Older adults can dramatically reduce the amount of ultraprocessed foods they eat while keeping a familiar, balanced diet – and this shift leads to improvements across several key markers related to how the body regulates appetite and metabolism. That’s the main finding of a new study my colleagues and I published in the journal Clinical Nutrition.

Ultraprocessed foods are made using industrial techniques and ingredients that aren’t typically used in home cooking. They often contain additives such as emulsifiers, flavorings, colors and preservatives. Common examples include packaged snacks, ready-to-eat meals and some processed meats. Studies have linked diets high in ultraprocessed foods to poorer health outcomes.

My team and I enrolled Americans ages 65 and older in our study, many of whom were overweight or had metabolic risk factors such as insulin resistance or high cholesterol. Participants followed two diets low in ultraprocessed foods for eight weeks each. One included lean red meat (pork); the other was vegetarian with milk and eggs. For two weeks in between, participants returned to their usual diets.

A total of 43 people began the dietary intervention, and 36 completed the full study.

In both diets, ultraprocessed foods made up less than 15% of the total calories – a significant reduction from the typical American diet, where more than 50% of total calories comes from ultraprocessed foods. The diets were designed to be realistic for everyday eating, and participants were not instructed to restrict calories, lose weight or change their physical activity.

We prepared, portioned and provided all meals and snacks for the study. Both diets emphasised minimally processed ingredients and aligned with the 2020-2025 Dietary Guidelines for Americans, the US government’s nutrient-based recommendations for healthy eating, while providing similar calories and amounts of key nutrients.

The 2025-2030 Dietary Guidelines for Americans, released on January 7, 2026, explicitly recommend eating less ultraprocessed food, but the previous versions of the guidelines did not specifically address food processing. Our feeding study design allowed us, for the first time, to examine the health effects of reducing ultraprocessed foods while keeping nutrient levels consistent with recommended targets.

We compared how participants fared while eating their habitual diets with how they responded to the two diets that were low in ultraprocessed foods. During the periods when participants ate fewer ultraprocessed foods, they naturally consumed fewer calories and lost weight, including total and abdominal body fat. Beyond weight loss, they also showed meaningful improvements in insulin sensitivity, healthier cholesterol levels, fewer signs of inflammation and favorable changes in hormones that help regulate appetite and metabolism.

These improvements were similar whether participants followed the meat-based or the vegetarian diet.

Why it matters

Ultraprocessed foods make up more than half the calories consumed by most U.S. adults. Although these foods are convenient and widely available, studies that track people’s diets over time increasingly link them with obesity and age-related chronic diseases such as Type 2 diabetes and heart disease. With older adults making up a growing share of the global population, strategies that preserve metabolic health could support healthy aging.

Most previous feeding studies testing how ultraprocessed foods affect people’s health haven’t reflected real-world eating, especially among Americans. For example, some studies have compared diets made up almost entirely of ultraprocessed foods with diets that contain little to none at all.

Our study aimed to more closely approximate people’s experience while still closely tracking the foods they consumed. It is the first to show that for older adults a realistic reduction in ultraprocessed foods, outside the lab, has measurable health benefits beyond just losing weight. For older adults especially, maintaining metabolic health helps preserve mobility, independence and quality of life.

What’s still unknown

Our study was small, reflecting the complexity of studies in which researchers tightly control what participants eat. It was not designed to show whether the metabolic improvements we observed can prevent or delay diseases such as diabetes or heart disease over time. Larger, longer studies will be needed to answer that.

On the practical side, it’s still unclear whether people can cut back on ultraprocessed foods in their daily lives without structured support, and what strategies would make it easier to do so. It’s also not fully understood which aspects of processing – for example, additives, emulsifiers or extrusion – matter more for health.

Answering these questions could help manufacturers produce foods that are healthier but still convenient – and make it easier for people to choose healthier food options.

Moul Dey is Professor of Nutrition Science, South Dakota State University.

This article was first published on The Conversation.

India is in the middle of the longevity conversation without quite admitting it. Life expectancy has crossed 72 years, healthy life expectancy sits a decade lower and by 2050 almost one in five Indians will be over 60.

Yet, when politicians talk of “Viksit Bharat 2047”, the ageing of India sounds like a footnote, not a central plotline. The government’s 2047 narrative is filled with images of high‑speed trains, digital public infrastructure and a dynamic young workforce. However, an ageing India will look less like a start‑up pitch and more like an overcrowded outpatient department unless policy choices change.

Though India’s average life expectancy has increased, healthy life expectancy still lags by around 10 years, which means many Indians are now living longer but spending a sizeable slice of late life with illness or disability. Behind the national averages lies a harsh geography of inequality and striking differentials by caste, gender and region.

Private insurers, corporate hospitals and wellness platforms are already designing products for middle‑class and affluent clients who expect to live into their 80s and want to stay “active” for as long as possible. Their version of healthy ageing features boutique diagnostics, fitness tracking, elective procedures and curated diets that are just about within reach of the salaried upper-middle class and easily within reach of the very rich.

For the majority, the script looks different. Informal workers with no pension, women whose unpaid care labour leaves them exhausted by midlife and rural households juggling non-communicable diseases with agricultural shocks will age into precariousness rather than comfort. Studies show lower life expectancy among marginalised groups than in many entire countries.

Longevity will become a privilege for gated enclaves while the rest of the country grows old the hard way.

Ageing India

Government data and independent projections indicate that older people already account for a little over 10% of India’s population, or about 100 million people, and that this share could approach 20% by mid‑century.

But longevity is not just about the number of candles on the cake. It is about who will carry the tray, pay for the cake and clean up after the guests.

A widely cited roadmap for “Swastha, Viksit Bharat” estimates that by 2047 India will need millions more doctors, nurses and hospital beds simply to cope with ageing. Chronic diseases already account for most deaths in India, and as people live longer, the burden of diabetes, cardiovascular disease and cancer will inevitably rise. The question is whether those extra years will be characterised by productivity and autonomy, or by avoidable hospital visits, catastrophic health spending and quiet despair.

As the share of older people rises, the demands on India’s care economy will also surge, especially for long‑term care, home‑based support and dementia services.

A NITI Aayog paper on senior care reforms already flags the scale of the challenge, with far‑reaching implications for pensions, health services and social protection by 2050.

Right now, most of that care is cross‑subsidised by women in the family, who provide unpaid support to older relatives while also holding down paid work or domestic responsibilities. Without deliberate policy, longer lives will mean longer hours of invisible labour for women, not a dignified old age supported by a mix of public services, community arrangements and fair labour markets.

The privilege of living long

Healthy longevity can be an economic asset. Older adults can contribute through work, mentorship, volunteering and intergenerational support if systems recognise their value and keep them healthy. But without investment in primary care, early detection, rehabilitation and mental health, India risks creating a large pool of older citizens who are “too well to die, too ill to live”, trapped in a limbo of manageable but unmanaged illness.

First, India needs to treat healthy life expectancy as seriously as life expectancy, with clear targets, state‑level scorecards and regular public reporting. It should not be acceptable for healthy life expectancy to trail life expectancy by a decade while governments congratulate themselves on demographic “success”.

Second, policy must pivot towards services that keep people functional, not just alive. That meansinvesting in geriatric primary care, fall prevention, rehabilitation, community mental health and accessible diagnostics that are usable outside big cities.

Third, the care economy must be dragged out of the shadows. India will need a pipeline of trained caregivers, nurses and allied health workers, backed by decent wages and protections, rather than families, and especially women, shouldering the load indefinitely.

At the same time, pension reform and social security for informal workers will decide whether millions of older Indians experience longevity as a gift or a sentence. Finally, healthy ageing policy has to be designed with an explicit equity lens, recognising that life expectancy and healthy life expectancy for a Dalit woman in a poor district and a man in an urban elite enclave are almost different species of experience.

If longevity is allowed to become just another marker of privilege, “Viksit Bharat 2047” will be a lopsided celebration, with the country’s future applauding from one side of the stadium while its past struggles to climb the steps on the other.

As Honorary President of The Himalayan Dialogues and a specialist in global leadership and crisis communication, Sunoor Verma writes in a personal capacity. His views are independent of his institutional affiliations. Details at www.sunoor.net.

On January 7, the Karnataka government announced a flagship programme to provide free menstrual cups to over a million female students. Since cups, unlike disposable sanitary pads, are reusable, the scheme is aimed at saving the state government over Rs 16 crore and prevent millions of pads from ending up in landfills.

The menstrual cups will be offered to older students, from class 9-12, alongside sanitary pads, from the next academic year. With this move, Karnataka is the first Indian state to endorse menstrual cups through a state-wide scheme.

By advocating for reusable period products, just months after introducing paid menstrual leave, Karnataka has taken a welcome step towards dismantling menstrual taboos and empowering women and girls.

In addition to being cheap and eco-friendly, cups can make dealing with periods less stressful. As one cup can hold three times more flow than a pad, girls can wear them all day without worrying about leaks and stains.

Asan, the social enterprise I work for, distributed over 100,000 free menstrual cups, over half of which have been to women and girls in rural Karnataka, from 2021 to 2025. Girls in our programmes reported significant cost savings on sanitary pads, higher rates of school and college attendance, fewer rashes and infections, and a measurable reduction in anxiety related to periods.

Despite these benefits, menstrual cup adoption is not always easy.

Cups are worn internally and must be sterilised every month, making them fundamentally different from pads in terms of insertion, removal and cleaning. The learning curve is steeper for adolescent girls and young women, with the added pressure of taboos over the insertion of menstrual cups into their bodies. Due to perceptions about “virginity” among conservative groups and communities, unmarried women and girls are often advised against insertable products.

Asan’s experience shows that menstrual cups can certainly be adopted at scale, if the distribution is accompanied by a meticulous behaviour change programme. Such a programme must provide continuous support to girls as well as their mothers for up to six months. This creates space for communities to gradually become accustomed to the product, and for network effects to take place, where early adopters can influence and train their peers.

Five steps for success

Based on years of experience designing menstrual cup behaviour change programmes, here are five key steps to ensure that the government’s scheme achieves its potential:

First, make sure the girls receive a truly good product. A low-quality cup that leaks, stains or fits poorly will be abandoned after the first attempt. The material should be USP Class VI (medical grade) silicone, and should be designed for ease of use, with different sizes available depending on menstrual flow.

Second, involve mothers in the education programme. If girls receive cups but their mothers are not aware of the product, they will face scepticism and resistance at home. The best way to get a girl to adopt a menstrual cup is to provide one to her mother first. Mothers realise the benefits of cups – and understand that they don’t impact virginity – once they try one themselves. They can then play a crucial role not only in influencing their daughters to try cups, but in training them on how to use them.

Third, create local language digital content, including how-to-use videos, that girls can watch in their free time. Written pamphlets are a useful start, but interactive videos that demonstrate how insertion, removal and cleaning are critical. These videos should be available in Kannada, English and all other languages spoken in the state. They can be easily disseminated on social media and Whatsapp.

Fourth, create a cohort of menstrual cup ambassadors. Early adopters of the cup are the best advocates, as they will spread the word to their peers. Sports teams are a great place to start, as girls who are active are likely to see the immediate benefits of cups, enabling them to run, bicycle, exercise and swim freely. Girls who take to cups easily should be rewarded for educating and training their peers.

Fifth, and perhaps most importantly, respect freedom of choice. I personally believe that menstrual cups are one of the best inventions of recent times: but not everyone will want to, or be able to, use one. Asan has worked with diverse communities including people with disabilities and girls with vaginismus, for whom cups are not a suitable option.

Providing a range of product options, as the government is indeed planning to do, ensures that everyone is included in the government’s menstrual health policy.

If implemented well, the Karnataka government’s menstrual cup scheme has the potential to transform the lives of millions of students. It will reduce anxieties associated with periods and can even improve learning outcomes, by enabling students to attend school and college with ease. It will set a wonderful example to other states of India – and indeed other countries – to follow suit.

Ira Guha is the founder of Asan, a social enterprise working to end period poverty.

India has stood strong as the pharmacy of the world by producing affordable and quality assured generic medications which make healthcare and treatment accessible for the global population.

Yet, over the years, multiple powerful countries have consistently put pressure on India to curtail its generic medicine industry through “data exclusivity”.

Data exclusivity grants the first applicants, which are usually major multinational pharmaceutical corporations, exclusive protection over clinical trial data submitted by them for an extended period.

Generic manufacturers, which would have otherwise received a greenlight from regulatory bodies to make affordable drugs, are forced to wait out long exclusivity periods or conduct expensive and ethically questionable clinical trials.

India has stood firm on its intent to protect its generic medicine manufacturing sector, which benefits a massive segment of patients suffering from diseases like tuberculosis, HIV-AIDS, cancer and more. As the pharmacy of the world, India has played a pivotal role in treating patients and preventing the spread of diseases, especially in countries most underserved. But recent developments indicate that India’s stance on data exclusivity is wavering.

For us at Médecins Sans Frontières, and several other humanitarian organisations who understand India’s critical role in fighting infectious diseases, this is a moment to reemphasise the role of accessible medical care to prevent societal collapse.

Pharmacy of the world

On October 8, the Central Drugs Standard Control Organisation released a notice that indicated it was considering introducing data exclusivity provisions into India’s drug regulatory laws, a move which will undermine the production of affordable medicines.

In 2025, Commerce and Industry Minister Piyush Goyal indicated that India could attract additional investments from the European Free Trade Association, if it introduced data exclusivity provisions in Indian law. Such demands, also long pushed by pharmaceutical corporations in wealthy nations, could weaken India’s pro-public health provisions.

India accounts for the supply of 20% of the global generic medicines and 60% of global vaccines, according to data from the India Brand Equity Foundation.

Indian generic medicines have been revolutionary in tackling AIDS by drastically reducing the cost of treatment in the Global South. Today, generic manufacturers supply over 80% of the antiretroviral drugs used globally to combat the disease. India also supplies an estimated 60% of the world’s vaccines. A majority of the vaccines for the immunisation programs run by the World Health Organization and UN children’s fund, Unicef, are supplied by India.

When it comes to Médecins Sans Frontières, globally, 95% of HIV medicines, 90% of Hepatitis C antivirals, 36% of tuberculosis treatments and 30% of vaccines are procured from Indian manufacturers.

Why generics matter

Data exclusivity could potentially extend the monopoly period on medicines beyond the 20 years of patent protection, forcing further delays on generic manufacturing. Without any new generics entering the market, the prices of medicines will remain high for longer periods, delaying access to much of the population.

This also raises the ethical concern of human experimentation without new scientific justification, since generic manufacturers may have to conduct fresh clinical trials for a medicine that already exists. Data exclusivity serves the purpose of monetary gains by rich pharmaceutical corporations at the expense of patients in India and beyond.

As a world leader in accessible and affordable healthcare, India must look at the larger costs of diluting its stance on data exclusivity. When affordable medicines do not reach the most affected, diseases cannot be contained, which devastates families, destabilises communities and increases the economic burden of diseases.

For example, a patient suffering from tuberculosis must follow a regimented treatment plan, reinforced by adequate nutrition and mental health support. Apart from the physical implications of TB, the patient and their families also face social stigma and ostracisation. Interruptions in treatment to patients can not only disrupt their lives but also allow the bacteria to mutate and become untreatable. This could lead to compounded complications, which increases the pressure on communities and health systems, incomes and economies.

In the United States, data exclusivity granted for a long-established treatment for gout called Colchicine, increased the price of the medicine by 50 times, from nine cents to $ 4.85 per tablet. The restrictions reinforce a vicious cycle of monopolies and high prices, making it harder for countries to eradicate diseases, even decades after treatments enter the market.

In the face of increased armed violence, climate disasters and other economic disruptions, countries should actively work on building resilience of its citizens. Resilience cannot be built without a robust healthcare system that can access and administer medications to the most affected populations.

For decades now, India has been a world leader in helping build this resilience. The price of life saving drugs, that run to hundreds and sometimes thousands of dollars, are reduced by as much as 90%-95% due to generic varieties. Science is a commons, and inventions are built on a pool of knowledge that have been funded by public and private entities over the decades and centuries. Denying access to lifesaving medicines only so a few multinational companies can rake in billions of dollars is logically flawed and morally corrupt.

Data exclusivity offers no real public-interest benefit. India has resisted the dilution of data exclusivity in the past, and we hope to see it continue to do so. The world depends on it.

Parthesarathy Rajendran is Executive Director, South Asia, Médecins Sans Frontières (MSF/Doctors Without Borders).

Those hoping to lose weight this year might be tempted to try to a diet challenge in the hopes of kick-starting their weight loss. But while we might think these kinds of short-term, restrictive diets will help give our waistlines a nudge, psychology and physiology shows us why this strategy can be so hard to stick to – and why it probably won’t result in long-term weight loss.

Research estimates that as few as 20% of people who lose weight through dieting manage to keep the weight off long-term.

For decades, psychologists have been trying to understand why it is that diets so often fail.

One potential reason for this is that diets often involve strict food rules – such as avoiding the foods you enjoy.

The problem with this strategy is that the foods people tend to crave most – such as chocolate, ice cream and crisps – activate the brain’s reward system. This creates positive feelings.

When we cut these foods out of our diet, we lose the pleasure they bring. This can then trigger food cravings – a complex psychological process where we experience an intense desire to eat a particular food, even when we’re not hungry.

Food cravings are often dependent on mood and may be particularly bad when we feel stressed. They can also be especially intense in the afternoon and evening when we feel more tired and have less willpower to resist these cravings.

Food cravings can drive overeating, especially when trying to diet. One review even showed that when people deliberately excluded certain foods from their diet, they experienced an increase in cravings for the foods they were avoiding.

Although the review’s authors conclude that this response can be unlearned, it explains why even short-term restrictive diets tend not to work. Crash diets can trigger stronger food cravings, which can make it harder to stick to your goals – and may even lead to weight gain instead.

Repeated dieting failures can also harm self-efficacy (our belief in our own ability to succeed), a psychological resource important for making lasting behaviour changes.

Nutritionists also agree that short-term restrictive diets aren’t great for long-term weight loss success.

Our appetite (how hungry we feel) and satiety (how long we feel full) are controlled by complex physiological signalling pathways that play a significant role in weight loss.

When we follow very low-calorie diets, our bodies react by increasing appetite, reducing satiety and even reducing energy expenditure (how many calories we burn).

The body also compensates for drastic calorie reductions by sending stronger hunger signals to the brain. This can drive overeating.

These physiological responses mean diets that are too restrictive can make weight loss harder – and may even lead to weight regain.

From an evolutionary perspective, these responses helped our ancestors to survive food scarcity – but today, it explains why severe calorie restriction so often leads to weight regain. In fact, research shows that people tend to regain about 50%-70% of the weight they lose after dieting.

Another possible explanation for this phenomenon is that you’re not just losing fat when the scale drops – you lose muscle too. This matters because muscle is a key contributor to resting energy expenditure, which is part of your metabolism. Research has also shown that a loss of muscle mass is associated with weight regain.

Since rapid weight loss diets create a large energy deficit and may contain lower amounts of protein, this increases the risk of losing muscle mass. It also increases your chances of regaining weight you may have lost while on the diet.

The best strategies

If you’re aiming to make a substantial weight loss attempt, an “all-or-nothing” crash diet may not be your best option. A slower, more balanced approach is far more likely to protect your muscles and support longer-lasting results.

Think nutrient quality, not calories

When it comes to eating well, the key is not to “diet”. As we’ve shown, restricting calories often backfires as our bodies and brains compensate by increasing food cravings and hunger signals. So instead of focusing on what to cut out, think about what you can add to meals to make them healthier.

The types of food we eat influences our appetite and satiety signals – not just the number of calories we consume. For example, protein provides feeling of fullness, and high-fibre carbohydrates keep us more satisfied than highly processed refined ones.

So, aim for nutrient-rich foods. Adding plenty of fibre to your meals, such as whole grains, legumes, lentils, beans, fruits and vegetables, is a great start.

Research suggests that eating more fibre as part of a balanced diet can also help you maintain a healthy body weight throughout your life.

So, rather than making short-term changes in January, aim for small swaps you can stick with throughout the year.

Think like a health coach

Health psychologists have developed frameworks of behaviour change techniques that are known to help people change their physical activity and eating behaviour longer term. These evidence-based techniques are usually used by health coaches to support patients with lifestyle changes – but you can be your own coach by applying some of them yourself.

Examples include setting goals, making an action plan, identifying barriers, or teaming up with a friend or partner.

In practice, this could mean setting a goal to lose a realistic amount of weight per week incrementally (around one to two pounds per week), identifying the things that might get in the way of your goals, exercising with a friend and tracking your progress.

Quick-fix, low-calorie diet challenges might promise fast results, but they rarely deliver lasting change. Following evidence-based advice from the fields of psychology and nutrition can help you avoid the restrictive diet trap this January and achieve more sustainable, longer term lifestyle changes.

Chloe Casey is Lecturer in Nutrition and Behaviour , Bournemouth University.

Sarah Hillier is Senior Lecturer in Nutrition, Bournemouth University.

This article was first published on The Conversation.

On January 7, a senior official of Ayushman Bharat in Haryana wrote to 1,300 public and private hospitals, asking them to install cameras in their intensive care units and provide live footage of the patients admitted.

The directive said that the hospitals’ claims under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana would be processed based on the CCTV feed they provide to the state agency.

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana is a cashless health insurance scheme for the poor, and senior citizens above 70. Under the scheme, beneficiaries can avail free treatment up to Rs 5 lakh at empanelled hospitals, which are then reimbursed by the government.

The order was meant for all hospitals in the state that have signed up for the Union government’s cashless insurance scheme, Pradhan Mantri Jan Arogya Yojana.

The directive went on to warn hospitals of financial penalties, suspension and administrative action if they failed to comply. If technical issues led to loss of camera feed or if a hospital failed to provide the feed, the state may deduct or reject their claims, the authority said.

The controversial directive provoked a sharp reaction from private hospitals in the state, who refused to implement it, citing patient privacy. The government hospitals, while officially not opposed to it, are yet to implement the order.

The Indian Medical Association has asked the state authority to withdraw the directive. “In an ICU, there are sick and vulnerable patients who need sponging and close monitoring,” Dr Sunila Soni, the president of Indian Medical Association, Haryana, told Scroll. “If we put cameras on them, it is a breach of their privacy.”

After protests from hospitals, the Haryana authority revised the directive to ask for cameras in the corridors leading to ICUs and at entry and exit points.

At the heart of the controversy is the long unresolved issue of hospital bills, insurance claims and allegations of fraud.

Hospitals say the government is purposely delaying payments and deducting amounts, while several state governments accuse hospitals of submitting fraudulent bills.

Over the last two years, private hospitals have taken out large protests in Haryana, Gujarat and Kerala, over delay in payments under the Pradhan Mantri Jan Arogya Yojana.

The CCTV order

In the January 7 letter, the joint CEO of Ayushman Bharat in Haryana argued that the directive was issued “in order to strengthen transparency, accountability, effective monitoring in the implementation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana and to prevent any misuse of scheme benefits”.

After doctors protested, the authority revised the directive, stating that cameras would only be positioned at entry and exit points of ICUs and high-dependency units and corridors, and would not reveal the identity of patients. They would not be placed in patient rooms, or in bedside and nursing care areas.

“The sole objective of installing these cameras is to monitor and prevent malpractices such as false booking or inflated booking,” the clarification stated.

False booking refers to a hospital submitting bills of a patient’s treatment to support a claim, even when no actual patient has been admitted. In inflated bookings, the hospital shows it is conducting a higher number of procedures than it has performed. “The live feed shall be utilised solely for verification, monitoring, audit and processing of claims,” the directive said.

Hospitals have to store the feed for 30 days and ensure the cameras are functional at all times, the order said. While claims are processed, CCTV surveillance may be used as a “supplementary tool” for audit, claim verification and fraud investigation.

The onus of data safety, maintaining cameras, storing footage, and prevention of tampering lies with the hospitals.

Why hospitals are protesting

Soni, the president of IMA, Haryana, told Scroll that the directive “came like a bolt from the blue”. She pointed out that an ICU includes all kinds of patients – including those not opting for the PMJAY scheme and those paying their own bills. “Even their recording will go to the government if we comply.”

Soni suggested that the government instead carry out manual inspections to ensure no forgery is taking place. “When a hospital signs a contract under Ayushman Bharat, it agrees to surprise inspections. The Ayushman Bharat vigilance team can do manual inspections. But they don’t visit regularly,” she said.

Dr Sunil Arora, who runs Surya Ortho and Trauma Centre in Faridabad, said the directive is not practical. “How do they plan to address privacy concerns?” he asked. “Patients are changed on the bed, or their clothes are partially removed to give an injection. What if a patient refuses being recorded on camera?” Arora said.

He added that in order to comply with the government, hospitals will have to spend on installing CCTVs.

Hospital malpractice?

In March last year, the Union health ministry informed the Rajya Sabha that since the inception of PMJAY, 3.56 lakh fraudulent claims have been rejected, totalling Rs 643 crore. At least 549 hospitals have been suspended for fraudulent claims across India.

An official from the Union health ministry said they are strengthening state anti-fraud units “to look into all kinds of malpractices”. “Such instances have reduced, more steps are being taken,” the official added.

Government officials in Haryana told Scroll that the directive was aimed to curb malpractice by hospitals.

Dr Sandeep Singh, the nodal officer of Ayushman Bharat for Sirsa district in Haryana, said overcharging patients is a common malpractice. The PMJAY scheme ensures cashless service up to Rs 5 lakh.

During inspections, Singh said he often found hospitals submitted bills for reimbursement to the state authority – even after they had charged patients. “If cameras are placed and we have access to the feed, hospitals will become more vigilant,” Singh said.

In Jhajjar, nodal officer Dr Sunita Tawar said she had asked a hospital to refund a patient as they had made her pay up. “The patient was charged even when the treatment was supposed to be free,” she said.

The nodal officer for Mewat district, Dr Vishal Singh, also flagged instances of fraud. Three months ago, he said he found that a patient supposed to be undergoing treatment at a hospital was not in the hospital at all. “We reject claims in such cases,” he said. “But constant physical monitoring by inspecting each patient is not possible. And there has to be a way to ensure hospitals reduce malpractices. The idea of CCTV may help to some extent.”

‘A lot of mistrust’

But several doctors argue that the problem was mistrust.

“There are some who indulge in inflated bills and fraud. But all hospitals are bearing the brunt of it,” said Dr Ramesh Chaudhary, who led a protest over unpaid dues in Gujarat against the government.

Chaudhary said the scrutiny of PMJAY claims are often rejected over minor errors “even if there is no intentional fraud.” “The government thinks each hospital is cheating them to get a higher payout,” he added. “There is a lot of mistrust.”

Hospital authorities also complain of an increasing compliance burden and unpaid bills.

Dr Yogesh Jindal, general secretary of IMA in Haryana, said till last September Rs 450 crore dues were yet to be paid to empanelled hospitals in the state. “After our protest, the government sanctioned Rs 325 crore,” he said.

Soni, the IMA state president, said so far only Rs 7 crore have been disbursed. Scroll was unable to verify this claim with the Haryana state authority.

Dr Jindal pointed out that the government is supposed to pay 18% annual interest if payments are delayed beyond a month. “But they are not paying the interest. Instead, the list of compliances is increasing each day,” he said. “We have to upload test reports on a daily basis for patients. There is too much to document. PMJAY is becoming an unfeasible scheme for the private sector.”

In death, 24-year-old dementia patient will help uncover biological, genetic aspects of disease

A UK man who is thought to be Britain’s youngest dementia sufferer recently passed away from the disease at only 24 years old. Andre Yarham, from Norfolk in England, was just 22 when he was first diagnosed with dementia.

At the age of 24, most brains are still settling into adulthood. But Yarham’s brain looked decades older – resembling the brain of a 70-year-old, according to the MRI scan that helped diagnose him with the disease.

Yarham initially began exhibiting symptoms of dementia in 2022, with family saying he had become increasingly forgetful and would sometimes have a blank expression on his face.

In the final stages of his life, he lost his speech, could no longer care for himself, behaved “inappropriately” and was bound to his wheelchair.

Dementia is usually associated with old age. However, some forms of dementia can strike astonishingly early and move frighteningly fast. Take frontotemporal dementia, for instance. This was the form of dementia that Yarham was diagnosed with.

Unlike Alzheimer’s disease, which tends to affect memory first, frontotemporal dementia attacks the parts of the brain involved in personality, behaviour and language. These regions sit behind the forehead and above the ears in the frontal and temporal lobes.

These areas help us plan, control impulses, understand speech and express ourselves. When they’re damaged, people may change in ways that are deeply distressing for families – becoming withdrawn, impulsive or unable to communicate.

Frontotemporal dementia is a less common form of dementia, thought to account for around one in 20 cases. What makes it especially cruel is that it can appear in young adulthood.

In many cases, frontotemporal dementia has a strong genetic component. Changes in specific genes can disrupt how brain cells handle proteins. Instead of these proteins being broken down and recycled, they clump together inside the neurons (brain cells) – interfering with their ability to function and survive. Over time, affected brain cells stop working and die. As more cells are lost, the brain tissue itself shrinks.

Why this process can sometimes begin so early in life is still not fully understood. However, when a person has a powerful genetic mutation, the disease does not need decades to unfold. Instead, the mutation allows the damage to accelerate and the brain’s usual resilience fails.

Brain scans carried out while Yarham was alive showed striking shrinkage for someone so young. But to compare Yarham’s brain with that of someone in their 70s would be misleading. His brain had not “aged faster” in the usual sense. Instead, large numbers of neurons had been lost in a short period of time because of the disease.

In healthy ageing, the brain changes slowly. Certain regions become a little thinner, but the overall structure remains intact for decades. But in aggressive forms of dementia, whole brain networks collapse at once.

In frontotemporal dementia, the frontal and temporal lobes can shrink dramatically. As these regions deteriorate, people lose the abilities that those areas support – including speech, emotional control and decision-making abilities. This would explain why Yarham lost language so late but so suddenly – and why his need for full-time care escalated so quickly.

Brain donation

Yarham’s family decided to donate his brain to research. This is an extraordinary gift – one that transforms tragedy into hope for others.

Dementia currently has no cure. Once symptoms begin, there’s no way to stop them and treatments which slow symptoms have limited effects. Part of the reason for this is because the brain is vastly complex and still not entirely understood. Every donated brain helps close that gap.

Brains affected by very early dementia are exceptionally rare. Each donated brain allows scientists to study, in fine detail, what went wrong at the level of cells and proteins. Although brain scans can tell us what brain parts have been lost, only donated tissue can reveal why.

Researchers can examine which proteins accumulated, which cell types were most vulnerable and how inflammation and immune responses may have contributed to the damage. That knowledge feeds directly into efforts to develop treatments that slow, stop or even prevent dementia.

The family’s decision to allow scientists to study tissue from such a rare, early-onset case of frontotemporal dementia could help unlock secrets that may guide treatments for generations to come.

As a neuroscientist, I have been asked how something like this can happen to someone so young. The honest answer is that we are only beginning to understand the biology that makes some brains vulnerable from the very start.

Cases like this underline why sustained investment in brain research, and the generosity of people willing to donate tissue, matters so deeply. The 24-year-old’s story is a reminder that dementia is not a single disease, and not a problem confined to old age. Understanding why it happened will be one small step toward making sure it does not happen again.

Rahul Sidhu is PhD Candidate, Neuroscience, University of Sheffield.

This article was first published on The Conversation.

When we lose weight, we don’t just lose body fat – we lose muscle, too.

This can be a problem for many reasons, because skeletal muscle is far more than the tissue that helps us move. It plays a crucial role in metabolic health, regulating blood sugar and healthy ageing. Losing muscle mass is linked to a reduced mobility, increased injury risk and is thought to potentially impair long-term weight loss.

With millions of people now using weight loss drugs such as Wegovy and Ozempic, understanding what impact this muscle loss might have on their health is important.

Loss of muscle mass is also a significant challenge for athletes too, as many sports encourage them to keep body weight low while still maintaining demanding training loads and keeping their power-output high. So an energy deficit can put significant stress on an athlete’s body – but to what extent it affects their normal function, is unclear.

Yet despite these widespread implications, we still know surprisingly little about how human muscle responds at the molecular level to the combination of calorie restriction and exercise. Understanding what happens to muscle when exercising in a calorie deficit is extremely important.

Newly published research from myself and my colleagues casts light on this exact topic. We showed that weight loss accompanied by aerobic exercise might not be that bad for the muscles after all – and indeed it may have positive effects.

We recruited 10 healthy, fit young men who completed two tightly controlled five-day experimental trials in our laboratory. During their first trial period, they consumed enough calories to maintain their body weight. But during the second, we reduced their daily calorie intake by 78% – a severe energy deficit.

During both trials, participants completed a tightly-controlled, 90-minute low- to moderate-intensity cycling exercise three times during each five-day period.

Throughout the trials, we measured blood markers such as glucose, ketones, fatty acids and key hormones linked to energy preservation. We did this to determine if – and to what extent – the energy deficit was affecting them.

We also collected muscle biopsies before and after each testing period. Using an advanced method called dynamic proteomic profiling, we analysed the production and abundance of hundreds of muscle proteins. This allowed us to build a detailed picture of how muscle adapts to sudden, substantial calorie restriction – even when exercise demands are maintained.

