Category: The Conversation – USA

Source: The Conversation – USA (3) – By Annie Persons, Lecturer in Literature, University of Virginia

If you follow the Trump administration’s social media posts, you might spot its new mascot: a cartoon lump of coal with big eyes and babylike features. “Coalie” sparked a backlash almost as soon as Interior Secretary Doug Burgum debuted it for the Office of Surface Mining and Reclamation Enforcement in early 2026.

Coalie’s design draws on a type of Japanese anime called Kawaii, a word meaning “cute” or “adorable.” It’s the latest in the White House’s efforts to pass off coal as harmless, despite the well-established environmental and human health harms of mining and burning the fossil fuel.

As a scholar of American literature and culture, I write about media portrayals of coal, beginning in the 19th century with its rise to become the leading fuel in the United States. Coal use grew until the early 2000s, when other sources became cheaper and its health and environmental damage became unacceptable to more of the public.

While “Coalie” might be new, the logic behind it is not. For centuries, coal’s promoters have worked hard to show coal as harmless – as well as “clean” and “beautiful,” to use President Donald Trump’s words.

‘An agreeable heat’

Humans living with the effects of burning coal have disliked it for as long as they have burned it.

In 1578, Queen Elizabeth complained that she was “greatly grieved and annoyed with [its] taste and smoke” in the air. In 1661, John Evelyne’s treatise Fumifugium outlined negative health effects of breathing coal smoke.

English settlers were drawn to North America in part because of the continent’s abundant supply of timber, a substitute for coal that deforestation had made prohibitively expensive in England.

But by the 19th century, the price of timber had risen in America as well. When, in the 1820s, news spread of Pennsylvania’s rich veins of anthracite coal, urban consumers were eager for a cheaper source of fuel.

In addition to its lower price, anthracite coal grew desirable because of its high carbon, low-sulfur content, which produced less visible smoke when it was burned. An enthusiastic 1815 letter to the editor of the American Daily Advertiser captured increasingly common attitudes toward anthracite as “affor[ding] a very regular and agreeable heat.”

‘A healthful home’

The spread of anthracite also shored up tolerance for smokier but cheaper bituminous coal.

To help people, housekeeping manuals aimed at the fossil fuel’s mostly female users tried to invent workarounds for its smoke. In 1869, Harriet Beecher Stowe, best known as the author of “Uncle Tom’s Cabin,” and her sister Catharine Beecher wrote one of many 19th-century articles to acknowledge the “evils” of coal smoke, while outlining “modes of making a healthful home,” in the housekeeping manual American Woman’s Home.

Consumers provided temporary solutions for maintaining indoor air quality while burning coal by sending in suggestions that were published in housekeeping manuals, magazines and newspapers.

At the same time, as the century progressed, coal and coal-stove companies began to suggest that burning coal was healthy, that it could improve indoor air as well as domestic aesthetics. One 1892 newspaper advertisement claimed that stoves were “necessary to heat, cheer, and beautify the home and preserve its health.”

To keep the children clean and bright …

In the 20th century, marketers churned out more colorful claims about the benefits of coal: One magazine advertisement showed a mother and child pointing at the crackling stove aflame with the company’s coal, saying it “cannot be excelled in purity, cleanliness, and free-burning qualities.”

Similarly, the Lackawanna Railroad Company came up with the classy, often rhyming, character of Phoebe Snow. In one ad, she points to the importance of comfort, suggesting that not only could anthracite fuel faster travel, but it could also make your travel – and your life – more comfortable.

Coal marketing often used children to suggest safety and reach parents. Another iteration of the Phoebe Snow series promised that anthracite-powered railway travel could keep children “clean and bright.”

A 1930s advertisement went so far as to position a piece of anthracite coal next to a child in a bathtub, a visual proximity implying that coal was as good as soap.

In fact, soap made of “coal tar” – a liquid byproduct of producing coke, a fuel made from bituminous coal used in industrial blast furnaces – did (and does) exist. The British company Wright’s, also popular in the U.S., generated a slew of advertisements praising its soap as having antiseptic properties for children.

Each of these advertisements tried to capitalize on a mother’s desire for healthy children. And they pushed back against the image of the tyrannical “King Coal” that had come about amid strikes by miners protesting dangerous, degraded working and living conditions as well as the rise of black lung disease.

‘Clean coal’

By the mid-20th century, petroleum took coal’s place as America’s main energy source. The U.S. environmental movement continued to grow, and people got interested in natural gas as an alternative to coal.

In response, coal companies doubled down on the fantasy of “clean” coal.

A 1979 advertisement for American Electric Power, for example, flew in the face of Clean Air Act mandates that coal corporations employ “scrubbing” technology to remove sulfur dioxide from smoke – the ad depicted someone cleaning coal by hand.

The myth continues

Today, coal generates only 16.2% of America’s electricity, down from generating more than half of the U.S. power supply in the 1990s. But the country isn’t done with it. Even though coal production today is far below its peak, as companies try to shut down old uneconomic plants, Trump has promised to “reinvigorate” the coal industry.

In addition to ordering some coal plants to continue operating, the Trump administration has pulled out old coal promotion tactics from the past, including repeatedly referring to coal as “clean and beautiful.” One image inserts Coalie next to a coal-mining family that otherwise looks like an ad that could have appeared a century ago.

And, like its predecessors, this picture tries to present an innocent image of a product that harms human health and the environment.

A 2018 study found that black lung disease was on the rise in Appalachia, where about 40% of America’s coal is mined today. Living near a fossil-fuel power plant exposes residents to pollutants that contribute to premature deaths, asthma and lung cancer, including tiny particulate matter known at PM 2.5, sulfur dioxide and mercury. Even when it’s just sitting in piles waiting to be used at a power plant, coal can harm human health as the wind blows across it and carries coal dust into the air and people’s lungs.

The myth of coal as healthy and family friendly has been around for centuries – but coal has never been clean, or cute.

Annie Persons does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. Trump’s new ‘Coalie’ mascot and myth of ‘clean, beautiful coal’ have a long history in advertising – https://theconversation.com/trumps-new-coalie-mascot-and-myth-of-clean-beautiful-coal-have-a-long-history-in-advertising-281742

Source: The Conversation – USA (3) – By Flynn McGuire, Resident in Physical Medicine and Rehabilitation, University of Utah

It’s tough to avoid the current hype about the health benefits of injecting peptides. Although these substances – essentially, synthetic bits of protein in solution – have long made the rounds in the fitness world, their popularity has exploded. Social media influencers, podcasters, wellness clinics and online sellers promote peptides as a quick and easy way to build muscle faster, heal injuries more quickly, reduce inflammation, lose fat, sleep better and more.

Health Secretary Robert F. Kennedy Jr. has repeatedly backed broader access to peptides. In April 2026, the Food and Drug Administration announced plans to consider allowing some of them to be made to order at specialist pharmacies after banning them in 2023.

But do these products actually work, and can people who use them be sure they are safe?

Two of the most-hyped peptides widely promoted for injury recovery are BPC-157 and TB-500, sometimes marketed together under the comic book-sounding nickname the “Wolverine stack.”

That stack is part of a much larger longevity and fitness boom in which vendors sell or promote many different peptide products, often for uses that have not been studied rigorously in people. Online, people swap dosing protocols, compare “stacks” and describe these compounds as shortcuts for everything from tendon recovery to fat loss and muscle gain.

I am a physician in physical medicine and rehabilitation who spends a lot of time thinking about how people recover from musculoskeletal injuries, including tendon problems, ligament sprains, muscle strains and joint injuries. After digging through the evidence on these compounds, I think the gap between the marketing and the science is much wider than most buyers realize.

Peptides can be real medicines

A peptide is just a short chain of protein building blocks called amino acids.

