make the Most of their Time.” I recently spoke with Ms. Vanderkam to find out exactly how she did it, the best apps for tracking time and why some people have been critical of her time-tracking advice. Here’s an edited version of our conversation.

Q.

How did you do this? Break it down for us — did you use a datebook, or an app?

A.

I used a spreadsheet. It’s just an Excel worksheet, with the days of the week across the top and then blocks for the time, from 5 a.m. to 5 a.m. in half-hour increments. It’s on my laptop, and it was pretty much open all the time.

Q.

How often did you update it?

A.

Most weekdays I probably updated it between three and six times. If I wasn’t at my laptop during the day, I kept a sort of a mental tally all day and filled it in in the evening. As long as you’re looking at half-hour blocks and paying attention, not estimating, you’re not likely to make big mistakes, the way you do if someone asks you, how much to you sleep, or how much do you work, and you just guess without any data. If you’re tracking, you’re going to be off by minutes, not hours, and you’ll still get the information you want.

Photo

A chart showing how Laura Vanderkam spent her time. <a href="https://static01.nyt.com/packages/pdf/health/KJ.pdf">See a larger version.</a>

A chart showing how Laura Vanderkam spent her time. See a larger version.Credit

Q.

What’s the first step to tracking your time? How long a period should you track?

A.

Just choose a tool to use. The tool itself doesn’t matter. You can use a spreadsheet, or one of a million time tracking apps, or a Moleskine notebook if you want to look all artsy. The key is to do it consistently. And a week is great, or even a few days. The longer you do, the more insights you get, but a week is enough to see patterns.

Q.

Any apps you recommend?

A.

Toggl is free for the basic version. If you want to use an app, I suggest using that for a while, and see if you feel like you need any extra bells and whistles. Once you know what you like, you look for a paid app.

Q.

What kinds of categories did you use?

A.

I didn’t categorize until I was finished. I just wrote a brief description of what I did during that half hour — feed baby/email, speech, church, shop Target, work on train, things like that. I categorized later. I looked at work, sleep, exercise, housework and errands, TV, reading and time in the car, because those were the things I was interested in. Different people will have different categories. I could have pulled out different things, like child care, but as a mother of four who often works at home, so much of that is nebulous. I’m pretty aware of it. But if I were concerned with whether I spent enough time with my kids, or wondering what those numbers looked like, I would have tallied that.

Q.

Did you expect to be able to account for every hour out of your 24?

A.

No. Some people get hung up on this. I’m not a perfectionist. If I ran on the treadmill for 27 minutes and spent three going upstairs and getting water, I’m calling that 30 minutes of exercise. And the time that’s sort of unclassifiable is fine with me — hanging out watching kids play, or flipping through a magazine. The big categories won’t go wrong.

Q.

Is there an issue with being honest with yourself? People always say, “I never watch TV,” but they seem to know everything that happens on “Game of Thrones.” Do you have to make a commitment to not lie to yourself to make this work?

A.

When I do this, it’s just for me. Which means that I don’t think there is any reason to lie on it. If you’re not happy with the amount of TV you watch, or whatever, time tracking is a good way to notice that. Just because you know where the time goes doesn’t mean that you need to punish yourself for wasting it or feel bad about spending it the way you do. Are you happy, or not? If you’re happy, celebrate that. There’s nothing wrong with sitting on the porch drinking a glass of wine and staring at the trees.

But if you have open time and you don’t ask yourself, what would make me happy — if you just spend that time mindlessly on Twitter because your phone is in your hand — then maybe this is your chance to ask what you want to do with that time that is meaningful. Life is what it is. It’s just a matter of asking, now I know this. Do I want to keep it, or do I want to change it?

Q.

One of the concerns in the comments on your “The Busy Person’s Lies” piece is that time tracking is a luxury of the upper class. Is time tracking useful for people who don’t have white-collar, flexible jobs?

A.

I think it’s still very useful. With some jobs, you know exactly how many hours you work — it’s right there on your check. But it’s still easy to have the rest of life go by mindlessly. Some of us need a reality check on work. Others want to check other things in their lives. We have only so many hours and a life is lived in hours. I think we all share an interest in figuring out where they go and if we are spending them in ways that are meaningful and enjoyable.

I did see the comments that sort of relegated this to first-world problems. I could understand that better if I were complaining, but I’m not. My point is that I see life as a working person in a prosperous country as very doable, and I think that is a good story to tell ourselves.

Q.

What’s one of the most important things we can learn from tracking our time?

A.

Sometimes we don’t want to own up to how much of time is a choice. But for many of us, there is a reasonable amount of choice in how we spend our days. Using the language of being “busy” lets us avoid responsibility for those choices.