During the five days in an energy deficit, participants lost about 3kg. Hormones such as leptin, T3 and IGF-1 also dropped sharply – clear signs the body was getting into an energy preservation mode.

But inside the muscle itself, something more unexpected was happening.

Muscle tissue changes

The muscle tissue mounted a strong and surprisingly positive response to the combination of exercise and calorie restriction.

First, we saw an increase in the amount of mitochondrial proteins within the muscle – and these proteins were also being created more quickly.

Mitochondria are the power generators inside cells. They convert fat and carbohydrates into usable energy. Higher amounts of mitochondrial proteins, and faster production of them, are hallmarks of a healthier and more efficient muscle.

We also saw a clear decrease in the amount and production of collagen and collagen-related proteins.

Collagen is an abundant protein that plays a role in providing structure and strength to the muscle. However, collagen tends to accumulate in excess as we age – contributing to stiffness and impaired function.

Taken together, these changes resemble a shift toward a more metabolically youthful muscle profile.

This kind of response has also been seen in long-term calorie-restriction studies in monkeys. But this is the first time it has been demonstrated in humans.

Healthier ageing

At first glance, it seems paradoxical that the body would invest energy in maintaining or improving muscle during a time of scarcity.

Muscle tissue is demanding and costly to maintain – and movement is energetically expensive, too. Shouldn’t the body simply reduce muscle activity to save energy?

The answer to this question may lie in our evolutionary past. Humans evolved as hunter-gatherers, who often faced periods of low food availability. During those times, the ability to move efficiently – to walk and run long distances, forage or hunt – was essential for survival. A body that shut down muscle function during hunger would have been less likely to survive and reproduce.

So the protective response we observed may reflect deep evolutionary adaptations: muscles stay ready to move even when fuel is running low.

Our study involved a small number of young men who were deliberately following an extreme energy deficit for a short period of time. As such, we cannot assume identical responses in women, older adults or people who are obese or have chronic health conditions.

Future studies will need to compare weight loss with and without exercise, examine less extreme calorie deficits, include women and older adults, and measure how these molecular changes translate into actual physical performance.

Nevertheless, our findings support the idea that exercise during weight loss may protect muscle quality – and may even enhance characteristics linked to healthier ageing.

These findings also have key implications for many people. People who are taking weight loss drugs or trying to lose weight may benefit from structured exercise to help them preserve muscle quality. Older adults, who are more vulnerable to muscle loss, may especially benefit from exercising while losing weight. Athletes may approach any energy deficit with care, but know that muscle keeps adapting to exercise stimulus.

Our study shows that human muscle is remarkably resilient. Even under severe stress, when much of the body is trying to conserve energy, muscle tissue seems to respond robustly – boosting its energy-producing machinery and limiting age-related degradation.

In other words, losing weight and exercising doesn’t just help preserve muscle – it may help keep it younger.

Jose L Areta is Associate Professor in Exercise Metabolism and Nutrition, Liverpool John Moores University.

This article was first published on The Conversation.

Last week, Dr Cyriac Abby Philips, better known by his social media, moniker @liverdoc, caused quite the stir on social media by revealing the results of a crowdfunded study that he had conducted on the quality of generic drugs sourced from various outlets, especially government funded pharmacies or schemes like the Jan Aushadi programme, rebranded as the Pradhan Mantri Bharatiya Janaushadhi Pariyojana by the present government.

While the peer-reviewed publication of the study is still awaited, the big takeaway from @liverdoc’s Twitter thread is that each and every of the 131 generic drugs he tested, including those from government supplied pharmacies passed every quality parameter laid down by the Indian Pharmacopeia Commission in its official publication, the Indian Pharmacopeia.

These results, especially the ones pertaining to government-funded pharmacies are quite incredible since historically the government’s own data has revealed chronic problems with generic drugs sold through these outlets.

For example, in 2017, a government-funded survey of drug quality in India involving 47,954 samples from various sources revealed that 10% of drugs sampled from government pharmacies failed testing in government laboratories. For the rest of the market, the rate of failure of drugs was approximately 3.16%.

The survey did not include fixed-dose combination drugs that contain two or more active pharmaceutical ingredients. These constitute the majority of the nation’s drug supply. There are other reports like one by Comptroller and Auditor General from 2012 which claimed that 25% of locally sourced drugs by the Armed Forces Medical Services Depot failed quality tests.

Similarly with the Jan Aushadhi programme, there have long been complaints from patients and doctors of poor quality outcomes from taking these drugs. In the last Parliamentary session, in December, the government disclosed that between 2020 and 2025, a total of 206 prosecutions were filed by state drug controllers against pharmaceutical manufacturers because samples of their drugs drawn from the Jan Aushadhi programME failed testing in their laboratories.

Given that state drug controllers prosecute only the worst cases of quality failures, the actual number of Not of Standard Quality drugs are likely much higher.

For example, if a drug has only 75% of the active ingredient, the prosecution guidelines laid down by the government prohibit criminal prosecution. Only if that number falls below 70% are state drug controllers required to prosecute. So the figure of 206 prosecutions disclosed in the Parliament represents only serious cases of Not of Standard Quality drugs, not every drug which failed quality testing.

Previous tests

There is then also regular news in the press of other drugs, drawn from private pharmacies and hospitals failing testing in government laboratories. In 2024, over 3,000 samples failed testing in government laboratories. In February 2025, the state government of Himachal Pradesh informed the state legislature that 1,683 samples of drugs manufactured within the state had reportedly had failed quality testing in the previous two years.

Given this weight of history, the results published by Philips are astounding and we look forward to the peer-reviewed publication of this study that hopefully provides more details on the design of the study and actual test results.

For example, were the samples which were sent for testing adequately “blinded”? This is crucial in today’s India because private laboratories are aware of the possibility of government backlash if they were to report a large number of drugs from the government’s flagship scheme failing quality testing.

In 2014, the government of India threatened to sue a group of American academics who had concluded on the basis of testing “made in India” generic drugs that the Indian pharmaceutical industry was more likely to sell poor quality generics in Africa. That study did not even mention the names of any Indian companies and yet it attracted a threatening legal action.

Blinding the lab to the source of the drugs was therefore a crucial requirement.

Similarly, the statistical model for the sample size of 131 samples included in the study. If one were to model based on the government's own Not of Standard Quality data, the number of samples from Jan Aushadhi stores would have to be more than twice that of the sample size to give a 90% confidence to an assertion that all samples sourced pass quality test.

Lastly, there has to be some disclosure on how exactly the laboratory procured “reference samples” from the Indian Pharmacopeia Commission. These “reference samples” are basically small quantities of the pure active ingredient against which the sample is tested in order to establish purity of the assay.

We raise this issue because there have been several complaints from state run laboratories regarding long delays by the Indian Pharmacopeia Commission. in supplying reference samples.

A couple of drugs mentioned in the doctor’s Twitter thread, (rifaximin and febuxostar) do not feature in the list of available reference standards published on the Indian Pharmacopeia Commission’s own website. An explanation of how the lab procured reference standards from Indian Pharmacopeia would go a long way in establishing the credibility of the study.

Critical issues

In addition to the above, we feel it is necessary to clarify some critical issues pertaining to the claim that pharmacopeial testing is all that matters for the purposes of establishing quality.

This is not completely true. In the 1960s, when the first antibiotics were going off patent in the United States, the country’s regulator was faced with the question of how exactly to validate the quality of generics. Repeating clinical trials was an expensive proposition and also unethical since some patients would have to be given a placebo.

The other option was to rely on pharmacopeial testing in the laboratory. However, this option was not considered a reliable indicator of the ability of a drug to dissolve in the stomach and permeate the intestinal lining of a patient in order to enter a patient’s bloodstream.

This is important because although both the innovator and generic use the same active ingredient, the other excipients such as the binding agents may differ from one another, affecting the ability of the generic to dissolve at the same rate as the innovator.

For this reason, the US Food and Drug Administration made it mandatory for generics to conduct bioequivalence testing – the generic drug would be given to healthy volunteers and the rate at which the drug became bioavailable in the human body would be measured in the volunteers’ blood and urine. If the dissolution curve matched the curve of the innovator drug, it was considered bioequivalent to the innovator and hence interchangeable.

The World Health Organisation released a technical recommendation regarding bioequivalence testing in 1996. India made it mandatory only in 2017, except that the rules were so vaguely formulated that we still do not know if the requirement extended to previously authorised generics. We also do not know the parameters of the waiver provided to generics that are highly soluble and permeable.

As a result, we do not know which generics in India are bioequivalent. In other countries such as the United States, the regulator publishes an “Orange Book” that allows patients and doctors to check the generics which have been rated to be “bioequivalent”. India does not do this.

We have been asking the government for quite sometime now to at least force the manufacturers to indicate on their labelling whether their drugs have been declared bioequivalent.

To return to Philips’ study, doctors should recognise that even if the drugs in question have all passed pharmacopeial testing, there is no guarantee these drugs will have the same effect in patients unless these drugs have also been established to be bioequivalent.

This is especially true for Narrow Therapeutic Index drugs. These are drugs where even a small change in bioavailability can have a significant effect in treatment outcomes. Examples of such drugs include Tacrolim, which is used to suppress the immune system after organ transplantation surgeries and drugs such as Levothyroxine, which is used to treat thyroid deficiencies. There are many documented studies of how generic Levothyroxine has caused poor treatment outcomes in patients due to bioavailability issues.

That the Indian pharmaceutical industry has had an issue with bioequivalence is not a secret. In fact, faked bioequivalence studies was one of the starting points of the scandal at Ranbaxy. Similar allegations were made against GVK Bio by international regulators.

There are also studies conducted by doctors at PGIMER which demonstrated with clinical trials that bioavailability of generic Tacrolimus and generic Itraconazole varied significantly from the innovator brands. For the second study, these brave government doctors were rumoured to have received backlash from the powers that be in Delhi.

Batch-to-batch consistency

Two more issues before we conclude.

The first is that surveys based on drug samples drawn from the market have limited value for the simple reason that such surveys rarely capture batch-to-batch consistency issues: the toughest part of pharmaceutical manufacturing is ensuring batch-to-batch consistency. In addition, testing of limited samples fails to capture contamination problems that are not consistent across batches.

It is precisely for this reason that regulatory practices in the West focus more on compliance with Good Manufacturing Practices – adherence to processes is the surest guarantee of quality. On this count, we have a huge mountain of evidence in American and European drug inspection reports of Indian facilities failing to comply with Good Manufacturing Practices standards. The rigour expected of the pharmaceutical industry in India is simply missing.

The second is that bulk procurement conducted by public agencies or private hospitals tend to deal with larger companies. They also have their own testing requirements before the release of drugs into the market. As a result, most of the drugs sampled as part of the Philips study had already cleared one round of testing that likely weeded out many poor quality manufacturers as evident from “blacklists” published by government agencies.

We suspect that results may have been very different if samples tested were procured from the smaller private pharmacies and government hospitals that follow a localised procurement strategy rather than a centralised bulk strategy. The former attracts more smaller manufacturers.

To conclude, while we are surprised by the results presented by Philips on Twitter, he has started an important public debate on the quality of generic drugs.

A peer-reviewed publication must now follow to establish the study’s credibility and hopefully, we will see more such studies in the future along with the necessary caveats. At stake are important issues of public health and the cost of access to medicine.

The writers are co-authors of The Truth Pill: The Myth of Drug Regulation In India.

Heart disease is the leading cause of death in the United States.

Since researchers first established the link between diet, cholesterol and heart disease in the 1950s, risk for heart disease has been partly assessed based on a patient’s cholesterol levels, which can be routinely measured via blood work at the doctor’s office.

However, accumulating evidence over the past two decades demonstrates that a biomarker called C-reactive protein – which signals the presence of low-grade inflammation – is a better predictor of risk for heart disease than cholesterol.

As a result, in September 2025, the American College of Cardiology published new recommendations for universal screening of C-reactive protein levels in all patients, alongside measuring cholesterol levels

What is C-reactive protein

C-reactive protein is created by the liver in response to infections, tissue damage, chronic inflammatory states from conditions like autoimmune diseases, and metabolic disturbances like obesity and diabetes. Essentially, it is a marker of inflammation – meaning immune system activation – in the body.

C-reactive protein can be easily measured with blood work at the doctor’s office. A low C-reactive protein level – under 1 milligram per deciliter – signifies minimal inflammation in the body, which is protective against heart disease. An elevated C-reactive protein level of greater than 3 milligrams per deciliter, signifies increased levels of inflammation and thus increased risk for heart disease. About 52% of Americans have an elevated level of C-reactive protein in their blood.

Research shows that C-reactive protein is a better predictive marker for heart attacks and strokes than “bad,” or LDL cholesterol, short for low-density lipoprotein, as well as another commonly measured genetically inherited biomarker called lipoprotein(a). One study found that C-reactive protein can predict heart disease just as well as blood pressure can.

Inflammation and heart disease

Inflammation plays a crucial role at every stage in the development and buildup of fatty plaque in the arteries, which causes a condition called atherosclerosis that can lead to heart attacks and strokes.

From the moment a blood vessel is damaged, be it from high blood sugar or cigarette smoke, immune cells immediately infiltrate the area. Those immune cells subsequently engulf cholesterol particles that are typically floating around in the blood stream to form a fatty plaque that resides in the wall of the vessel.

This process continues for decades until eventually, one day, immune mediators rupture the cap that encloses the plaque. This triggers the formation of a blood clot that obstructs blood flow, starves the surrounding tissues of oxygen and ultimately causes a heart attack or stroke.

Hence, cholesterol is only part of the story; it is, in fact, the immune system that facilitates each step in the processes that drive heart disease.

Diet and C-reactive protein

Lifestyle can significantly influence the amount of C-reactive protein produced by the liver.

Numerous foods and nutrients have been shown to lower C-reactive protein levels, including dietary fiber from foods like beans, vegetables, nuts and seeds, as well as berries, olive oil, green tea, chia seeds and flaxseeds.

Weight loss and exercise can also reduce C-reactive protein levels.

Cholesterol and heart disease risk

Though cholesterol may not be the most important predictor of risk for heart disease, it does remain highly relevant.

However, it’s not just the amount of cholesterol – or more specifically the amount of bad, or LDL, cholesterol – that matters. Two people with the same cholesterol level don’t necessarily have the same risk for heart disease. This is because risk is determined more so by the number of particles that the bad cholesterol is packaged into, as opposed to the total mass of bad cholesterol that’s floating around. More particles means higher risk.

That is why a blood test known as apolipoprotein B, which measures the number of cholesterol particles, is a better predictor of risk for heart disease than measurements of total amounts of bad cholesterol.

Like cholesterol and C-reactive protein, apolipoprotein B is also influenced by lifestyle factors like exercise, weight loss and diet. Nutrients like fiber, nuts and omega-3 fatty acids are associated with a decreased number of cholesterol particles, while increased sugar intake is associated with a larger number of cholesterol particles.

Furthermore, lipoprotein(a), a protein that lives in the wall surrounding cholesterol particles, is another marker that can predict heart disease more accurately than cholesterol levels. This is because the presence of lipoprotein(a) makes cholesterol particles sticky, so to speak, and thus more likely to get trapped in an atherosclerotic plaque.

However, unlike other risk factors, lipoprotein(a) levels are purely genetic, thus not influenced by lifestyle, and need only be measured once in a lifetime.

Preventing heart disease

Ultimately, heart disease is the product of many risk factors and their interactions over a lifetime.

Therefore, preventing heart disease is way more complicated than simply eating a cholesterol-free diet, as once thought.

Knowing your LDL cholesterol level alongside your C-reactive protein, apolipoprotein B and lipoprotein (a) levels paints a comprehensive picture of risk that can hopefully help motivate long-term commitment to the fundamentals of heart disease prevention. These include eating well, exercising consistently, getting adequate sleep, managing stress productively, maintaining healthy weight and, if applicable, quitting smoking.

Mary J Scourboutakos is Adjunct Assistant Professor in Family and Community Medicine, Macon & Joan Brock Virginia Health Sciences at Old Dominion University.

This article was first published on The Conversation.

Every January, internet searches for the terms “diet” and “weight loss” surge, gyms become busier and diet trends spread across social media. But research shows that most people who try the latest quick-fix plan do not keep the weight off.

Focusing on weight alone can overshadow other changes that improve health in more reliable and sustainable ways. Some of these may lead to weight loss and some may not, but the benefits are clear either way.

Here are five evidence-based resolutions that can support better health – and none are about losing weight.

1. Eat more plants

Eating more plants does not mean you have to become vegetarian. If you eat meat and want to continue, that is fine. You can still increase the amount and variety of plant foods on your plate.

There is a vast amount of research showing that diets rich in plant foods are linked with lower risks of major diseases. A meta-analysis of more than 2.2 million adults found that consistently sticking to a plant-based dietary pattern was associated with significantly lower risks of type 2 diabetes, cardiovascular disease, cancer and all-cause mortality (the risk of dying from any cause).

Although that study focused on people limiting or avoiding meat, other research has shown that even among omnivores, each additional 200 g of fruits and vegetables per day is linked with reduced risk of coronary heart disease, cardiovascular disease, cancer, stroke and premature mortality (dying earlier than expected for someone of your age).

Adding more plants is one of the simplest ways to improve your diet. This includes fruit and vegetables, but also grains, nuts, seeds, herbs, spices and pulses.

2. Exericse

If exercise were a pill, it would be prescribed to everyone. It is one of the most effective things you can do for your health.

Although exercise is often discussed in the context of weight loss, it is not as effective for losing weight as many people assume. Its real value lies in helping to maintain a healthy body weight and supporting overall health.

Research has shown that exercise alone improves several important health markers. It can raise levels of HDL cholesterol, often called “good cholesterol”, because higher levels help protect against heart disease. It also lowers triglycerides, a type of fat in the blood that increases cardiovascular risk when elevated.

Exercise helps the body regulate blood glucose more effectively, and it reduces arterial stiffness, meaning the arteries stay more flexible and less prone to the strain that increases the risk of heart disease and stroke. It can also reduce liver fat, which lowers the likelihood of developing non-alcoholic fatty liver disease. All of these improvements can happen even when a person’s weight stays the same.

More broadly, exercise has been shown to improve fitness, quality of life, sleep and symptoms of depression. These benefits arise because physical activity boosts blood flow to the brain, releases mood-supporting chemicals such as endorphins and helps regulate circadian rhythms – the internal 24-hour cycles that guide sleep, wakefulness, hormone release and other essential functions.

The best type of exercise is the one you enjoy, because you are more likely to stick to it. The benefits come from consistency. Building movement into everyday routines, such as taking the stairs, walking part of your commute or cycling the school run, can be as effective as structured workouts. This also means you do not need an expensive gym membership that might be abandoned by the end of January.

These approaches are not possible for everyone, so finding something that fits your circumstances is important. If you are new to exercise, easing in and building up gradually helps reduce the risk of injury and gives your body time to adapt.

3 Stress

This one is easier said than done, since stress is not usually something we choose. But it can have wide-ranging effects on the body. Long-term stress can weaken the immune system, raise blood pressure and cholesterol and disrupt sleep.

It can also change how we eat. Research suggests that around 40% of people eat more when stressed, another 40% eat less and about 20% do not change how much they eat.

Regardless of direction, the types of foods chosen often shift towards more pleasurable options higher in fat and sugar. Stress has also been linked with eating fewer fruits and vegetables.

Looking at what is driving your stress and seeing whether any part of it can be eased or managed differently can have meaningful effects on health.

4. Sleep

Sleep has a major impact on health. Not getting enough is linked with a range of physical and mental health conditions, including high blood pressure, heart disease, dementia and depression.

Adults are usually advised to get around seven hours a night, although this varies from person to person.

Sleep also influences diet. Lack of sleep has been linked with increased appetite and food intake. It also tends to increase preferences for high-energy foods such as sweets and fast food, partly because sleep deprivation disrupts hormones that regulate hunger and craving.

This advice can feel frustrating for people dealing with insomnia or caring responsibilities. But making a realistic plan to improve sleep, where possible, may be a new year resolution that pays off over time.

5. Alcohol

Alcohol is linked with long-term risks such as cancer, heart disease and liver disease. But even in the short term, it can disrupt sleep because alcohol changes sleep stages and reduces the amount of restorative deep sleep. Alcohol can also influence appetite and food choices by lowering inhibitions and making high-calorie foods seem more appealing.

NHS guidance advises people not to drink more than 14 units a week on a regular basis (equivalent to six pints of average-strength beer or 10 small glasses of lower-strength wine) and to have several “drink free days” per week. This guideline is intended to keep the risk of alcohol-related illness low, but research shows there is no completely safe level of drinking.

Enjoying a drink now and then is a personal choice. But reducing how much you drink is an evidence-based way to improve health.

Many new year resolutions focus on weight, yet long-term health is shaped by a much wider set of habits. Small, realistic steps can add up to meaningful improvements in health throughout the year.

Rachel Woods is Senior Lecturer in Physiology, University of Lincoln.

This article was first published on The Conversation.

“You need to prepare for dialysis”

The words exploded in the room. The silence that followed was deafening – not the kind that soothes, but the kind that follows devastating news.

It was September 2009. I felt the ground collapse beneath me. Just months earlier, I had been diagnosed with end-stage kidney failure.

My daughter was just five. Would I be there for her birthdays? Her college years? Her future?

Then came a fragile thread of hope: a kidney transplant. Amidst my fear of dialysis, this felt like life itself. My family rallied. Without hesitation, my mother said, “Take mine.” Calm, unwavering, unconditional.

But instead of relief, I was gripped with a different kind of fear. What if something happened to her? For months, I hesitated, torn between the will to survive and the guilt of causing her harm.

In 2010, after an agonising period of indecision, I underwent a successful transplant. As I emerged from anaesthesia, groggy and aching, my first words were, “How’s Mummy?” A nurse drew back the curtain in the recovery room. There she was – barely awake, turning her head towards me. Our eyes met in a moment of silent love, relief and overwhelming gratitude.

She had given me life – again.

Looking back, I now realise, we had never truly discussed what she might have to endure – the risks, the recovery and the emotional toll. We had no real way to assess the risk involved. We had moved forward blindly, placing our trust in the doctors.

That silence still echoes today through every living donor whose story remains untold.

Invisible presence

In 2016, I left my corporate career to work with MOHAN Foundation, a non-profit that promotes ethical organ donation. Since then, I’ve met dozens of living kidney and liver donors, many of them women. Their stories are powerful and yet often marked by emotional exhaustion, social pressure and loneliness.

One woman said, “I had no choice. If I’d refused, I would have been thrown out.” Another admitted, “The hospital is focussed only on the patient. I felt invisible – like just a means to an end.” A third confided, “My family was split – some insisted I donate because he is my husband, while others felt I shouldn’t feel pressured by duty or guilt.”

Too often, the donation is validated with a single thought: At least my loved one is doing well.

Gendered sacrifice

India’s transplant system relies heavily on living donors. In 2023, according to the National Organ and Tissue Transplant Organisation, 84% of transplants in India were from living donors. Of these, 63% were women. Yet only 36% of recipients who received organs from living donors were female.

This is no coincidence. In patriarchal family structures, women are often expected to sacrifice quietly, unquestioningly, out of duty. The system not only accepts this – it relies on it.

And yet, protections for these donors remain dangerously thin.

Illusion of consent

While living donors undergo medical clearance and sign consent forms, consent is often shaped by subtle and overt pressures – familial, financial and emotional.

Consent must be more than legal: it must be informed, voluntary, and free from coercion. This demands mandatory psychosocial evaluations and explicit screening for pressure, be it inheritance promises, emotional blackmail or family expectations. Donors should be empowered to withdraw at any stage – without fear, guilt or consequences.

And we must reduce our dependence on living donors by promoting deceased organ donation. That is a more equitable and systemic solution.

Missing link

India urgently needs independent living donor advocates – trained professionals, separate from the transplant team, tasked solely with protecting the donor’s interests. These advocates should assess emotional and financial vulnerability, explain risks and rights, and uphold the donor’s autonomy. Such safeguards exist in many countries. In India, they are rare, misunderstood, or altogether absent.

After surgery, most donors are left to navigate recovery on their own. Long-term follow-up is patchy, and many drop out of the system altogether. Worse, they often bear out-of-pocket expenses; travel, accommodation, lost wages and complications.

India lacks a national donor support scheme. That must change.

No one should face financial hardship for their altruism. Eliminating disincentives is key to protecting organ donation’s voluntary nature.

India needs a National Donor Support Fund, overseen by NOTTO, to provide financial protection for all donors regardless of income or hospital type. This fund should reimburse travel, lodging, and lost wages; provide free lifelong annual medical follow-up; offer government-backed health and life insurance; and support families of deceased donors.

International models offer guidance. The US Living Donor Protection Act ensures job and insurance safeguards. Israel provides tax breaks, paid leave, and lifelong healthcare. In India, the 42-day paid leave for central government employees who donate organs is a step forward – but it is far from enough.

Recently, NOTTO has signalled its intent to strengthen donor protections; but these efforts must go beyond symbolic gestures. We need a comprehensive, enforceable policy that treats donors with respect and give them the protection they deserve.

Policy action

Recent court rulings, particularly from Kerala, have affirmed donor’s rights and dignity. These must now guide national policy. As transplant centres proliferate across India, donor safeguards must become mandatory.

Because without donors, there is no transplant programme.

We owe them more than gratitude. We owe them protection, recognition and justice.

When I think back to that hospital curtain drawing open, to my mother’s silent smile through pain, I know what it means to owe your life to someone else. But no one should have to sacrifice in silence.

Let us break that silence – for every donor who gave, and everyone who still might.

Jaya Jairam is project director at MOHAN Foundation, Mumbai. Her email address is jaya@mohanfoundation.org.

As Americans gather for holiday celebrations, many will quietly thank the health care workers who keep their families and friends well: the ICU nurse who stabilised a grandparent, the doctor who adjusted a tricky prescription, the home health aide who ensures an aging relative can bathe and eat safely.

Far fewer may notice how many of these professionals are foreign-born, and how immigration policies shaped in Washington today could determine whether those same families can get care when they need it in the future.

As an economist who studies how immigration influences economies, including health care systems, I see a consistent picture: Immigrants are a vital part of the health care workforce, especially in roles facing staffing shortages.

Yet current immigration policies, such as increased visa fees, stricter eligibility requirements and enforcement actions that affect legally present workers living with undocumented family members, risk eroding this critical workforce, threatening timely care for millions of Americans. The timing couldn’t be worse.

Rising demand, looming shortages

America’s health care system is entering an unprecedented period of strain. An ageing population, coupled with rising rates of chronic conditions, is driving demand for care to new heights.

The workforce isn’t growing fast enough to meet those needs. The US faces a projected shortfall of up to 86,000 physicians by 2036. Hospitals, clinics and elder-care services are expected to add about 2.1 million jobs between 2022 and 2032. Many of those will be front-line caregiving roles: home health, personal care and nursing assistants.

For decades, immigrant health care workers have filled gaps where US-born workers are limited. They serve as doctors in rural clinics, nurses in understaffed hospitals and aides in nursing homes and home care settings.

Nationally, immigrants make up about 18% of the health care workforce, and they’re even more concentrated in critical roles. Roughly 1 in 4 physicians, 1 in 5 registered nurses and 1 in 3 home health aides are foreign-born.

State-level data reveals just how deeply immigrants are embedded in the health care system. Consider California, where immigrants account for 1 in 3 physicians, 36% of registered nurses and 42% of health aides. On the other side of the country, immigrants make up 35% of hospital staff in New York state. In New York City, they are the majority of health care workers, representing 57% of the health care workforce.

Even in states with smaller immigrant populations, their impact is outsized.

In Minnesota, immigrants are nearly 1 in 3 nursing assistants in nursing homes and home care agencies, despite being just 12% of the overall workforce. Iowa, where immigrants are just 6.3% of the population, relies on them for a disproportionate share of rural physicians.

These patterns transcend geography and partisan divides. From urban hospitals to rural clinics, immigrants keep facilities operational. Policies that reduce their numbers – through higher visa fees, stricter eligibility requirements or increased deportations – have ripple effects, closed hospital beds.

While health care demand soars, the pipeline for new health care workers could struggle to keep pace under current rules. Medical schools and nursing programs face capacity limits, and the time required to train new professionals – often a decade for doctors – means that there aren’t any quick fixes.

Immigrants have long bridged this gap – not just in clinical roles but in research and innovation. International students, who often pursue STEM and health-related fields at U.S. universities, are a key part of this pipeline. Yet recent surveys from the Council of Graduate Schools show a sharp decline in new international student enrollment for the 2025-26 academic year, driven partly by visa uncertainties and global talent competition.

If this trend holds, the smaller cohorts arriving today will mean fewer physicians, nurses, biostatisticians and medical researchers in the coming decade – precisely when demand peaks. Although no major research organisation has yet modeled the full impact that stricter immigration policies could have on the health care workforce, experts warn that tighter visa rules, higher application fees and stepped-up enforcement are likely to intensify shortages, not ease them.

These policies make it harder to hire foreign-born workers and create uncertainty for those already here. In turn, that complicates efforts to staff hospitals, clinics and long-term care facilities at a moment when the system can least afford additional strain.

Hidden toll

Patients don’t feel staffing gaps as statistics – they feel them physically.

A specialist appointment delayed by months can mean worsening pain. Older adults without home care aides face higher risks of falls, malnutrition and medication errors. An understaffed nursing home turning away patients leaves families scrambling. These aren’t hypotheticals – they’re already happening in pockets of the country where shortages are acute.

The costs of restrictive immigration policies won’t appear in federal budgets but in human tolls: months spent with untreated depression, discomfort awaiting procedures, or preventable hospitalisations. Rural communities, often served by immigrant physicians, and urban nursing homes, reliant on immigrant aides, will feel this most acutely.

Most Americans won’t read a visa bulletin or a labor market forecast over holiday dinners. But they will notice when it becomes harder to get care for a child, a partner or an aging parent.

Aligning immigration policy with the realities of the health care system will not, by itself, fix every problem in US health care. But tightening the rules in the face of rising demand and known shortages almost guarantees more disruption. If policymakers connect immigration policy to workforce realities, and adjust it accordingly, they can help ensure that when Americans reach out for care, someone is there to answer.

Bedassa Tadesse is Professor of Economics, University of Minnesota Duluth.

This article was first published on The Conversation.

You might think good sleep happens in your brain, but restorative sleep actually begins much lower in the body: in the gut.

The community of trillions of microbes living in your digestive tract, known as the gut microbiome, plays a powerful role in regulating sleep quality, mood and overall wellbeing. When the gut microbiome is balanced and healthy, sleep tends to follow. When it is disrupted, insomnia, restless nights and poor sleep cycles often appear.

Gut and brain communicate constantly through the gut-brain axis. This communication network involves nerves, hormones and immune signals.

The best known part of this system is the vagus nerve, which acts like a two-way communication line carrying information between gut and brain. Researchers are still studying how important the vagus nerve is for sleep, but evidence suggests that stronger vagal activity supports calmer nervous system states, steadier heart rhythms and smoother transitions into rest.

Because of this intimate connection, changes in the gut influence how the brain regulates stress, mood and sleep.

So, how does the gut actually communicate these signals to the brain?

Gut microbes do more than digest food. They produce neurotransmitters and metabolites that influence sleep-related hormones. Metabolites are small chemical by-products created when microbes break down food or interact with each other. Many of these compounds can influence inflammation, hormone production and the body’s internal clock. When the gut is in balance, these substances send steady, calming signals that support regular sleep. When the microbiome becomes imbalanced, a condition known as dysbiosis, this messaging system becomes unreliable.

The gut also produces several key sleep-related chemicals. Serotonin, for example, regulates mood and helps set the sleep-wake cycle. Most of the body’s serotonin is produced in the gut, and healthy bacteria help keep its production stable. Melatonin, which makes you feel sleepy at night, is made not only in the pineal gland but also throughout the digestive tract. The gut helps convert serotonin into melatonin, so its condition directly shapes how efficiently this happens.

The gut also supports the production of Gaba (gamma-aminobutyric acid), a calming neurotransmitter made by certain beneficial microbes. Gaba quiets the nervous system and signals that the body is safe enough to relax. Together, these chemicals form part of the body’s circadian rhythm, the internal 24-hour cycle that regulates sleep, appetite, hormones and temperature. When harmful bacteria dominate, that rhythm becomes less stable, which can contribute to insomnia, anxiety at bedtime and fragmented sleep.

Another major route linking gut and sleep is inflammation. A healthy gut maintains a balanced immune response. It does this by protecting the gut lining, hosting microbes that regulate immune activity and producing compounds that calm inflammatory reactions. If dysbiosis develops or a poor diet irritates the gut lining, gaps can form between the cells of the intestinal wall. This allows inflammatory molecules to escape into the bloodstream, creating chronic, low-grade inflammation.

Inflammation is known to interfere with sleep regulation. It disrupts the brain’s ability to coordinate smooth transitions between the stages of sleep because inflammatory chemicals influence the same brain regions that control alertness and rest. People with inflammatory gut conditions often experience this in very practical ways.

Irritable bowel syndrome, food sensitivities or increased intestinal permeability, often called leaky gut, all involve irritation or loosening of the gut lining. This allows immune-triggering substances to enter the bloodstream more easily, which increases inflammation and interferes with sleep. Inflammation also raises levels of the stress hormone cortisol, which makes the body feel primed for action rather than rest.