Some peptide drugs are important, legitimate medicines. Insulin is one example. GLP-1 drugs are another.

The issue is not whether something is a peptide but whether it has gone through the long process that makes medicines credible: reproducible manufacturing, careful dose testing, clinical trials for a specific condition and ongoing safety monitoring.

BPC-157, TB-500 and other internet-hyped peptides have not gone through that process. Such peptides are often sold online as supplements, or as research-grade products made for laboratory use but not FDA-approved as a treatment for people.

That distinction matters, because it means that producers might prepare such peptides at different concentrations, using different solvents, stabilizers and other ingredients. In other words, one vial of what’s supposedly the same substance would not necessarily be the same as the next, even if it were made by the same producer. And there’s no requirement that manufacturers ensure that products are free of contaminants.

Different vials could thus potentially behave differently in the body and may carry different risks, such as infection. That is a big problem if people are injecting something sold online as a shortcut to recovery.

The evidence for BPC-157

BPC-157 was discovered in the early 1990s as an isolated version of a peptide fragment linked to compounds found in stomach acid.

Early research focused on benefits for the gut, but because some animal studies suggested the compound could help promote blood vessel growth, calm inflammation and support tissue repair, researchers years later began testing it in cell and animal models of tendon, ligament, muscle, bone and cartilage injury.

Some hints from those studies are promising, which is why influencers and scientists got excited about BPC-157.

But in humans, the evidence is extremely thin. In fact, for common sports and orthopedic injuries, it’s close to nonexistent, as my colleagues and I found when we reviewed the published literature on BPC-157 for musculoskeletal healing in 2025.

The one published study we found in people included only 16 participants with knee pain. It relied on their self-assessment to gauge improvement and didn’t compare the group that received the peptide to one that did not. Those flaws made it impossible to tell whether the improvement was due to placebo effects, because many injuries get better over time anyway, or from the peptides.

Other reviews uncovered similar limitations: For musculoskeletal injuries, the studies in people are too sparse and low quality to pin down whether the peptide works or what risks it poses.

Basic, practical questions remain, too – such as what dose people should use, how long the compound lasts in different tissues and whether the product in a purchased vial actually matches its label.

TB-500 claims are even harder to evaluate

TB-500 has a slightly different story. It is usually marketed as a synthetic product related to a naturally occurring peptide called thymosin beta 4, which is found in many tissues.

Thymosin beta 4 has attracted scientific interest because it appears to be involved in processes relating to tissue repair, including cell movement, how new blood vessels form and how tissues respond to injury. Animal studies suggest it may support bone healing after fractures as well as muscle repair.

Researchers are beginning to study thymosin beta 4 in people – though, so far, most studies look at safety and not recovery from sports injuries.

Here’s the issue, though: TB-500 is a smaller piece of thymosin beta 4. This means that research on thymosin beta 4 does not necessarily show that TB-500, the version most commonly sold online, helps a person recover faster from a tendon, muscle or joint injury.

Another complication is that the biological processes thymosin beta 4 seems to promote, such as new blood vessel growth and cell migration, don’t just occur in bone or muscle healing. They also play a role in other contexts, such as scarring, abnormal tissue growth and cancer biology.

This does not prove harm, but it does mean these are not simple, risk-free recovery supplements. Human studies don’t just have to show that thymosin beta 4, TB-500 or products sold under that name help people recover from common sports injuries, but also that these products are safe for long-term use.

So far, data on safety is scant. A recent analysis of more than 12,000 Reddit posts about using BPC-157 and other peptides after musculoskeletal injuries or surgery found that users frequently raised concerns about side effects, product purity and long-term safety. For example, some users reported injection-site reactions, diarrhea and emotional numbness. Studies like this one rest on low-quality, anecdotal evidence, but it’s the only evidence available for most of these peptides.

How to think about bold peptide claims

What makes the current peptide craze so confusing is that BPC-157 and TB-500 are not miracle cures, but they are not pure nonsense either. They sit in a more uncomfortable middle ground: interesting biology, intriguing findings in animal studies and, realistically, no convincing proof that they promote musculoskeletal healing in people.

In other words, peptides on the whole can be real medicines. But that does not mean the vial being marketed online is a safe, tested treatment for an injured shoulder, Achilles tendon or knee.

When you encounter wellness influencers or online sellers promising the glamour of faster healing, better recovery or a more aesthetic body, a few mundane questions can help cut through the marketing:

• Has this exact product been tested in people with my injury?

• Was it studied at the same dose and by the same route being marketed online?

• Do I know exactly what is actually in the vial?

• Is the promised benefit strong enough to justify the risk of using a product that has not cleared the usual standards for drug quality and evidence?

For now, none of those questions yield a clear, positive answer.

Flynn McGuire does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. Can peptide injections help people recover from injuries? Here’s what you need to know – https://theconversation.com/can-peptide-injections-help-people-recover-from-injuries-heres-what-you-need-to-know-276353

Source: The Conversation – USA (2) – By Alex C. Lange, Assistant Professor, Higher Education, Colorado State University

Within the past decade, most women’s colleges in the United States – including Smith College, a liberal arts college in Northampton, Massachusetts – have expanded their admissions policies, allowing transgender students to also attend. Many of these policies allow transgender women to apply, while policies for transgender men and nonbinary students vary more widely.

The Trump administration announced on May 4, 2026, that it is investigating Smith College for violating Title IX, a law that prohibits discrimination based on someone’s sex.

“An all-women’s college loses all meaning if it is admitting biological males,” Assistant Secretary for Civil Rights Kimberly Richey said in a statement issued by the Education Department.

As a scholar of higher education who studies the experiences of LGBTQ+ students, I think it is important to recognize that women’s colleges offer a unique experience to students, including transgender and queer students. They create environments where students who are marginalized by their genders see themselves as leaders.

Women’s colleges have also long been welcoming places for lesbian and queer relationships, offering community and support as attitudes about gender and sexuality have changed.

A prior focus on trans athletes

Up until now, the Trump administration’s policy agenda on transgender rights and education has primarily focused on whether universities should let transgender students participate in college sports.

The Trump administration froze US$175 million in federal funding to the University of Pennsylvania in 2025 because it objected to how the school allowed transgender students to participate on women’s sports teams. One trans woman athlete named Lia Thomas, in particular, gained recognition for her strong performance on the women’s swim team at Penn.

The administration released the frozen funding after Penn agreed in July 2025 to block trans athletes like Thomas from participating in women’s sports.

Some of the sports-related lawsuits the administration filed in 2025 – like those targeting Penn and the University of Maine for allowing trans women to participate in women’s sports – have been settled out of court.

Other Title IX investigations into San José State University and the University of Nevada-Reno, for example, are still ongoing.

Understanding role of women’s colleges

Women’s colleges were created in the mid-to-late 1800s, when women were largely not allowed to enroll in most colleges. Women’s colleges became places where these students would be taken seriously as women and leaders.

As more colleges went coeducational, women’s colleges had to explain their purpose and evolving missions over time.

After World War II, for example, people said that American women who were working jobs outside the home should stop. Women’s colleges again explained their mission to the public, stating they could prepare women for the workforce and home. So, while women’s colleges were created to respond to the gendered exclusion of women, their missions have shifted as societal understandings of gender have evolved, too.

Transgender students didn’t suddenly appear at women’s colleges or other higher education institutions. But in the early 2000s, more students began to openly identify as transgender, and colleges increasingly had to decide how to adjust their policies.

Some older alumni of women’s colleges have expressed concern about admitting trans students, including whether allowing them affects a women’s college’s reputation, traditions or identity. These debates can matter a lot because most women’s colleges in the U.S. are private liberal arts colleges that depend on tuition payments and donations.

But some alumni have supported more expansive admissions policies consistent with the broader mission of women’s education.

