It’s April 2000. I’m 14 years old, lying on a beach in the Bahamas, a bottle of SPF 20 at my side. I periodically check to see how my suntan is developing, watching with fascination as my pale white skin turns a deep, chestnut brown. Through the headphones of my Discman, Baz Luhrmann is telling the class of ’99 to “trust me on the sunscreen.” I nod along to the beat, oblivious to the irony. Luhrmann’s caution is ahead of the curve.

Looking back, 14 seems very young to have been chasing a tan: a remnant of 1970s and ’80s childhoods where we didn’t blink twice at Sun Lovin’ Malibu Barbie featuring “peek-a-boo tan lines”—pale bikini strap-marks painted onto her bronzed body—and Suntan Tuesday Taylor, a plastic doll that developed a “tan” when she got enough natural light.

Nowadays, children and adults alike know the dangers of suntanning and the importance of taking preventive actions, like staying in the shade when the sun is strongest, covering up with clothing and hats, and reapplying a high-factor sunscreen to exposed skin regularly. But when did we start using sunscreen, and why? What does this history tell us about how we use it today, and how we might work toward a more sun-safe future?

In my home country of Britain, sun products in their earliest forms were intended to treat a sunburn after it had occurred. Handwritten recipes of such remedies date back to at least the 18th century. Many of these balms included household ingredients such as milk, lemon juice, and eggs, along with items from the kitchen garden, like strawberries, sage, and cucumber. Lemon juice’s citric acid would reduce pigmentation, although with quite a sting and the risk of serious irritation. Sage (steeped in water as a wash for the face) and cucumber would be soothing and cooling. Strawberry extract has antioxidant and anti-inflammatory properties and vitamin C content; recipes instructed people to crush the fruit directly onto their face before bedtime to give their skin “the most beautiful tint” in the morning. Among the historical ingredients, bullock’s gall (cow bile) stands out as particularly unappetizing; why it was used we can’t be sure, but research has shown that it may have unexpected medical benefits.

By the early 1900s, British seaside vacationers were able to pick up a bottle of “sunburn lotion” from the pharmacy. Formulas varied, but typically they included zinc as the key ingredient, which dermatology books also recommended. Zinc would continue to appear in sunburn remedies—today in the form of calamine lotion for sunburn relief.

Remedying the effects of sun exposure was all very well and good, but even better was preventing sunburn in the first place. Before we got to full sunblock (which zinc oxide would also come to feature in), for much of the 20^th-century suntan creams had a different primary goal: averting an “unsightly” sunburn while encouraging a “glamorous” suntan.

The “cult of sunbathing” began in the late 1920s and took off in the 1930s, aided in Britain by the growth of continental European tourism. In Lady Chatterley’s Lover (1928), D. H. Lawrence describes the “acres of sun-pinked” bodies sunbathing on the Venice Lido as not just burnt but “sun-cooked.” An array of suntan creams, lotions, and oils rapidly entered the market around this time, billing themselves on the promise of “suntan without sunburn.” A tan, wisdom went, was not only aesthetically appealing but also safe and healthy.

Early 20th-century scientists thought that the increased pigmentation of the suntan would protect the skin against what was believed to be the more damaging sunburn. So, if you gradually built up a suntan, you were supposedly increasing your skin’s natural “protection.” This misguided idea perpetuated for decades—exemplified in the United States by the famous “tan don’t burn” slogan that long accompanied the Coppertone girl. We now know that there is no such thing as a safe tan: the increased pigmentation of a suntan offers minimal protection, and moreover shows that the damage has already occurred. Instead, those early “suntan without sunburn” creams would have been allowing then-unknown long-term damage to take place. We also now know that while the early focus was on increasing pigmentation to protect pale, white skin from sunburn, sun protection is important for all skin tones.

But to get where we are today, some big changes had to happen. Already in the early decades of the 20th century, ingredients like quinine and aesculin (a chestnut extract) were showing some sun-screening efficacy. Then, in the 1930s, rapid advances in this technology began to proliferate. In 1935, chemist Eugène Schueller, who later founded L’Oreal, added benzyl salicylate to a tanning oil, marking the way for chemical UV radiation absorbers.

The first modern commercial sunscreen—chemist Franz Greiter’s Glacier Cream—arrived on the market in 1946. Greiter later developed and popularized the sun protection factor (SPF) rating, and his early cream is estimated to be around SPF 2. At around the same time, during World War II, pharmacist and airman Benjamin Green discovered “red vet pet,” a petroleum jelly substance that served as an effective sunblock for soldiers. It would later be developed into a more consumer-friendly formula sold as the famous Coppertone suntan lotion.

