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New study finds epilepsy drug could reduce sleep apnoea symptoms

New research has found that a drug used for epilepsy could be used to reduce the symptoms of sleep apnoea. Obstructive sleep apnoea, which affects about one in 20 people, according to the National Institute for Health and Care Excellence in England, includes symptoms like snoring and it causes a person's breathing to start and stop during the night, with many requiring an aid to help keep their airways open. An international study has identified that taking sulthiame, a drug sold under the brand name Ospolot in Europe, may help prevent patients' breathing from temporarily stopping. This provides an additional option for those unable to use mechanical breathing aids like the Cpap machines. “The standard treatment for obstructive sleep apnoea is sleeping with a machine that blows air through a face mask to keep the airways open. Unfortunately, many people find these machines hard to use over the long term, so there is a need to find alternative treatments,” Prof Jan Hedner from Sahlgrenska university hospital and the University of Gothenburg in Sweden said. Researchers conducted a randomised controlled trial of almost 300 obstructive sleep apnoea patients across Europe, who did not use Cpap machines. They were divided into four groups and given either a placebo or different strengths of sulthiame. The study measured patients’ breathing, oxygen levels, heart rhythm, eye movements, as well as brain and muscle activity while asleep. It found after 12 weeks, those taking sulthiame had up to 50% fewer occasions where their breathing stopped, and higher levels of oxygen in their blood. However, a bigger study needs to be done to confirm the beneficial effects on a larger group. The findings, were presented at the European Respiratory Society Congress in Vienna, Austria. Erika Radford, the head of health advice at Asthma + Lung UK said the findings were a positive step forward in moving away from having to rely on mechanical breathing equipment. “This potential alternative to the current main treatment would make it easier for people to manage their condition,” she said. Image: Shutterstock

Body

Common drug shows potential in reversing ageing

A common medication has been found to have anti-ageing qualities, with scientists finding that the drug can de-age monkeys. Metformin, a cheap and common diabetes drug that has been used since the 1950s, could be an anti-ageing elixir, with scientists from the Chinese Academy of Sciences and Beijing Institute of Genomics using the pill to "markedly" slow down ageing in the animals. According to the experts, the medication reduced deterioration of the brain and boosted cognitive abilities in the primates while also slowing down bone loss and aiding in the "rejuvenation" of several tissues and organs. The most significant improvements were seen in the liver and frontal lobe, the part of the brain responsible for language, reasoning, problem solving, memory, movement and personality. Researchers said all of the findings led to the conclusion that "metformin can reduce biological age indicators" up to six years, with the medication paving the way for ageing reversal in humans. The drug was previously tested on mice, but since testing the medication on Cynomolgus monkeys - that are both physiologically and functionally similar to humans - the tests have shown more promise for potential human trials. The researchers said of the 40-month study, "Our research pioneers the systemic reduction of multi-dimensional biological age in primates through metformin, paving the way for advancing pharmaceutical strategies against human ageing." The scientists added, "[The study] represents an important advance in the quest to delay human ageing, with geriatric medicine research gradually shifting its focus from treating individual chronic diseases to systemic intervention against ageing." Image credits: Shutterstock