Stress, sleep and gut health continually reinforce each other. Stress alters the gut microbiome by reducing beneficial microbes and increasing inflammatory compounds. A disrupted gut then sends distress signals to the brain, which heightens anxiety and disrupts sleep. Poor sleep raises cortisol further, which worsens gut imbalance. This creates a cycle that can be difficult to break unless the gut is supported.

Strengthening the gut can make sleep noticeably better, and the changes do not need to be complicated. Eating prebiotic and probiotic foods, particularly fermented foods, supports beneficial microbes because fermentation creates live cultures that help repopulate the gut. Reducing sugar and ultra-processed foods lowers inflammation and prevents dysbiosis because these foods tend to feed bacteria that promote irritation or produce inflammatory by-products.

Keeping consistent meal times helps the gut maintain a steady daily rhythm because the digestive system has its own internal clock. Managing stress makes a difference. Staying well hydrated helps the gut microbiome because fluid supports digestion, nutrient transport and the mucus layer that protects the gut lining. Together, these changes create a more stable gut environment that supports deeper and more restorative sleep.

Good sleep does not begin the moment you climb into bed. It begins long before that, shaped by the health of the gut and the messages it sends to the brain throughout the day. When the gut is supported and balanced, the body is better able to settle, recover and shift into the rhythms that allow sleep to improve naturally.

Manal Mohammed is Senior Lecturer, Medical Microbiology, University of Westminster.

This article was first published on The Conversation.

Your alarm goes off. Somehow you manage to get dressed, drag yourself to the gym, and start squatting.

But why does it feel so hard? Your legs are heavy and the weight you lifted only a couple of days ago – in the afternoon – feels almost impossible.

No, you’re not imagining it. There’s a large body of evidence to suggest most of us are stronger, more powerful, and have better endurance later in the day.

There are several reasons exercising can feel much harder first thing in the morning. Here’s why, and how you can adjust to morning exercise if you need to.

Circadian rhythm

Your body has a natural 24-hour clock that regulates hormones, body temperature and when you feel most awake or ready for sleep.

This clock is called your circadian rhythm. It is controlled by the brain but can also be influenced by external factors such as sunlight. This might explain why exercising in the morning in winter can be especially hard for some of us.

Research shows your circadian rhythm is clearly linked to exercise performance, which tends to follow a daily pattern.

Most people reach their peak between 4 and 7pm. This means we tend to be stronger, faster and more powerful in the afternoon and early evening.

We don’t know exactly why. But there are a few potential explanations.

Body temperature

Your core body temperature is at its lowest around 5am, and steadily increases across the day. When your body temperature rises, your muscles contract more efficiently. We think this is part of the reason people are typically stronger and more powerful later in the day.

Hormonal fluctuations

Insulin – the hormone that regulates blood sugar (glucose) levels – tends to be highest in the morning. This leads to a decrease in blood sugar, meaning less glucose your body can use as fuel, likely affecting how hard you can push.

Nervous system function

While we don’t know exactly why, there is some evidence to suggest your nervous system is better at sending signals to your muscles throughout the day. This allows you to use more of your muscle fibres during exercise, essentially making you stronger.

What if I’m a morning person

Your sleep chronotype can also affect exercise performance.

This describes your natural inclination for sleep and wakefulness at certain parts of the day – basically whether you’re a “morning person” (an “early bird”), or feel more productive and alert in the evening (a “night owl”).

Research shows night owls with a late chronotype do notably worse when exercising in the morning, compared to people with an early chronotype.

While we don’t know why this is the case, it might be that night owls experience smaller fluctuations in hormones and temperature throughout the day – although this is just speculation.

Interestingly, being sleep deprived seems to affect physical performance in the afternoon more than in the morning. So if you’re staying up late and not getting much sleep, you may actually find it easier to exercise the next morning than the next afternoon.

Does timing matter?

Whatever time of day, if you can feel yourself working you will make progress – for example, increasing muscle strength and improving aerobic fitness and heart health.

So if you’re exercising to get bigger, stronger and fitter, the timing doesn’t actually matter.

Besides, when we exercise often comes down to motivation and convenience. If you like to exercise earlier in the day and that suits you best, there’s no reason to change.

Adapting

If you have a sporting event coming up in the morning – and you usually train in the afternoon – you might want to prepare by doing some early exercise so you’re at your peak.

There is evidence to suggest that repeatedly training in the morning can close the gap between your afternoon and morning performance.

Basically, your body can get used to exercising at a particular time, although it will likely take a few weeks to adapt.

Finally, if you find exercising close to bedtime makes you feel too alert and is disrupting your sleep, you may want to try doing something more gentle at night and/or exercising earlier in the day.

Hunter Bennett is Lecturer in Exercise Science, University of South Australia.

This article was first published on The Conversation.

Between Halloween candy, Thanksgiving pies and holiday cookies, the end of the year is often packed with opportunities to consume sugar. But what happens in your mouth during those first minutes and hours after eating those sweets?

While you’re likely aware that eating too much sugar can cause cavities – that is, damage to your teeth – you might be less familiar with how bacteria use those sugars to build a sticky film called plaque on your teeth as soon as you take that first sweet bite.

We are a team of microbiologists that studies how oral bacteria cause tooth decay. Here’s what happens in your mouth the moment sugar passes your lips – and how to protect your teeth:

An acid plunge

Within seconds of your first bite or sip of something sugary, the bacteria that make the human mouth their home start using those dietary sugars to grow and multiply. In the process of converting those sugars into energy, these bacteria produce large quantities of acids. As a result, just a minute or two after consuming high-sugar foods or drinks, the acidity of your mouth increases into levels that can dissolve enamel – that is, the minerals making up the surface of your teeth.

Luckily, saliva comes to the rescue before these acids can start corroding the surface of your teeth. It washes away excess sugars while also neutralising the acids in your mouth.

Your mouth is also home to other bacteria that compete with cavity-causing bacteria for resources and space, fighting them off and restoring the acidity of your mouth to levels that aren’t harmful to teeth.

However, frequent consumption of sweets and sugary drinks can overfeed harmful bacteria in a way that neither saliva nor helpful bacteria can overcome.

Assault on enamel

Cavity-causing bacteria also use dietary sugars to make a sticky layer called a biofilm that acts like a fortress attached to the teeth. Biofilms are very hard to remove without mechanical force, such as from routinely brushing your teeth or cleaning at the dentist’s office.

In addition, biofilms impose a physical barrier that restricts what crosses its border, such that saliva can no longer do its job of neutralising acid as well. To make matters worse, while cavity-causing bacteria are able to survive in these acidic conditions, the good bacteria fighting them cannot.

In these protected fortresses, cavity-causing bacteria are able to keep multiplying, keeping the acidity level of the mouth elevated and leading to further loss of tooth minerals until a cavity becomes visible or painful.

How to protect your teeth

Before eating your next sugary treat, there are a few measures you can take to help keep the cavity-forming bacteria at bay and your teeth safe.

First, try to reduce the amount of sugar you eat and consume your sugary food or drink during a meal. This way, the increased saliva production that occurs while eating can help wash away sugars and neutralise acids in your mouth.

In addition, avoid snacking on sweets and sugary drinks throughout the day, especially those containing table sugar or high-fructose corn syrup. Continually exposing your mouth to sugar will keep its acidity level higher for longer periods of time.

Finally, remember to brush regularly, especially after meals, to remove as much dental plaque as possible. Daily flossing also helps remove plaque from areas that your toothbrush cannot reach.

José Lemos is Professor of Oral Biology, University of Florida.

Jacqueline Abranches is Associate Professor of Oral Biology, University of Florida.

This article was first published on The Conversation.

Strictly Come Dancing judge Shirley Ballas recently revealed that she’d “thought that was it” after a fish bone became lodged in her throat. Ballas’s terrifying ordeal lasted for 20 minutes, with the judge struggling to breathe until her hair and makeup artist managed to dislodge the bone using the Heimlich manoeuvre (also known as abdominal thrusts).

Ballas certainly isn’t the first person to make the news for such an ordeal. Even the late Queen Mother had experienced something similar.

Fish bones are actually one of the most common reasons people end up in the emergency department. This phenomenon is particularly common in Asian countries, where diets tend to include a lot of fish. The problem is so great, in fact, that in China specialist fish bone removal clinics have popped up.

Although fish are a good source of many minerals, protein and heart-healthy fatty acids, they also contain multiple small, delicate “pin” bones – usually in the fillet.

Cod have approximately 17 pin bones and salmon have around 30 – though some fish can have over 100. Eel bones have also frequently been linked to emergency room trips, while flounder bones are particularly dangerous because of the number and size of them – making it easy for them to get lodged far down the throat.

This means that despite the care taken during the food prep process, some may inadvertently slip through. These bones can be dangerous if swallowed accidentally – and choking is just one of the serious complications that they can cause.

Fish bones typically become lodged in the tonsils at the back of the throat, in the pharynx at the back of the mouth, the piriform sinus (a small hollow that plays a role in swallowing) and, of course, the oesophagus (the canal which connects the throat to the stomach).

If you do accidentally swallow a fish bone, you’ll probably experience coughing, a prickly or “something stuck” sensation in the throat, as well as pain or difficulty swallowing and spitting up blood.

However, they don’t always cause symptoms – and some people end up living unknowingly with a fish bone stuck in their throat. For instance, in 2012 a 69-year-old Japanese woman went to hospital complaining of a swollen neck – only for doctors to discover she had a 32mm fish bone which had been lodged in her throat for nine months.

Undiscovered fish bones can also migrate around the neck. Repeated swallowing can also result in the bones penetrating the wall of the oesophagus and moving into the tight spaces in the neck.

Here, the bone poses a high risk to the vast number of critical nerves and blood vessels that pass through the neck – such as the carotid artery, which is one of the major vessels that supplies blood to the brain.

Bones can also pierce the thyroid gland, which can cause abscesses and inflammation. This can also lead to sepsis, a rare but incredibly dangerous complication.

In some cases, lodged fish bones have even managed to migrate into the neck’s muscles and under the skin. They can even pop out the skin too – as happened recently to one Thai woman.

Any bones that manage to migrate out of the throat are a surgical emergency as there’s no way to dislodge it otherwise. These bones can also cause infections in the spaces around the heart, or migrate into the spinal cord leading to secondary infections which could cause paralysis.

This is why it’s imperative that if you do accidentally swallow a bone, you try to remove it as soon as possible.

What to do

Stuck fish bones can be removed in a variety of ways.

For some people, a forceful cough will be enough to eject it. This technique is most effective in cases where the bone is stuck in the airway, rather than the oesophagus.

But one problem with coughing is that instead of ejecting it, it could dislodge the bone and allow it to pass into the stomach and through the intestines, where there’s a risk of perforation.

Bones that are stuck in the wall of the oesophagus could potentially move through the body, but many cases will require endoscopic removal.

Some tips suggest that eating something such as bread or banana can force the bone down, but there’s no scientific evidence to support this remedy. It may even further block the airway or oesophagus – and could potentially make things worse by lodging the bone further into the tissue. So if coughing doesn’t help and you still have symptoms, seeking medical advice is the next sensible step.

Where a person is unable to speak or breathe then abdominal thrusts may be needed to help dislodge the offending fish bone (or other item). If it comes to this, you should call emergency services and seek urgent medical support.

Adam Taylor is Professor of Anatomy, Lancaster University.

This article was first published on The Conversation.

In almost any other city in the world, Delhi’s apocalyptic pollution levels would have sparked alarm. In India, however, it is business as usual. Governments are wary of taking action and even the once-activist judiciary is now lying low.

This state of affairs is untenable, Sunita Narain, director Centre for Science and Environments says in this episode of Scroll Adda.

The situation is severe and massive policy changes will have to be taken. Industries must be shifted to clean fuel, car and motorcycle users must be shifted to buses as well as trains and old, polluting vehicles must be barred from the streets of Delhi.

Narain notes the progress that has been made. Fuel today is much cleaner than it was a few years back. But also notes that any such steps forward are rolled back given the sheer increase in the number of private vehicles in Delhi. She is despondent about the Indian state’s response to pollution, arguing that earlier in her career as an environmental activist, institutions were far more responsive to people’s needs.

Producer: Raghav Kakkar

Editor: Hyder Habib

Research: Vaishnavi Rathod

Host: Shoaib Daniyal

The medical profession in India – as in much of the world – today has lost its way.

From a vocation of care and service, it has widely transformed into a soulless vehicle for super- profits. The growing separation of the medical profession from ethical practice and the overwhelming sway instead of profiteering is indeed the greatest, most intractable crisis of medical education today.

Medical colleges teach medical knowledge, skills and sophisticated clinical technology and practice. But can they equally teach an ethical approach to medical practice, a commitment to equity and a resolve to serve those most in need of one’s services without considerations of money? Can medical colleges restore a profession inebriated with private gain and profit to its core mission of care especially of people who are most disadvantaged?

Searching for answers, I look at two widely contrasting pathways chosen by India and Cuba, both middle-income countries that have adopted vastly different models for medical education.

The case of India

India has the largest numbers of medical colleges in the world. India also has one of the most privatised health care systems in the world.

The case of India illustrates best why training more health workers does not automatically bring the country closer to the goal of universal health care. It establishes emphatically that more trained health workers do not result necessarily in more doctors and nurses who serve in rural and forested regions and shanty towns.

As many as eight out of 10 trained physicians in India work for the private health sector, many in large corporate hospitals. This leaves just two out of ten trained physicians in India who choose to work in the public health sector. These too are mostly bunched in tertiary and super-tertiary hospitals in urban areas.

Even the small numbers in public hospitals do not guarantee greater health equity. Even doctors employed in public hospitals in India are notorious for running private practices on the side. Patients learn that they are more likely to be prescribed hospital beds and surgery in the public hospital if they first visit the same doctor’s private clinic and pay a few.

The ratio of just two out of 10 doctors in India who choose to work for the public health system is still a considerable over-statement if we consider the numbers of doctors who graduate in India. Among all low- and middle-income countries, India is the biggest source of trained physicians exported to the high-income countries.

Research shows that 4.9% of American physicians and 10.9% of British physicians are physicians trained in India. Studies indicate that many of these train in the leading public institutions of the country. Therefore, of all the doctors who graduate from Indian medical schools, even far less than two in 10 work in public health within India.

India’s most prestigious and top-ranked medical college is the super-tertiary All India Institute of Medical Sciences in Delhi, the national capital. From around 30,000 applicants, only 45 students (0.15%) are selected each year.

A dear friend teaches in this institute. He resigned from his comfortable position in the National Health Service in London to return to serve in the country of his birth. He loves his work and is greatly sought out by patients who travel from far corners of the country, drawn by his reputation. But when I asked him once how he likes his teaching responsibilities in the hospital, he replied dryly. “It’s okay,” he began laconically. “Except that even in their first year in the institute, only the bodies of my students are in the classroom. Their souls have already migrated to the US and the UK!”

That he was not exaggerating was confirmed by the findings of a significant study which revealed that 54% of AIIMS graduates during 1989-2000 now reside outside India. Students who qualified under the “general category” (meaning they were not in the affirmative-action category) were twice as likely to migrate abroad. Other studies also confirm similarly that elite medical schools contribute disproportionately to the ranks of emigrant physicians. Moreover, even within the elite schools, students with the highest academic achievement have the greatest likelihood of migrating.

This raises fundamental doubts not just about the quantum of medical education facilities available in low- and middle-income countries but also their quality. If high achievement is closely tied to a high likelihood of migrating to high-income countries, we need to ask what is considered high achievement in medical education? More so, when, for the overwhelming majority of those who do not migrate, the preferred career course is the private corporatised health sector.

The India story is a sombre reminder that the central challenge is therefore not of creating significantly larger numbers of health professionals trained in curative skills that are valued in the health sectors of high-income industrialised countries. If low- and middle-income countries expend limited public revenues to train health workers whose skills are valued in high-income countries, and these countries or the private health sector are the preferred sites of their vocation, these public revenues are contributing little to advancing the right to health care in their countries.

In the early decades of India’s freedom, the state vested significant public funds on establishing public medical colleges. These were attached to large tertiary care public hospitals. The clinical skills that students gathered must have been of sufficiently high-quality for the acceptance of Indian medical graduates in high-income countries in larger numbers than from any other country of the Global South. The students, through their internships and residencies, treated large numbers of lower-income patients who crowded the corridors of these public hospitals. Still, large numbers chose to leave the country, or cluster in urban centres, reluctant to serve the vast hinterland of the countryside and towns where more than half the population lived.

But neo-liberalism from the 1990s brought with it first the rapid decline of public health systems and growing reliance of rich and middle-class Indians on private corporate hospitals. We also have noted that after a large migration of graduates from the best-ranking medical schools, eight out of 10 doctors opted to work with the private health sector.

These winds of change transformed also the medical education sector. That India has more medical colleges than any other country in the world is not surprising because it is now the world’s most populous country. But India ranks very low in the number of doctors as a ratio of its population.

The difficulties of finding sufficient budgetary resources for financing health worker education led many governments, such as India, to turn to the private sector to open private medical and nursing schools. The advocates for this argue that privatisation not only provides necessary resources, but also flexibility and quality that can be complementary to public-sector training. International organisations advocate cautious integration of private resources within strong regulatory frameworks, prioritising public health needs. Health activists on the other hand typically oppose extensive privatisation due to equity concerns, advocating instead for strong public investment.

In a bid to fulfil the massive gaps in the health workforce, since the 1990s, the Indian government changed policy that resulted in transmuting medical education into a lucrative business. Businesspersons and politicians with no experience in running medical schools swarmed the country with money and connections to establish medical colleges. The result is that since the 1980s, the number of government colleges have doubled, while those run by the private sector rose 20 times. The number of medical schools rose steeply from 256 in 2006 to 479 in 2017. Of these, 259 are privately owned and managed. Around 48% of MBBS seats in India today are offered in private medical colleges.

Avinash Supe and Soumendra Sahoo in a significant essay titled “Malpractice in Medical Education” lament, “Medical education is now seen as a lucrative business linked to large profits. It has drifted away from its social mission.” These private medical colleges are founded and run by trusts established by powerful political and business interests. They “charge huge fees from aspiring students”.

In addition, many take large bribes to admit students. Regulation is wantonly weak. Regulatory bodies “have turned a blind eye to the deficiencies and subversions of the minimum standards laid down in several such institutions”. They do this because they are “passively caving in or actively succumbing to pecuniary temptations”.

The result of the high fees and bribes is that “for a middle-class student, it means the family having to mortgage their homes in order to fulfil their child’s ambition”. Supe and Sahoo observe that “earning money has become the major priority of a student graduating from medical college”. When such students start private practice, “they are tempted to over-investigate and over-treat their patients in order to earn back the money they spent in getting their medical degrees”.

Typically, hospitals run by private medical colleges offer a much smaller range of patients than those in public medical colleges. Further, examinations rely on rote-learning, diverting students even further away from patients and wards, which is where they should truly learn their vocation. The integrity of the exam system has also been disgracefully compromised.

In all of these ways, our assessment is harsh, but I believe it is not unfair that the medical education imparted by profit-seeking medical schools in India prepares a health workforce that learns early to value personal profit over their patient’s well-being. India’s is a morality tale of how to add large numbers to a country’s trained health care workforce while doing little to take health care to the doors of those who need it most.

The case of Cuba

Cuba’s accomplishments in medical education would place Cuba at the other end of the spectrum from India. Perhaps more than any other country in the world, Cuba has accomplished significantly equity-driven medical education. It has paved innovative pathways to building a massive health workforce equipped with not just the skills, but also the dedication and values of public service. This skilled and devoted workforce has enabled Cuba to secure, despite being a middle-income country, health outcomes that are comparable or better than those of rich countries. Cuba’s health workers are reported to be the soul of Cuba’s accomplishment of extending free quality health care to the entire population.

Accounts of Cuba’s remarkable accomplishments in medical education reveal that its first feat is in numbers. Before the revolution in 1959, Cuba had a single medical school and 6,300 doctors. Half these doctors left the country. Today, Cuba has the highest doctor to population ratio in the world.

But its achievements are much more than its incredible accretion of numbers. Cuba’s greater triumph is that Cuban doctors are widely acknowledged to stand out among their peers around the world for their willingness, even eagerness, to live among and serve disadvantaged populations, within Cuba and the rest of the world. Although it was not compulsory, almost all graduates have volunteered to serve in rural areas.

What in Cuba’s medical education policies made these singular, accomplishments possible? One significant difference from medical education around the world was that the basis for selection of medical students for entry into medical school was altered to prioritise the mettle of character over of the mind. Academic qualifications were not the sole or paramount criteria for admission to medical schools. Selectors gave weight to their sense of vocation, responsibility and commitment to solidarity.

Next, the students, unlike in most medical schools, spend a much smaller time in tertiary hospitals. A lot of their training is decentralised to health institutions located in communities. This is linked to three major innovations in the Cuban health system. The first of these was to extend health services to rural areas and develop a nationwide primary health care network. Then in 1965, Cuba created a network of 498 “comprehensive” polyclinics that initially covered 45,000 persons each, and then in the 1970s, 25,000-30,000 persons. These combined primary care, specialist services, diagnostics and health education. The third institutional innovation from the 1980s was the Family Doctor Programme. Family Medicine Clinics with a doctor and a nurse each covered neighbourhoods of 120-150 families, with curative services but also health education, epidemiologic surveys, linkages with social institutions like homes for the elderly and teaching.

This called for a new medical curriculum to train doctors who would “understand, integrate, coordinate and administer the treatment of each patient’s health needs, as well as the community at large”. Students learned to understand patient needs “holistically rather than as fragmented ‘organ/systems’ diagnosed and treated by different hospital specialists”. In 2003, this coalesced into a new medical training model that shifted further from medical schools and teaching hospitals to community polyclinic and clinics as the central sites for teaching general medicine.

Students studied in diverse settings, ranging from traditional classrooms, doctors’ surgeries, primary health care centres, polyclinics and hospitals. Approximately 75%-80% of the teaching occurred in community primary care facilities with an accredited polyclinic as the central teaching unit. The curriculum was designed to integrate clinical practice with public health principles, equipping students with the skills to address diverse health care challenges. Interdisciplinary approaches, such as combining biomedical sciences with psychology and sociology, ensured that graduates were prepared for the complexities of modern health care delivery. The emphasis on active learning and community engagement also fostered a sense of responsibility among future doctors.

Cuba’s focus on primary care and health promotion, designed to prevent 90% of health problems, was central to its medical education. A student spoke to The Lancet about how inspired he was by the focus on preventive medicine and public health. “The doctors actually take time to educate the community,” he said, such as going to a patient’s home to show them how to cook with less salt, or demonstrating proper hand-washing to mitigate infectious diseases such as cholera.

Evaluations revealed that the clinical skills of these doctors were no way less than those more conventionally trained. But they had a much higher average level of public spiritedness and willingness to serve in difficult areas, not just in Cuba but around the world.

The remarkable success of the Cuban health system deeply rooted in neighbourhood communities is widely acknowledged even by outside observers. A visiting American team of pharmacy college staff, for instance, applauded Cuba’s universal health care delivery system. This, they said, “exemplified home health” in which “doctors and nurses live within the communities and open their doors to all-hour care for their neighbours”. The Cuban health staff “devote considerable human resources to providing care and doctors are basically embedded in the neighbourhoods. When something is wrong, they can react quickly. They have achieved a high quality of life for their patients for the most part, which wasn’t a surprise”. “They have much better access to physicians for primary care than we have” in the United States, a team member opined. This gives a sound foundation to the focus of Cuban medical education on equity and service.

The Cuban government maintains that the spirit of service and solidarity that Cuban medical education has fostered has benefited not only less advantaged populations within Cuba. From the 1960s onward, Cuba dispatched medical brigades to provide disaster relief and long-term health care support in underserved regions worldwide. Cuban doctors have reached underserved and disaster-hit populations in the poorest regions of the world and also offered medical training to students from other Latin American and African countries. Stirred by this singular spirit of humanitarianism, Cuba has sent 325,000 of its health workers to 158 countries in over five decades since the revolution. A total of 49,000 Cuban health care workers are working in 65 countries around the world.

This is often presented as glowing demonstrations of Cuba’s unparalleled international medical solidarity through its medical internationalism programmes. Time magazine, however, underlines that this is not all about altruism. “When you have a very well-educated population but also shortages of cash and goods, you want to find a way to monetize it,” a Cuba expert told them. Cuba’s “army of white coats” leased to foreign governments brings in remittances of around 11 billion dollars a year, making this a higher revenue earner for the country even than the tourism industry.

In 1998, Cuba started an international medical school offering free medical education to people from low-income communities from around the world. It has trained, with full scholarships, free room and board and some spending money, more than 26,000 students drawn from more than 123 countries. Several students are Latin American and from sub-Saharan Africa. Many return to work with disadvantaged communities in their countries.

What still sets Cuban medical education apart from conventional models is its integration of social responsibility, equity and public health into the curriculum. Cuban medical training emphasises a broader skill set, including roles as caregivers, managers, community leaders and educators.

Right from 1965, a tradition grew in Cuban medical schools that medical graduates would pledge to renounce private practice.

Cuban medical education teaches not only primary care, but also the ethics and obligations of the medical profession. The ideology of solidarity is an inherent part of the curriculum. If there is a crisis anywhere in the world, a student said proudly to The Lancet, “I just pack some underwear and I’m ready to go.”

It is the “right of every citizen to have free and quality care”, that is also accessible and equitable, declares another student. “To be able to have a health system like we have, you need the political will.”

I am grateful for research support from Rishiraj Bhagawati.

Harsh Mander is a peace and justice worker, writer, teacher who leads the Karwan e Mohabbat, a people’s campaign to fight hate with radical love and solidarity. He teaches part-time at the South Asia Institute, Heidelberg University, and has authored many books, including Partitions of the Heart, Fatal Accidents of Birth and Looking Away.

Society is fascinated with health, fitness and longevity. This obsession has spawned a multi-million pound industry centred around pushing the latest cutting-edge science, lifestyle modifications and products that claim to prevent ageing and live as long as possible.

But the secret to a long life doesn’t have to be so complicated. There are many simple things everyone can do to slow down time and feel younger.

When we talk about age, we aren’t always talking about how many candles are on your birthday cake. We actually have two different ages.

The first is of course chronological age. This is the number of years you’ve been alive.

But we also have a “biological age.” This is sometimes referred to as “true age” or “internal body age.” This refers to how well all of the body’s internal systems are functioning by looking for signs of ageing in the cells, blood and DNA.

Research indicates that a person’s biological age, rather than their chronological age, is related to how long they live. Let’s say you looked at two 60-year-old people. The person whose biological age is younger would be more likely to outlive the person who had a higher biological age.

There are now many ways to measure your biological age with epigenetic testing, which only requires a little bit of spit and can be done at home. The saliva sample is then processed in a lab where the DNA is extracted to get information about what’s happening in the body.

The everyday lifestyle choices we make affects our biological age. While some of the decisions we make can increase it (such as drinking, smoking or being inactive), other factors can actually turn back the clock. Thus, how long we live may truly be in our hands.

Here are five evidence-backed ways of reducing your biological age:

1. Run away from ageing – literally

Being more physically active and regularly exercising throughout life reduces risk of death from all causes – directly increasing longevity.

It’s also never too late to get started. One study found that sedentary people who adopted an eight-week exercise programme (60 minute workouts done three times a week) reversed their biological age by around two years.

A mixture of strength and endurance exercises done three to four times a week (with sessions as short as 23 minutes) is also shown to significantly reduce ageing.

Exercise influences something called DNA methylation, a process which controls whether certain genes are “on” or “off.” As we age it’s natural that our genes start switching off – this is why we get wrinkles and grey hair.

But exercise helps to slow these processes down, meaning the genes that help do important functions in the body continue doing their job for longer.

2. You are what you eat

Making healthier food choices directly reduces biological age. This effect is even greater in those with chronic disease and obesity.

One study, which looked at nearly 2,700 women, found that adopting healthier eating patterns for 6-12 months was a key factor in staying younger for longer. This diet was also shown to slow ageing by an average of 2.4 years.

Healthier food choices included eating more fruits, vegetables, whole grains, nuts, legumes, fish, lean proteins and healthy fats (such as oil) and reducing intake of red meat, saturated fat, added sugars and sodium.

A well-balanced diet provides antioxidants, vitamins and anti-inflammatory compounds that help cells repair damage and reduce stress on our DNA. These nutrients also influence DNA methylation.

3. Improve sleep habits

Sleep is one of the strongest predictors of healthy ageing because it affects nearly every bodily system. Good quality sleep allows the body to repair DNA, restore hormonal balance, reduce inflammation and clear cellular waste – helping the immune, metabolic and nervous systems stay youthful and resilient.

One review showed that sleep quality is directly associated with how fast we age. People who sleep less than five hours per night have a significantly increased risk of age-related diseases such as diabetes, heart disease, cancer and dementia.

Additionally, a large UK study of nearly 200,000 participants found that those on shift work – and particularly night shifts – had a biological age around one year higher than their counterparts who worked at normal hours.

4. Avoid unhealthy vices

Habits such as vaping, smoking and drinking alcohol are the strongest and most consistent accelerators of ageing.

Smoking, for instance, is shown to rapidly age the lungs by up to 4.3 years and the airway cells by nearly five years.

Similarly, a study looking at 8,046 adults aged 30–79 years old found that consuming any amount of alcohol was associated with accelerated biological ageing. The more alcohol consumed the more age is accelerated.

These habits speed up biological ageing because they directly damage DNA, increase inflammation and overload cells with stress. This causes the body and organs to work harder – ageing them quicker.

5. Master your mind

Stress management is key. Research shows that being able to regulate emotions and manage stress levels predicts age acceleration. Another study found that working more than 40 hours a week on average increased biological age by two years, probably due to the stress.

Stress can directly accelerate biological age due to the way it affects hormonal response, damages DNA and reduces immunity. Stress can also indirectly affect other factors that may accelerate age, such as diet, sleep and whether we drink or smoke. This is why having a set of positive coping mechanisms to manage stress is so important.

A growing body of research is also showing that factors such as loneliness, exposure to extreme heat and cold, air pollution and our environment (such as living in deprived areas) can all also affect how we age.

It’s important to note that the affect of these factors on age may vary depending on the person, their genetics, how long they’ve stuck with these lifestyle habits and other factors at play.

Nevertheless, this gives insight into how changing even small habits can positively improve health and well-being and, in some cases, turn back the clock.

Henry Chung is Lecturer, School of Sport, Rehabilitation and Exercise Sciences, University of Essex.

Charlotte Gowers is Lecturer, Psychology, Sport and Sensory Science, Anglia Ruskin University.

This article was first published on The Conversation.

From upma and poha to idlis, parathas and puris, meals across India comprise carbohydrate-rich food, each with its ritual and regional identity. In the northern states wheat is the staple cereal, while the southern and northeastern states prefer rice. India’s food is inextricably intertwined with the cultural and the nutritional.

But increasingly, evidence indicates that these food habits have trapped Indians in a cycle of poor health. The Indian Council of Medical Research-India Diabetes study, published in Nature Medicine in October, quantifies how India’s diets are dangerously imbalanced: across states, over 60% of calories come from carbohydrates, mostly refined rice and wheat, while protein and healthy fats make up only a fraction of the intake about 12%, and animal protein just about 1% of total caloric intake, far below recommended levels.

The conventional food that most Indians eat broadly consisting of refined cereals like white rice and wheat, along with potatoes and added sugars in the form of roti, upma, puri, parathas with vegetables and dal is stripped of diversity that is undermining public health.

This carbohydrate overload correlates strongly with the increase in non-communicable diseases, such as diabetes, hypertension and obesity. The Nature Medicine study found that those consuming the highest proportion of refined carbohydrates had markedly higher odds of developing type 2 diabetes and abdominal obesity.

Researchers, in an article titled “The Double Burden of Malnutrition and Diabetes in India” published in the Diabetes Asia Journal in July, say this diet has created a paradox where 43% of India’s population is overfed yet undernourished, suffering from the “thin-fat” phenomenon where high caloric intake masks severe nutritional deficiencies. This reflects in what is causing Indians to fall sick, with the National Institute of Nutrition estimating that unhealthy diets are causing 56.4% of the country’s total disease burden.

These findings indicate a marked shift where India’s food security challenge is no longer about inadequate calories but what kind of food makes up a meal.

Dietary advice alone cannot correct this trajectory: it requires institutional redesign and cultural renewal, where indigenous food can be rebranded as nutritional alternatives. A combination of policy measures, such as the Odisha Millet Mission, cultural intervention, like celebrity chefs, and institutional cooperation, through schools and canteens, can make indigenous and nutritional food a symbol of modern consciousness rather than backwardness.

Cultural excess, nutritional neglect

Carbohydrates have long been a cultural anchor. The bigger and more elaborate the carbohydrate-based dish, the more it signals prosperity. This is possibly the result of cultural attachment as well as colonial hierarchies, or even sociological emulation, where, for instance, lower castes follow the lifestyle practices of upper castes. Cultural and religious taboos around meat, particularly beef and pork, have narrowed cheap sources of nutrition. In many homes, even eggs are contentious. Children grow up eating rice or chapati with dal, which is comforting but nutritionally narrow. These eating are instilled early, missing out on the opportunity to shape taste and habit.