Our understanding of the dangers of UV radiation has been advancing ever since. Now, the key focus of SPF development is on higher-efficacy formulas, and public health messaging has turned to the promotion of sun safety.

Despite what we now know about the health effects of UV exposure, the appeal of the glamorous tan persists. For those who want to safely achieve the look of Sun Lovin’ Malibu Barbie today, the 1930s tanning craze actually gave us one solution: “artificial bronzing” lotions. Marketed as offering “suntan without sunshine,” these fake tanning products were a welcome addition to the British market, especially, given our unpredictable summer weather. Early iterations were fairly simple formulas that used vegetable extracts to temporarily stain the skin, an effect that could be easily removed with soap and water. By the 1960s, more sophisticated fake-tanning chemical DHA was discovered: rather than staining, it interacts with the skin to create a more lasting effect. A boom of ’60s products followed suit, with catchy names like Easi-Tan, Turn Tan, My Tan, Man Tan, and She Tan. With today’s knowledge about the dangers of tanning from ultraviolet radiation, fake tan has an evident advantage as the only safe tan.

In 2019, my teenage beach days came flooding back to me as I sat in the doctor’s office, getting a mole checked out in a spot below my neck, where I’d had a deep, searing sunburn all those years ago.

It was reassuringly fine, but brought home the importance of continuing to keep an eye on skin changes while taking every precaution in the sun. Today if I’m on a beach it’s under a sun shade, with a T-shirt for extra cover, and the bottle of sunscreen by my side with an SPF 50 and a high UVA star rating.

The post Trust Me on the Sunscreen appeared first on Zócalo Public Square.

In early January 2018, I began to have a recurring dream. I’m sitting comfortably at the kitchen table surrounded by friends, when one of my teeth falls out. I reach up to my mouth and out come two, three more. Then, I run to the mirror, only to find my mouth full of jagged shards where my teeth used to be.

The location and people I’m sitting beside vary, but the outcome is always the same. My permanent teeth lie cupped in my palm like a handful of trail mix.

Tooth loss is a common subject of stress dreams. Dream interpreters and psychologists link it to poor self-image, fear of death, and loss of communication or control. My dream began as I packed up my apartment to move across the country for graduate school. I was afraid that uprooting my life would mean losing the community that defined me. Perhaps teeth had become a stand-in for the life I had built. Without teeth—without community—who would I be?

Both biologically and psychologically, our teeth are us, and they determine our futures. Their shape, layout, and imperfections can identify us, fingerprint-style, and serve as a physical record of our experiences, accumulating distinctive layers in response to life events like incarceration and menopause. Our oral health is inextricably tied to our overall health. How our teeth look can determine our social and economic success, and our self-esteem.

It’s strange, then, that our teeth—the hardest structures in our bodies—are so often neglected, by individuals and society. Indeed, they seem to exemplify and exacerbate all the worst aspects of American healthcare.

That starts with preventive care, or a lack thereof: The American Dental Association’s Health Policy Institute estimates that less than half of Americans visited a dentist in 2021. One reason getting people to the dentist is like pulling teeth is because as a society, we just don’t want to pay for it— just 73% of the U.S. population has dental insurance, millions fewer than the 91% with health insurance. And we don’t trust our dentists. Our anxiety about cleanings and treatments lead to avoidance, which leads to elevated pain, which only compounds the problem.

Poor dental care affects the rest of our bodies, too. Nitrate-reducing bacteria that live on the tongue convert nitrate, a compound in leafy green vegetables, into nitrite, a molecule our bodies use to produce nitric oxide, key to lowering blood pressure. There’s evidence that people with preeclampsia, or pregnancy-induced high blood pressure, have fewer of these nitrate-reducing species on their tongues. Frequent tongue brushing, but not antiseptic mouthwash, increases the abundance of these good bacteria.

Chronic inflammation in the mouth, including from persistent infection of the gums and teeth, can stress the heart and lead to increased risk of clogged arteries and heart attacks. Gum disease-related microbes that enter the bloodstream have been linked to inflammatory diseases like lupus and rheumatoid arthritis.

Tooth decay, lupus, and rheumatoid arthritis are more common among people of color, and lower socioeconomic status has been shown to correlate with worse treatment outcomes. The ways we care for our mouths, then, may aggravate existing disparities—and the landscape for dental care is fraught.

