It’s estimated that over 26 million people have taken a “direct-to-consumer” (or DTC) genetic testing kit, like 23andMe or AncestryDNA, and that number is likely to climb to 100 million by the end of the year. These companies trade on the idea that a quick spit swab test can clue you into your family history, genetic makeup, and the health conditions you may be at increased risk of developing (as long as you’re cool with sending off your genetic info to an online bank where it may be repurposed by data brokers, law enforcement, and a number of other entities).
But a new study published in the journal The BMJ on Wednesday says you should get a second opinion on DTC test results, because many kits are dishing out unreliable info. The tests are frequently giving false positives by indicating people are at risk for something when they really aren’t, researchers said. Another study published in July looked at the breast cancer genes BRCA1 and BRCA2 and found that 96 percent of the genetic variants identified by direct-to-consumer testing kits were false positives, and other researchers have estimated that about 40 percent of DTC results are straight-up inaccurate.
The BMJ study found that even if a DTC test shows a person has a genetic variant linked to a disease, that doesn’t mean they have that disease. For example: If your results say it looks like you’ll develop Parkinson’s disease, but no one in your family’s ever had it, you may just have an odd-looking piece of DNA that’s well-protected by other genetic factors that run in your family.
DTC kits may also indicate false negatives, suggesting a person is in the clear in terms of their risk of a particular condition when that’s not totally accurate. One example: Because DTC tests only look at three types of genetic variants linked to breast cancer, it doesn’t catch the 80 percent of people who have another disease-causing variant the tests don’t look for.
The researchers who conducted the study published Wednesday suspect a few reasons for these inaccuracies, mostly boiling down to that most of the databases used to interpret the tests aren’t up to date. On top of that, sometimes glitches occur (aka, the genotyping shows one genetic variant at first look, but follow-up tests show another). While these tests remain unreliable, the best source for medical advice and testing is your doctor.
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The Hidden Mental Health Costs of Climate Change
“People don’t really understand—until you actually see it coming at you in a wall of flame,” says a woman in the Rural Fire Service of New South Wales, in startling footage of fighting Australia’s raging bushfires last month. Extreme weather events like these are becoming more frequent and more severe: in the U.S. just this…
“People don’t really understand—until you actually see it coming at you in a wall of flame,” says a woman in the Rural Fire Service of New South Wales, in startling footage of fighting Australia’s raging bushfires last month. Extreme weather events like these are becoming more frequent and more severe: in the U.S. just this year, five states have set wildfire records. But it’s not just unlucky homeowners who are affected—fine particulate matter is an increasing concern for epidemiologists, who’ve found that public exposure can cause both acute and chronic disease.
Though these types of environmental catastrophes are often still talked about in terms of future consequences, climate change is already having a massive impact on public health. The World Health Organization (WHO) just released a report, which draws on data from 101 countries, highlighting these climate-related health risks—and the world’s lack of preparedness.
Impacts include increased risk of childhood diarrheal disease caused by a food supply that’s potentially more vulnerable to pathogens, heatwaves creating dangerous labor conditions, and increased disease risk from chronic exposures to things like air pollution later in life.
Mental health can be affected by climate change too, and depression, anxiety, and other mental health issues are identified in the report as climate-sensitive conditions. But only six countries emphasized that it was a priority for them. Katie Hayes, a climate change and mental health researcher, has recently published on the current and projected mental health consequences of the climate crisis in the International Journal of Mental Health Systems. She said that while attributing direct causes in the mental-health sphere can be challenging, it’s clear that the impacts of climate change are accelerating.
“Extreme weather events, like flooding, hurricanes, and wildfires have been linked to depression, anxiety, post-traumatic stress disorder (PTSD), suicidal ideation,” Hayes wrote in the International Journal of Environmental Research and Public Health. Further, “Vector-borne diseases like West Nile Virus and Lyme disease may compound mental health issues for people with pre-existing mental health illness.” Which is why, she said, “It’s important to link [mental health issues] to climate change,” because “these events, they’re no longer one-off—it’s not a one-in-100-year flood anymore.” Though it was only raised as a significant concern by six countries, Tara Neville, a lead author on the WHO report, said it’s important that “we are now seeing countries specifically identifying mental health issues as a health risk of climate change.”
Hayes notes that existing social injustices are amplified by climate change, and that it’s the most marginalized who are especially vulnerable, including people who have had to flee their homes because of climate change, or groups like indigenous communities who already struggle with access to healthcare. “Our physical health, our mental health, and our community health are all connected,” said Hayes.
The conclusions of the WHO report are buoyed by a litany of other recent research. In November, the Lancet Countdown, a project dedicated to monitoring health and climate change, released its 2019 report. “We’re able to say that for a child born today, their life is going to be affected by climate change at every single point,” said Nick Watts, executive director at the Lancet Countdown .
Nearly half of the countries WHO surveyed had conducted “a vulnerability and adaptation assessment for health,” but only 20 of the 48 countries said their findings led directly to funding policies to address public health impacts of climate change. Although there’s increasing concern and awareness of climate-related risks associated with extreme weather—like food- and water-borne diseases, or diseases carried by insects like mosquitoes—few countries have implemented significant policy changes.