Agricultural policy can also alter food habits, like the Green Revolution which led to the mechanisation of farming while high-yielding wheat and rice varieties. India’s agricultural as well as public food distribution system has deepened this dietary monoculture. Public procurement and subsidies overwhelmingly favour rice and wheat.

Millets, pulses and oilseeds that once formed the backbone of local diets are marginal. Yet, these are precisely the grains that are best suited for a climate-stressed world: they are drought-resilient, nutrient-dense and have a low glycemic index, which means they digest slowly, causing a gradual and steady rise in blood sugar levels rather than a dangerous spike.

Millets and pulses once dominated Indian diets because they fit the soil, the climate and the stomach. Historically, these grains accounted for nearly 40% of all cultivated grains in India and were the staple diet for much of the population.

But following the green revolution, the country locked itself into rice and wheat monocropping. Those choices made sense in the 1960s, when India had to import food to feed its growing population, but today they are untenable – environmentally, economically and nutritionally.

Millets such as ragi, jowar, bajra, kodo, foxtail, little and barnyard should make up at least a quarter of national grain consumption, but is less than 10% right now, according to government consumption data. Changing eating habits will benefit farmers too, as a mixed system of millets, pulses, oilseeds and livestock crops is more climate-resilient than the rice-wheat treadmill.

Reimagining public meals

The Centre’s Integrated Child Development Services and mid-day meal schemes, aimed at improving child nutrition and reducing malnutrition, could be frontline instruments of change. Instead of just rice and dal, children should eat millet rice/rotis, porridge, mixed-grain khichdi, pulses, oilseeds and protein-rich food such as eggs, meat and fish. Early exposure normalises food variety and establishes lifelong dietary diversity.

Procurement norms could follow this shift: states should be mandated to source a proportion of millets and pulses locally for school and anganwadi kitchens, which provide mid-day meals to children. Linking kitchen gardens and small livestock to these programmes can close the loop between local production and nutrition.

But changing the food on the plate will also mean confronting stigma. Millets need to be rebranded from being the poor man’s food to being positioned as climate-smart heritage food. Campaigns led by nutritionists, public figures and community kitchens could help drive change.

Similarly, nuanced messaging can normalise the sustainable consumption of animal-source proteins where acceptable, recognising that nutritional adequacy must precede moral absolutism.

Initiatives such as the introduction of ragi into the Integrated Child Development Services and public distribution system by the Karnataka government, and the revision of anganwadi menus by the Kerala government show how there can be a shift toward diversity. Yet, such examples are not the mainstream forces shaping India’s food system.

For farmers, crop diversification can be a livelihood insurance. A cropping mix of millets, pulses, oilseeds and small or large livestock builds ecological and income resilience. Agricultural policy must support crop diversity through assured procurement, price support and water and energy incentives that will move farmers away from paddy-wheat dependence.

Finally, the meaning of food security must reflect nourishment, rather than mere survival, rooted in culture, climate and community. The re-engineering of public food systems and cultural imagination must value variety over volume, offering a healthier alternative to India’s dietary path.

Ashima Chaudhary is Managing Partner, Rural Futures at WELL Labs, a water systems transformation centre based in Bengaluru.

For decades, we’ve been told that weight loss is a matter of willpower: eat less, move more. But modern science has proven this isn’t actually the case.

More on that in a moment. But first, let’s go back a few hundred thousand years to examine our early human ancestors. Because we can blame a lot of the difficulty we have with weight loss today on our predecessors of the past – maybe the ultimate case of blame the parents.

For our early ancestors, body fat was a lifeline: too little could mean starvation, too much could slow you down. Over time, the human body became remarkably good at guarding its energy reserves through complex biological defences wired into the brain. But in a world where food is everywhere and movement is optional, those same systems that once helped us survive uncertainty now make it difficult to lose weight.

When someone loses weight, the body reacts as if it were a threat to survival. Hunger hormones surge, food cravings intensify and energy expenditure drops. These adaptations evolved to optimise energy storage and usage in environments with fluctuating food availability. But today, with our easy access to cheap, calorie-dense junk food and sedentary routines, those same adaptations that once helped us to survive can cause us a few issues.

As we found in our recent research, our brains also have powerful mechanisms for defending body weight – and can sort of “remember” what that weight used to be. For our ancient ancestors, this meant that if weight was lost in hard times, their bodies would be able to “get back” to their usual weight during better times.

But for us modern humans, it means that our brains and bodies remember any excess weight gain as though our survival and lives depend upon it. So in effect, once the body has been heavier, the brain comes to treat that higher weight as the new normal – a level it feels compelled to defend.

The fact that our bodies have this capacity to “remember” our previous heavier weight helps to explain why so many people regain weight after dieting. But as the science shows, this weight regain is not due to a lack of discipline; rather, our biology is doing exactly what it evolved to do: defend against weight loss.

Hacking biology

This is where weight-loss medications such as Wegovy and Mounjaro have offered fresh hope. They work by mimicking gut hormones that tell the brain to curb appetite.

But not everyone responds well to such drugs. For some, the side effects can make them difficult to stick with, and for others, the drugs don’t seem to lead to weight loss at all. It’s also often the case that once treatment stops, biology reasserts itself – and the lost weight returns.

Advances in obesity and metabolism research may mean that it’s possible for future therapies to be able to turn down these signals that drive the body back to its original weight, even beyond the treatment period.

Research is also showing that good health isn’t the same thing as “a good weight”. As in, exercise, good sleep, balanced nutrition, and mental wellbeing can all improve heart and metabolic health, even if the number on the scales barely moves.

A whole society approach

Of course, obesity isn’t just an individual problem – it takes a society-wide approach to truly tackle the root causes. And research suggests that a number of preventative measures might make a difference – things such as investing in healthier school meals, reducing the marketing of junk food to children, designing neighbourhoods where walking and cycling are prioritised over cars, and restaurants having standardised food portions.

Scientists are also paying close attention to key early-life stages – from pregnancy to around the age of seven – when a child’s weight regulation system is particularly malleable.

Indeed, research has found that things like what parents eat, how infants are fed, and early lifestyle habits can all shape how the brain controls appetite and fat storage for years to come.

If you’re looking to lose weight, there are still things you can do – mainly by focusing less on crash diets and more on sustainable habits that support overall wellbeing. Prioritising sleep helps regulate appetite, for example, while regular activity – even walking – can improve your blood sugar levels and heart health.

The bottom line though is that obesity is not a personal failure, but rather a biological condition shaped by our brains, our genes, and the environments we live in. The good news is that advances in neuroscience and pharmacology are offering new opportunities in terms of treatments, while prevention strategies can shift the landscape for future generations.

So if you’ve struggled to lose weight and keep it off, know that you’re not alone, and it’s not your fault. The brain is a formidable opponent. But with science, medicine and smarter policies, we’re beginning to change the rules of the game.

Valdemar Brimnes Ingemann Johansen is PhD Fellow in the Faculty of Health and Medical Sciences, University of Copenhagen.

Christoffer Clemmensen is Associate Professor and Group Leader, Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen.

This article was first published on The Conversation.

The average Australian drinks almost 60 litres of soft drink a year. Many people see diet soft drinks as a “healthier” choice than regular ones, and when it comes to sugar, that’s true.

For example, a 375 millilitre can of Coca-Cola contains about seven teaspoons of added sugar (almost to 40 grams). That’s close to the World Health Organization’s (WHO) daily recommended limit for added sugars of 50g.

In comparison, the Diet Coke version is sweetened with artificial sweeteners such as aspartame and does not contain sugar.

So if you reach for diet soft drinks, is that so bad? Or is it worth giving them up too?

Are diet soft drinks really that bad?

Diet soft drinks provide few nutrients. They often contain artificial sweeteners and caffeine, and while they’re low in energy (kilojoules), they aren’t filling.

People who regularly drink diet soft drinks may have a higher risk of developing conditions such as heart disease and type 2 diabetes.

But this doesn’t necessarily mean the drinks cause these conditions. People who already have health concerns or are trying to manage their weight may be more likely to choose diet drinks, which might make this evidence a little misleading.

How about artificial sweeteners?

In 2023, the WHO classified aspartame (a common sweetener found in many diet soft drinks) as “possibly carcinogenic to humans”. This means the evidence linking aspartame to cancer is currently limited and not conclusive.

The WHO also emphasised that the public generally consumes safe levels of aspartame and only has evidence for concern if people drink the equivalent to 14 cans of soft drink a day.

There is also emerging evidence some artificial sweeteners might irritate the gut or alter the balance of gut bacteria. These effects are still being investigated. But they’ve added to concerns about the health impacts of drinking diet soft drinks over a long period of time.

Can I get used to the sweetness?

An occasional diet drink isn’t likely to fuel an addiction to sweet foods, but cutting back is still a good idea if this has become a daily habit.

After people cut back on very sweet foods or drinks, some research suggests they start noticing sweetness more easily and find very sweet things taste too sweet.

So if you’re trying to enjoy less-sweet drinks, give it time. Within a few weeks you might actually prefer the less-sweet taste.

Here are three evidence-based strategies to help you adjust.

1. Water it down

A gentle first step is to dilute your soft drink. Start by pouring less soft drink into a glass and topping it up with water or soda water, then gradually adjust the ratio over time.

It may taste less sweet at first, but your taste buds will adapt. This slow, steady approach can make change feel easier and more sustainable than quitting abruptly.

2. Make smarter swaps

Try replacing diet soft drink with a healthier alternative that still delivers flavour or fizz. Sparkling water or soda water with a squeeze of lime or lemon and a few mint leaves gives you the same bubbly refreshment with a natural and refreshing flavour. Add ice if it is a hot day, or to provide some crunch.

If you prefer plain water but it feels boring, infuse it with slices of fruit, cucumber, berries or herbs.

You could also try unsweetened iced tea, such as black, green or herbal tea. These offer a mild caffeine lift without the added sweeteners and can be served cold with ice and lemon.

Coconut water can also be a healthier alternative as it is low in sugar while providing some additional electrolytes, which help balance fluid in the body.

3. Know your triggers

If you often reach for a soft drink out of habit, boredom or an afternoon energy slump, paying attention to these moments can help. Once you spot your triggers, you can plan a different response. Take a short walk, call a friend or make a cup of tea instead.

Keeping a chilled, reusable water bottle nearby also helps. If your drink is always within reach, you’re less likely to grab a diet soft drink when you’re out and about.

If you drink diet soft drinks because you’re hungry, reach for something nourishing instead, such as a handful of nuts, a yoghurt or a piece of fruit. These foods will satisfy you for longer than a can of diet soft drink because they have nutrients, such as fibre, to keep you fuller for longer.

The bottom line

You don’t have to give up diet soft drinks altogether. But being mindful of how much soft drink you drink, and how often, can help you make choices that better support your long-term health.

Start small, be consistent and let your taste buds adjust. Over time, you might find what once tasted “flat” now feels refreshingly natural.

Lauren Ball is Professor of Community Health and Wellbeing, The University of Queensland.

Emily Burch is Accredited Practising Dietitian and Lecturer, Southern Cross University.

Mackenzie Derry is Nutritionist, Dietitian & PhD Candidate, The University of Queensland.

This article was first published on The Conversation.

Most of us think of orange juice as a simple breakfast habit, something you pour without much thought. Yet scientists are discovering that this everyday drink may be doing far more in the body than quenching thirst.

A recent study has shown that regular orange juice consumption can influence the activity of thousands of genes inside our immune cells. Many of these genes help control blood pressure, calm inflammation and manage the way the body processes sugar, all of which play an important role in long-term heart health.

The study followed adults who drank 500ml of pure pasteurised orange juice every day for two months. After 60 days, many genes associated with inflammation and higher blood pressure had become less active.

These included NAMPT, IL6, IL1B and NLRP3, which usually switch on when the body is under stress. Another gene known as SGK1, which affects the kidneys’ ability to hold onto sodium (salt), also became less active.

Such changes match previous findings that daily orange juice drinking can reduce blood pressure in young adults.

This is noteworthy because it offers a possible explanation for why orange juice has been linked to better heart health in several trials. The new work shows that the drink does not simply raise blood sugar. Instead, it appears to trigger small shifts in the body’s regulatory systems that reduce inflammation and help blood vessels relax.

Natural compounds in oranges, particularly hesperidin, a citrus flavonoid known for its antioxidant and anti-inflammatory effects, seem to influence processes related to high blood pressure, cholesterol balance and the way the body handles sugar.

The response also varies by body size. People carrying more weight tended to show greater changes in genes involved in fat metabolism, while leaner volunteers showed stronger effects on inflammation.

A systematic review of controlled trials involving 639 participants from 15 studies found that regular orange juice consumption lowered insulin resistance and blood cholesterol levels. Insulin resistance is a key feature of pre-diabetes, and high cholesterol is an established risk factor for heart disease.

Another analysis focusing on overweight and obese adults found small reductions in systolic blood pressure and increases in high density lipoprotein (HDL), often called the good cholesterol, after several weeks of daily orange juice consumption. Although these changes are modest, even slight improvements in blood pressure and cholesterol can make a meaningful difference when maintained over many years.

More clues come from studies that examine metabolites, the tiny molecules produced as the body processes food. A recent review found that orange juice influences pathways related to energy use, communication between cells and inflammation. It may also affect the gut microbiome, which is increasingly understood to play a role in heart health.

One study showed that drinking blood orange juice for a month increased the number of gut bacteria that produce short-chain fatty acids. These compounds help maintain healthy blood pressure and reduce inflammation. Volunteers also showed improved blood sugar control and lower levels of inflammatory markers.

People with metabolic syndrome, a cluster of risk factors that includes high blood pressure, raised blood sugar and excess body fat, may see particular benefits.

In one study, daily orange juice consumption improved the function of the lining of blood vessels, known as endothelial function, in 68 obese participants. Endothelial function describes how well blood vessels relax and widen, and better function is associated with a lower risk of heart attacks.

Not all studies report the same outcomes. A broader analysis of blood fat concentrations found that although levels of low density lipoprotein (LDL), often called the bad cholesterol, often fall, other lipid measurements such as triglycerides and HDL may not change much. Even so, people who regularly drink orange juice may still benefit.

A study of 129 workers in an orange juice factory in Brazil reported lower blood concentrations of apolipoprotein B, or apo-B, a marker that reflects the number of cholesterol-carrying particles linked to heart attack risk.

Altogether, the evidence challenges the idea that drinking citrus fruit juice is simply consuming sugar in a glass. Whole fruit remains the better choice because of its fibre, but a modest daily glass of pure orange juice appears to have effects that build up over time.

These include easing inflammation, supporting healthier blood flow and improving several blood markers linked to long-term heart health. It is a reminder that everyday foods can have more influence on the body than we might expect.

David C Gaze is Senior Lecturer in Chemical Pathology, University of Westminster.

This article was first published on The Conversation.

It seems contradictory: the pills you’re taking for headaches might actually be perpetuating them. Medication-overuse headache is a well-documented medical phenomenon, but the good news is it’s often reversible once identified.

Over 10 million people in the UK regularly get headaches, making up about one in every 25 visits to a GP. Most headaches are harmless and not a sign of a serious problem. Although many people worry they might have a brain tumour, less than 1% of those with headaches actually do.

Because there are so many possible causes of headaches, GPs must play detective. A detailed medical history and examination are essential, sometimes followed by specialist referral.

The challenge lies in determining whether a headache signals a serious underlying cause, or is benign. Even benign headaches, however, can greatly affect a person’s daily life and still need proper care.

Treatment depends on the type of headache. For example, migraines may be treated with anti-sickness medicine or beta blockers, while headaches related to anxiety or depression might improve with mental health support. Lifestyle changes, such as dietary changes and exercise, can also help manage many types of long-term headache.

However, doctors often see another type of persistent headache that has a clear pattern. Patients report getting repeated headaches that started or got worse after taking painkillers regularly for three months or longer.

This can happen in people with migraines, tension headache, or other painful conditions like back or joint pain. Some may take several types of medication, often more and more frequently, and end up stuck in a frustrating cycle that doesn’t seem to make sense at first.

The probable diagnosis is medication-overuse headaches. This condition is thought to affect about 1%-2% of people and is three-to-four times more common in women.

The culprit is often the painkillers themselves. Opiates like codeine, used to treat moderate pain from injuries or after surgery, come with a long list of side-effects including constipation, drowsiness, nausea, hallucinations – and headaches.

It’s not just strong opiate-based medications that can cause headaches. Common painkillers like paracetamol and NSAIDs (non-steroidal anti-inflammatories, such as ibuprofen) can also play a role. Some medications even combine paracetamol with an opiate, such as co-codamol.

Paracetamol has a simpler side-effect profile compared with drugs like codeine. When taken within the recommended daily limits – which depend on age and weight – it is generally a safe and effective painkiller. This has contributed to its widespread use and easy availability.

However, taking more than the recommended dose or using it too often can be very dangerous. This can lead to serious – sometimes fatal – complications, such as liver failure.

Even though side-effects are less common, studies have shown that regular use of paracetamol alone can also trigger chronic headaches in some people.

Other drugs besides painkillers can also cause problems. Using triptans too often – medications to stop migraine attacks – can also lead to medication-overuse headaches.

The term “overuse” might make it sound like patients are taking more than the recommended daily dose, which can happen and brings its own serious risks. However, in many cases of medication-overuse headaches, patients are neither exceeding dose limits nor taking the medication every single day.

For paracetamol or NSAIDs, medication-overuse headaches may develop if they are taken on 15 or more days per month. With opiates, headaches can appear with even less frequent use – sometimes after just ten days a month.

That’s why it’s important to talk to a doctor if you need to use any painkiller, even over-the-counter ones, for a long time. Not everyone will develop medication-overuse headaches, and the risk seems to differ from person to person, meaning individual susceptibility plays a big role.

Treatment

Treating these headaches can be challenging. It’s often hard for patients to recognise on their own that their medication is causing the problem. The usual approach involves gradually stopping the medication under guidance, eventually stopping it completely.

This can seem unfathomable to patients, especially since they expect painkillers like paracetamol to relieve their headaches. Some worry their pain will get worse as they cut back. That’s why working closely with a doctor is essential – to confirm the diagnosis, monitor progress and plan the next steps in treatment.

If you’re having headaches on more than 15 days a month, it’s important to see your GP. Talking it through can help identify underlying causes and explain these often debilitating symptom patterns. Keeping a headache diary – noting symptoms and daily details – can also support the diagnosis.

Why some medicines, especially painkillers, can make headaches worse isn’t fully understood. However, it’s important to be aware of this now well-established link and seek medical advice.

Only when some patients stop taking certain medications altogether do they discover the uncomfortable truth: that their pain was being fuelled by the very drugs they depended on.

Dan Baumgardt is Senior Lecturer, School of Psychology and Neuroscience, University of Bristol.

This article was first published on The Conversation.

Exercise is like medicine for the heart, and just like with medication, you need the right “dose” for it to be effective. But a recent study suggests that the dose might not be the same for everyone. Researchers found that men need roughly twice as much exercise as women to see the same reduction in their heart disease risk.

This recent study asked over 85,000 UK adults aged 37-73 to wear an accelerometer (a device that measures body movement and activity levels) on their wrist for seven days. They then tracked each participant’s health outcomes for just under eight years.

The results are eye-opening.

Women who did roughly four hours of moderate-to-vigorous physical activity per week – activities, such as brisk walking, jogging, cycling or dancing, which raise your breathing and heart rate – had around a 30% lower risk of coronary heart disease. Men needed to do roughly nine hours of the same types of physical activity to see a similar reduction.

This was also true for people already living with heart disease. The paper estimated that women diagnosed with coronary heart disease needed to do around 51 minutes of physical activity each week to reduce their risk of death from any cause by 30% – while men needed to do around 85 minutes of exercise.

Although these findings might sound shocking to the average person, they confirm something that exercise scientists have suspected for years. There is also a clear biological reason that can partly help explain why women and men see such different results from physical activity.

Biological differences

Women typically have higher oestrogen levels than men. This hormone has important effects on how the body responds to exercise.

Oestrogen can help the body burn more fat for fuel during endurance exercise and helps keep the blood vessels healthy – partly by supporting their energy-producing mitochondria (the tiny powerhouses inside cells that generate energy for vital functions).

Women also tend to have more slow-twitch muscle fibres, which are efficient and fatigue-resistant. These muscles suit the kinds of steady, sustained physical activity most exercise guidelines recommend.

So the gap in “minutes needed” for similar heart benefits between women and men isn’t as shocking as the findings might suggest.

Since the study used device-measured activity, instead of asking people to recall from memory the amount of activity they did, this means the data on physical activity was accurate.

It’s also important to note the study still showed a graded benefit. More total weekly activity was linked to lower risk of coronary heart disease in both women and men. Everyone gains from moving more. The difference is just in how much activity buys the same reduction in risk.

The study does not claim that women should do less exercise – nor that men can’t reach similar benefits. It only shows that men may need more weekly activity to get there.

But there are limits to keep in mind. Activity was measured for only one week – then people were followed for about eight years.

And, as it’s an observational study, other factors that could have partly influenced the results were not taken into account – such as menopausal status (when oestrogen levels drop significantly) or whether a woman was using hormone replacement therapy (which can restore some oestrogen levels). These factors could influence how women’s bodies responded to exercise.

It’s also worth noting that the volunteers came from the UK Biobank study. These volunteers tend to be healthier and less deprived than the general population – factors which can affect baseline heart health, access to safe places to exercise and time available for physical activity. This can affect how widely the results apply to everyone.

Still, these results make an important point about current exercise recommendations and whether they need to be revised.

Exercise recommendations

Current exercise guidelines from the World Health Organization, the American Heart Association and the NHS are sex-neutral. But this new study challenges these recommendations – showing they might not apply equally to everyone.

For decades, most exercise research was done predominantly in men and results were often assumed to apply equally to women. As better device-based data arrives, we’re learning that women and men may get different returns for the same number of active minutes.

This matters because women and men experience heart disease differently – from symptoms to outcomes. If the amount of exercise needed to reach the same benefit also differs, our advice should reflect that while still keeping things simple and practical.

This isn’t about telling women to exercise less. The 150-minute baseline remains a useful target – and many people don’t yet meet it. What these findings suggest is that women who meet current targets may see more heart health benefits per minute of exercise. That’s encouraging news for anyone who struggles to find time for longer workouts.

For men, the message isn’t “double your gym time”. It’s to keep building activity in ways that fit your week – with more total minutes bringing even greater heart health benefits. Whether different types or intensities of exercise might be more efficient for men remains a question for future research.

Both men and women clearly benefit from regular physical activity. That’s not in question. But what does need to be recognised is the clear biological differences that influence the returns men and women see from the same types of exercise.

Cardiac rehabilitation and exercise referral schemes often set identical targets for men and women. This new research suggests we may want to rethink schemes and tailor goals to each person’s starting point.

But until cardiac rehabilitation becomes more personalised, the core message for now is: move more, sit less. Aim for the baseline 150 minutes of exercise each week if you can. More helps if you’re able to.

Jack McNamara is Senior Lecturer in Clinical Exercise Physiology, University of East London.

This article was first published on The Conversation.

Every three seconds, someone in the world develops dementia. There are over 6 million people living with dementia in the U.S. and 57 million globally.

These figures will only increase in the coming years, as rates of dementia are predicted to double by 2060. If you don’t know someone affected by dementia, you probably will at some point.

Dementia is incredibly difficult both for the person experiencing it and for their loved ones, not only because of the symptoms of the disease but also because of the social stigma associated with cognitive decline. Experiencing stigma makes it difficult for people with dementia to ask for help, increases anxiety and depression, and ultimately leads to social isolation.

Dementia-related stigma is perpetuated through media messages that portray people with dementia as mindless and incapable, as well as through daily interactions in which others dismiss and dehumanize the person living with dementia.

These forms of invalidation – usually unintentional – accelerate and intensify the loss of self-worth and identity that dementia patients are already experiencing.

Fortunately, educating and spreading awareness can help reduce behaviours that propagate stigma and dehumanising treatment of people with dementia.

As a social scientist and researcher in interpersonal communication and family caregiving, I explore the social and relational side of dementia. Through my work with these patients and families, I’ve learned that reducing stigma and supporting self-worth for people who have dementia is often done through daily conversations.

How is dementia defined?

Dementia is an umbrella term that refers to a family of cognitive conditions involving memory loss, difficulty thinking or processing information, changes in ability to communicate and challenges with managing daily tasks.

The most common form of dementia is Alzheimer’s disease, but there are several other forms of dementia that can severely affect a person’s quality of life and that of their loved ones.

Most forms of dementia are progressive, meaning that the symptoms of the disease get steadily worse over time. A person with dementia can live with the disease for several years, and their symptoms will shift as the disease progresses.

People in the early stages of dementia, including mild cognitive impairment, continue to engage socially and participate in many of the activities they have always done. In the middle stage of the disease, people often need more help from others to complete daily tasks and may have more difficulty holding conversations. In the late stage, people with dementia are dependent on others and often lose the ability to communicate verbally.

Despite the cognitive declines that come with dementia, people living with dementia can maintain many of their former abilities as the disease progresses. Even in the late stages, research shows that people with dementia can understand tone of voice and nonverbal communication such as body language, facial expressions and gentle touch.

This makes it clear that people with dementia can continue having meaningful social connections and a sense of self-worth even as their disease progresses.

Focusing care around the person

In the 1990s, psychologist Tom Kitwood, who studied dementia patients in long-term care settings, introduced the notion of “personhood”. Personhood is a recognition of a person’s unique experiences and individual worth. He had observed that residents with dementia were sometimes treated as objects rather than people and were dismissed as being “no longer there” mentally. In response, Kitwood advocated for a new model of person-centered care.

In contrast to the medical model of care that was standard at the time, person-centered care aims to provide people with dementia comfort, attachment, inclusion, occupation and identity.

Comfort includes both physical and psychological comfort, ensuring that the person with dementia feels safe and is as pain-free as possible. Attachment and inclusion have to do with supporting a person with dementia’s closest relationships and making sure they feel included in social activities.

Occupation is about giving the person meaningful activities that are suited to their abilities, while identity is about preserving their unique sense of self. According to Kitwood, each of these elements of personhood can be upheld or threatened through a person’s interactions with others.

I find Kitwood’s work particularly important because it suggests that communication is at the heart of personhood.

Communicating to support personhood

So how can family members and friends communicate with their loved one with dementia to help preserve their sense of self?

Researchers have identified several evidence-based communication strategies that support person-centered care both in long-term care settings and within the family.

These include:

• Arranging the environment to support conversation. Have conversations in a quiet place with as few distractions as possible, sit at eye level and close to the person, make eye contact and use gestures to reinforce what you say.

• Acknowledging the person with dementia as a unique individual. Helping your loved one remember who they were before dementia is critical to supporting their sense of self-worth. In long-term care, this is done by greeting them, calling them by name and integrating their past experiences into conversations. In families, it is done by inviting the person to reminisce about their past or reminiscing together and by talking about their accomplishments and admirable qualities.

• Affirming and validating the person’s emotions. Even if you don’t understand what the person is thinking or feeling, avoid correcting them and instead acknowledge their underlying emotion.

• Seeking the person’s input about their care. This includes asking about their preferences for food or activities, usually using simple “yes” or “no” questions, and asking their permission before helping them with physical care such as bathing, moving or changing clothes.

• Using simple prompts to help the person successfully engage in conversation. This can be done through repeating or rephrasing questions, paraphrasing the person’s responses, pausing to give the person time to think, and providing simple prompts to help the person remember.

• Creating and maintaining connection. In families, this is done by giving a hug or kiss or saying “I love you”; doing activities together such as playing simple games, making art or playing music; and joking around and laughing together.

Communication shifts

Supporting personhood requires adjusting to the communication abilities of the person with dementia. Some communication strategies are helpful in one stage of the disease but not in others.

In a recent study, my team and I found that asking the person with dementia to recall the past was affirming for those who were early in the disease and who could still recall the past. But for people who were in later stages of the disease, asking them “Do you remember?” was received more like a test of memory and led to frustration or confusion. Similarly, we found that suggesting words to prompt recall was helpful later in the disease but demeaning for people who were in earlier stages of the disease who could still find their words without help.

Providing more help in conversation than is needed can lead people with dementia to withdraw, whereas appropriately adjusting to a person’s communication abilities can empower them to continue to engage socially.

Ultimately, supporting a person with dementia’s sense of self and self-worth in conversations is about finding a communication sweet spot – in other words, matching your approach to their current capabilities.

Changing your default approach to conversations can be challenging, but making simple communication changes can make all the difference. Meaningful conversations are the key to helping your loved one live their days to the fullest, with a sense of personal worth and a feeling of meaningful connection with others.

R Amanda Cooper is Assistant Professor of Communication, University of Connecticut.

This article was first published on The Conversation.

Whether it is sizzling in olive oil or crushed into a curry, garlic has long been a hero in the kitchen. But beyond its strong flavour, garlic has earned a reputation as a natural remedy with a surprising range of potential health benefits. From heart health to immune support, science increasingly supports what tradition has claimed for centuries: garlic is good for you.

The secret lies in its chemistry. Garlic (allium sativum) contains sulphur compounds, including diallyl disulfide and S-allyl cysteine, that are responsible for both its distinctive smell and its medicinal effects.

The most studied of these is allicin, which forms when garlic is chopped, crushed or chewed. Allicin is unstable and quickly breaks down into other sulphur-containing compounds that are linked to several health effects. Here are some of the best supported benefits.

1. Heart health

Garlic is widely studied for its potential to support the heart and blood vessels. Garlic supplements can help reduce high blood pressure, with some studies finding effects similar to certain prescribed medications. A 2019 analysis found that garlic supplements significantly lowered blood pressure in people with hypertension. This reduction was linked to a 16%-40% lower risk of cardiovascular events, such as heart attacks and strokes.

Research suggests this may be because garlic extract improves arterial elasticity so that arteries become more flexible, helping them expand and contract more easily as blood flows through. Stiff arteries make the heart work harder and are a risk factor for heart disease.

Garlic compounds also appear to help relax blood vessels by increasing levels of hydrogen sulphide and nitric oxide. These are gases naturally produced in the body that help blood vessels widen so blood can flow more easily. Allicin may also help reduce blood pressure by blocking angiotensin II, a hormone that causes blood vessels to tighten.

Research suggests garlic may also lower total cholesterol – the overall amount of cholesterol in the blood – and LDL cholesterol, often called bad cholesterol because high levels can clog arteries. Some studies show that taking garlic for longer than two months can reduce LDL cholesterol by up to 10% in people with mildly raised levels.

Lab studies show that garlic compounds can block liver enzymes that produce fats and cholesterol. They may also prevent plaque building up in the arteries by reducing LDL and making it more resistant to oxidation, a process that contributes to heart disease.

2. Immune support

The antibacterial effects of allicin are well recognised. Garlic extract has also been shown to have antimicrobial activity against bacteria, viruses and fungi.

One study found that people who took aged garlic extract had milder cold and flu symptoms, recovered more quickly and missed fewer days of work or school.

More recent research suggests garlic may support the immune system by activating certain types of white blood cells. These include macrophages, which are immune cells that engulf and destroy bacteria and viruses; lymphocytes, which include T cells and B cells that recognise infections and produce antibodies; and natural killer cells, which target and destroy infected or abnormal cells such as virus infected or cancerous cells.

Garlic may also help regulate inflammation, which is a key part of the immune response.

3. Cancer prevention

Early research suggests garlic may help reduce the risk of certain cancers, particularly those affecting the digestive system, colon, lungs and urinary tract.

A study found that garlic can affect key processes involved in cancer development. It may stop cancer cells from dividing, prevent the formation of new blood vessels that feed tumours and encourage cancer cells to die naturally. These effects appear to be linked to garlic’s influence on cell signalling pathways which control how cells grow and behave. Garlic’s antioxidant and anti-inflammatory properties may also contribute.

However, most of this evidence comes from laboratory and animal studies which do not always apply to humans. More robust clinical studies on people are needed.

Garlic has also been linked to other possible health benefits although research is still ongoing. Its antioxidant effects may help lower the risk of Alzheimer’s disease, and its anti-inflammatory properties may be useful in conditions such as osteoarthritis.

How much garlic is enough

There is no official recommended daily amount for garlic. Many studies use the equivalent of one to two cloves per day. Supplements are also widely available. Eating garlic as part of food provides fibre, vitamins and other plant compounds that supplements do not contain so food sources may offer extra benefits beyond supplements alone.

Garlic is generally safe but it can cause bloating, gas and heartburn especially when eaten raw or in large amounts. People with irritable bowel syndrome, acid reflux or those who are pregnant may be more sensitive.

Garlic is also known for causing bad breath and body odour. As allicin breaks down, it releases sulphur containing gases. Most are processed by the body but one called allyl methyl sulphide remains unmetabolised and leaves the body through breath and sweat.

Garlic can interact with certain medications if taken in large amounts. It may increase the effects of aspirin or blood-thinning medicines such as warfarin which can increase the risk of bleeding. Garlic may also lower blood pressure which could be a problem for people already taking medication for high or low blood pressure. Those who are pregnant or breastfeeding should be cautious because high-dose garlic supplements have not been well studied, so the effects on the developing baby or infant are not fully known.

Garlic is more than a flavour booster. It is a functional food with a growing body of scientific evidence behind it. While it is not a replacement for medical treatment, including garlic in your diet may offer real benefits for your heart and immune system.