According to the CareQuest Institute, a nonprofit aiming to increase equity in dental care, 93% of people living in poverty need dental care they aren’t getting. For many, it’s simply too expensive. A 2022 study from researchers at the American Dental Association found only about a third of dentists treat Medicaid patients. (Dentists are often paid less for treating patients on Medicaid.) In another ADA study, nearly 17% of adults reported that the cost of treatment prevented them from receiving dental care, more than twice the rate reported for other medical treatments. This cost barrier affects more than 1 in 5 Black patients and 1 in 4 Hispanic patients.

Unless something changes, these broad health disparities seem likely to get worse.

Dental science is advancing rapidly—with researchers testing gene therapy strategies to regrow teeth in humans and attempting to transplant oral microbiomes to cure infections—but it won’t deliver itself to patients. Manufacturers first introduced sealants—plastic coatings dentists apply to the grooves of the teeth to prevent cavities—in 1967. These treatments are effective; for children with a history of aggressive cavities, who are at higher risk for infection and tooth pain and extraction, they could be a particularly promising solution. But insurance often doesn’t cover sealants, so they don’t get used.

Many patients remain wary of dentists trying to upsell them. Some researchers have argued that implementing so-called value-based care in dentistry, rather than a fee-for-service model, will be a critical first step in getting people into the clinic willingly. The existing fee-for-service reimbursement means dentists don’t get paid for maintaining health but for fixing problems. It incentivizes surgical procedures over preventing cavities and bolsters the perception that dentists’ goal is to sell us something. Value-based care proponents also aim to build patient trust by actively involving patients in decision-making and, critically, considering how oral health is interrelated with overall health.

The four and a half years following my recurring nightmares were, ironically, the longest I’ve ever gone without seeing a dentist. While I visited the student health clinic for primary care check-ups, they didn’t do dental, and the idea of hunting for a dentist that would accept my insurance as I juggled classes and research for my PhD was daunting. The few clinics I called in those years never got back to me. Talking to my classmates, it’s clear that’s true of many in my community—and we’re some of the lucky ones. Graduate students in STEM fields typically receive higher stipends than students in the humanities, though many are still rent-burdened and without the disposable income to pay for expensive dental procedures. I’m lucky enough to have dental insurance, but across universities and graduate programs, dental coverage is not a given.

Now, at the cusp of graduating and facing the stress of changing communities once again, I’m daydreaming not of tooth loss but of regrowth. Changes to our oral health don’t need to have endless ripple effects on our appearance, identity, and overall health. Instead, maybe we can design a healthcare system that we can all trust to keep us healthy from the mouth down.

The post Why Is Accessing Good Dental Care Like Pulling Teeth? appeared first on Zócalo Public Square.

California’s San Joaquin Valley is a place of contradictions: It is the most agriculturally productive region in the world, growing over 250 crops and grossing approximately $35 billion in annual sales of everything from fruit and nuts to livestock, wine, milk, and grains. Its 27,000 square miles reside in a geographical sweet spot, with a Mediterranean climate and land watered by once mighty rivers flowing from the Sierra Nevada mountains. The valley possesses incredible cultural diversity, too: People of more than 70 different ethnicities, speaking over 100 languages, call the region home. It is the place that gave rise, among many important cultural moments, to the powerful farmworker movement that built solidarity across race, class, and other divides.

Despite this abundance, it is also a region of deep and concentrated poverty and food insecurity. The San Joaquin Valley is the United States’ most polluted air basin for fine particles (which, when inhaled, increase the risk of a host of health problems, including early death). It is one of the surfaces on Earth most altered by humankind due to a century of mining groundwater, which has caused land to sink by as much as 28 feet in some places and counting.

These contradictions hold obvious perils, but also promise—that the science and resources government and industry have poured into extraction can be redistributed and focused instead on eliminating environmental racism and building just, livable communities.

I was born and raised in the heart of the valley, in Madera County. I was diagnosed with asthma as a kid, although my race and class in many ways buffered me from the worst impacts of our air pollution problems.

For five years I worked as an organizer for the Central Valley Air Quality Coalition (CVAQ), raising awareness of air pollution’s health impacts. Over and over again, decision makers, air regulators, and industry lobbyists constantly told me, and the community leaders and youth advocates I worked with, that we had to accept our fate, that where we live makes pollution unavoidable.

The unhealthy air to which all 4.3 million valley breathers are supposed to resign ourselves is partly rooted in the region’s role in feeding the nation and world. Industrialized agribusiness in the valley utilizes hundreds of millions of tons of pesticides, fertilizers, and other chemical inputs and uses polluting equipment such as tractors and nut harvesters. The region is also a major source of oil and natural gas production, which emits a slew of toxic air pollutants and contributes to smog and particle pollution. Trucks and trains traveling up, down, and across the state via freeways that run through our communities play a role as well. Catastrophic, climate change-fueled wildfires and extreme heat compound an already dire situation.