“The concern is that governments simply aren’t moving fast enough,” Watts said.
It’s difficult to overstate the broad-reaching impacts. When we talk about disease, as emerging viruses like Zika demonstrate, “It’s important to say that no country, no population is immune,” Watts said. “The world’s very, very connected.”
As healthcare professionals scramble to deal with the fallout from a warming planet, they will have to deal with a new level of uncertainty. Whether in Australia, the U.S., or the U.K., healthcare systems have been built on an “assumption that the climate was going to be stable,” Watts said. “That’s no longer a safe assumption—whether we’re talking about the floods in Venice or the wildfires in California.”
Sean McDermott is a freelance journalist and photographer.
I’m HIV-Positive. My Partner Is Negative. This Is How We Have Sex
For many, HIV is the ultimate boogeyman of the modern sex-scape. Years of horror stories have led some to fear contracting the virus so much that it becomes a constant phobia. It has also led to the stigmatization of HIV-positive individuals as toxic or wicked—and desexualized. Who, this line of thought goes, once struck with…
For many, HIV is the ultimate boogeyman of the modern sex-scape. Years of horror stories have led some to fear contracting the virus so much that it becomes a constant phobia. It has also led to the stigmatization of HIV-positive individuals as toxic or wicked—and desexualized. Who, this line of thought goes, once struck with HIV could think of themself as a viable sexual object ever again? And who would view them as viable partners for any form of physical intimacy?
It is absurd that this even needs to be said, but people living with HIV are humans living full, long lives with a chronic but manageable condition, like so many others. They desire, and are deserving of, love and intimacy like anyone. Being in a relationship can actually be a vital motivator for some people to seek and keep up with treatment.
One might assume that HIV-positive people choose to date those who share their status, so as not to worry about transmitting the virus. And sure, this happens. But many HIV-positive and -negative people still pursue sex and intimacy together, in what are known as “serodiscordant” or mixed-status relationships. In the U.S. alone, there are at least 140,000 mixed-status couples, possibly many more, as that estimate was extrapolated from 23-year-old data. In countries where HIV is especially prevalent, more than 3 percent of all relationships are serodiscordant, and up to two-thirds of HIV-positive individuals are in such relationships.
Not all these couples know from the start that they are serodiscordant, thanks to a positive partner not knowing their status or contracting the virus while already in an established relationship. But many partners know they are mixed status when they get together and make it work.
There is no single strategy for HIV-positive and -negative people to pursue sex and intimacy. Some agree to pursue only emotional intimacy, perhaps consenting to forms of non-monogamy as well. Some only engage in non-penetrative sex. Some use condoms at all times. Increasingly, though, there’s recognition that effective treatment can lower one’s viral load to untransmissible levels. This makes the risk of an HIV-negative partner contracting the virus functionally nonexistent during unprotected sex with a HIV-positive partner who has had such a low load for at least six months and is maintaining their treatment regimen. The spread of PrEP—a preventive drug regimen used by an HIV-negative partner that reduces the risk of transmission by up to 99 percent—in recent years has also opened up new possibilities for a sense of security and less restrained intimacy. Some couples mix and match strategies as needed.
Vasilios Papapitsios: I became positive when I was 19. I’m 28 now. I’d just come out of the closet. I was living in a very hateful state [North Carolina] that had just defunded the AIDS drug assistance program, and I was going to school at UNC-Chapel Hill. As much as it thinks it is a progressive community, I was already feeling outed by a lot of my community members.
At that time, it was definitely easier to conceive of a relationship—or just casual sex—with another HIV-positive person because of the stigma I’d internalized and the fear of passing it along.
Elijah McKinnon: I’m from the San Francisco Bay area. I grew up in a pretty liberal household. I talked about sex and various STIs, including HIV, with my parents, who were in an open relationship and very open sexually. I had various relatives die from AIDS.
I had a lot of friends who were young and positive, but not out. It was more hidden than I think a lot of people are now about their status. So the first thing I learned is that I need to take ownership of my own status. What are the ways I can best protect myself? I mean not only from STIs, but a more holistic approach—like my mental sanity, my emotional sanity.
I never thought about serodiscordant relationships from this taboo perspective. One of my first…let’s just call him a boyfriend, was HIV positive. That’s when I discovered PrEP. I had to be 19, 20. This is right when the FDA approved it. I was super skeptical like, you want me to take what? Then after being involved with the study that changed the entire landscape of PrEP a couple years ago by testing a lot of people [using it] and seeing the significant decrease in [transmission of HIV], it was sort of a no-brainer for me. Leading into this relationship, I don’t think I had any barriers.
Vasilios: [Just before I met Eli in late 2016,] I’d been in New York for about half a year. It was suddenly an environment where people just didn’t care about my status. It was: That’s okay, the same way it’s okay for you to be gay. I felt more liberated and free to just be myself.
[Then I moved to Chicago.] It was the first time I was very open about my status to the public. I witnessed communities of people who were all on PrEP, or they know about it. I had been undetectable for a year or two. That was a major factor in terms of my internal stigma and fear.