While women’s schools have presented their own challenges for some queer and transgender students, they have long remained significant to the LGBTQ+ community.

What should women’s colleges be?

The number of women’s colleges has declined sharply over the past few decades.

In 1960 there were about 230 such colleges. In 2023 there were 30 women’s colleges in the United States. As more colleges became coeducational, women had more options, and many women’s colleges either closed, merged or began admitting men.

This decline in women’s colleges helps explain why debates over admitting trans students to women’s colleges are so charged. Each decision becomes part of a broader question about what women’s colleges are and should be.

The conversation around transgender and nonbinary students attending women’s colleges became more public in the 2010s. In 2013 Smith College denied admission to a trans woman because the student indicated that she was male on her federal financial aid forms.

This resulted in a big debate between Smith alumni and students about what the school’s admission policy should be. Leading up to this point, several women’s colleges – including Barnard, Smith, Mills and Wellesley – treated trans student applicants on a case-by-case basis, or in an informal way.

In 2014, Mount Holyoke, a women’s college in western Massachusetts, created one of the most expansive early policies on this issue. It allowed applications from transgender women and from some applicants who identified as transgender more broadly, while continuing to exclude cisgender men.

Smith also announced a new policy in 2015 that allowed anyone who identified as female to apply and be admitted.

Today, most but not all women’s colleges have their own policies regarding the admission of trans students. These policies vary: Some admit transgender women and some nonbinary applicants, while others are more restrictive. Many do not admit applicants who identify as men, including transgender men.

Mixed experiences for trans students

Some research finds that students overall at women’s colleges report higher levels of support – including from faculty – than students at coeducational colleges. Some transgender students arrive expecting these colleges to offer a safe and accepting atmosphere.

But some transgender students have negative experiences at women’s colleges and can feel like they are being watched too closely, ignored or both. These problems aren’t just because of interactions with other people. They can also occur when trans students encounter student records, bathrooms, housing and campus rules that assume everyone is either a man or a woman, or identifies with the sex they were assigned at birth.

Transgender students often report that college can feel less welcoming to them. Research on trans college students shows that academic, cocurricular, peer and institutional contexts shape how welcoming or alienating campus feels.

My research with other colleagues also examines how trans and queer students thrive in college, whether at co-ed or women’s colleges. Many form close-knit communities and are vital members of their campuses. The difficulties trans students face are not inherent to being trans. I believe they are produced by policies and systems that marginalize them because they are trans.

Barring transgender people from attending women’s colleges would block a higher education pathway for transgender and queer students.

Women’s colleges were created in response to gender inequality. I believe this history should push them to keep making college more open and supportive for students excluded because of gender.

Alex C. Lange receives funding from the Spencer Foundation.

– ref. Federal investigation into Smith College probes whether transgender students can attend women’s schools – challenging the evolving mission of women’s education – https://theconversation.com/federal-investigation-into-smith-college-probes-whether-transgender-students-can-attend-womens-schools-challenging-the-evolving-mission-of-womens-education-282219

Source: The Conversation – USA (2) – By Matthew Robertson, Research Scientist, Fisheries and Marine Institute, Memorial University of Newfoundland

One of the United States’ largest fisheries is hiding in plain sight. Recreational freshwater anglers in the lower 48 states catch – and keep – far more fish than any official body has estimated, according to new research from our team of North American fishery scientists.

Specifically, our analysis, which integrated thousands of recreational fishing surveys across the U.S., found that people who engage in recreational fishing in the country’s lakes, ponds and reservoirs catch between 2 billion and 6 billion fish each year. Many of them practice catch-and-release fishing, but even after accounting for all the fish released, we estimated that they keep between 230,000 and 670,000 metric tons of fish in the U.S. alone.

That’s between 17 and 48 times more fish than prior U.S. estimates that have been reported to the United Nations’ Food and Agriculture Organization.

And it’s about 20% of the United States’ total recorded annual consumption of fresh fish that has not been frozen. We estimated the value of the recreational fish catch is roughly US$3 billion a year. By contrast, domestic commercial processed fishery products are valued at about US$12 billion a year.

Not just for fun

Historically, most researchers and policymakers viewed recreational fishing as a leisure activity rather than a significant part of the nation’s food supply.

However, for many households, recreationally harvested fish – fish that people catch and keep, often to eat – represent a meaningful source of protein at very low cost. By recognizing this unseen harvest as a significant food source, policymakers can recognize that changes in recreational fishing opportunities don’t just affect anglers’ enjoyment, but also millions of households’ food security.

The immensity of recreational fishing also likely has effects on freshwater ecosystems that have gone unrecognized by fisheries managers.

For example, a 2019 analysis of nearly 200 lakes in northern Wisconsin found that around 40% of walleye recreational fisheries were overfished. Even when fish are released and not kept for eating, they can die shortly after release or be injured or stressed from having been caught. Injured and stressed fish may produce fewer offspring, be more vulnerable to predators and be less capable of catching prey.

Together, these effects on fish populations and the act of fishing can substantially change how freshwater ecosystems function. For example, removing top predators like walleye can lead to an increase in small fish, which eat tiny zooplankton, which feed on phytoplankton. If zooplankton populations fall, that can ultimately lead to more frequent algal blooms.

Effective fisheries management requires accurate estimates of fishing activity. Without that information, officials may overestimate fish population size, which could lead to unexpected population collapses and new fishery regulations and closures.

Why the numbers don’t add up

Official harvest statistics for fisheries, which are collected by the U.N. from national governments, usually focus on ocean fisheries, which are typically the largest and most lucrative.

As a result, the only official statistics for the U.S. freshwater fisheries harvest cover commercial fisheries that primarily operate in the Great Lakes.

Collecting data on recreational fisheries is challenging. Unlike commercial fisheries that unload their catch at centralized ports, it is impossible to know where recreational fishers are and what they are catching across the entire country. With an estimated 35 million people fishing across millions of rivers, lakes, ponds and reservoirs, the amount of recreational fishing makes it an extremely difficult activity to track.

Recreational fisheries data tends to be collected by state agencies that conduct angler surveys. Angler surveys involve counting and interviewing anglers at specific rivers, lakes, ponds and reservoirs to provide snapshots of who is fishing, how they fish and what they catch. Each state collects data differently, and surveys typically focus on a few locations rather than the entire state.

Without a coordinated national effort, the total recreational catch has remained effectively invisible because one state’s questions and findings do not always align with those in other states.

From local surveys to national statistics

Our new research, a collaborative effort between myself and four colleagues from the U.S. Geological Survey, the University of Missouri and Louisiana State University, sought to improve the quality of recreational fishing data. Over the past several years, our team has worked to compile angler surveys from across the country into a single database.

We have not received data from every river, lake, pond and reservoir; in fact, we have not even collected data from every state. But we have collected over 15,000 surveys from 40 states, and we are collecting more surveys every day.

To calculate our estimates, we combined three major factors:

• Nationwide numbers of fish caught and hours spent fishing.

• Assumptions about how many lakes, ponds and reservoirs people fish based on the relationships between water body size and known fishing locations.

• The proportion of caught fish that aren’t thrown back.

We arrived at an estimate of 2 billion to 6 billion fish caught.

Rethinking recreational fisheries

Even our most conservative assumption of harvested fish – 236,000 metric tons – is much higher than the prior U.N. estimates of 13,388 metric tons. We hope these new numbers will serve as initial estimates that will be continually refined as we and other researchers collect more data and better understand where and how people fish.

Getting this first estimate provides a baseline for fisheries managers to ensure fishing policies line up with the actual effects of recreational fishing.

We also note that recreational freshwater fishing happens across the globe. If the actual recreational fish harvest is significantly higher than has previously been estimated in the U.S., the same is likely true worldwide.