Research from California State University, Fullerton has shown that unhealthy air costs our region at least $6 billion dollars per year—paid in premature deaths, asthma attacks and other serious medical conditions, and missed school and work days. Compared to the national average, children in the San Joaquin Valley are twice as likely to be diagnosed with asthma before age 18.

The valley is a designated “sacrifice zone,” where industrial extraction and disposal takes precedence over human health—and where low-income, Black, brown, and Indigenous residents are asked to sacrifice the most. That is certainly true of south Stockton, which has some of the highest asthma rates in the state. Barred from living in other parts of the city, Filipinos immigrated there in the early 20th century, and the neighborhood became home to the largest diaspora in the nation. But in the 1970s, the state demolished large swaths of the neighborhood to construct Highway 4, an artery for the flow of goods in and out of the Port of Stockton. The port concentrates cancer-causing diesel pollution from ships, trains, trucks, and other equipment, which commingles with other pollution sources nearby, such as an industrial biomass plant that burns woody waste.

As I keep hearing, the people of south Stockton, like people across the San Joaquin Valley, have a “choice”: accept pollution-causing industries or suffer lost jobs and revenue. But I know it does not have to be this way. I have seen community-innovated solutions firsthand, in both my academic research and advocacy work in the region.

In extensive interviews with advocates, staff, and decision-makers at the San Joaquin Valley Air District, I learned that they agree on one thing: that the region needs transformation away from extractive industries in order to achieve clean air. As one decision-maker told me, “The only way you’re going to change the Air [District Governing] Board is change the boards of supervisors because they control the Air Board, and until you get a majority of the supervisors who don’t have that farmer mentality, you’re not going to be able to change the valley.” They added, “The economy has to be diversified.”

Change, however, can also come from the ground up, which I’ve witnessed in my time at CVAQ, where I returned as executive director after receiving my PhD in geography. I’ve seen how communities across the valley continue to take matters into their own hands when it comes to air pollution, to protect and improve neighborhoods. Local campaigns in Kern and Los Angeles Counties, combined with years of cross-regional organizing, have built the political will to help institute a 3,200-foot health and safety setback rule to protect people from oil drilling. The setback will help keep homes, hospitals, schools, and other sensitive receptors farther from oil wells, which increase the risks of respiratory illnesses, cancer, and other health issues for people living and working nearby.

In south Stockton, community groups like Little Manila Rising are providing asthma management services to the most impacted households, distributing resources such as indoor air filters, planting trees, and employing unhoused and formerly incarcerated community members. Little Manila Rising, CVAQ, and the enforcement division of the California Air Resources Board are collaborating on a multi-year research project that is engaging the community in studying and implementing solutions to address diesel truck traffic.

There are many more opportunities to create jobs and build a more equitable and healthy San Joaquin Valley. We have a history of building solidarity to achieve change. California has abundant science, people power, and economic resources to make good on its claims as an environmental trendsetter that prioritizes equity.

The post Where Bad Air Carries Peril and Promise appeared first on Zócalo Public Square.

My depression was triggered by The Lion King. Watching Scar throw Simba’s father to his death, I started crying and couldn’t stop. I was 11, terrified something would happen to my mom—my lifeline, and the parent who had removed us from an abusive situation six years earlier. That night, it felt like a dark room opened inside my chest, filled with feelings I couldn’t name.

The room stayed with me—sometimes growing larger, containing hopelessness and instances of self-harm, and sometimes emptying, only to fill up again with a new sense of despair. Ashamed of this endless loop, I struggled with how to integrate mental illness into my personal narrative.

Those feelings were the catalyst for my new children’s novel, Zia Erases the World, the story of an 11-year-old girl facing her first depression. Zia doesn’t know how to talk about her room of shadows, which she calls the Shadoom, and keeps her secret locked inside her. Upon discovering a magical dictionary that can erase whole concepts from existence, Zia erases fear, pain, and sadness. After the world unravels as a result, she has to make it right.

When I speak at schools around the country, I share two stories: Zia’s, and my own. I acknowledge that today’s students face realities I never imagined, from accelerating climate change to active shooter drills. In 2019 more than 1 in 3 high school students experienced persistent feelings of sadness or hopelessness, a 40 percent increase since 2009. That same year, 21 percent of American children reported having had a major depressive episode at some point.

