TUESDAY, Oct. 16, 2018 (HealthDay News) — Developing lean muscle mass is important for everyone — it can keep you active and independent throughout your life.
But to maximize the benefits of strength training, make sure you’re not making these common mistakes.
Mistake number 1: Letting momentum drive your workout. If you power through repetitions at a rapid clip, chances are that you’re using momentum rather than controlled muscle movement to do those reps. To get the most out of each rep, take two to three seconds to lift the weight and three to four seconds to return to the starting position.
Mistake number 2: Not moving through a complete range of motion. You’re shortchanging yourself if you’re also rushing through reps without carefully moving from your starting position to a full extension, no matter what the exercise. If you’re unable to do this, chances are you’re lifting too heavy a weight for your current ability.
Mistake number 3: Not lifting enough weight. Some women still incorrectly believe that they’ll develop manly muscle mass if they lift more than a few pounds. But female hormones typically won’t allow that to happen. To get the benefits of strength training, you have to challenge yourself, and that means lifting the most weight you can while still maintaining proper form.
Mistake number 4: Changing your routine too often. This can actually set you back because you’re not giving muscles time to react. Resist jumping to different exercises because you think you’re not seeing results fast enough. Progress is slow and steady. Expect it to take from one to three months to see results, according to the American Council on Exercise.
Mistake number 5: Not changing your routine often enough. On the flip side, not updating your routine enough can keep you from progressing. You might simply need to increase the weight you’re lifting, but it also could be time to move to more complex exercises or switch from free weights to machines.
If you’re unsure about the effectiveness of your current training regimen, schedule a brush-up session with a fitness expert.
The American Council on Exercise has more common exercise mistakes to avoid.
MONDAY, Oct. 15, 2018 (HealthDay News) — Nations that officially frown upon hitting kids as a form of punishment appear to have teens who are less prone to violence, new research suggests.
In countries that have a complete ban on corporal punishment (spanking and slapping), the rates of physical fighting among teens are as much as 69 percent lower than in countries without such a ban, the study found.
What isn’t clear from this research is whether or not a spanking ban directly caused a reduction in violent behavior.
Study author Frank Elgar, an associate professor of psychiatry at McGill University in Montreal, said there are several possibilities for the association behind spanking bans and lower violence rates among youth.
“There may be some influence of these legal bans that promotes changes in culture. Kids that grow up with this experience — not getting smacked or spanked — is one possibility for the association,” he said.
Another possibility, Elgar noted, is that there may be something about the country’s culture that discourages violence in the first place, and that’s why they chose to implement a spanking ban.
But he said there was a significant diversity in the countries that had bans on spanking and slapping.
“We were very surprised looking at countries with a ban on spanking or slapping, that countries that have decided that this is the way parents want to discipline was really a mixed bag. It wasn’t based just on economic or cultural factors,” Elgar said.
Corporal punishment is defined an adult’s use of physical force to correct or control a child’s inappropriate behavior. The punishment is meant to be painful, but not to physically injure the child. About 17 percent of teens reported experiencing corporal punishment at school or in the home in the past month, the study team reported.
The researchers looked at 88 countries participating in long-term research on youth violence. Teens in these countries represented nearly half of the world’s adolescents.
Thirty countries had full bans on spanking and slapping children at home or in school. Some of the countries with a ban include Estonia, Finland, Honduras, Kenya, New Zealand and Portugal.
Thirty-eight countries, including the United States and Canada, had partial corporal punishment bans, with spanking or slapping banned in schools but not at home. Twenty countries had no bans.
The study defined frequent teen violence as four or more physical fights within the past year.
Rates of frequent teen violence varied widely between countries. Teen girls in Costa Rica had the lowest rates, with 1 percent. Teen boys in Samoa had the highest, at 35 percent.
Teen boys in countries with a full ban were 69 percent less likely to be involved in frequent teen violence compared to countries without a ban. For teen girls, that number was 42 percent less, the researchers reported.
In countries with a partial ban, the rate of frequent violence was only lower among young women.
Elgar said the researchers controlled the data for a number of factors, such as a country’s wealth and homicide rates.
He noted that this subject is a divisive one, and said he doesn’t expect this study will change anyone’s mind, but he hopes to conduct further research to see if the downward trend in violence continues.