Body

"Lucky to be alive": Concerning Andrew O'Keefe update

Andrew O'Keefe will remain in jail after his bail was revoked, just days after being arrested on drug charges. The former TV host was arrested on Monday and charged with drug possession after police searched a nearby car and allegedly found methamphetamine. His arrest came just hours after the 52-year-old was discharged from the <a href="https://oversixty.com.au/health/caring/andrew-o-keefe-rushed-to-hospital" target="_blank" rel="noopener">hospital</a>, after he was revived by paramedics in the early hours on Sunday morning after an alleged drug overdose. In Waverley Local Court on Tuesday, Magistrate Jacqueline Milledge said O’Keefe was “lucky to be alive” as she read a police statement of facts on an application to detain the former TV host rather than let him out on bail again. O'Keefe was out on bail at the time of the alleged overdose, after allegedly breaching a court order, trespassing and intimidating a man in Sydney’s eastern suburbs in July. O’Keefe’s lawyer did not argue against the application and the magistrate revoked his bail, meaning he will remain custody before his return to court in October. “If he wants to stay alive that’s the best thing to do,” Milledge said. O’Keefe’s lawyer suggested a possible application for release on the next occasion for O’Keefe to receive treatment but Milledge said “a “highly persuasive” argument would be required. O’Keefe’s frequent appearances in court are “absolutely tragic” and “very, very sad,” the magistrate said. “He’s a frequent flyer, he’s just so used to it,” she said. “The mental health applications, the rehab, all been tried, and tested, and failed. “I just don’t see the same thing over and over again is going to be working for him and, god help him, it’s a shame that he doesn’t have an epiphany.” Image credits: Seven News

Caring

Andrew O'Keefe rushed to hospital

Andrew O'Keefe has been rushed to hospital after being revived by paramedics at a party in Sydney's Eastern Suburbs over the weekend. The disgraced TV host was partying at a home in Vaucluse at 3:30am on Saturday when emergency services were called after allegedly suffering a drug overdose. Paramedics revived O'Keefe at the scene before transporting him to the nearby St Vincent's Hospital for treatment. The Daily Telegraph reported that he has since been released from hospital. In a statement, NSW Police said of the incident, "Officers attached to Eastern Suburbs Police Area Command were called to a home unit on Old South Head Road at Vaucluse about 3.40am, responding to concerns for the welfare of a 52-year-old man." "NSW Ambulance paramedics rendered assistance to the man before taking him to St Vincent's Hospital where he was reported to be in a stable condition. Inquiries into the incident are continuing." O'Keefe's health incident comes just days after a court upheld his convictions for domestic violence assault, as District Court Judge John Pickering rejected his lawyers' arguments that a woman had inflicted scratch marks on her own arm and later blamed O'Keefe. The troubled former TV star was convicted in January of three counts of domestic violence-related assault, twice contravening an AVO against him, and two charges for possessing a prohibited drug. He was ordered to serve 18 months on a community corrections order, which involves supervision and reporting requirements, and fined $800 for the drug offences. Image credits: JOEL CARRETT/EPA-EFE/Shutterstock Editorial

Caring

Ian Thorpe opens up on darkest moment of his career

Ian Thorpe has recalled the moment an irregular drug test almost upended his life and destroyed his reputation. The Aussie swimming legend opened up about a few key moments in his personal life that coincided with the height of his swimming career in a tell-all new book. The 41-year-old athlete singled out the drug test chapter as one of the darkest moments of his career in a new book Profiles In Hope, written by former NSW Liberal leader John Brogden. In 2006, Thorpe underwent a routine drug test that returned an irregular result, with French newspaper L’Equipe reporting that he had returned an unusual level of testosterone. However, results also showed a hormone called leutenising hormone, another naturally occurring substance. The news of the test gained international attraction, and resulted in Thorpe launching a lawsuit against the newspaper. “An irregular test isn’t uncommon. They happen. So firstly, no one should know that information to begin with,” Thorpe says in the book, according to the <a title="www.dailymail.co.uk" href="https://www.dailymail.co.uk/sport/olympics/article-13845887/Ian-Thorpe-goes-public-never-heard-devastating-admission.html">Daily Mail</a>. “An irregular test means nothing. An irregular test gets thrown out." He said at the time the speculation that he was a cheat was “so upsetting” and the way the information was leaked to French journalist made him feel “deeply alarmed”. He also admitted that during the media storm around the testing, he did not want to leave his home and says now he had thoughts about taking his own life and staging it as an accident. The “Thorpedo” now has the tools in place for his mental health to look back and think he could have handled it better. “In that kind of state, you’re entirely irrational, your logic is warped,” he tells Brogden. “It’s only in the periods when you have clarity of mind, when your mental health is good, that you can actually reflect on things and say, ‘Well, I could have done this’. “I realised what I was doing wasn’t working, and that I needed help. So I got that help, and even though I was still in a long-term depressive state, I got better. I wasn’t at the point of suicide.” Need to talk to someone? Don't go it alone. Call Lifeline on 13 11 14 or <a href="http://lifeline.org.au/" target="_blank" rel="noopener noreferrer" data-stringify-link="http://lifeline.org.au" data-sk="tooltip_parent">lifeline.org.au</a> Image credits: Shutterstock