Matthew Robertson receives funding from a Marine Institute of Memorial University Start-Up Fund, the Canadian Natural Sciences and Engineering Research Council of Canada (NSERC) Discovery Grant, the Newfoundland and Labrador Innovation and Business Investment Corporation’s Research and Development program, the Atlantic Groundfish Council, the Environment and Climate Chance Canada (ECCC) Environmental Damages Fund, and the Robert and Edith Skinner Wildlife Management Fund.

This research was funded by a grant for the U.S. Geological Survey Climate Adaptation Science Center.

– ref. Recreational fishing in the US catches far more fish than previously estimated – https://theconversation.com/recreational-fishing-in-the-us-catches-far-more-fish-than-previously-estimated-276812

Source: The Conversation – USA (3) – By Samira Mehta, Associate Professor of Women and Gender Studies & Jewish Studies, University of Colorado Boulder

Mother’s Day seems like a strange time to celebrate birth control, which, on its most basic level, is about helping people to not become mothers – or not become mothers again.

But in the mid-20th century, much of birth control’s growing support came from attempts to support American women not as feminists, but as mothers. This is the story that I focus on in my 2026 book, “God Bless the Pill: The Surprising History of Contraception and Sexuality in American Religion.” Many religious leaders and U.S. politicians were looking for ways to strengthen the nuclear family, based around a homemaker mother and working father. Expanding legal access to contraception served as a way to make that happen.

Thought leaders who pushed to make birth control more available did not necessarily do so out of a desire to help women control their own bodies. They wanted to protect children and families and believed they were stronger when parents, particularly mothers, could devote intensive time to raising their children – ideally full time. Those views dovetailed with both political needs and Protestant beliefs of the moment.

‘Nuclear Family in the Nuclear Age’

The Cold War may have sprung from geopolitics and nuclear fears, but it was also a form of culture war, with American politicians pitting images of a “godly” United States against “godless communism.”

The nuclear family was a central piece of that propaganda. As historian Elaine Tyler May wrote, politicians, journalists and other public figures trumpeted the ideal of a mother, father and their children living in their own home: the “nuclear family in the nuclear age.” In their depiction, the American family was based on a sexually charged marriage between a beautiful – and fashionable – homemaker mother and a handsome father who could provide for his white, middle-class family.

This idealized family could own a suburban home, one or two cars, and a constantly revolving selection of modern conveniences. Mothers were expected to invest in their appearance, presenting fathers with a delectable wife when they came home from work – plus a sparkling house and a home-cooked meal. In theory, this perfect mother had time, emotional energy and economic resources to parent their children in a very hands-on way.

Some middle- and upper-class Americans could afford this lifestyle, but it was out of reach for many, including many families that were not white. In addition, as Betty Friedan, one of the mothers of second-wave feminism, would articulate in “The Feminine Mystique,” many women who did live that life were not actually happy. That said, the idealized family was a central piece of American rhetoric in the middle of the 20th century – as was religion.

In the 1950s, more Americans attended church and synagogue than in any other decade that century. Around World War II, American figures started to often invoke the phrase “Judeo-Christian” to describe the country – a belated nod to Catholic and Jewish citizens in the still mostly Protestant nation. Nuclear families’ faith was considered a key piece of American defense against a “godless” Soviet Union.

American propaganda contrasted these ideal U.S. families against a vision of communism in which both parents worked. Soviet families were depicted in apartments with a shared kitchen and bathroom down the hall, without the material wonders of capitalism – from a brand new Frigidaire to a Kitchen Aid stand mixer and a Cadillac in the driveway.

In U.S. political rhetoric, the American family lived in technicolor, and the Soviet family lived in black and white.

‘Responsible parenthood’

But affording that vision of the American dream would be easier with fewer children.

Basic birth control methods had been part of American life for a long time – as evidenced by a declining birth rate among the middle and upper class, starting in the middle of the 19th century. “Scientific” birth control that required medical visits, such as diaphragms, had been around since the early 20th century.

Diaphragms became more accepted, and in 1936, a U.S. appeals court formally classified birth control as medical equipment. The birth control pill, which had been developed throughout the 1950s, was formally approved by the Food and Drug Administration in 1960.

Different Protestant denominations had slowly come to accept birth control, though the Catholic Church remained staunchly opposed to all except the rhythm method. Contraception turned procreation into a new place where Christians could live morally: not having more children than they could afford, nurture, educate and raise with knowledge of God. Denominational statements from groups as diverse as the Lutherans and the Quakers articulated a Christian form of planned parenthood that they would call “responsible parenthood.” In many ways, it was primarily about motherhood.

In 1960, the Rev. Richard Fagley published “Population Explosion and Christian Responsibility,” the first pan-Protestant theory of responsible parenthood. Fagley, a Congregational minister, called the medical knowledge that led to the contraceptive pill “a liberating gift from God, to be used to the glory of God, in accordance with his will for men.” He went on to say that godly scientific knowledge “affects deeply the size of the family … and therefore has created a new area for responsible decisions.”

While Fagley was the first person to collect various denominations’ views into a cohesive theology, his position represented a Protestant consensus, and his argument was adopted by the National Council of Churches the following year.

Birth control, in this formulation, was not about being child-free, or being able to engage in sex outside marriage. Rather, it allowed couples to decide, prayerfully, how many children they could have, and when they would have them. “Responsible parenthood” framed family size around “Christian duty.”

‘Mother-wife’

The theology of responsible parenthood makes clear that it is not about feminist autonomy for women.

For instance, when the National Council of Churches released a statement on responsible parenthood, the reasons listed for limiting the number of children in the family included “The right of the child to be wanted, loved, cared for, educated, and trained in the ‘discipline and instruction of the Lord’ (Eph. 6:4). The rights of existing children to parental care have a proper claim.” In the 1960s, the person assumed to do the majority of the work to raise a child was the mother.

Religious leaders’ rationale included concern for the woman herself, but in her role as “the mother-wife,” as the statement said – framing women in relationship to the men and children in their lives. Birth control was important inasmuch as it preserved her body and mind to fill those roles. And the occasion for more widespread acceptance of “responsible parenthood” was the advent of the birth control pill, for which women were primarily responsible.

In other words, birth control gained acceptance as a way to perfect married motherhood. But in 1972, the Supreme Court case Eisenstadt v. Baird expanded the right of contraception from married people to single people, including teenage girls.

The religious consensus supporting birth control soon fractured among evangelicals and other conservative Protestants. Not only did they start to see birth control as supporting sex outside of marriage, but also as undermining a mother’s moral guidance of her daughters, who could now access contraception without parental consent. Many more liberal Protestants got quieter as well.

That early, vocal support for birth control has come back in recent years. Battles over the Affordable Care Act and the Supreme Court’s 2022 Dobbs v. Jackson decision have caused liberal Protestant denominations to reaffirm their commitment to reproductive healthcare, including birth control and abortion. That commitment has a long history – even if it is not a strictly feminist history.

Samira Mehta receives funding from the Henry Luce Foundation.

– ref. Protestant leaders once championed birth control – not to liberate women, but as part of ‘responsible parenthood’ – https://theconversation.com/protestant-leaders-once-championed-birth-control-not-to-liberate-women-but-as-part-of-responsible-parenthood-280980

Source: The Conversation – USA (2) – By Michael E. West, Director of the Alaska Earthquake Center and State Seismologist, University of Alaska Fairbanks

On the evening of Aug. 9, 2025, passengers on the Hanse Explorer finished taking selfies and videos of the South Sawyer Glacier, and the ship headed back down the fjord. Twelve hours later, a landslide from the adjacent mountain unexpectedly collapsed into the fjord, initiating the second-highest tsunami in recorded history.