Although the United States only has a partial ban on spanking, the American Academy of Pediatrics recommends against the use of physical punishment, explaining that it teaches kids aggressive behavior.
Dr. Victor Fornari, director of child and adolescent psychiatry at Zucker Hillside Hospital in Glen Oaks, N.Y., said, “Children learn from their parents. If parents use force, children learn force. If parents use reasoning and calm, children learn reasoning and calm.”
Fornari, who was not involved with the study, suggested that parents remain calm when young children misbehave.
“Offering a warning is very useful. If the child continues to not listen, a brief timeout may be helpful as long as the child was informed that the timeout would follow the warning,” he said. If a youngster continues to misbehave, he suggests a consequence such as no TV or video games for a day.
Fornari also suggested that parents know when to ask for help. “A tired and frustrated parent is not in a good position to discipline a child,” he said.
The study was published Oct. 15 in the journal BMJ Open.
Read more about the case against spanking from the American Psychological Association.
MONDAY, Oct. 15, 2018 (HealthDay News) — Letting women who’ve had a cesarean section dispense and control pain medication through a catheter reduces their use of addictive oral opioid painkillers, researchers report.
Their study included 576 women who had planned C-sections. In such cases, it’s common to inject a local anesthetic and a small dose of morphine into the spinal fluid. The morphine provides about 18 hours of pain relief after surgery, but significant pain may continue for several days.
In most cases, women are given oral opioids to manage that pain.
In this study, patients had a tiny, flexible catheter inserted into their lower back as part of the anesthesia for their C-section. After surgery, it was used to deliver medication that numbs the abdomen, and women could adjust the amount of pain relief by pushing a button.
After delivery, this patient-controlled epidural analgesia (PCEA) stayed in place for a median time of 43 hours. Half of women had it less time, half had it longer.
“During the time the women studied used PCEA for their pain relief, they didn’t need oral opioids,” said lead researcher Dr. Gilbert Grant, director of obstetric anesthesia at NYU Langone Health in New York City.
The longer the women were on PCEA, the fewer opioids they needed once PCEA stopped. Each hour of PCEA led to a 0.33 mg decrease in the use of the oral opioid oxycodone, according to the study.
Twenty-five percent of the women did not use any oral opioids after their surgery. That group was on PCEA for a median time of 44.9 hours, researchers said.
Such an approach could be a step in helping to combat the U.S. opioid epidemic.
The study was to be presented Monday at the annual meeting of the American Society of Anesthesiology, in San Francisco.
While use of epidurals during labor is routine, PCEA after C-section offers a number of benefits, said Grant.
Along with reducing the need for oral opioids, PCEA results in improved movement in the intestines (which reduces constipation), and gives the mother a sense of control, Grant said in a meeting news release. The patient can continue it as long as she is in the hospital.
Research presented at meetings is typically considered preliminary until published in a peer-reviewed journal.
The U.S. National Institute of Child Health and Human Development has more on cesarean section.
SUNDAY, Oct. 14, 2018 (HealthDay News) — Because of the medications they take, losing weight can be difficult for people with diabetes.
Diabetes medications are a major roadblock to weight loss, according to a paper from the American Association of Diabetes Educators.
“Diabetes medications are vital in helping manage blood sugar, so you shouldn’t stop taking them. Instead, ask (your doctor) about alternative medications and treatment strategies,” co-author Patricia Davidson said in an association news release. She’s an assistant professor at
West Chester University in Pennsylvania.
There are other things that could be holding you back, too. “Everyone needs an individualized strategy for managing diabetes and losing weight. A diabetes educator can help,” said co-author Katherine O’Neal, of the University of Oklahoma College of Pharmacy.
The paper outlines ways for people to manage their diabetes and lose weight. The tips might also help others avoid or delay getting type 2 diabetes, especially those with prediabetes.
Get at least 150 minutes a week (about 22 minutes a day) of physical activity. The more the better, so try to work toward 300 minutes of activity a week (about 43 minutes a day).
This might be easier to achieve if you do things you enjoy, such as dancing at home or at a club, walking the dog, or going for a stroll after dinner. Work activity into your daily routines, such as walking around the grocery store before loading up your cart, parking in the farthest spot when running errands, or sprinting up and down the stairs when doing laundry.
Watch your diet. High-fiber foods can lower your blood sugar, help you lose weight, and decrease the amount of medication you need. Try to get 25 to 30 grams of fiber a day.