Caring

Tragic flaw sees man use voluntary assisted dying drugs prescribed for his wife

Warning: This article contains discussions of suicide and depression that some readers may find upsetting A Queensland coroner has criticised the state's voluntary assisted dying laws, after an elderly man took his own life using drugs prescribed for his wife. The Coroner's Court in Brisbane held an inquest into the May 2023 death of a man in his 80s, referred to by the pseudonym ABC. The man's partner, who had a terminal illness, was found eligible for the voluntary assisted dying [VAD] program in March 2023. Under that law a person can self-administer a VAD substance in a private location but they must nominate a "contact person" who will be legally required to return any unused or leftover portion within 14 days. The self-administered drug was delivered to the couple's home a month later, and the man was the "contact person" responsible for the substance. On the same day the drug arrived, his wife was admitted to hospital with Covid, where they decided to take an intravenous VAD drug. She died in hospital on May 8, 2023. The man was told to return the drug within two days of his partner's death, but he failed to do so, using it to take his own life eight days later. He did not return the drug as he was unable to leave his home, and there was no arrangement made for a health professional to collect it. ABC’s adult daughter recalled the moment she found her lifeless father after returning from running errands. “I thought he was asleep in the chair. I put my arms around him. He was cold,” she told the inquest. The woman became emotional and said that she found an empty box in the kitchen and “knew immediately it was the VAD”. In his findings, coroner David O’Connell said he was not judging the merits of VAD, but it had led to a "tragedy" only 107 days after it was legalised. “Persons should not be placed in a position where they can be led into unwise decisions,” the coroner said in his findings handed down on Wednesday. O'Connell said that the laws had failed to find a balance between a patient's autonomy and lethal medication safety. “The VAD law has (the substance) provided to persons with no medical training, no regulatory oversight, and in a period of great personal and emotional turmoil,” he said. The inquest heard ABC had previously been diagnosed with, and received medication for depression, which should've been considered before approving someone as a contact person. "The fact that ABC had been medically diagnosed with depression and took medication was not something the VAD authorities considered, or even enquired on, when approving them to be a Contact Person. Indeed, there are simply no checks or enquiries of the Contact Person's suitability," he said. He added that while there was no breach of protocol or legislative processes by QVAD personnel, it was "not a well-considered law". O'Connell recommended the Queensland government implement an earlier draft of VAD laws that required oversight by a medical professional at all times. Queensland Health Minister Shannon Fentiman said the government would consider the coroner’s recommendations. “Following that case, we are working on a review of that legislation coming up to three years that will start next year, and that will obviously be one of the things that we look at,” she said. Image: Shutterstock