Whether you roast it, crush it or take it as a supplement, garlic deserves a place in your health routine. If you take medication or have existing health conditions speak to a doctor or pharmacist before using garlic in large amounts. As with any natural remedy, moderation is important.

Dipa Kamdar is Senior Lecturer in Pharmacy Practice, Kingston University.

This article was first published on The Conversation.

Some of the world’s healthiest and longest-living people follow the practice of hara hachi bu – an eating philosophy rooted in moderation. This practice comes from a Japanese Confucian teaching which instructs people to only eat until they’re around 80% full.

More recently, it’s been gaining attention as a strategy for weight loss. But while hara hachi bu might emphasise eating in moderation and stopping before you’re full, it shouldn’t really be as seen as a method of dietary restriction. Rather, it represents a way of eating that can help us learn to have awareness and gratitude while slowing down at mealtimes.

Research on hara hachi bu is limited. Previous studies have evaluated the overall dietary patterns of those living in regions where this eating philosophy is more commonplace, not the “80% rule” in isolation.

However, the available evidence does suggest hara hachi bu can reduce total daily calorie intake. It’s also associated with lower long-term weight gain and lower average body mass index (BMI). The practice also aligns with healthier meal-pattern choices in men, with participants choosing to eat more vegetables at mealtimes and fewer grains when following hara hachi bu.

Hara hachi bu also shares many similar principles with the concepts of mindful eating or intuitive eating. These non-diet, awareness-based approaches encourage a stronger connection with internal hunger and satiety cues. Research shows both approaches can also help reduce emotional eating and enhance overall diet quality.

Hara hachi bu may also have many advantages that go beyond losing weight.

For instance, hara hachi bu‘s focus on awareness and eating intuitively may offer a gentle and sustainable way of supporting long-term health changes. Sustainable health changes are far easier to maintain in the long-term. This may improve health and prevent weight regain, which can be a risk for those who lose weight through traditional diet approaches.

The ethos of hara hachi bu also makes perfect sense in the context of modern life and may help us develop a better relationship with the food we eat.

Evidence suggests that around 70% of adults and children use digital devices while eating. This behaviour has been linked to higher calorie intake, lower fruit and vegetable intake and a greater incidence of disordered eating behaviours including restriction, binge eating and overeating.

As a dietitian, I see it all the time. We put food on a pedestal, obsess over it, talk about it, post about it – but so often, we don’t actually enjoy it. We’ve lost that sense of connection and appreciation.

Being more aware of the food we eat and taking time to taste, enjoy and truly experience it as hara hachi bu emphasises, can allow us to reconnect with our bodies, support digestion and make more nourishing food choices.

For those who might want to give hara hachi bu or taking a more mindful and intuitive approach to improve their relationship with food, here are a few tips to try:

1. Check in with your body before eating

Ask yourself: Am I truly hungry? And if so, what kind of hunger is it — physical, emotional, or just habitual? If you’re physically hungry, denying yourself may only lead to stronger cravings or overeating later. But if you’re feeling bored, tired, or stressed, take a moment to pause. Giving yourself space to reflect can help prevent food from becoming a default coping mechanism.

2. Eat without distractions

Step away from screens and give your meal your full attention. Screens often serve as a distraction from our fullness cues, which can contribute to overeating.

3. Slow down and savour each bite

Eating should be a sensory and satisfying experience. Slowing down allows us to know when we’re satiated and should stop eating.

4. Aim to feel comfortably full, not stuffed

If we think of being hungry as a one and being so full you need to lie down as a ten, then eating until you’re around “80% full” means you should feel comfortably satisfied rather than stuffed. Eating slowly and being attuned to your body’s signals will help you achieve this.

5. Share meals when you can

Connection and conversation are part of what makes food meaningful. Connection at meal times is uniquely human and a key to longevity.

6. Aim for nourishment

Ensure your meals are rich in vitamins, minerals, fibre and energy.

7. Practice self-compassion

There’s no need to eat “perfectly”. The point of hara hachi bu is about being aware of your body – not about feeling guilty over what you’re eating.

Importantly, hara hachi bu is not meant to be a restrictive eating approach. It promotes moderation and eating in tune with your body – not “eating less”.

When viewed as a means of losing weight, it risks triggering a harmful cycle of restriction, dysregulation and overeating – the very opposite of the balanced, intuitive ethos it’s meant to embody. Focusing solely on eating less also distracts from more important aspects of nutrition – such as dietary quality and eating essential nutrients.

This practice also may not suit everyone. Athletes, children, older adults and those living with illness often have higher or more specific nutritional needs so this eating pattern may not be suitable for these groups.

While often reduced to a simple “80% full” guideline, hara hachi bu reflects a much broader principle of mindful moderation. At its core, it’s about tuning into the body, honouring hunger without overindulgence and appreciating food as fuel – a timeless habit worth adopting.

Aisling Pigott is Lecturer, Dietetics, Cardiff Metropolitan University.

This article was first published on The Conversation.

India is preparing for a countrywide rollout of the human papillomavirus vaccine, marking an important step towards reducing cervical cancer-related morbidity and mortality.

In April, the health ministry began training frontline workers following the interim budget announcement in February 2024 that the government would encourage vaccination against HPV for girls between the ages of nine to 14.

But limiting the vaccine to women and girls does not address the larger public health burden posed by HPV, a virus that affects people of all genders, not just women.

Apart from cervical cancer, HPV is implicated in other cancers – vulvar, vaginal, penile, anal, and oropharyngeal – and genital warts.

According to an American study conducted in 2019, nearly 85% of women and 91% of men with at least one sexual partner of the opposite sex are estimated to contract HPV during their lifetime. Research further indicates that men are more likely than women to carry high-risk HPV strains.

Globally, HPV-associated cancers are a substantial burden across genders. Apart from penile cancer, which affects men, anal cancer affects all genders with around 50,000 new cases and 19,000 deaths estimated worldwide in 2020.

Evidence from a 2012 US study indicates that anal cancer incidence rates are higher among men who have sex with men, especially those living with HIV – the human immunodeficiency virus.

In India, a study found a high incidence of HPV-associated cancers among men, who account for a significant portion of non-cervical cases: for 2025, the study projected nearly 25,000 cases of HPV-associated cancers among men and nearly a lakh among women.

Another study in two Indian cities of 300 HIV-positive men who have sex with men found a 95% prevalence of anal HPV infection among the men. Given the prevalence of HPV across all sexually active populations, vaccination must be inclusive of all genders to tackle HPV-related cancers.

Feminisation of HPV

The focus on vaccinating women is justified, given the disproportionate cervical cancer burden. But this framing perpetuates gender stereotypes and risks “feminising HPV” as a women’s issue, reinforcing the idea women are solely responsible for sexual and reproductive health.

It can also limit secondary prevention efforts, such as screening and treatment, to women while excluding men, preventing them from being aware of their own risks. The absence of HPV screening for men adds to this narrative.

The combined effect is that the diagnostic and treatment burden is placed primarily on women while men’s role in transmission and prevention is sidelined.

Moreover, restricting vaccination ends up further marginalising populations like men who have sex with men, transgender communities, and gender-diverse persons who are already vulnerable to systemic discrimination in healthcare.

HPV vaccines in the private sector are also out of reach for most Indians. Cervavac, India’s indigenous vaccine, costs about Rs 2,000 per dose, while Gardasil-9 is priced as high as Rs 11,000 per dose.

Recognising this cost barrier, the National Technical Advisory Group on Immunisation had recommended the inclusion of the HPV vaccine in India’s universal immunisation programme as early as 2022. In August, a parliamentary panel said the recommendation should be expedited “to reduce cervical cancer incidence and improve women’s health outcomes”.

Over 75K women die due to cervical cancer in India annually. It’s preventable thru HPV vaccine which costs 10K rupees! Thats unaffordable for most women & girls. Issued notice to Centre seeking
introduction of HPV vaccine in Universal Immunization Programme for adolescent girls. pic.twitter.com/SAT75d25fx

— Swati Maliwal (@SwatiJaiHind) August 16, 2023

What can India do

The challenges in India’s HPV vaccination programme can be addressed by a nuanced, rights-based, evidence-informed and gender-inclusive perspective.

First, school-based HPV vaccination programmes – already under way in Sikkim and Bihar – should be expanded to include all adolescents, regardless of gender. This would normalise vaccination as core preventive healthcare. As national efforts move from pilot to phased rollouts, subsequent drives should focus on vaccinating children of all genders, closing the current gap in protection.

Second, India needs large-scale, India-focused studies on men to build robust, country-specific evidence and challenge persistent misconceptions that HPV is not a male health concern. A study found that HPV vaccination awareness was lower among male healthcare students in Mangaluru than among their female counterparts. Female participants expressed willingness to be vaccinated but male students were hesitant even after receiving relevant health education, the study found.

Third, the success of any immunisation programme depends on community acceptance and political support. Vaccine hesitancy, for example, may arise from misconceptions, such as the false belief that vaccination leads to early sexual activity among adolescent girls. To counter this, the government must pair vaccine rollout with awareness initiatives. Campaigns emphasise that HPV is a concern for everyone, regardless of gender.

Outreach efforts must be sensitive, affirming and stigma-free. Inclusive messaging builds trust, increases vaccine uptake and helps break down stereotypes that frame reproductive healthcare solely as a woman’s concern.

Finally, a comprehensive HPV control strategy must strengthen and ensure accessible screening and testing for all, addressing the diagnostic gap that renders men “invisible” to HPV detection.

Global evidence shows that gender-just HPV vaccination reduces overall transmission by creating herd protection and protecting heterosexual and same-sex partnerships.

Countries such as Australia and the UK, which instituted gender-inclusive HPV vaccination, have shown a significant decrease in HPV-related disease burden. The European Cancer Organisation estimates that 42 countries are vaccinating boys and girls against HPV.

Closer home, Bhutan in 2010 became the first low-middle-income country to launch a national HPV vaccination programme, successfully attaining coverage rates exceeding 90%. In 2020, Bhutan began vaccinating adolescent boys as well.

India has taken a critical first step with the national rollout of the vaccine. The next step must be to ensure that this intervention is inclusive, accessible and transformative for all.

Shreya Eliza Sunny is a Research Associate at the Centre for Health Equity, Law & Policy, ILS Pune.

A new study suggests that even low levels of physical activity could protect the brain from Alzheimer’s disease – but not in the way scientists expected.

The researchers tracked almost 300 older adults with early brain signs of Alzheimer’s for nine to 11 years using pedometers. They found that physical activity didn’t reduce the toxic amyloid plaques that most Alzheimer’s treatments now target.

Instead, in people who already had these plaques, physical activity reduced the accumulation of misfolded tau proteins in specific brain areas. These proteins appear later in Alzheimer’s disease and are more closely linked to cognitive and functional decline. These signs of dementia were reduced by almost half in more active participants.

Benefits appeared at just 3,000 steps – roughly half an hour of walking at a moderate pace. The optimal range was 5,000 to 7,500 steps daily, after which the effect plateaued. More steps didn’t necessarily mean greater protection, which suggests a realistic target for older, sedentary people, rather than the often-cited 10,000 steps.

The study had limitations, however. It involved a fairly small group of mostly white, well-educated people in the US, and it didn’t take other lifestyle or health factors into account. Also, there may be other protective mechanisms of walking at play. But it does support other research suggesting that being physically active may lower the risk of dementia.

A UK study of 1,139 people over 50 found that those who were moderately to vigorously active had a 34%-50% reduction in dementia risk when followed over eight to 10 years. Among those who developed dementia, staying active reduced their memory decline, particularly in older women.

A larger 2022 UK study tracked 78,430 people for seven years using wrist accelerometers. It found a 25% reduction in dementia risk with just 3,800 steps daily, rising to 50% at 9,800 steps.

However, people who walked more also had better cardiovascular health – lower cholesterol, better sleep and blood pressure and reduced diabetes risk. Since these heart and stroke risk factors also increase dementia risk, the picture is complex.

Healthy habits often go together. People who exercise are more likely to eat well, not smoke, look after their heart health and have fewer financial stresses. This makes it hard to know which factor is having the biggest effect. The researchers tried to account for this, but because these habits are so closely linked, it’s difficult to say that exercise alone is responsible.

However, there is a strong case for this as there are multiple ways exercise might support the brain: improving cardiovascular health, increasing blood flow and boosting chemicals that promote brain-cell connections.

One such substance is irisin, a hormone produced by muscles that acts on almost all faulty brain mechanisms associated with Alzheimer’s, including inflammation. This and other chemicals, such as BDNF, associated with exercise, provide plausible biological pathways for how physical activity might directly influence brain health beyond its cardiovascular benefits.

But the relationship might work in reverse, too. People may become less active because of early Alzheimer’s symptoms. Those with hearing problems, for instance – itself a dementia risk factor – often report barriers that make them stop being active before other dementia symptoms appear.

Vicious circle

Reduced activity then accelerates memory decline. This creates a vicious circle. Early disease symptoms – such as not hearing – can affect self-esteem and reduce engagment in physical activity, which in turn worsens cognitive decline.

Brisk walking might be particularly beneficial. A small trial of 15 people with mild to moderate Alzheimer’s who did Nordic walking (an enhanced walking technique that uses poles to work your upper body as well as your legs) maintained brain function over 24 weeks, with some functions even improving.

The 15 who received only standard care showed decline or no improvement. Though small, the trial suggests that even people already diagnosed with Alzheimer’s might benefit from increased physical activity, including brisk walking.

Getting outside, particularly in nature, may be especially beneficial for preventing dementia – possibly because it improves mood and sleep while reducing isolation – all dementia risk factors. The combination of physical movement, natural light exposure and social interaction when walking outdoors may create multiple protective effects that complement each other.

The challenge now is helping people overcome barriers to outdoor activity, such as safety concerns, fear of falling, or simply preferring the comfort of the sofa – particularly during wetter, colder months. But the evidence suggests that even a few minutes of walking could make a difference, and that modest, achievable targets – a half-hour stroll rather than a marathon training regime – may offer substantial protection against cognitive decline.

Eef Hogervorst is Professor of Biological Psychology, Loughborough University.

This article was first published on The Conversation.

India accounted for the highest number of tuberculosis cases globally in 2024, the World Health Organisation said in a report released on Wednesday. The country recorded a quarter of the cases worldwide.

The Global Tuberculosis Report 2025 stated that just eight countries account for 67% of the global total of the disease, with India leading the list at 25%, followed by Indonesia at 10%, the Philippines at 6.8%, China at 6.5% and Pakistan at 6.3%.

The other countries are Nigeria at 4.8%, the Democratic Republic of the Congo at 3.9% and Bangladesh at 3.6%.

The report stated that India’s tuberculosis rate stood at 187 per one lakh population. The rate has reduced significantly by 21% from 2015 when the number stood at 237 per one lakh population.

However, it was still short of the elimination target set by the Union government of reducing the burden to 77 cases per one lakh population by 2025, the Deccan Herald reported. In 2018, Prime Minister Narendra Modi had announced a deadline of 2025 for eliminating tuberculosis.

The United Nations, on its part, has set a goal to eliminate the disease by 2030.

Tuberculosis mortality figures also improved marginally to 21 per one lakh population in 2024, as per the WHO report on Wednesday. However, this was again over three times higher than the elimination target set by the Union government, the newspaper reported.

As per the report, India recorded a third of the globe’s drug-resistant tuberculosis cases in 2024.

It stated that four countries accounted for more than half of the number of persons across the globe estimated to have developed multi-drug resistant and rifampicin-resistant tuberculosis in 2024. This included India at 32%, China and the Philippines at over 7%, and Russia at 6.7%.

Multi-drug resistant tuberculosis is a form of the disease that is resistant to rifampicin and isoniazid, which is a combination of two antibiotics. Rifampicin-resistant tuberculosis is caused by bacteria that are no longer susceptible to rifampicin, among the primary medicines used to treat the disease.

The World Health Organisation also noted that the number of persons susceptible to developing drug-resistant tuberculosis each year has gradually declined, adding that those with multi-drug resistant or rifampicin-resistant variants of the disease accounted for 3.2% of the total burden in 2024.

More than 1,64,000 persons also received treatment for drug-resistant tuberculosis in 2024.

Citing the Global Tuberculosis Report 2025, the Union Health Ministry on Thursday said that India’s “innovative case finding approach” had led to its treatment coverage to surge to over 92% in 2024, from 53% in 2015.

About 26.18 lakh tuberculosis patients were diagnosed in 2024, out of an estimated incidence of 27 lakh cases, the ministry said in a statement.

“This has helped reduce the number of ‘missing cases’ – those who had TB but were not reported to the programme – from an estimated 15 lakhs in 2015 to less than one lakh in 2024,” it said. “Also there is no significant increase in the number of MDR [Multi-drug resistant] TB patients in the country.”

The statement added: “Similarly, India’s TB mortality rate has decreased from 28 per lakh population in 2015 to 21 per lakh population in 2024, reflecting significant progress in reducing deaths due to TB.”

Every week of 2025 seems to bring a new health headline, whether it’s about climbing autism rates, changing vaccination recommendations or unexpected cancer risks.

For people trying to make informed choices about their own health and that of their families, it can be tough to make sense of it all. The science can feel contradictory and confusing. Human data is messy, and studies often yield conflicting results.

Sparring between government officials and scientists can muddy the picture further.

As professors who teach epidemiology and research methods to public health students, we start our students off with a few key questions that can help make sense of the evidence. We’ve come to realise that these lessons aren’t just for public health experts – they are tools that anyone can use to cut through bias, evaluate health claims and better understand health-related policy debates.

So next time you read a news article making a claim about a particular health condition, ask yourself these three questions.

1. Are people getting this illness more often?

Media reports often highlight changes in how frequently a condition is diagnosed. Take, for example, “Autism rates in US rise again to 1 in 31 kids, CDC says,” and “CDC finds nearly 1 in 3 US youth have prediabetes, but experts question scant data.”

Before raising the alarm about an unfolding epidemic, it’s important to consider whether the changes in rates are due to what public health researchers call artifactual changes or if they are true changes.

Artifactual changes can occur even when the rate of a disease or condition in the population has not actually changed. When researchers revise how they define a particular condition, the number of people counted as having it can change over time. Autism rates, for example, have increased at least partially due to an expanded definition of autism.

Another example is a change in what classifies someone as having high blood pressure. In 2017, the American Heart Association lowered the cutoff for diagnosing hypertension from 140/90 to 130/80. As a result, almost overnight, more people were considered to have the condition.

A condition’s rate can also appear to increase when doctors become better at detecting it. The widespread adoption of the PSA test, short for prostate-specific antigen test, a blood test for prostate cancer detection, in the early 1990s resulted in a surge in prostate cancer diagnoses. Some fraction of these cases were detected at such an early stage that they may never have progressed to cause illness or death during the patient’s lifetime.

Increased awareness of a condition due to media reports or public discussion can also result in more diagnoses. That’s especially true when diagnosis is not based on a definitive medical test but instead on clinical observations or reports. For example, increases in ADHD cases over time may partly reflect increased recognition and diagnosis as awareness grows.

True changes in the rates of a disease or health condition reflect real shifts in the factors that cause a condition to become more or less common in a population.

A classic example of a true change in a disease rate is smoking and lung cancer. Early in the 1900s, lung cancer was a rare disease in the United States. By the 1930s, doctors were noticing more cases in men, leading to studies investigating its potential causes, including smoking.

Based on the results of numerous studies reviewed by the U.S. surgeon general’s Advisory Committee on Smoking and Health in the early 1960s, the committee concluded that smoking was a primary cause of lung cancer. In the surgeon general’s landmark report published in 1964, which drew upon evidence from over 7,000 scientific and technical articles, the committee concluded that “cigarette smoking contributes substantially to mortality from certain specific diseases and the overall death rate.”

2. What kind of study led to this claim?

The strongest studies compare a control group, which does not receive the intervention being tested, and an experimental group, which does. Study participants are randomly assigned to one of these groups. This type of study design, called a randomized controlled trial, is considered the gold standard for proving when a treatment or other factor truly causes or prevents a disease.

However, a randomized controlled trial cannot be used to study potentially harmful factors such as pesticides or other chemicals found in our everyday environments. Exposing people to potentially harmful exposures would not be ethical. Instead, researchers need to rely on observational studies, which identify people who are already exposed to some factor in their daily lives – for example, those who work with pesticides – and compare their health outcomes to people who are not exposed to pesticides.

The challenge with observational studies is that the two groups of people often differ in unpredictable ways – and these differences might partly explain why one group has a higher rate of a certain disease or health condition. This is known as confounding. Statistical methods used to control for these differences between the groups are often imperfect. This is why it’s risky to draw conclusions from a single study.

3/ What other evidence is there?

Because a single study cannot prove cause and effect, experts review the total body of research on a topic, like a jury weighing all the testimony before rendering a verdict. Evidence often includes a combination of study types, including randomized clinical trials, observational studies and laboratory research. Randomized clinical trials test whether an intervention actually changes outcomes under controlled conditions, while observational studies look for patterns and associations in real-world populations. Laboratory research aims to uncover biological mechanisms linking a potential cause to a disease, and it is usually conducted under artificial circumstances.

For example, many studies have investigated the effects of chemicals in cigarette smoke. On balance, they have found that such chemicals cause cancer by damaging genetic material in lung cells. When this damage affects key genes, it can trigger the cells to divide uncontrollably and lead to the development of cancer.

Once scientists rule out explanations based in artifacts such as more people being classified with a condition due to changing definitions, they can combine evidence from a range of studies on a topic to build a convincing case for whether the factor they are investigating truly causes or prevents a disease or other condition. They weigh all the evidence because no single study settles the question, but together the pieces form a clearer picture.

The bottom line? If you see a health claim that seems too good – or too bad – to be true, take a moment to mentally run the evidence through these three questions before deciding what to believe.

Kimberly Johnson is Professor of Public Health, Washington University in St. Louis.

Amy Eyler is Professor of Research Methods, Washington University in St. Louis.

This article was first published on The Conversation.

Behind many sudden deaths lie clots that block blood flow to the heart, lungs or brain. Globally, blood clots are linked to one in four deaths, which is more than AIDS, breast cancer and traffic accidents combined.

In India, they tend to strike earlier than in Western countries, often during people’s most productive years. Every year, more than 2.5 million Indians die from heart-related causes, with clotting a major factor.

Yet the issue remains largely invisible in India’s public health agenda. The warning signs are easy to miss: pain in the chest or severe headache, swelling in a leg, or unexplained breathlessness or dizziness. Left untreated, this can lead to sudden death.

A stronger focus on prevention and early detection could turn the tide against this silent killer.

After viral infections, the risk of serious clotting remains high. The Covid-19 pandemic revealed that infections can make blood more prone to clotting by damaging blood vessels, activating platelets – tiny cell fragments that help form clots – and triggering inflammation. During the pandemic, the D-dimer test, which measures fragments of clots circulating in the blood, also became widely known as a way to detect abnormal clotting.

Public concern about clots has since faded, but the threat persists. Dangerous clots are often the hidden cause of heart attacks, strokes and blocked veins in the legs or lungs. These conditions, collectively known as venous thromboembolism, cover two related problems: deep vein thrombosis, when a clot forms in a deep vein (often in the leg), and pulmonary embolism, when that clot travels to the lungs. Both can recur, and cause sudden death or lead to lasting organ damage.

Evidence suggests that vaccination helps protect against severe illness and long Covid by maintaining immunity. However, rare cases of a condition called thrombosis with thrombocytopenia syndrome – a combination of clotting and unusually low platelet counts – were linked to the AstraZeneca and Johnson & Johnson vaccines, occurring in about 10 people per million doses. mRNA-based vaccines from Pfizer and Moderna have not shown this effect.

Experts agree that the benefits of vaccination far outweigh the small risk of such rare side effects.

The risk of clotting rises among people who are sedentary, obese, diabetic, recovering from surgery or trauma, or undergoing cancer treatment. Women face added risk during pregnancy or while using oral contraceptives, as hormone changes can make blood thicker. Some families carry genetic mutations that make their blood more likely to clot.

Geography can also play a role. Soldiers stationed at high altitudes in Siachen and Ladakh, and pilgrims trekking to Amarnath or Kailash Mansarovar, face conditions such as low oxygen, dehydration and extreme cold that increase clotting risk.

Prevention and new cures

The good news is that prevention is simple: move more, sit less and stay hydrated. Standing or walking every hour, even during long flights or hospital stays, helps maintain circulation. Those at risk should wear compression stockings, which gently squeeze the legs to prevent blood from pooling, and consult their doctors for early screening.

Treatment options have also advanced. Blood thinners or anticoagulants remain the main line of defence. Older drugs such as heparin (an injectable medicine) and warfarin (a tablet that prevents the liver from making clotting proteins) have long been used to stop new clots from forming.

Newer oral anticoagulants act more precisely on the body’s clotting process. Direct thrombin inhibitors such as dabigatran block thrombin, the key enzyme that builds clots, while other inhibitors like rivaroxaban target another crucial step.

India has made its own mark in this field. The Council of Scientific and Industrial Research developed the clot-busting enzyme streptokinase, introduced in 2009, which dissolves existing clots. New recombinant, or laboratory-engineered, versions are now being tested.

A next generation of drugs that block factor XI, another clotting protein, could offer safer long-term options. Global companies including Bayer, Novartis and China’s Jiangsu Hengrui are developing these therapies, now in clinical trials.

Around the world, scientists are also working on faster, more accurate diagnostic tools. Handheld devices such as ClotChip and new urine-based tests can detect abnormal clotting within minutes. Indian researchers have created innovations such as the Indian Institute of Science’s nanozyme – a microscopic enzyme mimic that prevents clots – and IIT (BHU)’s nanoparticles designed to deliver anti-clot drugs directly where they are needed.

The Defence Research and Development Organisation (DRDO) has developed a diagnostic test using microRNA-145, a small molecule in the blood that helps regulate gene activity and is linked to clot formation. This was later validated in Europe’s Trøndelag Health Study. Wearable ultrasound devices and smart biosensors could soon make detection faster, safer and more accessible.

Because clot treatment can be expensive and long-term, prevention remains far more cost-effective. Many cases arise during predictable hospital stays or cancer treatment.

In 2008, the US Surgeon General made clot prevention a national priority, prompting hospitals to use checklists and discharge guidelines that have saved thousands of lives. India has begun similar efforts. The Indian Council of Medical Research launched the country’s first hospital-based registry, i-RegVeD, in 2022, collecting real-time data from 16 tertiary hospitals. Early results from more than 2,800 patients show high recovery rates and about 3% mortality.

The National Academy of Medical Sciences’ 2024 task-force report also recommends routine hospital risk checks to detect clots early. These initiatives could help shape national policy and make care more evidence-based.

Despite strong public campaigns on diabetes and hypertension, awareness of blood clots remains minimal. It is rarely mentioned in schools, workplaces or even in-flight safety briefings, though simple awareness could save thousands of lives. A coordinated public campaign through social media, airlines, pilgrimage organisers and hospitals could make a critical difference.

Clots can be fatal but are largely preventable. Early recognition, timely medical care and sustained awareness can help India tackle this silent killer.

Mohammad Zahid Ashraf is Dean, Faculty of Life Sciences, Jamia Millia Islamia and a Fellow of all three of India’s National Science Academies.

Originally published under Creative Commons by 360info™.

They’ve become as ubiquitous on British high streets as coffee shops – bubble tea outlets offering their Instagram-worthy drinks in countless flavour combinations. The Taiwanese beverage, a blend of black tea, milk, sugar and chewy tapioca pearls, has gained global popularity since its origins in the 1980s. But recent findings suggest this trendy drink may warrant closer scrutiny.

A Consumer Reports investigation revealed high lead levels in some bubble tea products in the US, echoing previous concerns about cassava-based foods. (No equivalent UK testing has been published.) The tapioca pearls – those signature “bubbles” – are made from cassava starch, and the root vegetable readily absorbs lead and other heavy metals from soil as it grows.

The tapioca pearls also pose other risks beyond contamination. Their starchy composition means that consuming large quantities can slow stomach emptying – a condition called gastroparesis – or, in some cases, lead to complete blockages.

Both can cause nausea, vomiting and abdominal pain, and symptoms can be particularly severe in people who already have slow-moving digestion. Even guar gum – a thickener often added to bubble tea and harmless in small amounts – can lead to constipation if you drink it often.

The drink’s composition also affects kidney health. In 2023, Taiwanese doctors removed over 300 kidney stones from a 20-year-old woman who’d been drinking bubble tea instead of water. Certain components, including oxalate and elevated phosphate levels, can contribute to stone formation. However, this extreme case probably reflects exceptionally high consumption.

For children, the risks are more immediate. The pearls can be a choking hazard – a risk that is well documented by paediatricians. Adults are not immune to this risk. According to media reports in Singapore, a 19-year-old woman died after inhaling three pearls when sucking harder on a partially blocked straw, while another woman narrowly avoided the same fate thanks to fast-acting bystanders.

The sugar problem

The sugar content raises longer-term health concerns. Most bubble teas contain 20g-50g of sugar, comparable to or exceeding a can of Coca-Cola (35g). Research in Taiwan found that by age nine, children who regularly consumed bubble tea were 1.7 times more likely to have cavities in their permanent teeth.

In California, the drink is considered a contributing factor to the youth obesity epidemic, yet many young adults remain unaware of these risks. The high sugar and fat content increases the likelihood of developing type 2 diabetes, obesity and metabolic disease, while prolonged consumption may contribute to fatty liver disease – outcomes associated with any high-sugar product that spikes blood glucose and promotes fat storage in the liver.

Perhaps most surprisingly, emerging research suggests potential mental health implications. Studies of Chinese children who frequently consume bubble tea show an association with increased rates of anxiety and depression. Similar patterns appear in adults: research on Chinese nurses found that regular bubble tea consumption was associated with anxiety, depression, fatigue, job burnout and reduced wellbeing, even after controlling for other factors. The same study linked lower consumption to reduced thoughts of suicide, though establishing causation remains complex.

Strange scans

There’s even a curious medical phenomenon associated with consuming bubble tea: tapioca pearls appearing on scans of patients admitted for unrelated emergencies.

Doctors treating people after car accidents or with appendicitis have found dozens of pearls visible in stomachs and digestive tracts. These can occasionally cause diagnostic confusion, as they appear denser than the surrounding tissues and have stone-like properties similar to those seen with kidney- or gallstones.

This doesn’t mean bubble tea should be banned, but it does suggest we treat it as an occasional indulgence instead of a daily habit. And if you do indulge, consider skipping a straw. Drinking directly from the cup gives you better control, and allows your mouth’s sensory receptors to properly prepare for what’s coming.

Adam Taylor is Professor of Anatomy, Lancaster University.

This article was first published on The Conversation.

If you’re reading this there’s a good chance that you, like me, are a millennial. If so, you’ve probably noticed more and more cases of friends or acquaintances with diseases that you would normally associate with later adulthood – hypertension, type 2 diabetes or perhaps even the one that we’re all scared to name: cancer.

Millennials – people born between 1981 and 1995 – are the first generation at greater risk of developing tumours than their parents. Between 1990 and 2019, cases of early-onset cancer among people under 50 increased by 79% worldwide, and mortality by 28%.

The truth is that around 80% of cancers are “sporadic”, meaning they are not caused by hereditary mutations but by external factors that damage DNA over time. This includes what we eat and breathe, as well as our level of physical activity, rest, stress and exposure to harmful substances.

In other words, the things that make the biggest difference are the lifestyle factors that surround us every day, and not the genetics we inherit. And we know that our parents’ and grandparents’ lifestyles differed greatly from our own.

Diet effect

One of the main factors behind this “new epidemic” is diet. Childhood obesity began to skyrocket in the 1980s. In 2022, more than 390 million children and adolescents aged 5 to 19 were overweight – 160 million of these were obese, according to the WHO.

This condition is not just a question of aesthetics: it is associated with insulin resistance, low-grade chronic inflammation, and hormonal changes that increase the risk of developing colorectal, breast, or endometrial cancer.

Most importantly, the effects of childhood obestity do not disappear with age. According to the Colon Cancer Foundation, a meta-analysis involving more than 4.7 million people showed that those with a high body mass index in early life are at greater risk of colorectal cancer in adulthood: 39% higher in men and 19% higher in women compared to those who had a healthy BMI in childhood.

Changes in diet have also altered our gut microbiota. It has been shown that diets rich in ultra-processed foods reduce bacterial diversity, and increase the proportion of strains that produce pro-inflammatory metabolites.

This contributes to gastrointestinal diseases such as irritable bowel syndrome or SIBO, which often seem to be endemic among millennials – ask a group of 30-somethings which of them suffers from gastrointestinal problems and you’ll find few hands are left unraised.

Alcohol’s invisible effects

The second major culprit is alcohol, as millennial gatherings often revolve around a table laden with food and drink. For years it was thought that a glass of wine was could “protect” you in some way, but today we know that there is no safe level of alcohol consumption: the International Agency for Research on Cancer classifies it as a Group 1 carcinogen, on the same level as tobacco. This is because the body converts ethanol into acetaldehyde, a compound that damages DNA.

Furthermore, consumption patterns differ between generations. While baby boomers (those born between 1946 and 1964) drink more on a daily basis, millennials tend to drink less frequently but engage in more binge drinking, which carries significant risks. This is confirmed by the Spanish Ministry of Health’s 2024 EDADES survey, which explores the different levels of risk associated with different behaviours across generations.