In December 2021, US Surgeon General Vivek Murthy released a landmark advisory on the youth mental health crisis—which he called “alarming” before the pandemic and “devastating” after a year and a half of quarantines and isolation.

But if tweens and teens were given the chance to shape their own narratives, what would they say?

I decided to find out by speaking with them directly. Most of the young people I interviewed were strangers to me. But after more than a dozen interviews, I got to know Diemond, Camryn, Iona, Jaime, Wyatt, and Rayan, all of whom asked me to use their first names for this piece. “Depression feels like a bad dream,” said Diemond, a 19-year-old from New York. “The same dream over and over, and you can’t wake up.”

Camryn, an 18-year-old from Illinois, described depression as “a lot more than just feeling sad. It’s those ups and downs. Feeling empty and not having motivation to get out of bed, brush my hair, brush my teeth.”

Iona spoke to me outside their therapist’s office, two days before their 11th birthday. For them, the depression began as numbness. “When my dog got sick, I felt absolutely nothing. I couldn’t grieve or cry. That was tough. My dog passed away and I didn’t feel anything. It was just like if a snail died.”

“I got worse,” Iona went on. “I started feeling again, and I wanted to hurt myself.” These desires “weren’t scary to me at the time—I just thought they were normal and this happened to everybody. Now that I’m better and taking medication, I realize those weren’t normal thoughts.”

As I conducted more interviews, I noticed that the young people who identified as female or non-binary spoke more about depression. Those who identified as male spoke more about anxiety. My sample size was admittedly small—according to the CDC, boys and girls report similar levels of anxiety. But the statistics do point to higher rates of depression, suicidal ideation, and attempted suicide among girls.

Jaime, a fifth grader from Los Angeles, told me by phone how he tries to stave off his anxiety attacks by focusing on something else. “But sometimes it feels like you’re delaying the feeling, and then it builds up like water boiling. You get that low heat and it starts to simmer, and then you notice it and think, ‘I’ve gotta turn down the heat.’ But at some point, you’ve just gotta throw in the pasta. You gotta let it boil. And then let it pass. Just try not to burn down the house.”

Despite the subject matter, these weren’t depressing conversations. One mom shared that her son came out of his room “looking a foot taller.” He told her, “It felt so good to talk about everything.”

That was the one resounding common thread in all the interviews: Talking helps. Young people don’t want to be forced to talk, but having even one person they feel safe opening up to makes a huge difference, whether it’s a teacher, therapist, parent, or friend.

For 13-year-old Wyatt, the anxiety and depression began in third grade. “My uncle, my grandma, my cousin, and my cat all died, which was pretty hard for me,” he said. Eventually, he tried counseling. It took a couple of counselors to find the right fit, but the second one gave Wyatt tools that helped him move through the grief. “In my house we had this little corner with soft blankets and squishy things. Me and my mom set it up. It felt like you were getting hugged by a whole bunch of penguins. We called it the ‘Cozy Corner.’ I could go lie down and burrow in for a couple minutes or a couple hours, close my eyes and relax.”

Unsurprisingly, the pandemic came up often, and many acknowledged a pervasive sense of loss. “I’m 11,” Jaime said. “Covid was 25 percent of my life. When things finally started to get better, my mom took me to Trader Joe’s, and I just walked around remembering half the products in the store. ‘Look at the Fig Newtons! Look at the mango popsicles!’ I was having the time of my life. Only later did I get sad. I realized what a big part of my childhood I missed.”

Rayan, a high school senior from Syracuse, used the time to be more creative. “I created my first ever documentary during the pandemic,” she told me. “It covered my daily routine, coming to the United States, the fears of being an outsider. I have so many things people hate. I’m Black, I’m Muslim, I’m female.”

When I asked Rayan about mental health, she said she doesn’t like to talk about her emotions. But watching her quiet, haunting documentary, it’s abundantly clear she has found other means of self-expression. “When I write, it’s kind of like I’m talking to my emotions,” she said. “If nobody is listening, at least my notebook will listen to me.”

As a writer, I believe in the power of artistic expression to heal, comfort, and connect. Shaping our own narratives can help us find light amid the shadows: something the tweens and teens I spoke to did with stunning clarity and courage.

As a child, I was fortunate to have adults in my life I could open up to. After The Lion King, I told my mom what I was feeling, and she immediately found a mental health professional to offer support. Even so, it took many years before I could find the right words for my experience. But as I speak more publicly about my depression in the wake of Zia Erases the World, it has put me on a path parallel to Zia’s. Inspired by the honesty of the children and young adults I’ve met, I’m trying to embrace mental illness as a part of my narrative. And by naming my most private pain, my darkest secret, I hope to help young people feel the same way they’ve made me feel: less alone.