Caring

"So Australian": Local trust praised for response to illegal tree cutting

A resident's decision to cut down a tree for a better view of Sydney Harbour has backfired after a sign was erected where the tree once stood, to condemn tree vandalism. Following multiple reports of resident carrying out tree vandalism along affluent streets, the Sydney Harbour Federation Trust has called out the behaviour by setting up the sign in the Sydney lower North Shore suburb of Woolwich. "Tree vandalism has occurred in this area," the sign read. "The Sydney Harbour Federation Trust protects and manages this land for the enjoyment of the public. "Acts of vandalism like this deprive all of us of the natural environment." The sign also warned that offenders could be subject to fines and/or prosecution as punishment, and urged those who notice any suspicious activity to contact 8969 2100. After an image of the sign was shared to a Sydney group on social media, the local trust's actions have been praised, with many saying they "loved how petty this is" and one even declaring the response "so Australian". "I hope they keep this sign, as a reminder to anyone contemplating doing something similar," one commented. "We're petty but we have a right to be. You don't f**n poison or cut down trees. F**n unacceptable behaviour," another added. Others accused the person who cut down the tree of being "entitled". In last November alone, over 300 native trees and shrubs vanished in front of multi-million dollar homes along the Sydney Harbour waterfront strip. Lane Cove Council believe that hand tools were used to silently cut down the trees, which impacts plants, and local wildlife including wallabies, possums and dozens of other species. On Monday, the council put out a statement saying its "pursuit of justice" is now ramping up, referring to the incident as "the largest tree vandalism case in Lane Cove’s recent history". They are trying to obtain permission to put up a sign to block "the harbour view of the property which would most benefit from the mass clearing of the trees." "As the area is classified as a Threatened Ecological Community and contains some items of Aboriginal Heritage, it was important the appropriate approvals were in place before installing the signage," the council added. "The legal case and banner installation are important steps in our commitment to seeking the strongest possible recourse response to send a message that we stand tall against tree vandalism." Images: Reddit

Legal

Five people arrested over Matthew Perry's death

Five people have been arrested in connection with the death of Friends actor Matthew Perry, who died of a drug overdose in October 2023. Matthew Perry’s assistant Kenneth Iwamasa, two doctors, and two alleged drug dealers, including Jasveen Sangha, the so-called “Ketamine Queen of Los Angeles”, have been arrested over the star's death. All five suspectes are facing charges including “conspiracy to distribute ketamine” over allegations they supplied the 54-year-old with the illegal drugs in the final weeks of his life. In the last four days of his life, Mr Perry paid $100,000 AUD for 70 vials of ketamine. Three of the five people charged have pleaded guilty to several drug-related offences, while a licensed doctor and an alleged drug dealer arrested in California on Thursday are the lead defendants in a “broad, underground criminal network” to distribute ketamine to Mr Perry and others. “These defendants took advantage of Mr Perry’s addiction issues to enrich themselves. They knew what they were doing was wrong. They knew what they were doing was risking great danger to Mr Perry, but they did it anyway,” said US Attorney Martin Estrada. Following the arrests, Matthew Perry's stepfather has shared a message of gratitude to law enforcement and hoped justice would be served. Keith Morrison, a Canadian journalist, and other loved ones of the Friends star in a statement issued to NBC News say they are finding some solace in the legal system nine months on from his death. "We were and still are heartbroken by Matthew's death, but it has helped to know law enforcement has taken his case very seriously," they said. "We look forward to justice taking its course." Image credits: Matt Baron/BEI/Shutterstock Editorial

Legal

Aussie Olympian arrested in Paris after trying to buy drugs

An Aussie Olympian has been arrested after he was caught on the streets of Paris trying to buy a gram of cocaine. Hockey superstar Tom Craig tried to outrun police when he was caught, before realising he couldn't evade the authorities and surrendered. He and teammates had been at a family and friends celebration at the Hotel Maison in Montmartre in the 9th arrondissement after both his team and the Hockeyroos team of girlfriend Alice Arnott lost in the quarter finals. The 28-year-old had spent nearly 18 hours in custody after being arrested at midnight on Tuesday before being released with “a probationary criminal warning for drug use”. As a result of his indiscretion, the Kookaburras veteran has had his Olympic rights stripped from him, been banned from the athletes village and told he does not have the right to march in the closing ceremony. Craig, who is a qualified solicitor, fronted the media in central Paris hours before an AOC press conference, in which he apologised for his behaviour. “I would firstly like to apologise for what has occurred over the last 24 hours,” the Tokyo silver medallist said. “I made a terrible mistake and I take full responsibility for my actions." “My actions are my own and by no way reflect the values of my family, my teammates, my friends, the sport and the Australian Olympic team. I have embarrassed you all and I’m truly sorry.” In the AOC press conference, Australian Olympic chef de mission Anna Meares said she was adamant Kookaburras star Tom Craig was acting alone when trying to purchase the drugs. “We do feel very confident that this is an isolated incident,” Meares said. “I would rather be here talking about the three gold medals that we have won today. But here we are first." “I cannot condone what Tom has done. He is a good person who made a bad decision. But there are consequences that come with decisions like this." “Our team has been exemplary at these Games and his actions do not reflect the values of this team, nor do they diminish this team’s performances. He has apologised, shown remorse and he has owned up to his mistake and we will support him if he needs help." Image credits: X (Twitter)/DAVE HUNT/EPA-EFE/Shutterstock Editorial