I always use the example of a woman whose water heater broke during the week when she was tracking her time, and it took her seven hours to deal with it. Any of us would say we don’t have seven hours, but when we have water all over the basement floor, we find seven hours.

How do we figure out what really matters to us, and how we can treat it like a broken water heater? That’s the big question.

If you choose to track your time, and the results push you toward changes in how you spend time or how you think about it, let us know. Email us at wellfamily@nytimes.com, and we might use your story in a later post.

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Can High-Intensity Exercise Help Me Lose Weight? And Other Questions, Answered

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Credit Getty Images

I recently wrote about a study showing that one minute of intense interval training, tucked into a workout that was, in total, 10 minutes long, produced comparable health and fitness benefits to 45 minutes of more moderate, uninterrupted endurance training.

Readers posted almost 400 comments to the article and flooded the Internet and my inbox with questions and sentiments about extremely short workouts. Given the extent of the response and the astuteness of the questions, I thought I would address some of the issues that arose over and over.

Q. Are high-intensity interval workouts actually better for you than longer, endurance-style workouts — or just shorter?

A. Better is such a subjective word. At the moment, the two types of workouts appear to be largely equivalent to each other in terms of a wide variety of health and fitness benefits.

In the study that I wrote about, “1 Minute of All-Out Exercise May Equal 45 Minutes of Moderate Exertion,” for instance, three months of high-intensity interval training practiced three times per week led to approximately the same improvements in aerobic endurance, insulin resistance and muscular health as far longer sessions of moderate pedaling on a stationary bicycle.

One type of workout was not more beneficial than the other, in other words, but one required much, much less time.

Other studies have generally produced similar results, although, to be honest, the science related to interval training for health purposes and not simply for athletic performance remains scant. An interesting new review of past research to be published in June did conclude that, for overweight and obese children, short sessions of intense intervals may lead to greater improvements in endurance and blood pressure than longer bouts of moderate exercise, although the authors did not discuss how best to get children to complete frequent interval sessions.

The upshot of the available science is that if you currently have the time and inclination to complete long-ish, moderate workouts — if you enjoy running, cycling, swimming, walking or rowing for 30 minutes or more, for instance — by all means, continue.

If, on the other hand, you frequently skip workouts because you feel that you do not have enough time to exercise, then very brief, high-intensity intervals may be ideal for you. They can robustly improve health and fitness without overcrowding schedules.

Q.

What about combining brief high-intensity workouts with longer, endurance workouts?

A.

Alternating high-intensity workouts with endurance-style workouts may yield the greatest health and fitness gains of all.

In a 2014 study, a group of sedentary adults began either a standard endurance-training program, in which they pedaled a bicycle moderately for 30 minutes five times a week, or swapped one of those bike rides for an interval session. All of the participants wound up significantly more aerobically fit after 12 weeks.

But the men and women who had completed one interval session per week had developed slightly more overall endurance than the other volunteers. As a result, they had lowered their risk for premature death by about an additional 18 percent, the study’s authors conclude.

Q.

Do I have to use a stationary bicycle for interval training?

A.

Most recent studies of high-intensity intervals have involved computerized stationary bicycles because scientists can easily monitor the riders’ pace and intensity. But there is nothing magical about the equipment. The key to high-intensity interval training is the intensity, which most of us can gauge either with a heart rate monitor or our own honest judgment.

For moderate exercise, your heart rate typically should be between 70 and 85 percent of your maximum. (I recently wrote about how to determine your individual maximum heart rate.) This intensity would feel like about an 8 on an arduousness scale of 1 to 10.

During an intense interval, however, your heart rate should rise to 90 percent of your maximum heart rate, or above. Think of this as feeling like about a 9.5 on the 10-point scale. You maintain that intensity for only 10 or 20 seconds at a time, however, followed by several minutes of very easy exercise before repeating the intense work.

Almost any type of exercise can be used for interval training, including running up the stairs in your office’s stairwell during your lunch hour, said Martin Gibala, a professor of kinesiology at McMaster University in Hamilton, Ontario, and an expert on intervals. (His book about the science and practical implications of high-intensity interval training will be published in early 2017.)

Q.

Will high-intensity intervals help me to lose weight?

A.

Few studies have yet looked at the long-term effects on body weight of exercising exclusively with high-intensity intervals, although some experiments do hint that high-intensity interval training can reduce body fat, at least in the short term.

In a 2015 study, for example, overweight, out-of-shape men who began either to jog or otherwise exercise moderately for an hour five days per week for six weeks or to complete intensive interval training for a few minutes per week all dropped body fat and about the same percentages of fat, despite very different amounts of exercise. Likewise, a group of women recovering from breast cancer who were assigned either to moderate exercise or brief interval training for three weeks lost comparable amounts of body fat during the study.