At least 10 grams of your daily fiber intake should come from fruits and vegetables. Aim for five servings a day: ideally, one or two fruits and three or four veggies. Whole grains are another important source of fiber.
A food and/or activity tracking mobile app can help keep you motivated. It’s also a good idea to seek online and in-person support groups of people in the same situation.
Weight-loss surgery may be an option, but is typically limited to people who are very obese. It also carries significant risks.
The American Diabetes Association has more on weight loss.
FRIDAY, Oct. 12, 2018 (American Heart Association) — Having optimal cardiovascular health as a child could predict the health of tiny blood vessels in the eye in adulthood — a finding that could serve as an early marker of heart disease, according to new research.
The study, published Friday in the Journal of the American Heart Association, investigated the association between cardiovascular health and the size and shape of blood vessels in the retina. Researchers in the U.K. and Finland studied the eye and cardiovascular health of 418 participants in five cities in Finland, from age 12 to 18, then ending 25 years later when participants were in mid-adulthood, from ages 37 to 43.
“After comparing cardiovascular risk factors with the size and shape of retinal blood vessels, we were able to show that ideal cardiovascular health in childhood, and improvement to mid-adulthood, appear to have a protective effect on the retinal microvasculature,” said Dr. Robyn Tapp, the study’s senior author and a researcher at St. Georges University of London.
It is the first study to examine the impact of ideal cardiovascular health from childhood to mid-adulthood on the health of the blood vessel structure in the eye, Tapp said. Changes in the small blood vessels of the retina have been linked with high blood pressure, atherosclerosis and diabetes, among other conditions.
The study’s findings highlight the importance of having good heart health “across the life course,” Tapp said.
While the results don’t prove a connection between cardiovascular health and eye health, the study is a step in the right direction, said Dr. Mary Frances Cotch, chief of epidemiology at the National Institutes of Health’s National Eye Institute in Bethesda, Maryland.
“It seems plausible that diseases we find in middle and old age actually start in younger ages, perhaps childhood and earlier,” said Cotch, who was not involved in the study. “I applaud them for looking at how experiences in childhood extrapolate to health in adult life. I don’t think we do enough of that.”
Tapp said her study’s topic needs further investigation, with a larger study population and extensive long-term follow-ups.
Cotch said she would like to see in-depth studies of today’s children that investigate other risk factors for eye disease that shows up later in life. “Some areas that are ripe for study are the environmental exposures that children may have, including the influence of diet, stress, chemicals and pollution, factors which likely vary across diverse geographic regions. There’s a lot we don’t know.”
FRIDAY, Oct. 12, 2018 (HealthDay News) — Women whose final stages of pregnancy occur during the short, dark days of winter may be at increased risk for postpartum depression, a new study suggests.
It has to do with reduced exposure to sunlight — the same culprit that contributes to seasonal affective disorder, or SAD. That’s a type of depression that usually starts in fall and winter and disappears in spring and summer.
The study authors said their findings should prompt doctors to encourage pregnant women who are at high risk for postpartum depression to increase their exposure to daylight and boost their levels of vitamin D.
The study was led by Deepika Goyal, a professor of nursing at San Jose State University. She and her team reviewed data on nearly 300 first-time mothers who took part in randomized controlled sleep trials before and after pregnancy.
The researchers looked at the amount of daylight during the women’s last trimester of pregnancy and other risk factors for postpartum depression, such as medical history, age, socioeconomic status and sleep quality.
Overall, participants had a 30 percent risk for depression. Their odds were strongly influenced by the number of daylight hours during the last month of pregnancy and immediately after delivery.
Women who were in the late stages of pregnancy during winter had a 35 percent risk — the highest scores — for postpartum depression. And their symptoms were more severe, the study found.
Women whose third trimester coincided with longer hours of daylight had a 26 percent risk for depression, the study showed.
“Among first-time mothers, the length of day in the third trimester, specifically day lengths that are shortening compared to day lengths that are short, long or lengthening, were associated with concurrent depressive symptom severity,” Goyal said.
The study was published recently in a special issue of the Journal of Behavioral Medicine focused on postpartum health.
Researchers said that women in their third trimester may benefit from exposure to artificial light during months with the shortest days. This treatment, which could reduce their depression risk, should continue for three months after delivery.