Legal

“Outrageous”: Silver medal stripped after illegal act

The women's 5,000m final has ended in controversy after the second place holder was stripped of her medal and disqualified. Kenya’s Beatrice Chebet took out first place in the final, while her fellow countrywoman Faith Kipyegon crossed the line second. The two Kenyan champions were seen celebrating with their country's flag after the race concluded, but their celebrations were cut short when news of Kipyegon's disqualification came through. Replays show that with two laps of the race to go, Kipyegon became entangled in a close proximity battle with Ethiopian rival Gudaf Tsegay as they raced for the first place. Kipyegon appeared to pull on the arm of Tsegay who reacted angrily by fending off the Kenyan. A Eurosport commentator was in disbelief over the display and couldn’t quite believe Kipyegon had been disqualified over the act. “That was outrageous I’m afraid. I am astonished,” he said on the global broadcast. “That was dreadful. She was not in front of her and shouldn’t have moved into her space. She wasn’t remotely far enough in front of her. There’s a rule you cannot [enter] into the space of an athlete where their feet are landing. Tsegay there was very out of order." “I think Tsegay was pushing into Kipyegon. Kipyegon just tried to protect her area, her zone so to speak." “If anything from those pictures what I’ve witnessed so far, and we need to get more information, I think Tsegay should have been disqualified. I am utterly flabbergasted. I cannot believe it. If anything they’ve got it completely wrong.” Because of the disqualification, Dutchwoman Sifansaw Hassan moved into the silver medal position, while Italy’s Nadia Battocletti took bronze. The Kenyan team officials, however, were determined to fight the disqualification, as they swiftly filed an appeal, arguing that the contact between the two athletes was incidental and did not warrant being stripped of her medal. After a thorough review of the incident, the appeal panel agreed with the Kenyan team’s assessment, concluding that the contact was part of the natural dynamics of a highly competitive race. As a result, Kipyegon's silver medal was reinstated. Image credits: Dave Shopland/Shutterstock Editorial <p style="box-sizing: inherit; border: 0px; font-stretch: inherit; line-height: inherit; font-size-adjust: inherit; font-kerning: inherit; font-variant-alternates: inherit; font-variant-ligatures: inherit; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-position: inherit; font-feature-settings: inherit; font-optical-sizing: inherit; font-variation-settings: inherit; margin: 0px 0px 24px; padding: 0px; vertical-align: baseline;">