At my last school visit, a fifth grader asked: “When did your Shadoom go away?”

The answer, much like depression itself, is complicated. It did go away, and it didn’t.

But what I told her—what I tell everyone I speak to—is that you are always adding tools to aid in your self-care. Therapy. Medication. Friends. Art. Music. Books. If you can name your own dark room, the people in your life can rise up to meet you. Mental health struggles become a means of connection, not isolation. And instead of erasing your story, you tell it as a way to survive.

The post How the Kids Are Getting to All Right appeared first on Zócalo Public Square.

Then came colic. Night after night, cuddles were met with blood curdling screams, each one more enigmatic than the last.

Yet by all reasonable standards, she was completely fine: her diaper was dry. She just ate. There was no sign of reflux. She’d just woken from sleep. Nevertheless, every night, for weeks, my daughter continued to cry, typically from the hours of 10 PM to 2 AM.

At the time, I was in my third year of my pediatric residency, merely weeks away from becoming a board-certified pediatrician. I felt as though I should know how to comfort my daughter, if not as her mother than as a medical professional, who had dedicated more than a decade toward higher education, and the last three years to pediatrics exclusively.

On my newborn rotations in residency, I regularly counseled new parents on the nuances of infants and provided experienced parents refreshers, both clinical and practical. I recited feeding regimens, skin abnormalities, stooling patterns, and other “basics” with ease. I lived by the five S’s— swaddle, side-stomach position, shush, swing, and suck—introduced by pediatrician Harvey Karp in The Happiest Baby on the Block. Again and again, moms watched in awe as I used these techniques to soothe their babies to sleep after marathons of cluster feeding, and I felt like I was empowering them to do the same.

But all of these methods failed to pacify my own daughter. Her screams were so piercing that one night, I took her to her changing table, completely undressed her, and looked at every finger and toe for hair tourniquets. Finding none, I proceeded to perform a full physical examination, complete with cardiac auscultation and primitive reflex assessment. Everything was normal. I swaddled her up, held her in my arms, and sank deeply into the recliner in her nursery. She screamed herself to sleep, and I felt like a failure.

First described in 1954 by physician Morris Wessel in a paper describing infants who cried excessively, colic stems from the Greek “kolikos,” which means “relating to the colon.” Wessel and others suggested that colic stems from gastrointestinal issues, but modern medicine has not pinpointed an exact etiology. To meet the definition, an infant must cry for at least three hours per day for at least three days per week for at least three weeks without an otherwise identifiable cause. Approximately 20 percent of newborns, like my daughter, are subject to this phenomenon, primarily from 3 to 12 weeks of age. But few research dollars are allocated to the condition, because it is self-limiting: In other words, curing colic “just takes time.”

But I wasn’t ready to hear that yet. I’ve always believed that mothers and doctors fix things; we clean up the scrapes and bandage them up. And if we cannot cure the ailment, we give comfort. Finding myself in a situation with my own daughter where I could provide neither my confidence in my abilities as a parent and medical professional plummeted.

In the following weeks, I received a lot of well-meaning advice from friends and family who wanted to help ease the burden. I leaned into my own medical background, as well, reading what little else I could find on the subject: Some parents find comfort in giving their newborns mylicon drops, a medication advertised to relieve the bowels of gas. Others change their infant’s formula or their own diet if they are breastfeeding. I gave my daughter a probiotic, Lactobacillus reuteri, the only medication studies show to have mild benefit.

In my line of work, I have fought harder battles than an infant with colic. During this global pandemic, I have treated patients dying in pediatric intensive care units, unable to be surrounded by their family or friends. Now as a pediatric hematology and oncology fellow, I regularly tell mothers and fathers their child has or is dying from cancer.

But this was my daughter, and her pain penetrated my heart in ways I’ve always hardened myself against while at work. In short, I lost sight of one of the most basic tenets of medical ethics: you do not treat your family.

I was reminded of this at her three-month check-up, when her pediatrician (also a friend from residency) assured me that I was not overlooking any aspect of my baby’s health. This affirmation gave me a new sense of resolution and confidence. Yes, she’s uncomfortable, but I was doing everything in my power to ensure that she’s healthy and loved. With that realization, I started to trust myself as a physician again and recognize that I needed to give myself the space to be her mom first and doctor second. In that space, I found new conviction in the cure for colic: time.