We conduct research on earthquakes and tsunamis at the Alaska Earthquake Center, and one of us serves as Alaska state seismologist. In a new study with colleagues, we detail how that landslide sent water and debris 1,580 feet (481 meters) up the other side of the fjord – higher than the top floor of the Taipei 101 skyscraper – and then continued down Tracy Arm. The force of the water stripped the fjord’s walls down to bare rock.

It was just after 5 o’clock in the morning on a dreary day, and fortunately, no ships were nearby. In the months after, some cruise lines started avoiding Tracy Arm. However, the conditions that led to this event are not at all unique to this fjord.

Landslides are common in the coastal mountains of Alaska where rapid uplift, caused by tectonic forces and long-term ice loss, converges with the erosive forces of precipitation and moving glaciers. But a curious pattern has emerged in recent years: Multiple major landslides have occurred precisely at the terminus of a retreating glacier.

Though the mechanics are still poorly understood, these mountains appear to become unstable when the ice disappears. When the landslide hits the water, the momentum of millions of tons of rock is transferred into tsunami waves.

This same phenomenon is playing out from Alaska to Greenland and Norway, sometimes with deadly consequences. Across the Arctic, countries are trying to come to terms with this growing hazard. The options are not attractive: avoid vast swaths of coastline, or live with a poorly understood risk. We believe there is an obvious role for alert systems, but only if scientists have a better understanding of where and when landslides are likely to occur.

Signs that a landslide might be coming

The Tracy Arm landslide is a powerful example.

The landslide occurred in August, when warm ocean waters and heavier precipitation favor both glacier retreat and slope failure. The glacier below the landslide area had experienced rapid calving – large chunks of ice breaking off and falling into the water – and it had retreated more than a third of a mile in the two months prior. Heavy rain had been falling. Rain enters fractures in the mountain and pushes them closer to failure by increasing the water pressure in cracks.

Most provocative are the thousands of small seismic tremors that emanated from the area of the slide in the days prior to the mountainside collapsing.

We believe that this combination of signs would have been sufficient to issue progressive alerts to any ships in the vicinity and homes and businesses that could have been harmed by a tsunami at least a day prior to the failure – had a monitoring program existed.

Escalating alerts are used for everything from terrorism and nuclear plant safety to avalanches and volcanic unrest. They don’t remove the risk, but they do make it easier for people to safely coexist with hazards.

For example, though people are still killed in avalanches, alert systems have played an essential role in making winter backcountry travel safer for more people. The collapse at Tracy Arm demonstrates what could be possible for landslides.

What an alert system could look like

We believe that the combination of weather and rapid glacier retreat in early August 2025 was likely sufficient to issue an alert notifying people that the hazard may be temporarily elevated in a general area. On a yellow-orange-red scale, this would be a yellow alert.

In the hours prior to the landslide, the exponential increase in seismic events and telltale transition to what is known as seismic tremor – a continuous “hum” of seismic energy – were sufficient to communicate a time-sensitive warning for a specific region.

These observations, recorded as a byproduct of regional earthquake monitoring, warranted an “orange” alert noting immediate concern. The signs were arguably sufficient to recommend keeping boats and ships out of the fjord.

Our research over the past few years has demonstrated that once a large landslide has started, it is possible to detect and measure the event within a couple of minutes. In this amount of time, seismic waves in the surrounding area can indicate the rough size of the landslide and whether it occurred near open water.

A monitoring program that could quickly communicate this would be able to issue a red alert, signaling an event in progress.

The National Oceanic and Atmospheric Administration’s tsunami warning program has spent decades fine-tuning rapid message dissemination. A warning system would have offered little help for ships in the immediate vicinity, but it could have provided perhaps 10 minutes of warning for those who rode out the harrowing tsunami farther away.

There is no landslide monitoring system operating yet at this scale in the U.S. Building one will require cooperation across state and federal agencies, and strengthened monitoring and communication networks. Even then, it will not be fail-proof.

Understanding risk, not removing it

Alert systems do not remove the risk entirely, but they are a better option than no warning at all. Over time, they also build awareness as communities and visitors get used to thinking about these hazards.

Many of the most alluring places on Earth come with significant hazards. Arctic fjords are among them. The same processes that create this hazard – glacier retreat, steep terrain, dynamic geology – are also what make these landscapes so compelling. The mix of glaciers, ice-choked waters and steep mountains is exactly what draws people to these places. People will continue to visit and experience them.

The question is not whether these places should be avoided altogether, but how to help people make more informed decisions. We believe that stronger geophysical and meteorological monitoring, coupled with new research and communication channels, is the first step.

On Aug. 9, visitors unknowingly passed through a landscape on the cusp of failure. An alert system might have given tour companies and people in the area the information they needed to make more informed choices and avoid being caught by surprise.

Michael West is part of a cooperative effort between the Alaska Earthquake Center, the Alaska Division of Geological and Geophysical Surveys, and the U.S. Geological Survey’s Landslide Hazards Program to improve the understanding of large deep-seated landslides in Alaska. This effort receives financial support from the USGS.

Ezgi Karasozen is part of a cooperative effort between the Alaska Earthquake Center, the Alaska Division of Geological and Geophysical Surveys, and the U.S. Geological Survey’s Landslide Hazards Program to improve the understanding of large deep-seated landslides in Alaska. This effort receives financial support from the USGS.

– ref. Alaska’s near-record landslide tsunami sent a wave 1,580 feet up the fjord walls – and left clues for building a warning system – https://theconversation.com/alaskas-near-record-landslide-tsunami-sent-a-wave-1-580-feet-up-the-fjord-walls-and-left-clues-for-building-a-warning-system-282017

Source: The Conversation – USA (2) – By Peter Adams, Professor of Civil and Environmental Engineering, Engineering and Public Policy, Carnegie Mellon University

With U.S. electricity demand starting to rise quickly and expected to continue rising, largely because of the power needed for data centers that process artificial intelligence, people are looking for almost any potential solution.

And people are warning that the full projected demand may not actually develop, which could make massive investments in power plants unnecessary, raising Americans’ electricity rates even more.

U.S. Secretary of Energy Chris Wright is among those who have been promoting what might seem to be an attractive idea: “We have 35 gigawatts of backup generators that are sitting there,” he told an audience of natural gas industry leaders in December 2025. He was referring to diesel-fired engines at hospitals, office complexes, corporate campuses and even data centers to provide electricity if the grid goes down.

That amount of power would be a significant step toward meeting the nation’s expected energy needs, without needing new long-term investments in power plants or transmission lines. But it’s also vital to know, as Wright went on to note, that “emissions rules or whatever” mean those generators can’t just be turned on and left running when there’s not a power outage or other emergency.

As an environmental engineer who studies air pollution from the energy system, I believe this proposal is concerning. Those emissions rules are in place because diesel-powered generators are among the dirtiest sources of energy, emitting fine particulate matter and related chemicals. That is a pollutant whose total emissions from all sources are estimated to cause about 100,000 premature deaths every year in the U.S. And in fact, emissions regulations on backup generators are less stringent than other power sources because they are intended only to run in emergency situations.

If Wright’s idea took hold, diesel fumes would pour into the nation’s air, often near major metropolitan areas that already have air pollution problems. To see more closely what would happen, John Allen, a research assistant at Carnegie Mellon University, and I projected the effects on public health and air quality of running backup diesel generators at data centers.

Simulating the emissions of diesel generators

Comprehensive data is hard to nail down about locations of data centers and which ones have how many diesel generators on site. Nobody has yet made a detailed proposal for which generators might be switched on, or for how long, so we did an exploratory analysis.

We started with an online database of locations of data centers. We also found documentation suggesting there is at least 35 gigawatts of diesel-powered generating capacity at data centers across the U.S., so we allocated that amount, which Wright had mentioned, proportionally to each data center’s size.