Pregnant women with a history of mental health issues and those who have signs of depression should spend more time outdoors during the final months of pregnancy or use therapeutic devices such as light boxes to increase their exposure to light, the researchers said.
“Women should be encouraged to get frequent exposure to daylight throughout their pregnancies to enhance their vitamin D levels and to suppress the hormone melatonin,” Goyal said in a journal news release.
Doctors should urge pregnant women to get more outdoor physical activity if the weather permits and it’s safe for them to do so, the researchers added.
“Daily walks during daylight hours may be more effective in improving mood than walking inside a shopping mall or using a treadmill in a gym,” Goyal said. “Likewise, early morning or late evening walks may be relaxing but would be less effective in increasing vitamin D exposure or suppressing melatonin.”
The U.S. National Institute of Mental Health provides more information on postpartum depression.
THURSDAY, Oct. 11, 2018 (HealthDay News) — The hormone prolactin — most commonly associated with breastfeeding — may play a role in reducing the risk of type 2 diabetes, a new study suggests.
Researchers found that women with the highest levels of the hormone, though still in the normal range, had a 27 percent reduced risk of developing type 2 diabetes compared to those with the lowest levels in the normal range.
“Prolactin is a multi-function hormone — it is not only related to pregnancy and breastfeeding, it also plays an important role in many other biological functions, like metabolism, immune regulation and water balance,” said study lead author Jun Li. She is a post-doctoral research fellow at the Harvard T.H. Chan School of Public Health in Boston.
Li said previous studies have shown that prolactin may affect insulin secretion and sensitivity. Insulin carries sugar from the bloodstream into the body’s cells to be used as fuel. People with type 2 diabetes don’t use insulin efficiently, and as a result, their blood sugar levels rise too high.
Although the study linked higher (but still normal) levels of prolactin to a lower risk of developing type 2 diabetes, Li said it’s not yet clear if there are any practical implications from these findings.
“It’s too early to tell if altering prolactin concentrations is a suitable way for diabetes prevention,” she said, adding that normally high prolactin levels are associated with a higher breast cancer risk. Plus, higher-than-normal levels can promote weight gain and increase insulin resistance, along with other adverse effects.
“Future studies are needed to find out the mechanism and come up with practical strategies,” Li said.
Diabetes expert Dr. Joel Zonszein said much about prolactin is unknown. “It’s a hormone made by the pituitary gland, and in women it goes up during lactation. But, we don’t really know what it does in men.”
What doctors do know is that prolactin levels normally vary a lot, he said. Zonszein is director of the clinical diabetes center at Montefiore Medical Center in New York City.
Zonszein also noted that a diabetes medication called Cycloset (bromocriptine mesylate) lowers prolactin levels at the same time it lowers blood sugar levels — an effect that would seem to contradict the new findings.
The study included more than 8,600 healthy American women whose health was tracked over time as part of a national study. Most were white and in their late 40s or 50s when the study began.
From that group, 699 women developed type 2 diabetes during an average follow-up period of 22 years.
The researchers adjusted the data to account for women’s menopausal status and other diabetes risk factors.
The findings showed that the higher the women’s prolactin levels (while still in the normal range), the less likely they were to develop type 2 diabetes.
But the study does not prove cause and effect.
The report was published Oct. 11 in the journal Diabetologia.
Learn more about preventing type 2 diabetes from the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.
THURSDAY, Oct. 11, 2018 (HealthDay News) — Although many people suffering from painful gout flare-ups point to diet as the culprit, new research suggests DNA plays a much bigger role.
The findings challenge the long-held belief that diet is the major factor in gout, a joint disease that causes extreme pain and swelling. Gout is caused by hyperuricemia — high blood levels of uric acid, which forms crystals that collect around the joints.
In the study, New Zealand researchers analyzed genetic and diet data from nearly 17,000 American men and women of European ancestry.
The investigators found that diet was much less important than the individual patient’s genes in deciding whether or not they would develop hyperuricemia.
The findings “are important in showing the relative contributions of overall diet and inherited genetic factors” in gout, wrote a team led by Dr. Tony Merriman of the University of Otago.
In a related editorial, rheumatologist Dr. Ed Roddy, of Keele University in the United Kingdom, said the findings have important psychological implications for patients.