But these were small-scale, brief experiments. Whether interval training helps or hinders long-term weight control is still unknown.

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‘Two-Minute-Warnings’ Make Turning Off the TV Harder

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Credit Getty Images

Two-minute warnings may work well in sports, but they don’t, apparently, work for children.

New research shows that giving a child a “two-minute warning” before turning off a video game or TV show does not make it easier for a child to turn away from a screen. In fact, it makes it harder.

To learn more about how families manage a child’s screen time, researchers from the University of Washington’s Computing for Healthy Living & Learning Lab interviewed 27 families with children ages 1 to 5 about how they limit and end a child’s viewing time. They then asked a separate set of 28 families to fill out a diary describing each time their child interacted with a screen over a period of two weeks, including how the screen time experience ended, whether the child was upset with the ending, and how the screen time fit into a child’s ordinary routine.

Parents reported that their children were significantly more upset, more often, when given a warning that screen time was about to end than when screen time was stopped without a warning.

It’s a small study, but a detailed one, and its results surprised the researchers.

“We had thought that giving kids a little bit of a warning to set expectations would help things go better, and it actually made them much worse,” said the lead author, Alexis Hiniker, a University of Washington doctoral candidate in human-centered design and engineering.

Julie Kientz, associate professor of human-centered design and engineering at the University of Washington and the paper’s senior author, said the researchers had a theory: maybe instead of easing a child’s transition away from screens, a two-minute warning prepares them to fight it.

“This is definitely the age where parents are trying to avoid power struggles and kids are very welcoming to them,” said Dr. Kientz. “We think possibly that the two-minute warning kind of primed them for knowing that there was going to be this battle.”

To be certain that the behavior was related to the two-minute warning, the researchers culled through their data, looking for other associations. Did the parents offer the two-minute warning only before less pleasant activities, or before parents were getting ready to leave? But they weren’t able to find any associations other than the warnings themselves.

Ms. Hiniker said programs that automatically repeat or show previews immediately after a show is over can make it difficult for a child to turn away from a screen. Parents were also successful in easing transitions by blaming the technology, declaring the battery dead, the Wi-Fi broken, or pretending that a program a child watched on vacation was not available at home.

“What the technology itself did made a huge difference,” said Ms. Hiniker. “If the technology was backing the parent up, and kind of saying ‘screen time is done now,’ then things went better than if the parent just told the child ‘you’re done.’”

Making screen time part of a routine also eased the transition away from it, the researchers said. If a screen was always turned off at a particular stage — for example, when breakfast was ready — children rarely objected. But parents, they said, were reluctant to use that as a tool, worried that it would “cement screen time into their schedule” and lead to more.

One final surprise for the researchers, and for the parents who participated in the research: In general, the transitions away from screen time went remarkably well. And in about one in four screen sessions, children turned screens off on their own, something many parents interviewed said had never happened before — suggesting that parents may be putting too much weight on a few negative experiences when they think about screen time.

“About 80 percent of the transitions were totally fine,” said Ms. Hiniker. “In fact a lot of the time kids were happy about it — they were excited to do whatever was coming next.”

Two-minute warnings may work well in sports, but they don’t, apparently, work for children.

New research shows that giving a child a “two-minute warning” before turning off a video game or TV show does not make it easier for a child to turn away from a screen. In fact, it makes it harder.

To learn more about how families manage a child’s screen time, researchers from the University of Washington’s Computing for Healthy Living and Learning Lab interviewed 27 families with children ages 1 to 5 about how they limit and end a child’s viewing time. They then asked a separate set of 28 families to fill out a diary describing each time their child interacted with a screen over a period of two weeks, including how the screen time experience ended, whether the child was upset with the ending, and how the screen time fit into a child’s ordinary routine.

Parents reported that their children were significantly more upset, more often, when given a warning that screen time was about to end than when screen time was stopped without a warning.

It’s a small study, but a detailed one, and its results surprised the researchers.

“We had thought that giving kids a little bit of a warning to set expectations would help things go better, and it actually made them much worse,” said the lead author, Alexis Hiniker, a University of Washington doctoral candidate in human-centered design and engineering.

Julie Kientz, associate professor of human-centered design and engineering at the University of Washington and the paper’s senior author, said the researchers had a theory: maybe instead of easing a child’s transition away from screens, a two-minute warning prepares them to fight it.

“This is definitely the age where parents are trying to avoid power struggles and kids are very welcoming to them,” said Dr. Kientz. “We think possibly that the two-minute warning kind of primed them for knowing that there was going to be this battle.”