And, as if that weren’t enough, a recent study by Environmental Science & Technology found that many beers contain perfluoroalkyl substances (PFAS). These chemicals, also known as “forever chemicals”, are linked to higher rates of testicular and kidney cancer.

Not enough sleep

We sleep less and worse than previous generations. Recent surveys show that millennials and generation Z get an average of 30-45 minutes less sleep per night than baby boomers, largely due to night-time exposure to screens and social media. This artificial light disrupts the release of melatonin, an antioxidant hormone that regulates the cell cycle.

Chronic lack of sleep not only impairs DNA repair, but also reduces melatonin’s protective effects against cancer. Reduced levels of this hormone have been linked to a reduced ability to counteract oxidative DNA damage and increased cell proliferation.

Furthermore, disrupted circadian rhythms interfere with the expression of genes that are key to repairing DNA. This means mutations accumulate over time, increasing the risk of tumour-forming processes.

The weight of stress

Millennials are probably the generation with the highest cortisol levels. When this “stress hormone” remains elevated for a long time, it not only promotes insulin resistance and hypertension, but also weakens the immune system.

Research reveals that chronic stress increases inflammation, hinders the body’s defences from eliminating abnormal cells, and can even “awaken” dormant tumour cells. In fact, studies in the general population have found that people with higher stress levels are up to twice as likely to die from cancer as those who manage stress better.

Risks of self-medicating

Lastly, younger generations also resort to self-medication more than previous ones. This poses new short and long-term risks.

Frequent use of paracetamol is linked to increased liver damage and a possible increase in liver cancer. Oral contraceptives, used for very long periods due to delayed motherhood, slightly increase the risk of breast and cervical cancer, although they do protect against ovarian and endometrial cancer.

In addition, prolonged use of antacids and antibiotics has been linked to an increased risk of digestive cancer through indirect mechanisms such as carcinogenic compounds or intestinal dysbiosis (an imbalance in the gut microbiota).

What does the future hold?

The projections are worrying. It is expected that cancer cases could rise from around 20 million in 2022 to nearly 35 million in 2050 – an overall increase of almost 77%. The trend is particularly marked in digestive and gynaecological tumours, which are becoming more and more common in young adults.

We are the generation of immediacy, anxiety and quick-fix pills, but all is not lost, as we can take control of many of the factors that make us ill, starting today. Adopting healthier habits can reduce risks, and improve our quality of life in a future that is not as distant as we might like to believe.

Lydia Begoña Horndler Gil is Profesor en inmunología y biología del cáncer, Universidad San Jorge.

This article was first published on The Conversation.

Generations of women in Sampreetha’s family have worked on their rice fields. During the Covid-19 lockdown, Sampreetha, who goes by her first name, was pursuing a master’s degree in agriculture. When her college closed, she returned home to Sakleshpur, Karnataka, and began helping on the family’s six-acre farm. She soon realised that paddy cultivation involved a chain of menial, labour-intensive tasks, most of them carried out by women.

Women farmers may not be familiar with the term “climate change”, but they constantly feel its effects on their bodies and in their pockets, she observes. “They don’t know the words ‘adaptation’ or ‘mitigation’. But they say, ‘it didn’t feel like this 10 years ago. Earlier, the rains came in June or July, but now they are late’,” Sampreetha says.

Paddy cultivation supplies half the global population with staple food, but also accounts for 48% of greenhouse gas emissions from croplands. However, many call these “survival” emissions as they provide livelihood to millions of farmers across economies. India refused to sign the Global Methane Pledge at COP26 in 2021 held at Glasgow, UK, wherein countries promised a 30% reduction of emissions by 2030, since it threatened the livelihood of the large population of small and marginal farmers.

Studies, however, show that these farmers are also now suffering because of climate change. With every 1 degree celsius rise in temperature, paddy yields declined by 10%-15% leading to food and income insecurity across the regions, according to the International Rice Research Institute.

Women farmers on the frontline

Climate change, combined with the drudgery required for rice cultivation, was severely affecting women farmers’ well-being, explains Dhanya Punnoli, an independent researcher formerly with the Government College, Chittur in Kerala.

Punnoli studied women rice farmers from Palakkad district, the rice granary of Kerala, to understand on-ground and year-round effects of climate change.

In the chapter “Assessment of Women Farmers’ Drudgery in Rice Farming with Climate Change: A Case Study from South India” in Gender-Transformative Approaches for Climate Change Adaptation, published by Springer Climate in 2025, she writes that women farmers were exposed to waterborne diseases, several skin conditions and allergies, dehydration and heat exhaustion, among other health issues associated with rice cultivation. The study, a participatory survey of 135 male and female farmers, also found that difficulties associated with physical labour during the three crop-producing seasons vary.

Out of the 99 female farmers surveyed, 27 said that their health was severely impacted by climate-induced disasters; only six out of the 36 male farmers responded that they were severely impacted by climate-related challenges in rice farming.

When temperatures soared, health problems like severe skin damage, irritation, and itching were reported by the farmers. Dehydration-related illnesses were common, followed by heat boils and prickly heat rashes. The least impacted people were either having high adaptive capacity – they had better economic status and living standards, higher educational qualifications, or less sensitivity and exposure to impacts, such as working on farms located away from flood-prone areas.

“When we say ‘farmer,’ we imagine a man. But rice cultivation is mostly done by women,” Sampreetha explains. Transplanting, where young rice seedlings are moved from a nursery to a main field to ensure a uniform and established crop, is back-breaking work largely done by women.

A 2020 study published in Springer Nature calculates that women contributed 60% of the work in manually transplanting India’s 44 million hectares of rice farmland, which amounts to 814 million labour days. A study from Odisha shows that rice transplanting and associated activities account for around 22% of the total time spent by women family members and 46% of women wage labourers.

Sudhanshu Singh, director, International Rice Research Institute South Asia Regional Centre, points out: “Across South Asia, women carry out most of the labour-intensive operations in rice farming, such as transplanting, weeding, harvesting, threshing, winnowing, and grain or seed processing. With rising temperatures, unpredictable rainfall, and longer dry spells, their workload and vulnerability are increasing.”

Health and economy

Women own only 13.9% of farmland in India, as per the data available in the Agriculture Census. But they constitute over 42% of the agricultural workforce, and in some states, they make up the majority of full-time agricultural workers, according to the Periodic Labour Force Survey 2024.

One of the reasons for worsening health and incomes of women rice farmers is that they continue to follow the same cultivation strategies that previous generations did, Sampreetha explains. They could identify the changing patterns of rainfall and increasing heat, but did not have the freedom, resources or capacity to change the way they farm, experts point out.

Women’s agency and land ownership, or lack of it, is one of the biggest factors determining their response to climate change. Since women farmers typically have limited land ownership, decisions regarding irrigation, farm machinery and credit services have to be deferred often to male land owners. Thus, “when climate stress reduces agricultural productivity, women’s capacity to adapt or recover is much lower than that of men”, Singh explains.

In Palakkad, the effects of climate change are no longer confined to a particular season but play out across all three cropping cycles of the year, says Punnoli. The first cropping season usually ends in August or September, but delayed monsoons in June now often force farmers to skip it altogether.

“In the last five or six years, we’ve noticed a kind of mini-summer after this period. Farmers are unable to bear the heat from the high daytime temperatures,” she observes. In 2023, for instance, the Kerala State Disaster Management Authority issued heat advisories as early as August, when temperatures in Palakkad crossed 35 degrees celsius, followed soon after by bouts of heavy rainfall.

Between 1983 and 2023, Kerala saw an increase in winter and summer rainfall rates even as its overall annual rainfall declined, according to a study published in the Bulletin of Atmospheric Science and Technology (2025). The study found that rainfall patterns are shifting unevenly across the state – some regions are becoming wetter or drier faster than others – highlighting the complex imprint of climate change.

Thunder and lightning have also become frequent disruptions, keeping women farmers away from their fields. Globally, lightning strikes are projected to increase by about 12% with every 1 degree celsius rise in average air temperature.

The early onset of summer now overlaps with the second cropping season, compounding heat stress for farm labourers. In 2024, Kerala not only experienced summer in January and February, but also recorded its hottest spell since 1901. “That kind of temperature shift makes farming extremely hard. There are no resting places or water facilities,” Punnoli says. “I’ve seen women carrying water in plastic bags and bottles, something I’d never seen before. They can’t afford bottled water priced at Rs 20.”

Yet, these climate impacts are far from uniform across Kerala. “Each region tells a different story: the problems of coastal, saline areas are not the same as those of the drylands. Only when you go into people’s hearts do you begin to understand their local realities,” she says.

Singh from IRRI adds that in eastern India, irregular monsoon patterns often compel farmers to replant crops several times, extending women’s hours in the field, leading to fatigue. In lowland ecologies like northern Bihar and Assam, frequent and recurrent floods destroy crops and erode household food security, the burden of which falls on women. Amid such shocks, women’s unpaid care responsibilities intensify as they cope with food scarcity, fetch water, and tend to their families’ health needs, he notes.

Agency and adaptive capacity

Sampreetha’s research found that not all women are coping well with the worsening climate change. She surveyed the adaptive capacity of 120 women farmers in two Karnataka villages in Shimmoga and Hassan. “Women don’t know of climate-resilient technologies. The agriculture department is lacking in providing training programmes, especially for women farmers,” Sampreetha says.

The first step towards adaptation is to “simplify and streamline farming practices, making them more accessible and efficient for women,” according to Singh. Mechanised options such as drum seeders, mechanical weeders, and reapers reduce physical effort and time in the field. Technologies like laser land levelling and Direct Seeded Rice improve yields. They not only save water, and reduce emissions, but also ease women’s workload, Singh notes. The 2020 Nature study found that such interventions can reduce emissions by five to 25% depending on the technology adopted, while also reducing the burden on women by 75%-90%.

Punnoli suggests that setting up more custom hiring centres – government- or community-run facilities that rent farm machinery and equipment to small and marginal farmers at affordable rates – could help improve access to climate-smart technologies. “Kerala, for instance, doesn’t have such centres. There are so many tools and mechanised solutions developed by ICAR, but they aren’t reaching women farmers,” she explains.

Women farmers also told Sampreetha that they would benefit from more female extension officers and regular training sessions. Singh notes that the IRRI has partnered with state governments and rural federations to build a cadre of women master trainers. “These women receive training on climate-smart and sustainable agricultural practices and then share their knowledge with others in their communities,” he says. Collaborations with Mission Shakti in Odisha and JEEViKA in Bihar have been particularly effective.

Experts add that other interventions, such as digital inclusion, localised early-warning systems, and Agromet Advisories, are helping women farmers adapt to climate extremes.

“The future of resilient agriculture in South Asia depends on how well we empower women,” Singh emphasises. “Their leadership is essential to transforming food systems, improving nutrition, and achieving climate resilience.”

This article was first published on Mongabay.

Sujata Ghadke, 46, was admitted to a hospital in Pune for a routine surgery. The surgery went well but she never came back home. Her bereaved husband later spotted the name of a deadly bacteria in her hospital records. The hospital had kept him in the dark about it, he said.

Watch this and other first-hand accounts in our special documentary, which takes a hard look at the hidden epidemic of hospital-acquired infections in India.

In 1989, Dr Narin Sehgal got a licence to open a five-bedded nursing home in Delhi’s Paschim Vihar – without having to establish any infection control protocols.

“We had learnt about basic sterilisation, cleanliness, donning, and the importance of cleaning the body before surgery in medical college,” Sehgal said. “But we knew nothing beyond that about infection control.”

Nursing homes that ran out of residential buildings did not even have space for infection control, he noted. “I realised everybody practiced infection control differently. It was arbitrary,” he said.

In 2005, the National Accreditation Board for Hospitals was formed to improve healthcare quality in India by laying down standards for certification.

An NABH accreditation is not mandatory, but it is much coveted. The same year, Sehgal decided to get his nursing home accredited – it would improve his nursing home’s rating and draw more patients.

By then, it had expanded into a 30-bed facility – without any official scrutiny of its infection practices.

Applying for the accreditation opened Sehgal’s eyes to the shortcomings in his nursing home’s infection protocol.

For instance, the nursing home had a small room with a steriliser machine and a wash basin where sterilised and non-sterilised instruments would often mix. NABH told Sehgal he would have to convert it into a central sterile services department to segregate sterilised linen and instruments from unsterilised ones.

Sehgal worked hard at measuring up to the NABH requirements, but he failed to get accreditation because of inadequate infrastructure.

“I decided to acquire more space to set up a central sterile services department, an X-ray room and an operation theatre in order to meet NABH standards,” he said.

In 2014, he applied again. In 2016, he received NABH accreditation for his now 100-bedded facility.

The hospital’s infection control nurse Priti Rajput said they purchased “one of the best” plasma sterilisers at a cost of Rs 65 lakh. “Infection control requires investment. Our HAI [healthcare-associated infection] rates are much below the benchmarks,” she said.

Sehgal added: “I believe those without accreditation should not be allowed to operate at all. That is the only way to ensure good practices.”

In this report – the third and final part of our series on healthcare-associated infections – we look at how zero regulation in India makes it easier for hospitals to evade compliance on infection protocols.

No law, no regulation, and no punitive action

The Ministry of Health and Family Welfare has no system to monitor infection rate in hospitals. It has not made it mandatory for a hospital or nursing home to have a standard infection control protocol.

“When a hospital is set up, overall infection control practices are not assessed at the time of giving registration licence,” said Dr Narendra Saini, chairman of the Indian Medical Association’s antimicrobial resistance standing committee. Currently, only biomedical waste management and pollution norms are assessed at the time of registration by local civic bodies.

In 2010, the Clinical Establishments Act was enacted to lay down minimum standards for a hospital to operate. This included adherence to certain infection control protocols.

But in the two decades since, the Act has been implemented by only 19 states. Even in those states, experts said hospitals or nursing homes are rarely held to account under the law.

Unless hospitals opt for accreditation from the National Accreditation Board of Hospitals, the principal accreditation body for hospitals, they have no obligation to implement any form of infection control, Saini said. Infection control is a core part of the NABH’s assessment.

Of India’s 70,000-odd hospitals, only 2,700 have NABH accreditation.

In a response to Scroll’s Right to Information request, Quality Council of India, which heads the NABH, said they provide accreditation for four years to hospitals.

In that duration, at least three inspections are carried out. For renewal, a hospital has to undergo intensive assessment. Such monitoring ensures hospitals follow infection control norms.

“That does not mean [hospitals without NABH accreditation] don’t have infection control protocols,” Saini said. “They do, but to what extent, we have no idea.”

He added that nursing homes are completely out of scrutiny because of their limited resources and zero monitoring by the government.

Many pointed out that the lack of regulatory oversight means there is no incentive for hospitals to invest in infection control. “If you do it (implement infection control), nobody is checking whether you are doing it the right way, and if you don’t do it, nobody is going to pull you up,” said Dr Vijaya Patil, who heads the infection control committee at Tata Memorial Hospital, India’s largest cancer institute.

NABH CEO Dr Atul Mohan Kochhar said there is a strong case to make some kind of quality control mandatory. “Third party oversight makes infection control uniform, precise, and ensures fidelity,” he said.

“There has to be a law in this regard,” he added. “But because health is a state subject, there is a discord.”

No scrutiny from insurance sector

India not only lacks strong government regulation of hospital-acquired infections, even the health insurance sector, increasingly a major player in the country’s hospitals, fails to act as a watchdog.

In the United States, the two government insurance programs – Medicare and Medicaid – refuse to reimburse a hospital the extra treatment cost incurred due to a hospital acquired infection. The hospital is not allowed to pass this extra cost to the patient.

“That is a strong incentive for hospitals to prevent such infections from happening in the first place,” said Dr Sanjay Nagral, surgeon and the chairperson of Forum for Medical Ethics Society.

In India, there is no such system in place. Two insurance agents told Scroll that insurance companies largely cover the additional cost incurred due to hospital acquired infection. In rare cases where they refuse to reimburse, a patient has to foot the bill.

Milind Gurav, associated with Tata AIG insurance, said their policy allows the additional cost up to the total sum insured if the patient’s condition becomes severe due to complications arising out of treatment. “We approve a certain amount. But that amount can be increased if the hospital justifies the treatment. Hospital-acquired infections are covered too,” he said.

Tejas Shah, a financial advisor, said his clients with private insurance have never faced any trouble in getting insurance payment for an infection that occurred in the hospital during treatment.

Patil, head of infection committee in Tata hospital, pointed out that the lack of financial responsibility makes hospitals lax in their approach towards infection control. “If insurance companies refused to foot the bill, like in the US, hospitals would become more accountable,” she said.

While insurance companies have data of individual hospitals and their infection rates in the US, in India such data is not maintained by insurance companies.

Kochhar of NABH said discussions have begun in the central government to track data and standards maintained by hospitals. “Ayushman Bharat Digital Mission is a step towards that. There is a central push to collate data and hospital infection control is going to be a key component,” he said.

Ayushman Bharat Digital Mission is an attempt to digitalise the healthcare sector in India by registering hospitals, nursing homes, doctors and creating a database where patients’ files can be accessed online.

Kochhar also points towards the changing awareness around infection control. “Twenty years ago, there were no quality control managers in hospitals. Now there are,” he said.

Government hospitals are also waking up to the need for infection control. At least 18 AIIMS have applied for NABH accreditation. “Soon HAI will become a key component for insurance companies and the government to track,” Kochhar said.

Until that happens, infection control will remain an arbitrary and voluntary exercise.

Read the other parts of this series here.

Silent killers are stalking Indian hospitals. Who is responsible?

This reporting was supported by a grant from the Thakur Family Foundation. Thakur Family Foundation has not exercised any editorial control over the contents of this article.

In August, pulmonologist Avya Bansal received a 65-year-old patient in Mumbai. She came intubated, in a state of respiratory distress.

Bansal immediately carried out a quick screening test for various pathogens, and found it to be positive for the acinetobacter bacteria.

Acinetobacter is found in abundance in hospital environments – and the bacteria is always on the lookout for immuno-compromised people.

The 65-year-old had undergone a hip replacement surgery at another city hospital. Five days later, she developed fever, then pneumonia and slipped into respiratory distress. When she came to Bansal in Bombay Hospital, she was on a ventilator.

“A classic case of hospital-acquired infection,” Bansal noted.

The senior citizen already had lung fibrosis. Acinetobacter worsened it to the extent that her lungs could no longer take in or expel air even as antibiotics dripped in vain through a saline bottle.

A week later, she died of respiratory failure.

Bansal said infections, like hers, could “possibly be prevented” if the hospital staff followed stringent infection control measures for immuno-compromised patients.

But the patient’s family did not know of such a concept. Even if they did, there was no way to check the infection rate at the hospital where she had been admitted for the surgery. Such data is not publicly disclosed by hospitals in India.

Scroll contacted the country’s top public and private hospitals, seeking data on their infection rates. While some public hospitals shared the data in response to a Right to Information request, barring Wockhardt hospital, all leading private hospital chains such as Fortis, Medanta, Max and Apollo, ignored or declined our requests.

In this report – the second part of our series on healthcare-associated infections in India – we examine the importance of hospital-level data on infections, and the consequence of hospitals failing to make such disclosures.

A black box

Around the world, many countries have made it mandatory for hospitals to publicly declare their infection rate.

In the United States of America, for instance, an online repository called Hospital Compare not only provides details of beds, occupancy and specialities available at the hospital but also its infection rate.

The Australian government runs a portal where patients can check hand hygiene compliance by hospitals. In the United Kingdom, the government collects infection rate data from each hospital and summarises it in their annual reports.

Why is the disclosure of infection rate by hospitals important?

Dr Vijaya Patil, the head of the infection control committee at Tata Memorial Hospital, the country’s largest cancer institute, explained: “If I have to decide where to get operated, I can make an informed decision if I know a hospital has high compliance with hand hygiene and low HAI rate. But if that hospital has a high incidence of hospital-acquired infections, no matter how good the surgeon is, I still stand a chance of getting infected after the surgery.”

And yet, India’s top hospitals – both public and private – do not make such public disclosures.

Even the 90 hospitals that are part of India’s only monitoring system, HAI Surveillance network, are not required to regularly report their infection rate data to the network.

Scroll filed a Right to Information request with the Indian Council of Medical Research, asking for data on the infection rates at each of these 90 hospitals, of which 69 are government-run. In its response, the ICMR said “patient-level data are not collected” and “rates for individual hospitals were not reported” to them.

The network does not carry out regular infection surveillance at these hospitals. “HAI surveillance is conducted on an event basis, and only overall HAI rates are calculated,” ICMR said, which means that ICMR may ask hospitals to submit their infection rate – periodically, say once in a year or two years – for academic and research purposes.

The only regular monitoring of infection control protocol at hospitals by a third party is done by the National Accreditation Board for Hospitals and Healthcare Providers – a body that sets standards and provides accreditation to healthcare organisations. It conducts regular inspections at over 2,700 hospitals that it has accredited.

But that implies that most of the 70,000-odd hospitals in the country are not monitored at all.

When Scroll sought data on the infection rates at these 2,700 hospitals, NABH declined the request. “We cannot share this data. It would be a breach of confidence,” said Dr Atul Mohan Kochhar, the chief executive officer of NABH.

A Right to Information request was filed with the Quality Council of India, which heads NABH, asking for data on hospitals whose accreditation was cancelled due to poor infection control. The QCI replied that the “data asked in desired format is not available”.

Kochhar explained that NABH would have to ask each of the 2,700 hospitals for permission to share their data. “If the government made the notification [of infection rates] mandatory, just like it had for Covid-19 infections, then hospitals will have to comply,” he said.

State of India’s AIIMS

Even in India’s best government hospitals, infection control practices hardly inspire confidence.

In August, Scroll filed a Right to Information query with all the 20 functional All India Institutes for Medical Science – the top-most public hospitals that come under the Union health ministry.

Only 14 AIIMS provided either partial or complete healthcare-associated infection rates.

Strikingly, the oldest AIIMS in the country, AIIMS Delhi, stated they “did not have the required information”, despite being at the helm of the HAI Surveillance Network. Scroll filed a first appeal, but the hospital did not change its stance.

Eight of the AIIMS reported 1,711 cases of healthcare-associated infections between January 1, 2024, and July 31, 2025.

A hospital ought to record at least four kinds of common infections: bloodstream infection, caused by catheters or tubes that carry medicines and fluids to the body, ventilator-associated pneumonia, an infection in lungs due to prolonged ventilator use, urinary tract infections caused due to germs in the catheter, and surgical site infection, which occurs when the place of incision gets infected.

But of the 14 who responded to the RTI, at least nine AIIMS failed to record all four types of infections.

An analysis of RTI responses by all the institutes paints a worrying picture. Not only do infection rates differ vastly among AIIMS, some are alarmingly far from meeting international benchmarks.

Scroll also sought minutes of the meetings of the infection control committees at AIIMS. Only four institutes shared their minutes.

In three AIIMS, the infection control committee met only once or twice a year. In AIIMS Gorakhpur, the infection control committee has not met even once to discuss their infection protocol and correct their lapses. In AIIMS Bilaspur, the last meeting of the infection control committee happened in February 2024. No meeting was conducted this year till July 31. Without such meetings every month, hospitals are not able to identify and correct lapses in infection protocol in time.

Since AIIMS Delhi did not provide the information under RTI, we checked their annual reports of 2023-24. It reported that out of 3,811 environmental samples – swabs taken from walls, tabletops and surfaces of equipment, air, bedrails, water– 26% were found unsterile. That indicates a high infection risk to patients.

Similar concerns arose in other institutes. In AIIMS Rishikesh, in multiple audits of patients who got hospital-acquired infections, the committee noted that hospital staff had not followed hand hygiene protocols due to inadequate supply of hand rub.

For instance, the hospital noted that a burns patient had possibly been infected in May because of “inadequate supply of hand rub”, “routine environmental cleaning not done due to no supply” , and “scrub the hub not done properly”. Scrub the hub is a critical healthcare procedure to prevent infection from catheters. The catheter's connection point is scrubbed with an antiseptic to kill microbes.

Private hospitals

We also contacted 10 of the most prominent private hospitals and hospital chains in India – Fortis, Apollo, Medanta, Aster Medcity, Wockhardt, HN Reliance, Kokilaben Dhirubhai Ambani, Nanavati, Artemis, and Max Superspecialty – asking them to share their latest HAI rates, the number of patients who caught HAI, the number of associated deaths, and their infection control protocol.

Fortis, Apollo, HN Reliance and Kokilaben Dhirubhai Ambani hospital declined to share their data. Medanta and Aster Medcity did not respond to our request. Artemis, Nanavati and Max Superspecialty hospital acknowledged our request but did not provide data.

Only Wockhardt hospital responded. Dr Parag Rindani, chief executive officer of the group, told Scroll that the hospital chain’s overall healthcare associated infection rate for 2024 stood at 0.6. That is well within CDC standards.

Rindani said the hospital’s infection committees meet every month. They follow what NABH mandates: focus on high-risk areas, hand hygiene, and surgical protocols.

“And yet healthcare-associated infections are part and parcel of treatment in a hospital,” Rindani said. “There is always an inherent risk of infection.”

None of the hospitals, including Wockhardt, display their infection rates on websites for patients to check. “If there is a standardised method of reporting, then it can be done,” Rindani said, explaining that each hospital has its own system of monitoring.

Patil, head of Tata hospital’s infection committee, said that if hospitals start displaying their infection rates, compliance will pick up. “If hospitals know they are being watched, they will make efforts. Otherwise they will cut corners in infection control.”

Kochhar, NABH’s CEO, agreed. “We do need central data to capture these key indicators and make it public. Big corporate chains do maintain all internal records, but they don’t find it necessary to publish it.”

While India’s corporate hospitals might be unwilling to disclose data on infection rates, officials at these hospitals emphasised that they have invested heavily in infection control.

At PD Hinduja Hospital in Mumbai, infection control officer Dr Shaoli Basu briskly walks through all wards every day, with a UV marker in her hand that she randomly rubs on tables, hospital surfaces and bed rails. She returns 24 hours later to the same spots, this time with a torch. If the invisible mark glows in its flash, Basu pulls up the housekeeping staff for not cleaning properly.

Basu introduced a series of measures, including the UV marker, as part of the super specialty hospital’s infection control protocol.

The results are evident: when Scroll visited the hospital in June, its records showed the rate of blood stream infection that can spread through central line insertion were within the benchmarks set by US Centers for Disease Control and Prevention.

In contrast, a retrospective study at AIIMS in Bhopal of its intensive care unit patients between 2015 and 2019 found blood stream infection rate at 33%. “We found that several infection control protocols were missing in the hospital,” said author Dr Sentenna Chenchula, who worked in the hospital’s microbiology department till 2021.

A rural hospital in MP

The vast majority of public hospitals in India – the first point of care for many Indians – fail to prioritise infection control because of scarcity of human and financial resources.

In Madhya Pradesh’s industrial town of Pithampur, for instance, the 30-bedded government hospital is the only treatment centre for a large migratory population that has settled from nearby districts to work in the factories of the country’s largest automobile manufacturers.

Every day, 300 people visit the outpatient department and 10 get admitted.

A visit to the hospital in August showed that there were no hand sanitisers or even a wash basin in the two hospital wards.

Hand hygiene – washing hands or using alcohol based rubs – is a first line of defence against pathogens. According to the World Health Organisation, there are five key moments when hospital staff should sterilise their hands: before touching a patient, after touching a patient, before any aseptic procedure, after touching a patient’s surroundings, and after exposure to any body fluids.

Staff nurse Mamta Jamra said there were too many patients and very few nurses for her to follow hand hygiene. “The wash basin is outside the ward,” she said. “And it is not possible to go out to wash hands after we see each patient.”

Dr Ajay Girwal, in-charge of the hospital, admitted that sepsis cases were common. “But even if I suspect the source of infection to be in the hospital environment, we don’t send samples for testing,” he said. That’s because neither do government guidelines mandate such testing nor are diagnostic facilities easily accessible, he explained.

The nearest laboratory in Indore is 35 km away but it is overburdened.

Nurse Sulochna Pal said they regularly clean the operation theatre but the samples to test for microbial growth are sent every quarter when deep cleaning and fumigation is undertaken. “If we send six to seven samples, they test only three,” Pal said.

Pal said they have received no training on infection control practices. “We learnt how to collect samples from the operation theatre on YouTube,” she said.

Undetected pathogens

The divide is not just between public and private hospitals. Within private hospitals too, the bulk fail in basic infection control practices.

Many patients discover this the hard way.

Freelance writer Deepali Rathod’s father underwent a cataract procedure at a private hospital in March. Within 10 days, 68-year-old Rajendra Gupta, who runs a transport business, had lost all vision in his left eye. He has only 30% vision in the right eye.

When Gupta got fluids from his eye tested at another hospital, they were found to be infected by pseudomonas aeruginosa bacteria, a highly resistant bug that is often found growing on unsterile surgical instruments. Scroll has seen the report.

Rathod and her husband Deep, an IT professional, then began to trace patients treated by the hospital where the surgery had taken place – Dr Pandit Eye Surgery and Laser Hospital in Navi Mumbai.

“I found six patients who lost their vision after undergoing a procedure at the hospital between 2013 and 2025. All because the doctor did not undertake proper sterilisation,” she said. It had gone undetected also because the hospital was not mandated to disclose infection rates.

Rathod, a former journalist, then approached the local police in Vashi to register a first information report. When they refused, she contacted the police commissioner and Maharashtra health minister who directed the district civil surgeon to conduct an inquiry.

Thane civil surgeon Dr Kailash Pawar told Scroll that their inquiry found negligent practices by the hospital. “We wrote a letter to the Navi Mumbai Municipal Corporation to conduct an inquiry into the hospital's infection control practices and another letter to the police to take action,” Pawar said. Eventually, the accounts of six other patients were added to the FIR.

Sub-inspector Nivas Shinde, who is the investigating officer in the case, told Scroll that the police also wrote to the Navi Mumbai Municipal Corporation to investigate the case of Dr Chandan Pandit, the surgeon who operated on Gupta and who practised at a hospital run by the civic body.

In September, the municipal corporation suspended Pandit, Dr Prashant Jawade, health officer of Navi Mumbai Municipal Corporation told Scroll.

Jawade added that Pandit should not have been doing private practice. “Since he is employed with the corporation, he cannot do so. But it was found that he ran his own clinic. That is not permitted,” Jawed said. Scroll has seen a copy of the suspension letter.

When contacted by Scroll, Pandit, whose father owns the hospital, said he could not comment since the matter was sub-judice.

Read the other parts of this series here.

Silent killers are stalking Indian hospitals. Who is responsible?

This reporting was supported by a grant from the Thakur Family Foundation. Thakur Family Foundation has not exercised any editorial control over the contents of this article.

On May 19, Sujata Ghadke was wheeled into an operation theatre in Pune, western Maharashtra.

A non-cancerous tumour near her intestine needed surgery.

Doctors at the private hospital had assured her husband, Seelove Ghadke, that it was not an uncommon procedure and Sujata had no other health complications to worry about.

The 4.5 cm tumour was “successfully removed” and a biopsy report confirmed that it was benign.

But as she lay on the hospital bed over the next few days, the 46-year-old homemaker complained of an acute headache and lower body pain. Ghadke flagged her condition to doctors several times, as their teenage daughter Shrushti looked on helplessly. She was given medicines for her pain.

In the early hours of May 25, Sujata fell unconscious.

“That was the last time I spoke with her,” Ghadke, 51, recollects, medical documents spread on his lap and the sofa at his one-storey Pune residence.

In the days that followed, Sujata’s family was told that she had contracted an infection. Doctors put her on antibiotics, conducted a battery of tests, and the hospital bill kept rising.

Ghadke borrowed money from relatives and paid Rs 7.75 lakh. “I earn Rs 25,000 a month at a private firm,” he said. “I don’t have a lot of money saved. But saving my wife was more important. Money I could earn later and return to people,” he said.

But on June 6, Sujata passed away due to septic shock that spurred a multi-organ failure.

A grief-stricken Ghadke, in deep debt and a young daughter to care for, was left stunned. “I kept thinking that her surgery had gone well. It was not a cancerous tumour. Then what went wrong?”

He began to pore over her medical reports.

In Sujata’s blood culture report dated May 26, Ghadke saw mention of “Burkholderia cepacia”.

It was, he found out, a highly resistant rod-shaped bacteria on which at least 10 commonly used antibiotics fail to work.

The doctors had never mentioned how she had got this infection. “Why would they hide it?” he said.

Ghadke began approaching lawyers and trying to track other patients admitted in the same intensive care unit as Sujata to check if they had been infected too.

Over the course of his research, Ghadke came across a medical phrase – healthcare-associated infection, which is also called a hospital-acquired infection or nosocomial infection.

A healthcare-associated infection, or HAI, occurs when a patient gets an infection 48 hours after being admitted to a hospital or within a month of discharge. It is not an infection a patient is originally admitted for.

Sujata’s treating physician, Dr Anjali Pillay, confirmed to Scroll over phone that Sujata caught the Burkholderia infection post surgery. But Pillay refused to comment further, redirecting us to Inamdar hospital, where Sujata was treated.

Scroll sent emails to Inamdar hospital twice – first in July and followed it up in October. We also contacted the hospital management through phone and text messages.