Legal

For a century, it’s been illegal to swim in the Seine. Will Paris’s clean-up make the river safe for Olympic swimmers?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/ian-a-wright-5162">Ian A. Wright</a>, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a> Five eagerly anticipated events in the Paris Olympics will be the mens and womens 10 kilometre marathon swimming races, as well as the 1,500 metre swimming section of three triathlon events. Why? Because all will be held in the Seine River in the centre of Paris. The swimmers – including <a href="https://www.swimmingworldmagazine.com/news/trio-complete-an-historic-australian-olympic-marathon-swim-team-for-paris-2024">four Australians</a> – will pass famous landmarks such as the Musee d'Orsay as they swim through the historic heart of the city. This will have enormous scenic appeal for spectators. But will it be safe for swimmers? Rivers running through large cities are <a href="https://www.nature.com/articles/s42949-021-00026-w">often polluted</a>, whether from stormwater, chemical pollution or wastewater spills. As the marathon swimmers pass the <a href="https://musee-egouts.paris.fr/en/">Paris Sewer Museum</a>, they may well wonder if they’re in clean water. For more than 100 years, swimming in the Seine has actually been illegal, due to concerns over what the water could do to human health. Authorities <a href="https://www.theguardian.com/sport/article/2024/may/24/olympic-games-clean-up-aims-to-leave-parisians-swimming-in-the-seine">have been working</a> to clean up the water, spending A$2.2 billion (€1.3 billion) on improving water quality. The goal: cut bacterial contamination by 75% before the first swimmer touches the water. These measures are having an impact – but recent heavy rains have seen bacteria levels spike. While officials have put on brave faces, there’s now a <a href="https://www.reuters.com/sports/olympics/paris-2024-sets-up-reserve-site-marathon-swimming-if-seine-unsuitable-2024-07-05/">contingency plan</a> in case the Seine isn’t safe. <h2>Why swim in the Seine at all?</h2> Urban rivers have a questionable reputation. But this isn’t the first time the Seine River has been used for Olympic swimming. In the 1900 Paris Olympics, <a href="https://olympics.com/en/olympic-games/paris-1900/results/swimming">seven swimming events</a> were all held in the river. These games were the first modern Olympics where <a href="https://olympics.com/ioc/faq/history-and-origin-of-the-games/when-did-women-first-compete-in-the-olympic-games">women could compete</a> in some sports, but swimming was not one of those permitted. The Australian swimmer who competed, Frederick Lane, had to swim under the United Kingdom’s flag as Australia did not have a flag until Federation the following year. He won two gold medals. One was for the 200 metre freestyle race, and the other for a bizarre race never held again: the 200m <a href="https://www.olympedia.org/results/4433">swimming obstacle race</a>, where swimmers had to climb over poles and boats. These Olympics also saw the first and last underwater swimming race, which was also in the Seine. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/606823/original/file-20240715-17-kajph6.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/606823/original/file-20240715-17-kajph6.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/606823/original/file-20240715-17-kajph6.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=378&fit=crop&dpr=1 600w, https://images.theconversation.com/files/606823/original/file-20240715-17-kajph6.jpg?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=378&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/606823/original/file-20240715-17-kajph6.jpg?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=378&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/606823/original/file-20240715-17-kajph6.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=475&fit=crop&dpr=1 754w, https://images.theconversation.com/files/606823/original/file-20240715-17-kajph6.jpg?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=475&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/606823/original/file-20240715-17-kajph6.jpg?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=475&fit=crop&dpr=3 2262w" alt="historic photo swimming seine river paris" /></a><figcaption>Swimmers took to the Seine’s waters at the 1900 Paris Olympics, when the river ran cleaner. <a class="source" href="https://commons.wikimedia.org/wiki/File:Swimming_1900.jpg">Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></figcaption></figure> Back then, the waters of the Seine were cleaner. That’s because there was a great demand for human waste on farms – and cities were the main source. Back then, “night soil” (human waste) had a <a href="https://hess.copernicus.org/articles/11/1757/2007/hess-11-1757-2007.pdf">real market value</a>. No one would think of dumping it in rivers. But as time went on, sewerage systems developed and other fertilisers such as guano and mineral fertilisers arrived. By the early 20th century, most of the city’s wastewater went into the Seine. In 1923, the swimming ban came into effect. A year later, Paris hosted the Olympics for its second time – and swimmers competed in 50 metre pools. In recent years, many cities around the world have worked to clean up their urban waterways. River swimming is <a href="https://www.timeout.com/news/the-european-cities-cleaning-up-rivers-for-wild-swimmers-101821">now common</a> in cities such as Copenhagen, Berlin and Vienna, where river health has improved dramatically. <h2>How can you clean a river like the Seine?