That’s because people with gout often face stigma due to the misconception that gout is a “self-inflicted” condition, caused by unhealthy lifestyle habits. That, in turn, can make some patients reluctant to seek medical help.
But the new research “provides important evidence that much of patients’ preponderance to hyperuricemia and gout is [genetic and] non-modifiable, countering these harmful but well-established views and practices,” Roddy said.
For centuries, diet was considered the main risk factor for gout, and recent studies suggest that certain foods such as meat, shellfish, alcohol and sugary soft drinks are associated with a higher risk of gout, while other foods such as fruit, vegetables, low-fat dairy products and coffee may protect against gout.
But other studies have also shown that genetics plays an important role in gout.
Dr. Waseem Mir is a rheumatologist at Lenox Hill Hospital in New York City. The new findings are “consistent with what I see in clinical practice,” he said.
“There is a lot of misunderstanding amongst patients as to why they are getting gout attacks. Diet seems to play little role even in clinical practice,” he said.
“What we learn from this study is that it is a genetic problem and needs to be addressed with medication and not just diet in most cases,” Mir added.
The study was published online Oct. 11 in the BMJ.
The U.S. National Institute of Arthritis and Musculoskeletal Diseases has more on gout.
THURSDAY, Oct. 11, 2018 (HealthDay News) — While rates of colon cancer have declined among people 50 and older, they’re on the rise for younger Americans. Now, new research suggests widening waistlines may be one reason why.
In the study, women aged 20 to 49 who were overweight or obese had up to twice the risk for colon cancer before age 50, compared with normal-weight women.
“Our findings really highlight the importance of maintaining a healthy weight, beginning in early adulthood, for the prevention of early onset colorectal cancer,” said study co-author Yin Cao. She’s an assistant professor of surgery at Washington University in St. Louis.
Even though obesity has been floated as a possible reason for rising colon cancer rates among the young, “we were surprised by the strength of the link,” Cao said in a university news release.
The study wasn’t designed to prove cause and effect, only an association. But one colon cancer expert wasn’t surprised by the finding.
Dr. Jeffrey Aronoff, a colorectal surgeon at Lenox Hill Hospital in New York City, noted that obesity has long been a risk factor for colon cancer in people over 50. “I do believe that a healthy lifestyle, which includes diet, exercise,” may help curb even younger people’s odds for the disease, he said.
In the new study, Cao and her colleagues collected data on more than 85,000 U.S. women ages 25 to 44 who took part in a large, ongoing study.
Women who were heavy as teens and gained weight in early adulthood had an increased risk of colon cancer before age 50, the researchers found.
In fact, they estimated that about 22 percent of early onset colon cancers could have been prevented if those who were diagnosed had maintained a healthy weight. Across the whole American population, that could represent thousands of cases of early onset colon cancer that might be prevented.
The risk of early onset colon cancer for overweight and obese women was the same regardless of whether or not the woman had a family history of the disease.
Cao and her team members cautioned that the study cannot prove that increased weight causes early onset colon cancer, only that the two are associated. It is possible that weight is just a marker for other risk factors, such as diabetes or metabolic issues like high blood pressure or higher cholesterol, which have also been on the rise.
And the researchers stress that despite the rise in colon cancer among people under 50, it remains relatively rare, at about 8 cases per 100,000 people. Still, because screening for colon cancer usually starts at 50, those who develop it younger are often diagnosed when the disease is in its late stages and more difficult to treat.
That’s why the American Cancer Society recently lowered its recommended age at which most people should have a first screening colonoscopy. The new guidelines advise that screening begins at 45, not 50 as in the previous guidelines.
Colon cancer expert Dr. Sherif Andrawes directs endoscopy at Staten Island University Hospital in New York City. He said the study “is very important and confirms a recent observation among clinicians and experts in the field.”
And Andrawes said there’s another reason to urge Americans to get screened for colon cancer earlier.
“A bigger concern is those younger patients with cancer present symptomatic at diagnosis — which may reflect aggressive disease and an advanced stage at onset of discovery, which leads to overall worse outcomes in a younger individual,” he said.
And what about the risk for young obese men? According to Cao’s team, one limitation of the study is that it included mostly white women, so more research is needed to see if these associations hold for men and other populations.
The report was published online Oct. 11 in the journal JAMA Oncology.
For more information on obesity and cancer, visit the American Cancer Society.