My world blossomed. I was allowing myself to have intimacy and love and sex in ways that I couldn’t before…I realized I just deserved that and wasn’t this scourge of society.
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Elijah: I met Vas during a performance where they were doing a blood ritual [that involved taking a bath in fake blood] that centers on queer people living with chronic illnesses. So I was very much aware of their status.
Vasilios: I knew she was the PrEP girl. [Eli helped develop PrEP4Love, a campaign raising awareness of PrEP among black gay men, straight black women, and black trans women, and was a model in campaign ads all over Chicago.] She knew I was the poz artist and advocate.
Elijah: I’m black and queer and non-binary. We live on opposite ends of the country. We have different interests and passions. We’re constantly approaching things from the perspectives of our past traumas. There are constantly tensions between our other identities that we are processing. Our status is, I don’t want to say low on the totem pole, but there are other things we are processing.
Vasilios: We have an open relationship. Usually it’s separate. Sometimes it’s not.
I have to be aware that there are other STIs when you do not use a prophylactic. Even if people I’m having sex with are on PrEP, that doesn’t mean other things are thrown out the window. For me, PrEP is like a mental prophylactic. It gives us the opportunity to get into it and not have to think, oh my goodness, this little act of intimacy or sex is so wonderful but there’s still a lingering fear. That doesn’t really exist for me anymore. And that is an amazing gift. But any sex interaction, I have to think about, huh, I don’t know this person or whatever, I’m taking a risk.
How do I put this… We use condoms [together] if we need to. But we don’t really want to.
Elijah: There are a lot of tools that people don’t know about when navigating sex. Like the number of partners, or knowing how to have communicative conversations with those partners as just number one. That allows you to navigate sexually through an experience however you want to.
There are obviously condoms and PrEP, but also positioning [in terms of who is the recipient of penetrative sex; the receiving partner is at more risk]. There are ways of being intimate that are non-penetrative. There’re so many different things we discuss. Everything on our relationship is on the table. When it’s not, things begin to spiral because we’re not being communicative.
One thing that really has been intimate about our respective statuses is that I feel, versus a lot of other relationships, we’re more actively involved with each other’s holistic health. Not just okay, what’s your CD4 count? But how’s your mind doing? Let’s check in. How are you eating?
Vasilios: I think we have learned from our past experiences. And we complement each other in our different healing journeys.
Elijah: Up until about a year ago, I got a lot of questions, like: Aren’t you scared? Don’t you just think it would be easier with a negative person? I don’t even know what any of those questions mean!
There are still a lot of people who are very unaware due to fear and stigma around how to not only be in a serodiscordant relationship but be in a gay, queer, alternative relationship in general. Because they don’t have any models and the models that we do have are very monolithic. If it weren’t status, it’d be something else, like: How is it being in a mixed-race relationship?
That is just one facet of our multi-faceted relationship. It’s a topic that’s up for discussion, not so much negotiation. And it isn’t a barrier to accessing our most intimate depths of pleasure and joy.
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More People Than Ever Are Trying to Lose Weight, to No Avail
Despite reportedly trying lots of different weight loss methods, adults in the United States have seen overall increases in weight and actual measured BMI, according to a new study published this week in JAMA Network Open. The research basically paints a picture of people spinning their diet and activity wheels, reportedly restricting their food intake,…
Despite reportedly trying lots of different weight loss methods, adults in the United States have seen overall increases in weight and actual measured BMI, according to a new study published this week in JAMA Network Open. The research basically paints a picture of people spinning their diet and activity wheels, reportedly restricting their food intake, increasing exercise, and drinking a ton of water, all to no avail.
The most interesting data within the study is the table of things people say they’ve done to try and lose weight, and how those tactics have changed over the 17 years of the research period. The number of people who say they “ate less food,” for instance, increased by 11 percent, and there was a more than 26 percent increase in “drinking more water” as a weight-management strategy (a questionable method); while only seven people say they drank water as a weight loss tactic in 1999–2000, 1,370 said the same in 2015–2016. Steady increases can be seen each year, which is a nice way to trace the celebrity diet cliché to just “drink a lot of water!!!” through time.
Researchers don’t offer much in the line of why this is happening (or maybe more fair to say, not happening). The study hypothesizes people are over-reporting the efforts they’re making to lose weight (the study data comes from a nationally representative survey). Or the gap in weight loss efforts and weight gained could come from a previously observed trend that people who perceive themselves to be overweight are more likely to increase their weight over time. This would also make sense, given that the number of people who think of themselves as overweight also increased in the study’s timeframe.
Researchers ultimately conclude that even though more people say they were trying to lose weight, across the board, weights and BMI increased. Of course, higher weights and higher BMI doesn’t necessarily speak to poor health: It’s extremely possible to gain mass in a healthy way; having more weight doesn’t necessarily mean being less healthy. But the overall picture of how healthy the country is isn’t what’s on display in this study. If anything, this study shows that people are certainly more stressed out about their weight, which can have a loose connection to health. But they’re not getting the tools they need to feel equipped to live healthily, or accept their healthy bodies.
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