I started to take each day hour by hour, diaper by diaper. And sure enough, like clockwork, around 13 to 14 weeks, the nonsensical crying ebbed almost as quickly as it washed over us.

Relief was an understatement. Seeing my daughter through colic was a singularly terrifying and exhausting experience, one that jettisoned me into the realities of motherhood. There is a helplessness that nobody warns you of as you celebrate the birth of an infant. How somehow your own heart has left your body, and survival, both yours and theirs, is dependent on their wellbeing.

The experience has also lent me a new understanding to each patient encounter. In the moments where I recognize the same of loss of control in new parents that my husband and I went through, I bypass the five S’s and remind them to trust themselves and give it time.

Time is the most contentious medicine. Glance around the waiting room the next time you are at the doctor’s office. I imagine you will find most engrossed in their phones, trying their best to pass the time. We all want something active to help us feel engaged, most especially when there is nothing to do.

But take it from a pediatrician who is also a mother, your child will grow faster than you can possibly imagine. You will be thankful for that some days. Other days you may wish to stop blinking all together, if only to slow down the changes happening right in front of you. But that is not how time works.

Right now, I am enjoying my daughter’s cries of excitement as I walk through the door after a day at the hospital. And I am hoping that one day soon she will sleep through the night. Fingers crossed.

The post Curing My Daughter’s Colic appeared first on Zócalo Public Square.

Now that 2020 is mercifully in the past, we have data (from the U.S. Bureau of Economic Analysis) to evaluate the “grim calculus” in each state. And looking at that data—especially for large states, which have more diversified economies—the results may surprise. It’s hard to find any real trade-off between COVID lockdowns and decreased economic activity.

If anything, we find the opposite.

First, let’s step back and look at larger state data. Of those states that performed better economically than the U.S. as a whole in 2020, the state of Washington, with greater than average COVID restrictions, took first place. Then came three less COVID-stringent states—Arizona, Colorado and Georgia—followed by three more stringent states—North Carolina, Maryland, and Virginia.

Then, in eighth place, came California, one of the most stringent states. After California, only three other states outperformed the country economically—Texas, Indiana, and Florida, all less stringent. Across these 11 states it is hard to find a trade-off; states with more COVID restrictions did well economically and those with fewer restrictions also did well.

And if we look beyond those 11 states to all states, we find a striking pattern: States with more stringent interventions had on average better economic outcomes and better health outcomes.

Is this just a statistical anomaly? The answer seems to be no. One reason to be confident of the result is to look at other countries. Consider, for example, Sweden, well-known for having few stringent COVID measures. In 2020, Sweden had worse health outcomes than the similar Scandinavian countries of Denmark, Norway, and Finland. At the same time, its economic outcomes during the pandemic were no better than any of its healthier neighbors.

The finding also fits with history. A 2008 Federal Reserve Bank of St. Louis survey of the 1918 influenza pandemic found that St. Louis, which took the flu more seriously and opened up later, had better economic and health outcomes than Philadelphia, a city that opened up sooner.

Similarly, 2020 research into the 1918 pandemic found that cities with more stringent interventions had better employment gains and better health outcomes.

What explains this seemingly strange but persistent result? The power of government signaling.

When a state indicates through policy and pronouncements that it takes the pandemic seriously enough to impose measures (sometimes extreme) to control the spread of the disease and protect public health, it is sending a message to its citizens. Part of that message is about businesses. The state is saying that there are protocols in place to make open businesses as safe as possible, and were that not possible, the businesses would be closed.

But when a state indicates through policy, as Sweden did, that individuals should make a choice as to what they do during a pandemic and that the government will not choose for them, it sends a different signal. It is saying, “Citizens, you are on your own, choose wisely.” So, while an open business will be busier than a closed one, the open businesses are likely to do better in a place with more stringent restrictions.

Does this show up in data? Yes, in some ways. Using OpenTable’s data for the pandemic, a decline in the number of diners was more dramatic for restaurants and bars in California than Texas. However, for those individual businesses were open, hours worked by employees fell by only 1.5 percent in California versus an 8.9 percent decline in Texas. But this is simply cherry picking two states. The decline in the number of diners in Minnesota, Massachusetts, and Ohio was comparable to that in Florida, Georgia, and Missouri even though the former were closer to California in restrictions and the latter closer to the Swedish approach.