We asked if the hospital had concluded that Sujata’s case was a hospital-acquired infection, if other patients admitted in the ICU with her had contracted similar infections, if the hospital has taken remedial steps after Sujata’s death, and if patients who contract infections get concessions in bills from the hospital. Our emails elicited no response. The story will be updated if and when the hospital responds.

Underreported crisis

Thousands of Indians admitted to hospitals for treatment find themselves saddled with infections that they did not originally have. Not only does this lengthen their hospital stay and increase healthcare costs, for some it even leads to serious medical complications and death.

While there is no official data on hospital-acquired infections in India, several studies have found that the rate of prevalence is amongst the highest globally.

But this remains a massively underreported crisis. Most healthcare-associated infections in India are not traced to source partly because of a lack of awareness among patients. And even when they are, hospitals fail to take responsibility for them.

In this three-part series, Scroll investigates how patients bear the burden of such infections, why they have frustratingly few options of redressal, and how the complete lack of regulation allows hospitals to get away with poor standards of infection control. We spoke to 27 doctors and infection control experts, and filed several Right to Information requests to shine a light on this silent, unacknowledged affliction.

A baby on ventilator

Forty-two-year-old homemaker Barbara Nunes gave birth to a baby girl in November 2020 in Nagaland.

As Adrianna had been born premature, she was shifted to the neonatal intensive care unit at a private hospital in Chumukedima.

In the next three months, Adrianna caught one infection after another – first, meningitis and then pneumonia.

The hospital doctors would tell Nunes that as Adrianna was a pre-term baby, her immune system was weak, making her prone to infections.

But one day in 2020, a specialist doctor from outside was called to examine her. He told Nunes that Adrianna’s vision was impaired.

Till then, she told Scroll, no one in the hospital had told her about this.

Nunes contacted the doctor and met him outside the hospital. The doctor said that he suspected the baby had caught an infection in the hospital which affected her vision.

That is when Nunes decided to dig further.

Over the next two years, Adrianna was in and out of the hospital. But since March 2021, she has been in the hospital on ventilator support due to global cortical atrophy, an infection of the central nervous system that leads to loss of brain cells.

Adrianna, who is fed by a tube, is unlikely to ever recover.

Nunes is convinced that the doctor who had alerted her to a hospital-acquired infection was right.

“Adrianna was in the neonatal ICU on a ventilator, had central line catheters and other devices connected to her, making her extremely vulnerable to infections,” Nunes said.

She claimed that her daughter caught at least 10 different bugs during her stay in hospital.

Over the last couple of years, Nunes has collected laboratory reports that she says prove her charges. Scroll has seen laboratory reports that confirm that Adrianna contracted at least eight infections in the hospital.

“One of the infections she caught developed into meningitis,” Nunes claimed.

But proving that the hospital erred in its infection control protocol has been difficult. “Doctors (from outside) are not willing to testify against the hospital,” Nunes said.

Several doctors told Scroll that confirming a hospital-associated infection is difficult if culture reports of devices or tubes inserted into a patient and instruments used during treatment are missing. Even if such reports are available, a doctor is wary of testifying against another from his fraternity.

Nunes and her husband have decided to fight legally. They filed a civil petition against the multi-specialty hospital in Chumukedima. The hospital has filed a counter case in the district court over unpaid bills of Rs 1 crore.

Adrianna remains admitted in the same hospital. Scroll has withheld the hospital’s name since the matter is in the courts.

“Before all this, I did not [even] know what a hospital associated infection was,” Nunes said.

What is a hospital-acquired infection?

A healthcare-associated infection can be of two kinds, explained Dr Rohini Kelkar, an expert in infection control. “It could be due to endogenous or exogenous factors,” she told Scroll.

In the former, microorganisms naturally present within the human body grow uncontrollably. This is how people with low immunity end up with multiple infections during their hospital stay.

In exogenous infections, bugs present in the environment infect the human body.

A hospital is a breeding ground of such bugs.

They can enter the human body through a device, like the urinary catheter or a saline drip, or during a surgery when your body is cut open and infected instruments are used, or when ventilator tubes are pushed down through the nose and mouth. They can also enter the bloodstream through a central line, a tube inserted in the chest, neck or arms.

Kelkar, who has contributed to World Health Organisation’s guidelines on hospital infection control and trained doctors in infection control, said that not all healthcare associated infections are avoidable, especially if they involve patients at higher risk – for instance, cancer patients with extremely poor immunity, senior citizens with multiple co-morbidities, or those on prolonged ventilator support.

But in a majority of cases, “such infections can be prevented by following good infection prevention and control practices”, said Dr Camilla Rodrigues, head of microbiology at PD Hinduja Hospital in Mumbai.

Kelkar agreed: “The hospital can do a lot to prevent most of them by following simple practices like washing hands, and cleaning and sterilising instruments used for surgery.”

How India compares on infection control

Awareness about healthcare-associated infections and their surveillance began in the 1950s and 1960s in the United States and Europe.

One of the earliest records of a critical healthcare-associated infection in India comes from Tata Memorial hospital in Mumbai.

In 1988, three children with leukaemia died at the hospital and five more contracted meningitis within 18 hours of chemotherapy. “When we began to investigate, we found that the likely source of infection was the injection needle used for drawing the drug administered to them. This was likely contaminated,” said Kelkar, who was then the head of the hospital’s microbiology department.

Traces of a pathogen, Acinetobacter calcoaceticus, were found on one of the needles. “The hospital immediately switched to single-use disposable needles. We put a whole lot of sterilisation protocols in place after that incident,” Kelkar said.

But to this day, infection control is not a priority for many Indian hospitals, especially nursing homes and smaller hospitals that have limited resources.

“How many hospitals use quality disinfectants? How many follow hand hygiene? How many have state-of-the-art sterilisers? Not many,” Kelkar told Scroll.

The Union health ministry neither maintains records nor mandates hospitals to report such infections.

But the limited studies available indicate that the rates of healthcare associated infection in India is significantly higher than in countries like the US, Europe or Australia.

In the US, the Centers for Disease Control and Prevention records that 3.2% patients get healthcare-associated infections. In Australia, a 2019 study of 19 hospitals found a rate of 9.9% HAI in patients. In Europe, 7.1% patients get HAI, according to the European Centre for Disease Prevention and Control.

A 2014 study in the Indian Journal of Basic and Applied Medical Research put HAI rates between a wide window of 11% and 83% in Indian hospitals.

In India, the Indian Council of Medical Research is at the helm of the HAI Surveillance Network, which monitors infection rates of 90 public and private hospitals.

Scroll filed a Right to Information request with the ICMR, asking for infection rates recorded by the network.

We sought data on urinary tract infections, ventilator-associated pneumonia and bloodstream infections that are caused by the presence of germs in tubes or central lines inserted in the body – for example, an intravenous catheter used to deliver medicines or fluids to the patient.

While ICMR said it did not have data on individual hospitals, its response showed that overall infection rates were far higher than the benchmark set by the US’s Centers for Disease Control.

For instance, between July 2024 and June 2025, bloodstream infections in the 90 hospitals that were part of the ICMR network was at 5.08 per 1,000 line days.

This figure was derived by dividing the number of patients with bloodstream infections by the total number of days for which any central line is inserted on all patients and multiplying this by 1,000.

Similarly, urinary tract infections, which is an infection in the bladder, urethra or kidneys due to germs that enter through urinary catheter, were at 2.82 per 1,000 line days, and the rate of ventilator associated pneumonia – lung infection caused by ventilators – was at 8.13 per 1,000 ventilator days.

The benchmark set by the Centers for Disease Control and Prevention for bloodstream infection is 0.9 per 1,000 line days, urinary tract infection is 1.3 per 1,000 line days and ventilator associated pneumonia is 1.1 per 1,000 ventilator days.

Some argue that the CDC’s standards are hard to meet for a developing economy like India.

A more rational benchmark has been set by International Nosocomial Infection Control Consortium for low and middle-income countries: 4.9 per 1,000 line days for bloodstream infection, 5.3 per 1,000 line days for urinary tract infection and 13.1 per 1,000 ventilator days for ventilator associated pneumonia. Even here, Indian hospitals fail to meet the benchmark for bloodstream infections.

A more recent study in the Lancet looked at infections in blood specifically caused by central lines in 54 Indian hospitals over seven years. It found the rate of infection to be 8.8 per 1,000 device days, 10 times higher than the figure in ICUs of the USA, at 0.87 per 1,000 device days.

Longer hospital stays, patients unaware

Most Indian hospitals are unwilling to reveal information about suspected healthcare-acquired infections to patients’ families, nor do they take financial responsibility for lapses in infection control practices. As a result, families have few ways to seek redressal.

For instance, in Sujata’s case, the bacteria found in her reports – Burkholderia cepacia – is mostly known to spread through contaminated instruments or use of non-sterile water.

But since the hospital did not divulge information to Ghadke or respond to Scroll, the route of infection in her case is difficult to ascertain.

When Scroll showed Sujata’s reports to an independent infection control expert, she said it was difficult to ascertain the route of infection since the hospital never sent the instruments used on Sujata and tubes inserted in her body for tests to look for pathogens. If they did, the reports were not shared with Ghadke.

In many cases, patients do not even come to know that an infection they acquired in a hospital has resulted in a prolonged stay and increased their hospital bills.

A study from Bhopal’s AIIMS found that such infections led to an increased ICU stay – 13.8 days on an average – compared to 8.2 days amongst patients who do not acquire such an infection. In private hospitals, the stay is longer.

“A longer stay means that the cost of treatment also increases,” Santenna Chenchula, the study’s lead author, told Scroll.

In a government hospital, that could mean an additional cost of Rs 35,000 to Rs 85,000, and in a private hospital about Rs 2 lakh more, according to various studies of HAI treatment in India that Scroll assessed.

But Scroll found that in reality patients had to shell out much more in private hospitals.

For Sujata, the treatment that began with a simple tumour removal surgery costing Rs 1.69 lakh and scheduled hospital stay of six days rose by seven times to Rs 11.5 lakh in 20 days. Till date, Ghadke has not cleared the entire bill.

The fight for compensation

For a patient who has contracted a hospital acquired infection, there are few remedies. There is no law to govern such cases in India. They cannot approach medical councils.

Dr Shivkumar Utture, national chairman of Indian Medical Association, and former member of the Maharashtra Medical Council, said, “Medical councils only look at cases of negligence against a doctor, not an entire hospital. A healthcare-associated infection involves a hospital, not a doctor. It falls outside our purview.”

In some cases, patients’ families have approached state medical councils and been turned down. The police are also wary of registering first information reports unless a government hospital or a district civil surgeon confirms a hospital-acquired infection in writing.

Raghvendra Rao, a patient rights activist, said the biggest challenge is to get another doctor to certify that the infection is hospital acquired. “It is a conspiracy of silence,” Rao said. “Seldom do doctors agree to certify against members of their own fraternity.”

“There are very few cases where patients succeed in getting compensation,” said Amulya Nidhi, an activist with Jan Arogya Abhiyaan, an umbrella association of not-for-profit health organisations.

One route is approaching the National Consumer Disputes Redressal Commission. “Even they usually ask for an outside doctor’s report,” Nidhi said.

Aalim Javeri, now 33, was 10 years old when his father, Sadruddin Hashimali Javeri, died of septicaemia in a private corporate hospital in Hyderabad following a bypass surgery conducted to clear blockages in his artery.

Through his medical documents, the family realised that 64-year-old Javeri, who was an advisor to the scion of Hyderabad’s former royal Nizam family, Mukarram Jah, had contracted multiple infections during his post-operative care.

Laboratory test records at the hospital showed that the tip of the catheter inserted in Javeri, had Staphylococcus sciuri, a gram positive bacteria that is resistant to a wide range of drugs.

Another report found that the fluids in the endotracheal tube, which is inserted in the throat of ventilated patients, had gram positive bacteria. A third tube called intercostal drainage tube, which is used to extract fluids from around the lungs, had Staphylococcus bacteria growing on it.

“The hospital staff did not change the catheter frequently,” Aalim said. “The post-operative care was shambolic.”

The insurance company refused to clear the claim because the hospital did not provide original bills, Aalim claimed.

It took three years, during which the family collected evidence, contacted experts, and finally approached the National Consumer Disputes Redressal Commission in 2005 to seek compensation from Care hospital in Banjara Hills, a part of the Quality Care India Limited.

During the hearing in the commission, the hospital maintained that it “took all necessary precautions and administered appropriate antibiotics based on culture sensitivity reports” and that the patient had a medical history that made him susceptible to infections. The hospital did not respond to Scroll’s email.

It took 19 years for the commission to pass an order identifying the hospital’s negligence and asking it to pay a compensation of Rs 10 lakh to the Javeri family.

The hospital has appealed the decision at the Supreme Court. Javeri, too, has approached the apex court stating that the compensation is not adequate.

Javeri’s mother, Begum Scheherazade Javeri, passed away in March this year. “She didn’t get to see justice delivered,” Aalim said, recounting the innumerable visits they had made to Delhi for hearings, and the adjournments that delayed the case for two decades.

“If this can happen to us,” Aalim told Scroll, referring to the influence the family has due to its closeness to the Nizam’s descendants, “imagine what could happen to others?”

Read the other parts of this series here.

What hospitals are not telling you about killer bugs in their wards

This reporting was supported by a grant from the Thakur Family Foundation. Thakur Family Foundation has not exercised any editorial control over the contents of this article.

The basic principle of weight loss is straightforward: if you consume fewer calories than you burn, you’ll lose weight. In practice though, this isn’t usually so easy or simple.

Alongside counting calories or eating smaller portions, many people add exercise into the equation when trying to lose weight to help tip the balance. Yet research shows that exercise may only have modest effects on weight loss.

But before you ditch your workouts, it’s important to note that exercise still plays a really important role when it comes to health – perhaps especially in keeping the pounds off after reaching your goal weight.

There are several processes that help explain why exercise doesn’t always result in huge amounts of weight loss.

Exercise can stimulate appetite, leading to increased food intake. People may also subconsciously move less throughout the rest of the day after doing a workout, which means exercise may have less impact on their overall calorie deficit.

The body also becomes more efficient over time – burning fewer calories while doing the same activity. This process, sometimes called “metabolic adaptation”, reflects the body’s tendency to defend against weight loss.

From an evolutionary perspective, conserving energy during periods of intense physical activity probably protected our ancestors from starvation. But in today’s world, metabolic adaptation is one of many factors that can make weight loss difficult.

Importance of exercise

Although exercise may not be the main driver of weight loss, it seems it might play a role in maintaining weight loss.

In a study of over 1,100 people, physical activity was shown to have little effect on the amount of weight a person initially lost. However, doing higher levels of activity after losing weight was strongly linked to maintaining the weight loss.

It’s worth noting that exercise was also associated with measurable health improvements – including better cholesterol, lower inflammation, better blood sugar control and insulin sensitivity, all of which are associated with lower risk of health problems, such as heart disease and type 2 diabetes.

These many health benefits show just how important it is to exercise both while losing weight and maintaining weight loss.

Evidence also suggests that combining exercise with weight loss drugs (such as Saxenda), may help people maintain their weight loss better than using the drug alone.

Why exercise works

It may seem confusing that exercise isn’t especially effective for losing weight but can help prevent regain. The reasons behind this paradox aren’t fully understood, but several mechanisms may offer an explanation.

The first has to do with our resting energy expenditure (the amount of calories our body burns when doing nothing).

When we lose weight, our resting energy expenditure decreases by more than you would expect for the amount of weight lost. This is thought to contribute to weight regain. But exercise raises total daily energy expenditure, which can help to partially offset this.

A second factor relates to muscle mass.

Weight loss usually results in the loss of both fat and muscle. Losing muscle lowers resting energy expenditure, which can contribute to weight regain.

But exercise, especially resistance training (such as Pilates or lifting weights), can help preserve or even rebuild muscle mass. This can boost our metabolism, which may aid in long-term weight maintenance.

Physical activity also helps our body to maintain its ability to burn fat. After losing weight, the body often becomes less efficient at using fat for energy.

But intense exercise can improve fat burning and metabolic flexibility – the ability to switch between burning carbohydrates and fat depending on what’s available. This helps the body continue burning fat even when calorie intake is low or weight is lost.

Exercise improves insulin sensitivity as well. This reduces the amount of insulin required to regulate blood sugar. This is beneficial as higher insulin levels can promote fat storage and reduce fat breakdown.

Exercise has many indirect effects on us that can aid in weight maintenance. For instance, exercise can improve sleep, mood and reduce stress levels. These all reduce levels of the stress hormone cortisol, which could lower the amount of fat the body stores.

Regular activity can also help regulate appetite and blood glucose, which may help reduce cravings and limit overeating.

It’s important to acknowledge that everyone is different. This means we all respond differently to exercise in terms of how many calories we burn or whether a workout makes us feel hungrier later in the day.

Different types of workouts also confer their own benefits when it comes to health and weight maintenance.

Aerobic exercise (such as brisk walking, cycling or running) burns calories and, at higher intensities, may also enhance the body’s ability to burn fat for fuel.

Resistance training, on the other hand, helps build and preserve muscle mass. This supports a higher resting energy expenditure, aiding long-term weight maintenance.

Exercise may not be the most powerful tool for losing weight, but it could help sustain hard-earned weight loss. Perhaps most importantly, it offers many physical and mental health benefits that go far beyond the numbers on the scale.

Rachel Woods is Senior Lecturer in Physiology, University of Lincoln.

This article was first published on The Conversation.

India’s healthcare system faces major challenges in accessibility, quality, and cost. With only 1.3 hospital beds per 1,000 people in 2024 – well below the World Health Organization’s recommendation of three per 100 – the country struggles to provide adequate care, especially in rural areas. Over the past two decades, private equity has played a significant role in addressing these gaps.

Private equity investments in India’s healthcare and pharmaceutical sector reached $5.5 billion in 2023, a 25% increase from the previous year. The country’s healthcare market including diagnostics, outpatient consultations, retail pharmacies and hospitals was valued at $180 billion in 2023, and is expected to reach about $320 billion by 2028. Major investments in hospital chains have led to expanded and upgraded facilities, particularly in tier 2 and tier 3 cities, improving healthcare access for millions.

As of 2024, India had 44,100 private hospitals and approximately 1.18 million beds in private hospitals, with an expected addition of more than 22,000 beds in the next few years. However, the focus on high-margin services has sparked concerns about rising healthcare costs and inequities in access, as wealthier urban populations benefit more from these investments while rural and low-income communities face continued barriers. These disparities raise questions about how private equity investments align with public health objectives and the need for equity in healthcare.

Indian healthcare Sector

India’s healthcare sector is a mix of public and private entities, with the private sector playing an increasingly dominant role. Historically, the public system has been underfunded, with health spending accounting for only 1.2% to 1.5% of gross domestic product, well below the 5% recommended in order to achieve universal health coverage.

Public facilities are often overstretched and under-resourced, leaving large gaps in service delivery. In contrast, the private sector, consisting of nursing homes to large hospitals, offers better services for those who can afford it. Their exorbitant cost, however, runs the risk of exacerbating inequality in healthcare access.

Since economic liberalisation in 1991, the private sector’s role has expanded through market reforms and government policies like the National Health Policies of 2002 and 2017. These policies encouraged public-private partnerships to enhance healthcare delivery, focusing on infrastructure, specialised services and universal health coverage. The 2017 policy, in particular, facilitated private investments, integrating private providers into government initiatives like Ayushman Bharat Yojana, which aims to increase healthcare access for underserved populations.

However, this reliance on the private sector has raised concerns about rising healthcare costs and unequal access, particularly for marginalised groups, as private investments are often concentrated in urban areas. In 1986-’87, hospitalisation in private hospitals cost 2.3 times more than public hospitals in rural areas and 3.1 times more in urban areas. By 2017-’18, these gaps widened to 6.4 times in rural areas and 8.0 times in urban areas. This profit-driven healthcare system has widened inequalities, forcing rural areas to depend on poorly funded government hospitals, which often lack doctors, medical equipment, and essential services.

Expanding private sector

Private investments have significantly boosted India’s healthcare infrastructure over the past decade. Around 63% of India’s 70,000 operational hospitals and 60% of its 1.9 million hospital beds are in the private sector. Projections indicate that over 22,000 new hospital beds will be added in private hospitals in the next three-five years, tripling the number added between 2019 and 2024.

Private equity-backed hospital chains like Manipal Hospitals, Fortis Healthcare, and Care Hospitals have expanded their networks and improved services using private equity funds. For instance, in 2024, Fortis announced plans to invest $156 million to expand its facilities, while Manipal Hospitals has, over the last five years, spent $251 million to expand its network through acquisitions. US-based private equity firm Blackstone has, since 2023, reportedly committed nearly $1 billion to the sector.

Between 2021 and 2024, healthcare accounted for 17%-18% of total private equity exits in India. While these firms have invested to tap into India’s expanding healthcare market, their ability to divest in response to global market dynamics creates instability, underscoring the need for regulatory oversight to ensure that healthcare infrastructure remains resilient, regardless of market fluctuations or geopolitical shifts.

Beyond physical infrastructure, private equity investments have fueled growth in digital health platforms such as Practo, which secured $193 million in funding by 2022. The expansion of telemedicine and online pharmacies has improved access to healthcare services, especially during the Covid-19 pandemic.

Healthcare costs

The commercialisation of healthcare services has resulted in markedly higher medical bills, especially for tertiary care and diagnostic services. In 2024, out-of-pocket health expenditure constituted approximately 54.8% of current health expenditure (45.98% in 2022) in India, one of the highest rates globally, with private hospitals contributing significantly to this figure.

This situation threatens the viability of universal healthcare objectives and fosters indebtedness among families reliant on expensive medical treatments. As of 2023, healthcare expenses pushed 8%-9% of all Indian households below the poverty line.

In addition, the increased reliance on private equity in healthcare impacts the overall system. Private equity-backed entities may overlook less profitable, yet essential services such as preventive and primary healthcare. Despite the expansion of healthcare infrastructure in India, inequities in access to quality services remain a significant challenge.

Private equity investments typically focus on high-return markets, prioritising urban and affluent populations while neglecting rural and marginalised communities.

Nearly 70% of India’s population lives in rural areas, where healthcare resources are scarce and access to quality care is limited. Private equity investments do little to change that. Research shows that private equity-backed hospitals and diagnostic centres are predominantly located in urban areas, with few established in rural regions. This concentration not only reinforces socioeconomic divides but also forces rural residents to travel long distances for medical attention, resulting in delayed treatment and worsening health outcomes.

Meanwhile, the emphasis on specialised treatments and elective procedures comes at the expense of comprehensive primary care, which is essential for addressing public health needs and reducing disparities.

This model diverts attention and funding from foundational services that can prevent illnesses and promote community health. Consequently, access limitations for vulnerable populations – rural or urban – perpetuate a cycle of inequality where health outcomes closely align with socioeconomic status.

One effort to address this was built into the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana in 2018, in which private hospitals (including in Tier 2 and Tier 3 cities) were encouraged to empanel themselves under the scheme to provide services at affordable rates. However, since then, 609 private hospitals have opted out of the scheme, citing low reimbursement tariffs and delayed payments from the government.

Conclusion

Private equity investments are reshaping India’s healthcare sector, enhancing infrastructure and services. However, this transformation presents challenges related to equity, access, and rising costs. The profitability-driven focus of private equity-backed healthcare entities has led to increased healthcare expenses and disparities in access. While urban and affluent populations benefit from improved services, rural and low-income communities often face barriers to quality care.

To address these challenges, regulatory policy interventions are essential to ensure that healthcare remains accessible and equitable for all. Indian regulators and policymakers need to do more to understand the influence of profit motives on healthcare access in order to critically assess existing policies that prioritise financial returns over patient care.

Even as the private sector invests in expanding India’s healthcare infrastructure, policymakers must assess these developments against a framework that encourages public investment in healthcare, expands the availability of comprehensive services, and ensures that marginalised communities receive the care they need.

Additionally, recognising the systemic barriers created by market-driven approaches allows policymakers to advocate for reforms prioritising health equity and social justice. Ultimately, fostering a more inclusive dialogue around healthcare can promote a system that values human well-being over profit, paving the way for a more equitable healthcare landscape in India.

Vivek ND is an Adjunct Faculty in the School of Legal Studies and Governance, Vidyashilp University, Bangalore. He has a PhD in Political Science from the University of Hyderabad. He can be found on X @viveknenmini and on Bluesky @viveknd.bsky.social.

The article was first published in India in Transition, a publication of the Center for the Advanced Study of India, University of Pennsylvania.

When María Branyas Morera died in 2024 at the age of 117, she left more than memories. She left science a gift: samples of her microbiome.

Researchers discovered her gut was as diverse as someone decades younger: rich in beneficial bacteria linked to resilience and longevity. Her daily yoghurt habit and Mediterranean diet may have helped. While we can’t all inherit “lucky genes”, nurturing our microbiome may be one way to support lifelong health.

In a recent paper in Cell Reports Medicine, researchers presented what may be the most detailed scientific investigation of a supercentenarian (a person aged 110 or older). Before her death, Branyas agreed to participate in research aimed at uncovering how she lived such a long and healthy life.

When scientists compared her samples with those of people who had not reached such exceptional ages, the genetic results were unsurprising: Branyas carried protective variants that guard against common diseases. But they also looked at something over which we have more control – the gut microbiome.

This microbiome is the vast community of bacteria, fungi and other microorganisms that live in the intestines. They help digest food, produce vitamins, influence our immune system and even communicate with the brain. While our genes play only a small role in shaping our microbiome, diet and lifestyle are far more important.

Normally, as people age, gut microbiomes lose diversity – the variety of microbial species – and beneficial microbes such as Bifidobacterium decline. This reduction in diversity has been linked to frailty.

Branyas’s gut told a different story. Her microbiome was as diverse as that of a much younger adult and was especially rich in the bacterial family Bifidobacteriaceae, including the genus Bifidobacterium. In most older people these bacteria decline, but Branyas’s levels matched previous reports of elevated Bifidobacterium in other centenarians and supercentenarians. The researchers concluded that this unusually youthful microbiome may have supported her gut and immune health, contributing to her extraordinary longevity.

Bifidobacteria are among the first microbes to colonise an infant’s gut and are generally considered beneficial throughout life. Studies link them to supporting immune function, protecting against gastrointestinal disorders and helping regulate cholesterol.

Her diet offered a clue to why she maintained such high levels of Bifidobacterium. Branyas reported eating three yoghurts every day, each containing live bacteria that are known to support the growth of Bifidobacterium. She also followed a largely Mediterranean diet, a pattern of eating consistently linked to gut microbiome diversity and good health.

Other foods that encourage Bifidobacterium include kefir, kombucha and fermented vegetables such as kimchi and sauerkraut. These contain probiotics – live bacteria that can settle in the gut and confer health benefits. But probiotics need fuel. Prebiotics – dietary fibres we can’t digest but that our microbes thrive on – are found in foods like onions, garlic, leeks, asparagus, bananas, oats and legumes. Together, probiotics and prebiotics help maintain a balanced microbiome.

Of course, this was a study of a single individual, and the scientists are not claiming that her microbiome alone explains her long life. Her extraordinary longevity was almost certainly the result of many interwoven factors: protective genes, efficient metabolism, low inflammation – and, quite possibly, the support of a diverse gut microbiome.

Microbiome research is advancing rapidly, but no one yet knows what the “perfect” microbiome looks like. Greater diversity is generally associated with better health, but there is no single recipe for a long life. Even so, Branyas’s case reinforces a growing consensus: nurturing a diverse, beneficial microbiome is linked to better health and resilience.

While we cannot choose our genes, we can support our gut microbes. Simple steps include eating fermented foods, such as live yoghurts, kefir, kimchi and sauerkraut, as well as fruit, vegetables, legumes and whole grains, which supply the prebiotics that healthy microbes need.

Following a Mediterranean-style diet – built around vegetables, fruits and whole grains, with olive oil as the main fat, fish and legumes eaten regularly, and red meat, processed foods and added sugars kept to a minimum – has been repeatedly linked to both microbiome diversity and reduced disease risk.

These habits will not guarantee a lifespan beyond 110, but they are associated with lower risks of cancer, type 2 diabetes and cardiovascular disease.

María Branyas Morera’s life is a reminder that longevity depends on a delicate balance of genetics, lifestyle and biology. We cannot control every factor, but tending to our gut microbiome is one meaningful step toward lasting health.

Rachel Woods is Senior Lecturer in Physiology, University of Lincoln

This article was first published on The Conversation.

It was a harsh winter morning in October 2019 in a Jammu village, when Makhno Devi took her 11-year-old son, Rutav, to the nearest sub-district hospital.

For three days, Rutav had stopped urinating, his body temperature had risen and he was refusing to eat.

But doctors at the hospital in Ramnagar town struggled to treat the boy. By evening, they referred him to the district hospital in Udhampur and gave Makhno an ambulance.

Udhampur was 36 km away, a ride over hilly terrain. Rutav died on the way.

Thirty-eight-year-old Makhno, who grows maize on a small farmland in Kirmoo village, said that the ambulance driver left the family on the road with the body. For the next three months, no health team visited her to ask about Rutav’s death.

Then in February 2020, she was told that her son’s death had been caused by a contaminated cough syrup she had forced him to gulp down for three days, a syrup she had bought off the counter from a chemist in Ramnagar.

Thirteen more children died in Jammu’s Ramnagar district after Rutav – all of them had consumed Coldbest-PC cough syrup. Six who survived were left with permanent disabilities.

The syrup had been manufactured 500 km away in Himachal Pradesh’s Sirmaur district by pharmaceutical company Digital Vision.

Makhno’s statement was recorded by the local police. That was all. She did not get any compensation, since Rutav’s death occurred on the road with no medical certification.

Rutav is one of 172 children who have been killed since 2020 by contaminated cough syrups manufactured by Indian pharmaceutical companies. The deaths have been reported from India, The Gambia and Uzbekistan. Even censure from international agencies like the World Health Organisation has failed to stop the deaths.

Most recently, 22 children in Madhya Pradesh’s Chhindwara died after having cough syrup that had been adulterated by the toxic industrial solvent, diethylene glycol, which led to kidney failure in the children – the same solvent that had led to the deaths in Jammu.

Over the last few weeks, as Makhno heard of the deaths in Chhindwara, it seemed to her as if nothing had changed. “Even after our children died, if this is happening, what was the government doing?” she asked.

Makhno said she has no hope that the Himachal Pradesh manufacturer responsible for her son’s death will be punished. Her pessimism is not without basis.

Since 2020, four different manufacturers have been held responsible for using the toxic industrial solvent, diethylene glycol, in the syrups that led to kidney failure in the deceased children. Three of them are still in business.

Scroll went back to the Jammu families who lost their children in 2020 to find a recurring pattern of injustice – cases stuck in an excruciatingly slow judicial system, pharmaceutical companies that get away.

The firm, Digital Vision, has not only gone on to resume production, but also found guilty of more drug quality violations, data accessed by Scroll shows. But the trial against it in the 2020 case has not proceeded because of a stay order by the Jammu bench of the High Court of Jammu and Kashmir.

“I keep remembering him,” Makhno said, talking of Rutav, her first-born. “We didn’t get justice.”

Delay in detection

Two months after Rutav’s death, Murfa Begum, a 25-year-old woman from a village in Ramnagar district in Jammu, lost her three-month-old child. The infant died after consuming two doses of the toxic Coldbest cough syrup.

Begum alleged that for several weeks, the health department did not respond. “We cried, we raised the alarm but they began an investigation too late,” she said.

The Ramnagar district administration began testing water samples, food grains and blood samples only in January 2020 – three months after the first death. “By then more children were dying,” Murfa said.

On February 17, 2020, Chandigarh’s Regional Drug Testing laboratory found that samples of Coldbest had 34.34% of diethylene glycol, which causes kidney failure in children.

“Ye to katal hua,” said Murfa. This is murder.

A similar delay was seen in Chhindwara where it took a month for the district authorities to suspect a contaminated cough syrup was causing the deaths of children.

A slew of first information reports were filed in Ramnagar, Ambala and Sirmaur. The FIR in Ramnagar invoked sections involving culpable homicide not amounting to murder, adulteration of drugs, sale of adulterated drugs, and causing grievous hurt and several sections of the Drugs and Cosmetics Act that deal with sale of harmful drugs and its punishment.

The accused included the Ambala-based owners of Digital Vision, Purushottam Goyal and his two sons Konic and Manic Goyal, the company that distributed the cough syrup and the chemist who sold it. The state drug controller also registered four cases of drug safety violations against Digital Vision.

A social activist from Jammu who followed these cases, Sukesh Khajuria, said the Goyals got bail within an hour of arrest while the chemist’s bail kept getting rejected. “The rich and powerful always get away,” Khajuria said.

The company that got away

Ashok Kumar obsessively watches the last video of his son, Aniruddh, from January 2020. It shows the two-year-old boy in a hospital in Jammu, and his mother trying to distract and feed him.

Aniruddh caught a chest infection in late December 2019. By then accounts of children dying mysteriously had already flooded households, Kumar, a government school teacher in Ramnagar town, said.

Like Makhno, Kumar had gone to the same chemist for medical advice. “There was no child specialist in Ramnagar. So we all used to go to this one chemist who prescribed drugs,” Kumar said. Aniruddh was administered Coldbest syrup for two days. By the second night, he began vomiting and getting loose motions.