We looked at a scenario where these generators ran continuously throughout the year, generating 310 terawatt-hours of electricity. The generators might be used less – Wright himself talked about running them for only “a few hours per year.” But once they’re allowed to be turned on for regular power generation, people might get used to having that electricity available.

We assumed that all diesel generators are relatively new and comply with the Environmental Protection Agency’s most recent and stringent standards, which took full effect in 2015.

We compared the air pollution created from the diesel generators with a scenario where that same amount of power – 310 terawatt-hours – came from the existing mix of power plants in regional electrical grids. This could happen if utility companies built more generation capacity of the same types that already exist in the region or built new transmission lines to deliver more power from elsewhere.

Because no air quality model is perfect, we used three different computer simulations, each of which has been published in scholarly research journals, to simulate what would happen to the diesel pollution and how people downwind would be affected.

Diesel is dirtier

We found that using diesel generators rather than grid electricity would cause significant amounts of fine particulate matter pollution that would be dangerous to people’s health. The exact results varied with each simulation and with a range of assumptions about emissions from diesel generators. But in general, we found that using backup diesel generators this way would cause about 500 more premature deaths per year in the U.S. compared with getting the same electricity from the central grid.

In a scenario where diesel generators were somewhat dirtier than the most recent standards, one air quality model had more than 800 additional people dying prematurely each year nationwide.

In the counties that would be hardest hit by the diesel generators’ pollution, the concentrations of fine particulate matter would increase by 0.25 to 2 micrograms per cubic meter of air, depending on the location and other assumptions for our calculations. This might not sound like a lot, but most urban areas in the U.S. already have fine particulate air pollution that’s close to the EPA limit of 9 micrograms per cubic meter. Adding that much more pollution risks tipping those communities beyond federal standards.

The Clean Air Act requires states to adjust their emissions to meet standards, so upping pollution from backup generators would require other cuts in emissions, such as at power plants and transportation.

Inspection and maintenance challenges

The results concern us, but reality might be even worse. We assumed that diesel generators would meet the most recent Tier 4 EPA emissions standards, but they may be older or exempt for other reasons.

For all our simulations, we assumed inspections and maintenance would keep emissions controls functioning properly at all generators. Modern diesel particulate filters are effective at reducing emissions, though not eliminating them entirely. When those filters fail, emissions skyrocket. Monitoring and maintenance at all of the generators, if they were running continuously, would be a logistical nightmare for regulators and the owners of the generators, and likely expensive as well.

Historically, centralized power plants that have thorough on-site monitoring are the most likely to have emissions control equipment running correctly to reduce emissions verifiably. Shifting to smaller generator units in a wide range of locations creates more potential points of failure and makes it harder to figure out that something has gone wrong, and where.

In our analysis, we compared backup diesel generators with the current electrical grid, where 60% of generation is still from fossil fuels. Increasing generation from renewable energy sources, such as solar panels and wind power, could help meet the rising demand for power without the additional emissions of dangerous air pollution.

Peter Adams has received research funding from various federal organizations, including EPA, NASA, NSF, and DOE as well as private philanthropic organizations.

– ref. Using diesel generators to power the AI revolution would kill hundreds of Americans a year – https://theconversation.com/using-diesel-generators-to-power-the-ai-revolution-would-kill-hundreds-of-americans-a-year-280892

Source: The Conversation – USA (2) – By Kyle Manley, Postdoctoral research fellow, University of Colorado Boulder

Colorado’s two largest fires on record, the Cameron Peak and East Troublesome fires, burned hundreds of thousands of acres across some of the state’s most visited landscapes in 2020.

The fires scorched trails, campgrounds and beloved ecosystems in and around Rocky Mountain National Park and the Arapahoe and Roosevelt national forests.

More than five years later, the scars remain stark: blackened hillsides, closed trails and bare slopes where forests once stood. According to our recent research, which has not yet been peer reviewed, the fires caused significant and lasting declines in visitation at the burned sites.

Even after the 2020 fires, Rocky Mountain National Park attracted 4.2 million visitors in 2024, generating US$862 million in economic output in local gateway communities such as Estes Park and Grand Lake. Rocky Mountain National Park is a significant contributor to the nearly 1 billion annual visits and $700 billion in spending that public lands generate nationwide as outdoor recreation continues to grow. It also supports a variety of important social values beyond the economy, including mental health and well-being, cultural and spiritual connection, and the sense of place that binds people to landscapes.

But these landscapes are changing fast. Wildfires are affecting our public lands at an accelerating scale and increasing intensity. Yet how fire affects recreation has remained poorly understood.

That’s the question I set out to answer with an interdisciplinary team of researchers. As a scientist who studies the benefits nature provides to people and how those benefits are affected by climate change, I wanted to know whether fire is eroding one of the most recognized and valued benefits of nature: recreation.

Tracking visitation across burned landscapes

Our first challenge was gathering data about visits to these outdoor areas.

A handful of monitored public lands track visitor counts, but those counts can tell us only so much about how fires affect recreation. Wildfires often cross boundaries, for example from a national park into a national forest, and span dispersed remote areas where no one is monitoring visitation.

Alternatively, every time someone logs a hike on AllTrails, posts a nature photo to Flickr, reports a bird sighting on eBird or simply carries a phone into the backcountry, they leave a precise digital trace of where and when they spent time outdoors. We trained a visitation model on the on-site counts that do exist at monitored sites, using millions of these digital traces, alongside other recreation drivers such as weather, land cover and site characteristics, as predictors.

Across Colorado and California, this approach let us track visitation in burned areas across hundreds of wildfires and prescribed burns for years before and after each fire, even in the remote, unmonitored landscapes where most fires burn. But changes in visitation can have many causes, including weather, broader recreation trends, even pandemic effects. So we statistically paired each burned site with a very similar unburned site elsewhere on public lands. This let us measure not just what happened after each fire, but also what we could expect would have happened without it. The gap between those two is how fire actually affected recreation.

We found that it’s not simply fire itself that drives people away, but a confluence of the type and severity of a fire, the ecosystem that burned and the social values connected to the fire-impacted landscape.

Wildfires that empty trails – and ones that don’t

In Colorado, the average wildfire reduced visitation to burned sites by 8% in the year of the fire. Those declines never recovered to prefire levels for the five-year postfire period we tracked.

As fires grew larger and burned more intensely, recreational losses sharpened. Visitation dropped 15% to 20% at sites burned at higher severity. These declines lasted years. Take the Cameron Peak Fire, for example. The Arapaho and Roosevelt national forests typically see about 8 million visits a year. Our model estimates that the area burned in the Cameron Peak Fire drew nearly 500,000 visits annually before the fire. Applying our 15% to 20% average declines estimated for moderate- to high-severity wildfires, that translates to roughly 70,000 to 100,000 fewer trips annually, losses our analysis finds persist for years.

But these postfire recreational losses were largely concentrated in forested landscapes. Wildfires that occurred in grasslands, such as the southeastern Colorado Cherry Canyon Fire in 2020, by contrast, seemed to barely register with visitors. Visitation at these grassland-dominated burn sites showed essentially no change. This pattern reveals something important. People’s recreational responses to fire are not just about the physical damage and accessibility impacts. They reflect the particular relationships people hold with different landscapes. Grasses recover within a season or two, and the wide-open vistas that draw people to those landscapes remain intact, even after a fire.

Forests are different. The towering canopies, shaded trails and old-growth character that people value may take decades or centuries to return, if they return at all in a changing climate.

In California, our analysis reveals how these human-nature relationships also vary across regions, with much sharper and more persistent losses than in Colorado. Californian wildfires reduced visitation by 18% in the first year on average, and high-severity forest fires produced losses of 33% that showed no recovery five years after the fire. California’s fires tend to be significantly larger, more severe and more concentrated in forested landscapes.