WEDNESDAY, Oct. 10, 2018 (American Heart Association) — It’s been 70 years since a small, middle-class community 23 miles west of Boston became the linchpin in helping to solve the mysteries of heart disease.
Smoking. Cholesterol. Blood pressure. Obesity. It’s common knowledge today that these all can lead to heart trouble. But in the 1940s, with one in two deaths caused by cardiovascular disease and even after President Franklin Roosevelt died from the effects of heart failure and a massive stroke, the information would have been considered revolutionary.
The world has changed by leaps and bounds since Oct. 11, 1948, when, prompted by legislation signed after the president’s death, researchers examined the first community volunteer for the Framingham Heart Study. The volunteer was one of 5,209 mostly white women and men who participated in physicals, lab samples and questionnaires, and who agreed to return every two years. About two-thirds of adults in the town took part.
Since then, the FHS, now a joint project of Boston University and the National Heart, Lung, and Blood Institute, has taken in three generations of ever more diverse, and unpaid, participants. The study launched offshoots in 1994 and 2003 to include more races and ethnicities. That’s 15,447 people of varying ages and backgrounds who are part of the science looking into the human genome, the brain and countless other high-tech side trips into the human body and the roots of disease.
“Every part of the body that can be measured, imaged or assessed, we’ve done so over the last 70 years,” said Dr. Vasan S. Ramachandran, principal investigator and director of the study for Boston University. “It’s a remarkable human experiment. It’s with humility I say that. It’s unbelievable, and to be part of it is a gift, a privilege and an honor.”
Today, about one in three deaths in the United States are attributed to cardiovascular disease, about 2,300 people each day. And about 92.1 million adults are living with some sort of heart disease or after-effects of stroke.
Framingham popularized the idea of cardiovascular risk factors, the conditions or behaviors that increase the chances of having a heart attack or stroke. FHS researchers published work homing in on those factors, such as high blood pressure, physical inactivity and excess weight. The study refined the idea of “good” and “bad” cholesterol. And as early as 1960, it pinned smoking as one of the culprits for heart disease.
But the work continues to branch out from the heart to the brain, and even to the molecular level, adapting to the demands of science, said Ramachandran, who was hired as a Framingham researcher fresh out of cardiology training 25 years ago. “When science has made something possible, we are there to leverage it in the study.”
Dr. Daniel Levy also was a young cardiology resident when he first visited Framingham to work on a research project. They hired him, and he said he felt like “a kid in a candy store” with all the work being done at the time in the 1980s on cardiovascular disease prevention. And now, as FHS director for the National Heart, Lung, and Blood Institute, he still sounds that way.
“When I started here 34 years ago, I couldn’t have imagined I’d be doing some of the things I’m doing now,” he said. “We’ve gone beyond the heart to far-reaching programs in stroke and Alzheimer’s to epigenetics, how environment changes how our genes work, to the next generation of risk factors and to understand the molecular basis of disease.”
As of August, FHS data has spawned 3,698 published studies in medical, peer-reviewed journals. The study has huge repositories of data, from cell lines and gene sequences to scanned images of the heart, brain, bone and liver. Researchers have conducted whole genome sequencing on about 4,000 people. Its brain research program already has received 230 brains from participants who have died, with 572 more participants signed up to donate theirs.
Judie Saltonstall is one of them. She’s a second-generation participant who moved to Arizona 29 years ago and still faithfully logs on to her computer every three months to answer questionnaires and memory quizzes. The 75-year-old is part of a contingent of FHS participants living all over the country who travel back to Framingham whenever needed for exams and tests. She reels off a list: retina photographs, bone density tests, and MRIs of the brain, heart and abdomen.
“It’s kind of exciting to do,” said Saltonstall, a mother of four and a former teacher. “It’s important for me personally, but also for them to know what’s going on with me and to learn from that, whatever good it does.”
It’s something John Stefanini, who still lives in Framingham, understands. He and his four older brothers all are part of the FHS. It’s a source of pride, even if he sometimes gets puzzled reactions.
“The reaction sometimes is almost disbelief that you would allow someone to poke and prod and test you in such an invasive and transparent way,” said the 54-year-old lawyer and former state representative. “Why would you do that? You lose a day’s work, or you have to sleep with wires attached to you for a few days, or you have to collect bodily fluids. But you do it with great pride because you are contributing to the health of the world. That’s something we take very seriously.”