Ashok Kumar took his son to three different hospitals before he arrived at Chandigarh’s Post Graduate Institute. He died of acute kidney injury and a brain haemorrhage soon after.

Kumar was one of 12 families that received compensation of Rs 3 lakh. But he seeks more. “I want those accountable to be punished,” he told Scroll.

What enrages Kumar is that Digital Vision, the manufacturer of Coldbest, continues to make drugs. The firm has branched into making antibiotics, antioxidants, protein powders, analgesics, and orthopaedic medicines, according to its website. Its products are exported to Afghanistan, Sri Lanka, Nigeria, Sudan, Ghana, Congo, Myanmar, Nepal, Cambodia, Vietnam, Ireland and Spain.

Digital Vision did not respond to an email asking them what corrective steps they had taken after the Jammu case.

Tellingly, the company had been red-flagged even before the Jammu deaths.

Between 2012 and 2020, 12 drugs manufactured by the Himachal-based firm, including syrup-based formulations and tablets, were found to be “not of standard quality”, shows data accessed by Scroll from an online database on which state drug controllers report cases of substandard drugs. Not all states are meticulous about uploading this data on the portal.

Moreover, even after the Jammu deaths, on five different occasions, officials from Maharashtra’s Food and Drug Administration found Digital Vision’s drugs to be “not of standard quality” during random tests.

Of these, Azithromycin oral suspension, a common antibiotic it produced, was found to be “not of standard quality” on three occasions.

Maharashtra’s joint commissioner of drugs, DR Gahane, told Scroll that they had issued a showcause notice to the manufacturer and informed the Himachal Pradesh drug controller about the violations.

Asked about action taken against the firm, Himachal Pradesh’s assistant drug controller Sunny Kushal told Scroll he is “not interested in discussing Digital Vision”.

As recently as December 2024, the Himachal Pradesh excise commissioner in an order reported that the firm was manufacturing morphine tablets without a proper licence and exporting it to Sri Lanka. It notified the state drug controller to look into violations under the Drugs and Cosmetics Act. Scroll has seen the order. Kaushal did not respond to Scroll’s messages on the action taken.

Meanwhile, the firm continues operations. Sushil Yadav, general manager, marketing, at Digital Vision, refused to comment on the violations. The company did not reply to an email.

Slow trial

The slow judicial process has also thwarted the course of justice for the Jammu families.

In 2023, three years after the deaths of the children, a 742-page chargesheet was filed by a Special Investigation Team tasked with the probe and the trial began in Udhampur sessions court.

In February 2024, the sessions court judge asked certain aspects of the case to be investigated further. In March 2024, the manufacturer approached the Jammu High Court for a stay on reinvestigation. The court granted its request.

“Since then, the case is stuck,” Khajuria said. “Every time there is a hearing, their counsel mentions the High Court stay and a new date is given,” he said.

The stay has also affected the trial of cases against Digital Vision lodged by the Food and Drug Administration in a special court in Jammu meant for cases filed under the Drugs and Cosmetics Act. A drug official said they have submitted objections but the trial is dragging on.

“Sometimes for simple prosecution cases, it can take 15 years or more for conviction to come,” the drug official said.

Khajuria said that he had approached the National Human Rights Commission to seek compensation for the families of children who died.

In 2021, the NHRC directed Jammu and Kashmir to pay Rs 3 lakh compensation. This was immediately contested by the state at the High Court but their petition was dismissed. Later, the state government appealed to the Supreme Court.

In a judgement by the apex court in November 2022, a two-judge bench observed that “it was specially found that the officers of the drug and food control department were negligent and therefore ultimately the state will be liable to pay compensation”.

“Your officers are found to be negligent. They ought to have been vigilant. Don’t compel us to say things about food and industry department. They don’t perform duties at all,” the judges observed, PTI reported.

Despite the strong words from the court, no action has been taken against drug inspectors in Jammu.

Drug inspectors are bound to inspect a manufacturing unit at least once a year to ensure compliance to rules. But as a parliamentary standing committee report on chemicals and fertilisers pointed out last December, there is a 60% vacancy in sanctioned posts of drug inspectors – 303 out of 504 are vacant.

High vacancies affect not only the number of inspections a drug inspector can undertake but also the number of convictions. The same report found out that between 2015-’16 and 2018-’19, of the 2.3 lakh drug samples examined by state drug controllers, 593 were declared spurious and 9,266 were of substandard quality. But that resulted in only 35 convictions by the courts – a rate of 5.9%.

However, former drug controller of Jammu and Kashmir Lotika Khajuria told Scroll the department in fact worked “promptly to gather all evidence against Digital Vision and filed a case”. But the parents of the children who died question the government’s intent. “The investigation in this case is not satisfactory,” Kumar, the schoolteacher, told Scroll. “It is an eyewash.”

Disabled for life

At least six children who survived the deadly cough syrup in Jammu live with multiple disabilities.

Sapna Kumar was less than a year old when she had the Coldbest syrup in 2020.

She survived but has 40% disability. She has difficulty in movement, moderate intellectual impairment and disability in vision and hearing.

Pavan Kumar was in hospital for over three months in 2020, after consuming the cough syrup, of which 50 days were on ventilator support.

Now seven years old, the child has partial vision, high blood pressure and cannot hear from one ear, his father Shambhu Ram told Scroll.

“We have to visit Chandigarh’s PGI hospital every month. I have to borrow money regularly for his treatment,” Ram, a daily-wage labourer, said.

None of the children who were disabled received any compensation. “This is the value of a poor person’s life in India,” Ram said.

Most people know roughly what kind of lifestyle they should be living to stay healthy.

Think regular exercise, a balanced diet and sufficient sleep. Yet, despite all the hacks, trackers and motivational quotes, many of us still struggle to stick with our health goals.

Meanwhile, people worldwide are experiencing more lifestyle-associated chronic disease than ever before.

But what if the missing piece in your health journey wasn’t more discipline – but more stillness?

Research shows that mindfulness meditation can help facilitate this pursuit of health goals through stillness, and that getting started is easier than you might think – no Buddhist monk robes or silent retreats required.

Given how ubiquitous and accessible mindfulness resources are these days, I have been surprised to see mindfulness discussed and studied only as a mental health tool, stopping short of exploring its usefulness for a whole range of lifestyle choices.

I am a psychologist and behavioral scientist researching ways to help people live healthier lives, especially by moving more and regulating stress more efficiently.

My team’s work and that of other researchers suggests that mindfulness could play a pivotal role in paving the way for a healthier society, one mindful breath at a time.

Mindfulness unpacked

Mindfulness has become a buzzword of late, with initiatives now present in schools, boardrooms and even among first responders. But what is it, really?

Mindfulness refers to the practice or instance of paying careful attention to one’s present-moment experience – such as their thoughts, breath, bodily sensations and the environment – and doing so nonjudgmentally. Its origins are in Buddhist traditions, where it plays a crucial role in connecting communities and promoting selflessness.

Over the past 50 years, however, mindfulness-based practice has been Westernised into structured therapeutic programs and stress-management tools, which have been widely studied for their benefits to mental and physical health.

Research has shown that mindfulness offers wide-ranging benefits to the mind, the body and productivity.

Mindfulness-based programmes, both in person and digitally delivered, can effectively treat depression and anxiety, protect from burnout, improve sleep and reduce pain.

The impacts extend beyond subjective experience too. Studies find that experienced meditators – that is, people who have been meditating for at least one year – have lower markers of inflammation, which means that their bodies are better able to fight off infections and regulate stress. They also showed improved cognitive abilities and even altered brain structure.

But I find the potential for mindfulness to support a healthy lifestyle most exciting of all.

How can mindfulness help you build healthy habits?

My team’s research suggests that mindfulness equips people with the psychological skills required to successfully change behaviour. Knowing what to do to achieve healthy habits is rarely what stands in people’s way. But knowing how to stay motivated and keep showing up in the face of everyday obstacles such as lack of time, illness or competing priorities is the most common reason people fall off the wagon – and therefore need the most support. This is where mindfulness comes in.

Multiple studies have found that people who meditate regularly for at least two months become more inherently motivated to look after their health, which is a hallmark of those who adhere to a balanced diet and exercise regularly.

A 2024 study with over 1,200 participants that I led found more positive attitudes toward healthy habits and stronger intentions to put them into practice in meditators who practiced mindfulness for 10 minutes daily alongside a mobile app, compared with nonmeditators. This may happen because mindfulness encourages self-reflection and helps people feel more in tune with their bodies, making it easier to remember why being healthier is important to us.

Another key way mindfulness helps keep momentum with healthy habits is by restructuring one’s response to pain, discomfort and failure. This is not to say that meditators feel no pain, nor that pain during exercise is encouraged – it is not!

Mild discomfort, however, is a very common experience of novice exercisers. For example, you may feel out of breath or muscle fatigue when initially taking up a new activity, which is when people are most likely to give up. Mindfulness teaches you to notice these sensations but see them as transient and with minimal judgment, making them less disruptive to habit-building.

Putting mindfulness into practice

A classic mindfulness exercise includes observing the breath and counting inhales up to 10 at a time. This is surprisingly difficult to do without getting distracted, and a core part of the exercise is noticing the distraction and returning to the counting. In other words, mindfulness involves the practice of failure in small, inconsequential ways, making real-world perceived failure – such as a missed exercise session or a one-off indulgent meal – feel more manageable. This strengthens your ability to stay consistent in pursuit of health goals.

Finally, paying mindful attention to our bodies and the environment makes us more observant, resulting in a more varied and enjoyable exercising or eating experience. Participants in another study we conducted reported noticing the seasons changing, a greater connection to their surroundings and being better able to detect their own progress when exercising mindfully. This made them more likely to keep going in their habits.

Luckily, there are plenty of tools available to get started with mindfulness practice these days, many of them free. Mobile applications, such as Headspace or Calm, are popular and effective starting points, providing audio-guided sessions to follow along. Some are as short as five minutes. Research suggests that doing a mindfulness session first thing in the morning is the easiest to maintain, and after a month or so you may start to see the skills from your meditative practice reverberating beyond the sessions themselves.

Based on our research on mindfulness and exercise, I collaborated with the nonprofit Medito Foundation to create the first mindfulness program dedicated to moving more. When we tested the program in a research study, participants who meditated alongside these sessions for one month reported doing much more exercise than before the study and having stronger intentions to keep moving compared with participants who did not meditate. Increasingly, the mobile applications mentioned above are offering mindful movement meditations too.

If the idea of a seated practice does not sound appealing, you can instead choose an activity to dedicate your full attention to. This can be your next walk outdoors, where you notice as much about your experience and surroundings as possible. Feeling your feet on the ground and the sensations on your skin are a great place to start.

For people with even less time available, short bursts of mindfulness can be incorporated into even the busiest of routines. Try taking a few mindful, nondistracted breaths while your coffee is brewing, during a restroom break or while riding the elevator. It may just be the grounding moment you need to feel and perform better for the rest of the day.

Masha Remskar is Psychologist and Postdoctoral Researcher in Behavioral Science, Arizona State University.

This article was first published on The Conversation.

We spend nearly a third of our lives asleep, yet sleep is anything but wasted time. Far from being passive downtime, it is an active and essential process that helps restore the body and protect the brain. When sleep is disrupted, the brain feels the consequences – sometimes in subtle ways that accumulate over years.

In a new study, my colleagues and I examined sleep behaviour and detailed brain MRI scan data in more than 27,000 UK adults between the ages of 40 and 70. We found that people with poor sleep had brains that appeared significantly older than expected based on their actual age.

What does it mean for the brain to “look older”? While we all grow chronologically older at the same pace, some people’s biological clocks can tick faster or slower than others. New advances in brain imaging and artificial intelligence allow researchers to estimate a person’s brain age based on patterns in brain MRI scans, such as loss of brain tissue, thinning of the cortex and damage to blood vessels.

In our study, brain age was estimated using over 1,000 different imaging markers from MRI scans. We first trained a machine learning model on the scans of the healthiest participants – people with no major diseases, whose brains should closely match their chronological age. Once the model “learned” what normal ageing looks like, we applied it to the full study population.

Having a brain age higher than your actual age can be a signal of departure from healthy ageing. Previous research has linked an older-appearing brain to faster cognitive decline, greater dementia risk and even higher risk of early death.

Sleep is complex, and no single measure can tell the whole story of a person’s sleep health. Our study, therefore, focused on five aspects of sleep self-reported by the study participants: their chronotype (“morning” or “evening” person), how many hours they typically sleep (seven to eight hours is considered optimal), whether they experience insomnia, whether they snore and whether they feel excessively sleepy during the day.

These characteristics can interact in synergistic ways. For example, someone with frequent insomnia may also feel more daytime sleepiness, and having a late chronotype may lead to shorter sleep duration. By integrating all five characteristics into a “healthy sleep score”, we captured a fuller picture of overall sleep health.

People with four or five healthy traits had a “healthy” sleep profile, while those with two to three had an “intermediate” profile, and those with zero or one had a “poor” profile.

When we compared brain age across different sleep profiles, the differences were clear. The gap between brain age and chronological age widened by about six months for every one point decrease in healthy sleep score. On average, people with a poor sleep profile had brains that appeared nearly one year older than expected based on their chronological age, while those with a healthy sleep profile showed no such gap.

We also considered the five sleep characteristics individually: late chronotype and abnormal sleep duration stood out as the biggest contributors to faster brain ageing.

A year may not sound like much, but in terms of brain health, it matters. Even small accelerations in brain ageing can compound over time, potentially increasing the risk of cognitive impairment, dementia and other neurological conditions.

The good news is that sleep habits are modifiable. While not all sleep problems are easily fixed, simple strategies: keeping a regular sleep schedule; limiting caffeine, alcohol and screen use before bedtime; and creating a dark and quiet sleep environment can improve sleep health and may protect brain health.

How exactly does the quality of a person’s sleep affect their brain health?

One explanation may be inflammation. Increasing evidence suggests that sleep disturbances raise the level of inflammation in the body. In turn, inflammation can harm the brain in several ways: damaging blood vessels, triggering the buildup of toxic proteins and speeding up brain cell death.

We were able to investigate the role of inflammation thanks to blood samples collected from participants at the beginning of the study. These samples contain a wealth of information about different inflammatory biomarkers circulating in the body. When we factored this into our analysis, we found that inflammation levels accounted for about 10% of the connection between sleep and brain ageing.

Other processes

Another explanation centres on the glymphatic system – the brain’s built-in waste clearance network, which is mainly active during sleep. When sleep is disrupted or insufficient, this system may not function properly, allowing harmful substances to build up in the brain.

Yet another possibility is that poor sleep increases the risk of other health conditions that are themselves damaging for brain health, including type 2 diabetes, obesity and cardiovascular disease.

Our study is one of the largest and most comprehensive of its kind, benefiting from a very large study population, a multidimensional measure of sleep health, and a detailed estimation of brain age through thousands of brain MRI features. Though previous research connected poor sleep to cognitive decline and dementia, our study further demonstrated that poor sleep is tied to a measurably older-looking brain, and inflammation might explain this link.

Brain ageing cannot be avoided, but our behaviour and lifestyle choices can shape how it unfolds. The implications of our research are clear: to keep the brain healthier for longer, it is important to make sleep a priority.

Abigail Dove is Postdoctoral Researcher, Neuroepidemiology, Karolinska Institutet.

This article was first published on The Conversation.

Research has revealed a steep increase in liver disease in recent years. Meanwhile, there is growing evidence of health harms from alcohol, including drinking at levels that were previously considered “moderate.” These developments make a persuasive case for viewing alcohol consumption from a public health perspective.

As an internal medicine physician and alcohol epidemiologist, I’m interested in the overlap between liver disease and alcohol use among patients and in the general population. As it turns out, these topics are closely related, but maybe in surprising ways.

The liver is essential: humans need it to live. The liver contributes to metabolism and food storage, produces proteins that help with blood clotting and plays a vital role in the immune system.

At the cellular level, alcohol is a toxic substance that is metabolised (broken down) primarily in the liver. When the dose of alcohol is too high, liver cells become inflamed and damaged (liver inflammation is called hepatitis).

Over time, inflamed or damaged cells are replaced by fibrosis, which is the replacement of normal liver tissue with scar tissue, resulting in cirrhosis, or severe scarring and liver dysfunction. Cirrhosis can be fatal on its own and can also lead to liver cancer.

How does alcohol contribute to liver disease

Liver disease caused by alcohol is referred to as alcohol-related liver disease or ALD, previously called alcoholic liver disease. The heaviest drinkers, often those who have alcohol use disorder (AUD), can develop cirrhosis and liver failure.

But alcohol-related liver disease does not only affect people with AUD/heavy drinking. A growing body of evidence suggests chronic alcohol use at lower levels may also impact liver function and lead to disease, particularly among those with other risk factors for liver disease.

Patterns of alcohol consumption are also important, including among those who may not consume high amounts of alcohol on average. For example, binge drinking (defined as men consuming five or more drinks or women consuming four or more drinks per occasion) is a pattern of consumption that is very damaging to the liver because it results in high blood alcohol concentrations.

Binge drinking can be harmful to the liver, even among people who don’t drink very much on average or don’t have an alcohol use disorder.

Why are deaths from liver disease increasing

Deaths from liver disease have been increasing dramatically in Canada and the United States over the past two decades. A key factor is increased alcohol consumption during the same period, but this has been trending down over the past couple of years. Between 2016 and 2022, Canadian deaths from alcohol-caused liver disease increased by 22%.

But alcohol isn’t the only key contributor to the rise in deaths from liver disease. Another is the rise of a condition called metabolic dysfunction-associated steatotic liver disease, or MASLD.

Despite the complicated name, MASLD is a type of liver disease that is caused by the same metabolic disturbances that have accompanied the rise of overweight and obesity coupled with inadequate physical activity. This is the same set of risk factors that have led to the increase in diabetes. So one can conceive of MASLD as the liver equivalent of diabetes.

Hepatitis C, which is a blood-borne viral infection that can be acquired through injection drug use and needle sharing, is another important contributor to liver disease and cirrhosis.

Even though medical terminology has historically differentiated between alcohol and non-alcohol-related liver diseases, alcohol contributes to the progression of supposedly non-alcoholic liver disease, including MASLD and hepatitis C.

My colleagues and I studied patients with MASLD from the US-based Framingham Heart Study. We found that even among non-heavy drinkers, there was a dose-dependent relationship between the amount of alcohol use and the severity of both liver inflammation and fibrosis.

Similarly, even low levels of alcohol use can hasten the development of liver cirrhosis among those with hepatitis C. For example, research has shown that in patients with hepatitis C, there is an 11% increase in risk of cirrhosis with each one-drink increase in average drinks per day.

Preventing and reducing alcohol-related harm

Beyond providing medical care for individual patients with known liver disease, steps need to be taken upstream within the health system. These include screening around alcohol use in primary care, counselling interventions for those with risky drinking habits and treatment for those with alcohol use disorders. To do this effectively, there needs to be more resources available for all of these interventions.

However, treating individuals does not address the larger public health issue: measures are needed to lower alcohol consumption at the population level.

This is a cornerstone of preventing and reducing liver disease and its resulting disability, hospitalisations and death. And the most effective way to reduce alcohol consumption is through alcohol control policies that:

• Make alcohol more expensive (for example, alcohol taxes and minimum prices);

• Less available (such as restrictions on hours of sale, or the number of locations that sell alcohol), or

• Less desirable socially (such as limits on advertising and marketing or sports sponsorships).

In previous research, we found that states with 10 per cent stronger or more restrictive alcohol policies had lower ALD mortality rates. Furthermore, states that increased restrictiveness by even five per cent showed subsequent reductions in ALD.

Liver harm caused by alcohol is a public health problem. Collectively, we need to take better care of our livers by taking steps to reduce alcohol consumption in the population.

Timothy Naimi is Director, Canadian Institute for Substance Use Research; Professor, Division of Medical Sciences, University of Victoria.

This article was first published on The Conversation.

Following Tamil Nadu, Madhya Pradesh and Kerala, five more states have banned the sale and distribution of Coldrif cough syrup, which is allegedly linked to the death of 16 children.

The states are Karnataka, Punjab, Himachal Pradesh, Uttar Pradesh and Puducherry.

This came after 16 children, aged between one and seven, died due to kidney failure in the past month in Madhya Pradesh and Rajasthan after consuming the cough syrup.

The Madhya Pradesh government had asked authorities in Tamil Nadu to look into the safety of the formulation. On October 2, a report by the Tamil Nadu director of drug control found that samples of Coldrif cough syrup manufactured at a plant of Sresan Pharmaceuticals in the state’s Kancheepuram district were found to be “NSQ”, or not of standard quality.

The report said that the samples contained 48.6% diethylene glycol, which can cause acute kidney and liver failure.

Following Tamil Nadu's finding, on October 5, Madhya Pradesh also reported that one sample of Coldrif had 48.6% of diethylene glycol in it.

The permissible limit of diethylene glycol as an impurity is 0.1%. However, drug officials Scroll spoke to said that the chemical is unsafe even in trace amounts and should ideally be completely absent from an ingestible syrup. Its presence is a serious quality compliance issue, the officials said.

On Sunday, the Uttar Pradesh government banned the sale, import and export of Coldrif cough syrup, ANI reported.

The Karnataka government followed suit on Monday and banned the use of any cold and cough syrup for children below the age of two, while prohibiting the use of Coldrif cough syrup, The Indian Express reported.

On the same day, the Punjab Food and Drugs Administration also banned the sale, distribution and use of Coldrif cough syrup, PTI reported.

In Himachal Pradesh, authorities have completely banned the use of Coldrif cough syrup, while another syrup produced in the state, by the name Nastro-DS, is under scrutiny despite a clean chit from the Madhya Pradesh food and drugs administration, The New Indian Express reported.

“The lab analysis of Nastro-DS cough syrup samples has shown the presence of diethylene glycol within permissible limits,” Himachal Pradesh Drug Controller Manish Kapoor was quoted as saying. “Aqunova Pharma voluntarily decided to put on hold the production of Nastro-DS cough syrup after the Madhya Pradesh FDA took the samples.”

The Puducherry Drug Control Department has also prohibited the purchase, distribution and sale of a specific batch of Coldrif syrup.

In 2023, an inquiry by the World Health Organization had found diethylene glycol in India-made cough syrups allegedly linked to the deaths of 70 children in The Gambia.

In the wake of the deaths, the Directorate General of Health Services on Friday issued an advisory to all states and Union Territories, reiterating the “judicious prescribing and dispensing” of cough syrups for children.

The department, which reports to the Union health ministry, said that most “acute cough illnesses in children are self-limiting and resolve without pharmacological intervention”, adding that cough and cold medications should not be prescribed for children under two years.

Gujarat bans two other cough syrups

On Tuesday, the Gujarat Food and Drugs Control Administration banned the use of Respifresh TR and Relife – two other cough syrups that were found to have diethylene glycol beyond permissible levels.

On Monday, the Madhya Pradesh drug controller had labelled the two syrups that were manufactured in Gujarat as “not of standard quality”.

Of the 13 samples of the cough syrups collected by the Chhindwara drug inspector, 10 were assessed as being of “standard quality”, while three were found to be “not of standard quality”.

PIL before SC urges probe into deaths

Meanwhile, a lawyer has filed a public interest litigation before the Supreme Court seeking an independent, court-monitored probe into the deaths of multiple children in Rajasthan and Madhya Pradesh, Bar and Bench reported on Tuesday.

The petition highlighted that “no nationwide recall was initiated by the Union Ministry of Health and Family Welfare or the Central Drugs Standard Control Organisation, thereby allowing continued sale of the toxic drug in other states”.

The plea called for a look into forming a national drug recall policy in the country.

Two days before Rishika Peepre came down with a cough and cold on August 27, she was doing what five-year-olds do – dancing and playing.

That day, her father Suresh Peepre Khatik, a resident of Madhya Pradesh’s Sethiya village, took her to a local doctor who prescribed her cough syrup.

Rishika vomited the entire night after taking the medicine.

Three days later, she complained of severe stomach pain. Khatik admitted her to a hospital in Chhindwara.

Rishika had always been a healthy child but her condition deteriorated within a week. She was diagnosed with kidney failure and advised dialysis.

As no paediatric dialysis facility existed in Chhindwara, Khatik took her 120 km away to Nagpur’s Nelson hospital, where she underwent nine cycles of dialysis.

By September 16, Khatik ran out of funds. “Doctors said they cannot treat her if I don’t pay. So we got her discharged that day.”

Ten minutes after they left the hospital, Rishika died.

Since August, 11 children in Parasia – the tehsil in MP’s Chhindwara where Rishika lived – have died of kidney failure after consuming cough syrups. All were between the ages of one and six years. At least 10 others have been hospitalised.

All the children had been administered one of two cough syrups – Coldrif, manufactured by the Tamil Nadu-based Sresan Pharmaceutical and Nastro-DS, which was made by Himachal Pradesh-based Aquinnova Pharmaceuticals.

As the death toll increased, officials in Madhya Pradesh told Scroll that in late September they began to suspect that the cough syrup had been contaminated.

Their doubts were confirmed on October 2 when Tamil Nadu found the control batch of Coldrif cough syrup “adulterated” with 48.6% of diethylene glycol, a highly toxic chemical. Tamil Nadu drug inspectors had picked up the samples from Sresan’s Kancheepuram plant.

While the initial findings by Madhya Pradesh’s drug inspectors contradicted the Tamil Nadu report, on October 5 the state’s drug testing laboratory in Bhopal also found 46.28% of diethylene glycol in a sample of Coldrif cough syrup collected from a distributor.

This is not the first time cough syrups made in India and contaminated by diethylene glycol or DEG have led to deaths of children.

In 2023, 70 children had died in The Gambia after consuming cough syrups made in India. An inquiry by the World Health Organization had found the medicines adulterated with diethylene glycol. The same year, Uzbekistan blamed India-made cough syrups for the death of 18 children.

The tragedy in Chhindwara has left behind not just grieving families, but also a trail of debt.

“We not only lost our daughter, we also lost our entire savings in her treatment,” said Khatik, who spent Rs 9 lakh on Rishika’s treatment.

Khatik, who runs a meat shop, said all the women in his family mortgaged their jewellery to raise money for her treatment.

Several other families told Scroll that they had run out of money after paying lakhs in treatment. They complained of inaction and apathy from the state health department.

Nilesh Suryavanshi, whose three-year-old son Mayank is on a ventilator, alleged that the government has offered no financial assistance to the families. “Parents are struggling and taking their children to hospitals without any support,” he added.

Two cough syrups, two probes

A cough syrup requires a solvent to dissolve all its active ingredients – the compounds that make a drug effective – and to add sweetness and act as a lubricant. Usually, the solvent used is pharma-grade glycerine or propylene glycol, a clear, sweet and viscous liquid.

To cut corners, manufacturers knowingly or accidentally use a cheaper solvent called industrial glycerine, which is used to make cosmetics, a Maharashtra-based drug official told Scroll.

The industrial-grade glycerine can contain diethylene glycol and ethylene glycol, which if consumed can lead to vomiting, abdominal pain, kidney failure and often death.

All the children in Parasia who died showed these symptoms.

The use of diethylene glycol, or DEG, is banned in cough syrups. In its report, Tamil Nadu stated that DEG “is a poisonous substance which may render the contents injurious to health”.

Tamil Nadu’s findings were significant, since initially both the Union government and the Madhya Pradesh government found no anomalies in the cough medicine.

Six samples of the two syrups tested by Central Drugs Standard Control Organisation and three samples tested by the state drug laboratory in Madhya Pradesh initially were found “free of diethylene glycol/ethylene glycol”. The samples picked by CDSCO and the state government were from the same batch of drugs that the children consumed.

On October 3, Tamil Nadu issued a stop production notice to Sresan Pharma and banned the sale of Coldrif with immediate recall of the batches of medicine that had gone out to shops. Madhya Pradesh, Kerala, Rajasthan and Maharashtra followed suit.

Tamil Nadu also notified various states where the batch was distributed to stop its use. Sresan Pharmaceutical did not respond to an email from Scroll.

While Tamil Nadu was swift in response and tested the sample within a day, the Himachal Pradesh drug controller has been slower in its investigation of the other cough syrup consumed by the Chhindwara children, Nastro DS, made by Aquinnova Pharmaceuticals.

While samples of Nastro DS cough syrup were taken from Aquinnova’s Baddi unit, according to the unit’s incharge, the report of the tests has not been released.

Zatropha Pharma, which markets the cough syrup, in an email response to Scroll’s queries, said: “We have provided all the documents to the concerned drug authorities”. Rishabh Garg, a partner in Zatropha, told Scroll that the original manufacturer of the cough syrup is Aquinnova Pharmaceuticals, and questions should be directed to them.

Vikas Goyal, head of Aquinnova’s Baddi unit, told Scroll that they “have tested and cleared all laboratory requirements for the cough syrup”. He added, “We only purchase pharmacopeia grade glycerine. We did not find DEG contamination in our syrup.” Goyal said that the Himachal Pradesh drug controller has initiated an investigation.

Children are the most vulnerable to side effects of DEG poisoning. But as Scroll has reported, India’s drug rules do not mandate compulsory testing of DEG contamination in a cough syrup before it is cleared for sale.

“If this (testing) is made compulsory, we can detect many contaminated cough syrups before such tragedies occur,” the Maharashtra drug official said, requesting anonymity.

A doctor’s arrest

In Ridhora village, 13-month-old Prateek Pawar was amongst the first cases that caught the district administration's attention. He developed a minor cough and cold on August 20.

His father Sanjay Pawar took him to Dr Praveen Soni in Parasia who prescribed Coldrif.

For five days, Prateek was administered 2.5 ml of cough syrup four times a day. By the third day, his urination completely stopped.

For over a month now, Prateek has been in various hospitals. He is currently in Nagpur’s Lata Mangeshkar hospital for treatment of acute kidney injury. He has undergone three cycles of dialysis.

His father, Pawar, said they have spent Rs 5 lakh till now.

“My son is still in the ICU but he is recovering,” said Pawar, a farmer. “I have exhausted my savings and borrowed money from several people to keep his treatment going.”

Pawar blames Soni for prescribing an excessive dose of the syrup. Soni, a medical officer with Madhya Pradesh government hospital in Parasia, also runs a private clinic.

Of the eight children under treatment in Chhindwara and Nagpur, four consulted Soni and the others consulted a doctor identified as Thakur.

Scroll has accessed the children’s medical records, as collated by the district health department. Of the eight, six are critically ill with kidney failure.

Kapil Pawar, whose two-and-a-half-year-old son Vedansh was treated by Soni, too, alleged that the doctor had prescribed a high dose of the medicine – 3 ml of Coldrif four times a day.

Vedansh fell ill in early September. A few days after taking the cough syrup, he stopped urinating. On September 9, he was rushed to a hospital in Chhindwara and then referred to Nagpur.

Pawar alleged that the treating paediatrician in Nagpur informed him that his son “should not have been administered more than 1ml of the medicine”.

But Soni denied claims of incorrect dosage. He has been prescribing Coldrif for a “few years”, he said. “This problem has never occurred before. How a drug is manufactured is beyond my control,” he said, when he spoke to Scroll on October 3.

Two days later, Soni was suspended from the post of medical officer for practising privately and for not swiftly detecting kidney ailment in children and initiating the correct treatment. The same day, he was arrested by Chhindwara police.

Jeetendra Jat, deputy superintendent of police in Parasia, told Scroll they had waited for the health department’s investigation before initiating action.

On October 3, the Union health ministry issued an advisory to all states to avoid prescribing cough and cold medication to children aged less than 2. The same advisory also noted that cough syrup is generally not given to children below the age of 5.

In Chhindwara, paediatrician Dr Poonam Jain said she is flooded with cases of children who had the common flu, took either of the cough syrups, and fell severely ill since late August. Only a handful of patients are responding to medicines, she said.

Dr Pavan Nandulkar, another paediatrician, said children coming to him reported creatinine levels of 4-5, which is five times the normal. “Such levels mean the child will eventually suffer toxin-mediated kidney injury. The cause of death of all children who were referred to Nagpur hospitals was this,” Nandurkar said.

Absent government

Families of the children have been going from one hospital to the other for treatment, often at prohibitive costs.

Three-and-a-half-year-old Mayank fell ill in late September and required hospitalisation on September 25.

His father Nilesh Suryavanshi said he was referred from Chhindwara to Lata Mangeshkar hospital in Nagpur, where he found the treatment costs to be very high. “We went to the Nelson hospital and when our money got over, we came to the government medical college in Nagpur four days ago,” he said.

Suryavanshi has spent over Rs 8 lakhs on treatment. “My son is on a ventilator,” he said. “Crucial time was wasted in Chhindwara. Government doctors should have acted and begun treatment swiftly if so many children had already fallen ill.”

Mayank is in “critical condition”, doctors have now informed him.

Parasia MLA Sohan Balmik said he has written to Chief Minister Mohan Yadav to provide free treatment and support to patients.

Other families, too, alleged that the Madhya Pradesh health department was asleep on the job.

Pawan Pawar, whose two-year-old son Parth fell ill and stopped urinating in mid-September after consuming two doses of Nastro DS cough syrup, said he was alerted when two other families from his village had rushed to Nagpur after their children fell ill and showed similar symptoms.

Pawar stopped the cough syrup and took his son to Nagpur’s Aastha hospital. “There was no awareness raised by the health department here,” he said. “They began to take action very late. By then, several children had started falling ill.”