However, small fires in California actually increased visitation by 8%. This suggests that after years of megafires, a small burn may barely register. Californians have grown accustomed to a fire-shaped landscape, and a modest fire scar may not be enough to keep them off the trails.

Prescribed fire tells a different story

As wildfire intensifies, land managers are responding by expanding prescribed fire programs. They are intentionally setting lower-intensity fires to clear out the dead trees, dry brush and accumulated debris built up from over a century of fire suppression that can feed catastrophic wildfires.

Current prescribed fire planning tends to focus on reducing fire suppression costs and protecting properties, as well as managing ecosystems by reducing fuel loads and improving wildlife habitat. But managers are scaling up these programs without knowing how prescribed fire affects the recreationists who visit these landscapes, a gap our analysis sets out to fill.

In Colorado, we found that on average prescribed fire actually increased visitation by about 8% in the year of the fire. This increase may reflect improved trail conditions, enhanced wildlife habitat that attracts birders and hunters, or positive public perceptions of proactive management.

In California, prescribed fire on average decreased visitation by about 3%. Crucially, in stark contrast to wildfire, impacts were short-lived, with visitation returning to prefire levels within three years in both states.

Beyond their direct effects on recreation, prescribed burns also reduce the likelihood of future extreme fires – the very fires that drive the largest and longest-lasting recreation declines.

Why this matters beyond fire

Some of the Colorado communities that are most dependent economically on recreation experienced the steepest visitation declines in the period we studied. These are towns such as Grand Lake, Durango and Gunnison, where shops, hotels, restaurants and seasonal workers rely on a steady flow of visitors, and where sales tax from those visitors funds the infrastructure and daily life of the community. Persistent declines in visitation threaten the long-term viability of these places.

The implications run beyond fire. Calls to consider less tangible benefits of nature, such as recreation, into climate impact assessments, extreme events research and conservation planning have grown recently. Turning those calls into action requires evidence that can help land managers make decisions. Our work provides some of that evidence for fire and a framework that can be used for other disturbances, such as floods and droughts. Without accounting for these less tangible values of nature, increasingly extreme climate impacts will keep eroding the experiences, livelihoods and connections that sustain the well-being of millions of Americans.

Read more of our stories about Colorado.

Kyle Manley receives funding from the CIRES Visiting Fellows Program, funded by NOAA cooperative agreement NA22OAR4320151.

– ref. Fire is transforming the US West’s public lands – research shows overlooked cost to recreation – https://theconversation.com/fire-is-transforming-the-us-wests-public-lands-research-shows-overlooked-cost-to-recreation-279831

Source: The Conversation – USA (3) – By Erika Yamazaki, PhD candidate in Neuroscience, Northwestern University

Annual medical checkups typically cover the basics: diet, exercise and mental state. Surprisingly, many primary care providers fail to ask about one of the fundamental contributors to well-being: sleep.

We are two neuroscientists who study sleep and memory. We have both experienced this omission with our own doctors, even though we represent different ages and genders.

When asked, almost everyone has complaints about their sleep, yet most people fail to prioritize sleep. But poor sleep shouldn’t be ignored.

One particularly problematic sleep disorder is sleep apnea, and it is not rare. The condition affects nearly 1 billion people worldwide, estimates suggest, and the number continues to grow. In October 2025, former basketball star Shaquille O’Neal was featured in an awareness campaign for sleep apnea. But much greater awareness is needed.

The most common type of sleep apnea, obstructive sleep apnea, is characterized by repeated blockage of breathing during sleep, often resulting in sleepiness during the day, headaches or snoring – or a combination of these – and in the long term, increased risk for cardiovascular diseases.

Patients may not fit the typical profile: The stereotype is that the ones with sleep apnea are older males trending toward obese. Others may find that their sleep-related complaints are overlooked at wellness checks. These are missed opportunities for gathering critical health information that is important for diagnosis. Sleep apnea thus remains undiagnosed far too often in women and also in other groups.

Sleep apnea is not just about sleep

Sleep apnea is more than a sleep disorder. While it manifests when you are sleeping, with repeated partial or total pauses of breathing during sleep – termed hypopneas and apneas – its effects extend far beyond the night.

Repeated apneas and hypopneas tend to occur alongside reductions in oxygen levels in the brain and body. These episodes can happen more than 100 times per hour and on average last about 20 seconds. Despite brief awakenings that can occur after a person with sleep apnea stops breathing, by the morning they usually don’t remember ever pausing their breathing.

Reduced oxygen then leads to increases in blood pressure and heart rate, which stresses the cardiovascular system. Untreated sleep apnea can lead to a host of cardiovascular diseases, such as hypertension, heart failure and stroke. Sleep apnea is also associated with increased risk of dementia, as in Alzheimer’s disease and other neurodegenerative disorders.

Beyond health effects, the disorder is linked to reduced quality of life, a higher risk for motor vehicle accidents and increased medical costs for individuals, as well as for societies and governments.

A growing problem meets new solutions

The growing prevalence of obstructive sleep apnea reflects multiple factors. Greater awareness among medical professionals and accessible screening tools have helped.

At the same time, an increase in obesity rates and an aging global population have also contributed to the rise in cases diagnosed.

The treatment of sleep apnea has also advanced considerably over the past 20 years. The standard treatment for sleep apnea is continuous positive airway pressure, or CPAP, which prevents airway collapse with a stream of air through the mouth or nose.

However, people often report that CPAP is burdensome, and for some the therapy is intolerable. For those who dislike CPAP, implantable nerve stimulation devices can be effective. Other therapies include oral appliances to shift the jaw forward and open the airway, positional therapies to avoid back-sleeping, and myofunctional training to strengthen tongue and throat muscles.

Nevertheless, new treatment approaches are still needed. In late 2024, the U.S. Food and Drug Administration approved tirzepatide – the active ingredient in the GLP-1 drugs Mounjaro and Zepbound – for treating obstructive sleep apnea. The drug helps by lowering body weight, given that excess weight is associated with the disorder.

Both new and long-standing treatments for sleep apnea can be effective in reducing the detrimental health consequences. Yet these advances raise an important question: Who gets diagnosed and ultimately benefits from the treatments – and who doesn’t?

Who gets diagnosed – and who gets missed

Despite the growing prevalence of sleep apnea, diagnosis and treatment do not occur equally across populations. Women with sleep apnea often experience headaches, insomnia and depression – symptoms that common screening tools for sleep apnea do not mention.

Hormonal changes throughout a woman’s life, different anatomy of the airway and differences in sensitivity to higher levels of carbon dioxide in the blood compared to men all suggest that more research and better tools are needed to improve healthcare for women with sleep apnea.

Many of the current diagnostic tools and treatment standards were developed based on studies in white populations.

Pulse oximetry on the finger detects decreases in blood oxygen, a key marker of sleep apnea screening and diagnosis. These finger oximeters are less sensitive in people with darker skin pigment, which likely leads to underestimates of severity.

At the same time, Medicaid beneficiaries in the U.S., who are disproportionately from racial minorities, are more likely to be denied long-term coverage for CPAP treatment, despite the finding that Black men have more severe sleep apnea than their white counterparts.

What you can do

Your probability of getting a referral to a specialist increases ninefold when you ask your primary care provider about sleep apnea. And there’s no need to be overly concerned about undergoing a sleep study in a hospital. Sleep studies can now be conducted at home to diagnose sleep apnea.

If you or your bed partner have any suspicions based on even a small subset of the possible symptoms of sleep apnea, bring it up with your healthcare provider. Mention any daytime symptoms, such as excessive sleepiness or headaches, and any nighttime symptoms, such as frequent urination, waking up short of breath, snoring or insomnia.