To be certain that the behavior was related to the two-minute warning, the researchers culled through their data, looking for other associations. Did the parents offer the two-minute warning only before less pleasant activities, or before parents were getting ready to leave? But they weren’t able to find any associations other than the warnings themselves.

Ms. Hiniker said programs that automatically repeat or show previews immediately after a show is over can make it difficult for a child to turn away from a screen. Parents were also successful in easing transitions by blaming the technology, declaring the battery dead, the Wi-Fi broken, or pretending that a program a child watched on vacation was not available at home.

“What the technology itself did made a huge difference,” said Ms. Hiniker. “If the technology was backing the parent up, and kind of saying ‘screen time is done now,’ then things went better than if the parent just told the child ‘you’re done.’”

Making screen time part of a routine also eased the transition away from it, the researchers said. If a screen was always turned off at a particular stage — for example, when breakfast was ready — children rarely objected. But parents, they said, were reluctant to use that as a tool, worried that it would “cement screen time into their schedule” and lead to more.

One final surprise for the researchers, and for the parents who participated in the research: In general, the transitions away from screen time went remarkably well. And in about one in four screen sessions, children turned screens off on their own, something many parents interviewed said had never happened before — suggesting that parents may be putting too much weight on a few negative experiences when they think about screen time.

“About 80 percent of the transitions were totally fine,” Ms. Hiniker said. “In fact a lot of the time kids were happy about it — they were excited to do whatever was coming next.”

Raising a Child With Grit Can Mean Letting Her Quit

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Angela Duckworth

Angela DuckworthCredit

The rule at the “grit” expert Angela Duckworth’s house? You can quit. But you can’t quit on a hard day.

Few parents who pick up Angela Duckworth’s book “Grit: The Power of Passion and Perseverance,” will be thinking about raising a quitter.

But Dr. Duckworth, an assistant professor of psychology at the University of Pennsylvania, has some unexpected advice.

“Quitting is essential, especially when you’re young,” said Dr. Duckworth, who was named a MacArthur “genius” in 2013 for her development of the concept of “grit”— the combination of determination and direction that drives some people to constantly work, improve and achieve. “It’s counterintuitive, especially for parents looking for an affirmation that discipline and hard work are what matters — but interests come first.”

Very young kids, she says, should be allowed to explore, even if that means abandoning projects and even practices.

The reason it’s sometimes all right to let a child quit, Dr. Duckworth said, is that the predecessor to developing grit is the kind of play that leads to passion. Parents shouldn’t be discouraged by those early starts and stops. “Kids don’t work hard on things they don’t care about,” she says.

As children grow older, seeing things through becomes more important.

“A child in elementary school should be able to stick with things for more than a few weeks,” she said. A middle-school-age child should be able to do a full year or season, and once a child is in high school, research suggests that spending more than a year or a single season on an activity is important. “It’s important to experience what it’s like to come back,” she said, and to see how you improve with experience and how things change as coaches or advisers change.

Still, even for an older child, there are times when quitting is the right choice. Another season of a sport comes at a cost: less time to try something new. There are also times when that urge to quit comes from frustration or fear, or even a sort of inertia. The mother of the world-record-holding sprinter Usain Bolt probably doesn’t regret pulling him away from video games to insist that he go to track practice.

So how does a parent know when to demand that a child keep going, and when to support a decision to stop?

In Dr. Duckworth’s house, there’s a rule, she said. “You can’t quit on a hard day.” You play in the rain, you return to class after a scolding from a teacher, you pick up the instrument again until that hard passage has become easy.

“Parents know what a kid doesn’t know,” Dr. Duckworth said. “For a kid, it’s irrational to keep going when they’re discouraged. Parents know that everyone feels that way.”

Dr. Duckworth is quick to note that her book is not a parenting manual. It’s an exploration of the sometimes surprising ways hard work, passion and perseverance matter more than talent, a reminder that what observers sometimes see as the overnight success of the incredibly gifted, particularly in the realm of athletics, is really the product of drive as well as ability, and a discussion of how all of us — not just children — can grow our “grit” throughout our lives.

Instilling grit in your child requires a combination of being demanding and supportive, said Dr. Duckworth. “You need to push your kids a little bit, but they also need to know that they’re supported.”

Second, parents need to “model” grit. Talk about the challenges you face now, or have faced in the past, and how you persisted. Tell family stories about the ways your clan just doesn’t quit.

And never discount the importance of fun. Children should be allowed to try the things they gravitate toward, and those sometimes don’t appear until a child has had time to explore and understand what makes him or her happy. Dr. Duckworth tells the story of a talented young swimmer explaining why he wanted to switch to rowing — he “really wanted to be outside.”

There’s a process, she said, of “learning what rings your bell.”

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