The retail sector data paint a similar picture. For the same large states mentioned above, there is no significant correlation between changes in retail sales and the stringency of COVID interventions. A similar analysis of retail purchases by type of store also shows no correlation between interventions and the volume of sales. And, for the smallest 10 states, the same result holds true. People headed to online platforms to purchase goods at about the same rate regardless of the stringency of interventions.

The bottom line is that people respond to the information they have and the signals they receive from their government. Clearly, business closures increase unemployment in affected sectors. But there is no evidence to suggest that closures and other public health interventions have led to worse economic outcomes. So, the trade-off, such as it is, must be between sectors directly impacted by interventions and, in states and countries with fewer interventions, voluntary lower demand and more work absenteeism due to higher overall infection rates.

Knowing all this, you might still believe that the freedom to choose is valuable enough to pay the societal and health costs of that freedom. But empirically it is not a trade-off between health and economic outcomes. It is a trade-off between the freedom to choose and public health.

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At a virtual event presented by Zócalo and the Commonwealth Club on YouTube, Facebook, and Twitter, Sunstein—Harvard Law School’s Robert Walmsley University Professor and author of the new book Too Much Information: Understanding What You Don’t Want To Know—strove to answer the question, “How Much Information Is Too Much?”

The inspiration for the book and the event, he told moderator Lauren Goode, senior writer and podcast host at WIRED, was partly his friend’s thoughts regarding popcorn and partly his father being diagnosed with a brain tumor in his 60s. Sunstein’s mother chose not to tell him that he would die within the year. She decided, “telling him he’s going to die is too much information,” said Sunstein, explaining that she wanted her husband to enjoy his last months without staring death in the face. “She didn’t want to ruin his popcorn, basically.”

How do you decide what information is worth sharing, or what information you yourself need? It comes down to two questions, said Sunstein: Is the information useful? And, how does the information make people feel?

There’s a great deal of information that people don’t want to know, Sunstein has found in his research, including calorie counts, genetic tendencies (including whether you are predisposed to cancer and Alzheimer’s), the fuel economy of your car—even whether the person you’re crushing on returns the sentiment.

“For some people, information isn’t going to change their behavior,” said Sunstein. They don’t want to know if hell exists because they’re probably going if so, and they don’t want the calorie count on their cheeseburger because they’re not going to start a diet. However, others consider such information useful—they want to know the side effects of a medication they’re taking in order to decide whether it’s worth it.

This dilemma “gets at something deep in the human condition,” said Sunstein, that goes back to the choice Adam and Eve face in the Garden of Eden. “Do they want to eat the apple—which is the question, do they want to know?”

But Adam and Eve only had themselves to worry about. In 2020, we have the novel coronavirus and loads of new information coming at us from all fronts. “What do you propose is too much information in the era of COVID-19?” Goode asked Sunstein.

We can go back to the same two questions once again, said Sunstein. The usefulness of information is paramount, especially to people most vulnerable to the virus. “They need to know, even if it scares them, because they might be scared but alive, and that’s a good tradeoff,” he said. The question of how information makes us feel is more complicated because terrifying people or making everything seem hopeless is cruel. “You want to give people the information with a sense of hope and good cheer,” said Sunstein, pointing to New Zealand Prime Minister Jacinda Ardern telling her nation that the Easter bunny and tooth fairy were exempt from lockdown.

And then there is the question of misinformation—which can become dangerous, as in the case of hydroxychloroquine, an arthritis medicine that President Trump called a “game changer,” despite its known side effects and a lack of data backing up any benefits it may have against COVID-19. “When you have something that has become so polarizing,” asked Goode, “how do you propose that people in positions of authority communicate about it?”

“The obvious thing about misinformation that’s bad is that people believe it, and they’ll act in response to it,” said Sunstein. And even if they’re immediately given a correction, they’ll still remember the first statement as true. “That’s a real problem for social media and for newspapers and magazines. It suggests that telling people a falsehood even when it’s corrected may be not a good thing,” he warned.

Social media and politics were hot topics in the audience question-and-answer session, from Facebook’s recent announcement that they are banning new political ads a week before the election to the role of information when it comes to keeping democracy alive.

“Love it,” said Sunstein regarding Facebook’s ban, which he believes could help prevent “a falsehood pandemic that could create a terrible distortion.” When pressed by Goode, he noted that it was possible that the ban should be put in place earlier.

And when it comes to democracy, Sunstein believes that giving people the choice—to read further or not—is paramount, because some people want and need more information and others will be overwhelmed by more than the basics. “Citizens need to be able to figure out whom they like and the issues,” he said. “But also, they’re entitled to be busy and to want to know something about the issues they care about but not about the rest.”

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