Starting the conversation may be the first step toward diagnosis and treatment – and to better health and well-being.

Ken Paller receives research funding from the US National Institutes of Health and the Tiny Blue Dot Foundation. He consults for and owns shares in NextSense, Inc.

Erika Yamazaki does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. Sleep apnea compromises far more than a good night’s rest – 2 neuroscientists outline the risks and the need for better diagnosis – https://theconversation.com/sleep-apnea-compromises-far-more-than-a-good-nights-rest-2-neuroscientists-outline-the-risks-and-the-need-for-better-diagnosis-276732

Source: The Conversation – USA (3) – By Sukhun Kang, Assistant Professor of Technology Management, University of California, Santa Barbara

Some clinical trials aren’t designed to answer scientific questions. They’re designed to market drugs. In our recently published research, my team and I analyzed over 34,000 industry-funded trials and found that hundreds of studies across seven medical fields were likely designed to promote a drug to physicians rather than to generate scientific data. For some fields, nearly 1% of clinical trials were for marketing purposes.

Known as seeding trials, these studies prioritize marketing over science while disguising their commercial purpose as legitimate research. Pharmaceutical companies use them to familiarize physicians with new products under the guise of data collection. Participants sign consent forms, believing they are contributing to medical knowledge.

In reality, patients are absorbing risks that serve corporate interests rather than resolving genuine uncertainty about the therapeutic potential of a drug.

The term seeding trial first entered the medical literature in 1994, when then-commissioner of the Food and Drug Administration David Kessler and his colleagues described such studies as attempts to entice doctors to prescribe new drugs through trials that appear to serve little scientific purpose.

Three decades later, the problem of seeding trials persists.

How seeding trials work

While the structure of a seeding trial looks similar to legitimate clinical trials on the surface, the objectives are different.

In a typical clinical trial, researchers recruit patients across clinics and hospitals to test whether a treatment is safe and effective.

In contrast, the pharmaceutical company behind a seeding trial enrolls large numbers of physicians at many sites, each seeing only a few patients. The goal is exposure: getting doctors to prescribe the drug, not generating robust data. Doctors may be selected based on their prescribing volume rather than their research credentials.

In a legitimate trial, the number of study sites reflects the number of patients needed to answer a scientific question. In a seeding trial, the number of sites reflects the number of doctors the company wants to reach.

Seeding trials often target drugs already on the market and operate as Phase 4, or postmarketing, studies. These types of studies are typically conducted after a drug has been approved to monitor its long-term safety or effectiveness. This trial stage receives less regulatory scrutiny than trials for initial drug approval, and the aims of the study may have limited relevance to actual patient care. For example, a seeding trial might measure whether patients prefer the taste of a new formulation or how quickly a drug dissolves in the stomach, rather than whether it actually improves health outcomes.

Legitimate trials also have independent oversight, with committees of scientists and ethicists who monitor the study’s progress and can halt it if patients are being harmed.

In a seeding trial, this oversight is often minimal. The sponsor of the study – typically the pharmaceutical company funding the research – maintains heavy control over the trial’s design and conduct.

Cases that exposed seeding trials

Seeding trials had attracted little public attention until litigation in the 1990s forced open the internal files of two major pharmaceutical companies, revealing that studies presented as science had been designed as marketing campaigns.

The most notorious example is Merck’s ADVANTAGE trial for the painkiller Vioxx (rofecoxib), which was first approved in 1999. The company presented the study, which ran from 1999 to 2001, as scientific research, but internal documents revealed that its primary purpose was to encourage physicians to prescribe Vioxx to their patients.

Meanwhile, Merck was accused of downplaying the significant cardiovascular risks associated with the drug. The consequences were severe: Approximately 30,000 lawsuits and nearly $5 billion in compensation followed Vioxx’s withdrawal from the market.

Parke-Davis’ STEPS trial for the painkiller Neurontin (gabapentin) – first approved in 1993 for epilepsy – followed a similar pattern of disguising marketing as research. Internal documents showed that the trial, which ran from 1996 to 1998, aimed to disseminate marketing messages through the medical literature and encourage clinicians to prescribe the drug off-label for conditions it was not approved for, such as neuropathic pain and bipolar disorder.

Unlike Vioxx, gabapentin was never withdrawn. The trial’s commercial legacy outlasted its scientific one.

These cases came to light only because litigation forced the release of internal company documents. Without that exposure, they would have remained indistinguishable from ordinary research.

How common are seeding trials?

My team and I study how pharmaceutical firms innovate and respond to regulations. To estimate the prevalence of seeding trials, we analyzed nearly 34,400 industry-funded Phase 3 and Phase 4 studies that posted results on ClinicalTrials.gov between 1998 and 2024. The trials covered seven therapeutic areas where researchers had previously documented seeding trials, including major depressive disorder, epilepsy, Type 2 diabetes and rheumatoid arthritis.

We screened these trials for criteria that prior research has identified as hallmarks of a seeded trial, such as low patient-to-site ratios and limited independent oversight.

Ultimately, we identified 204 trials – 0.59% – that had characteristics consistent with marketing-driven study design. The prevalence of these probable seeding trials in different disciplines ranged from 0.15% in osteoarthritis to 0.98% in rheumatoid arthritis.

These figures might understate the true scope of marketing-driven research. The criteria we used capture only the most identifiable cases of studies driven by marketing purposes. Definitively identifying seeding trials requires access to internal sponsor documents revealing the intent of the study, and those documents surface only through litigation or whistleblowers.

Many trials occupy an ambiguous middle ground, generating useful data while simultaneously serving promotional objectives. Without systematic surveillance, the full extent of marketing-driven studies remains unknown.

The criteria to identify seeding trials also require careful interpretation. A low patient-to-site ratio, for instance, can reflect the practical difficulties of enrolling patients in studies of drugs already on the market, such as trials testing new drug combinations or new uses for an existing treatment. These markers are best understood as signals of possible marketing intent warranting closer scrutiny, not proof of marketing intent.

Whether the prevalence of seeding trials has shifted with the expansion of transparency requirements over the past decade cannot be determined from existing registry data.

What can be done

Seeding trials may be uncommon, but they are not accidental. They reflect structural incentives in a system where the companies that fund research also stand to gain from its results. Strengthening transparency in clinical trial registration, funding disclosure and oversight would help ensure that clinical research serves patients first.

Along with other researchers, we’ve proposed reforms that cluster around two areas. The first is standardized reporting that discloses trial funding, investigator payments, enrollment criteria and the rationale for site selection. The second is independent oversight, such as committees funded through pooled industry levies, which are fees collected from pharmaceutical companies to finance independent monitoring. Random audits with publicly available results are one form of such oversight.

Some infrastructure for tracking financial relationships between industry and physicians is already in place. In the U.S., the Open Payments database allows public tracking of industry payments to physicians. But regulatory variability across countries creates openings for companies to conduct marketing-driven trials in jurisdictions with weaker oversight, particularly in low- and middle-income countries.

Clinicians can protect themselves and their patients by screening for a set of red flags before agreeing to participate in or cite a trial in their research. These include unusually low patient-to-site ratios, selecting investigators based on prescribing volume, sponsor-dominated oversight and study endpoints of limited clinical relevance. Consent forms are among the few documents patients see before enrolling, and clearer disclosure of the commercial and scientific purpose of a study is among the reforms we have called for.

For patients, clinicians and regulators alike, the question to ask of any trial is the same: Whom does it really serve?

Sukhun Kang does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. Clinical trials that are actually marketing ploys targeting doctors – how seeding trials put profit over patients – https://theconversation.com/clinical-trials-that-are-actually-marketing-ploys-targeting-doctors-how-seeding-trials-put-profit-over-patients-280398