</h2> Cleaning the Seine is a challenge. Paris is home to 11 million people, with plenty of industry. Urban rivers are almost inevitably polluted by waste from the <a href="https://www.nature.com/articles/s42949-021-00026-w%5D">surrounding city</a>. Leaking and overflowing sewage systems are a major source of pollution. In places like the UK, <a href="https://www.bbc.com/news/explainers-62631320">sewage spills</a> into waterways have become a major political issue. When wastewater spills into rivers, it carries pollutants and dangerous loads of <a href="https://www.cdc.gov/mmwr/volumes/67/wr/mm6725a1.htm">disease-causing microorganisms</a>, such as Escherichia coli (commonly known as E. coli). Untreated water can have viruses, bacteria and disease-causing protozoa. In the lead-up to the Paris games, authorities have been working to improve water quality enough to bring some Olympic swimming back to the Seine. Stormwater – often contaminated by dog poo or sewage overflows – is <a href="https://www.theguardian.com/environment/2023/oct/08/can-paris-clean-seine-for-next-year-2024-olympics">being cleaned</a> before it is released into the river. Despite the money and effort, there are still real questions over whether it will be enough to guarantee swimmer safety. Bacterial levels hit risky levels <a href="https://edition.cnn.com/2024/07/11/sport/paris-olympics-seine-triathlon-bacteria-spiking-intl/index.html">most days in June</a> due to unseasonally heavy rains, but the water has <a href="https://www.france24.com/en/france/20240712-seine-clean-enough-to-swim-for-most-of-past-12-days-paris-says-ahead-of-olympics">improved in July</a>. This week, French sports minister Amélie Oudéa-Castéra <a href="https://www.nbclosangeles.com/paris-2024-summer-olympics/french-sports-minister-takes-dip-in-seine-river-2024-paris-olympics/3458469/">swam a few metres</a> in the Seine in an effort to douse concerns. By contrast, the other Olympic swimming events will take place in a recently constructed 50 metre pool, which will have very good water quality. The pool water is filtered and treated with a disinfectant such as chlorine or bromine. It will be regularly tested to ensure optimal water quality. At the Tokyo 2020 Olympics, triathletes had to swim in polluted Tokyo Bay. But similar concerns over sickness proved unfounded. The real challenge was the <a href="https://www.theguardian.com/environment/2021/aug/05/olympic-athletes-and-volunteers-in-tokyo-tortured-by-heat">oppressive heat</a>. <h2>What’s at risk?</h2> The most likely outcome if races are held when bacterial levels are unsafe would be getting a gastrointestinal bug. Officials have some control over this. Contamination is worst after heavy rain. Races could be delayed if need be. Many swimmers – especially those who compete in open-water competitions – are familiar with swimming in water with some level of pollution. Some see it as worth the risk. Italian double world champion swimmer Gregorio Paltrinieri <a href="https://www.france24.com/en/live-news/20240226-paris-holds-its-breath-for-olympic-swimming-events-in-murky-seine">said in January</a>: <blockquote> Even if the water is dirty, I would rather swim in an electric atmosphere in the centre of Paris than in an anonymous stretch of water. </blockquote> Paris 2024 organisers previously warned there was no plan B for the 10 km marathon races in the Seine if water quality testing is unsuitable. But this has now changed. If the river isn’t clean enough, open water swimming <a href="https://www.reuters.com/sports/olympics/paris-2024-sets-up-reserve-site-marathon-swimming-if-seine-unsuitable-2024-07-05/">will be moved</a> to the rowing venue. The Olympic triathlon is planned around a swimming leg in the Seine. But triathletes <a href="https://www.espn.com.au/olympics/story/_/id/39912675/triathlon-leg-cancelled-seine-quality-paris-2024-chief">have been told</a> the swim leg could be skipped if the water is unsafe, which would turn the race into a running and cycling duathlon. As the world’s attention turns to Paris, there will be many anxious officials behind the scenes hoping their hard work on making the Seine swimmable pays off.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/231705/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/ian-a-wright-5162">Ian A. Wright</a>, Associate Professor in Environmental Science, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a> Image credits: CARON/ZEPPELIN/SIPA/Shutterstock Editorial This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/for-a-century-its-been-illegal-to-swim-in-the-seine-will-pariss-clean-up-make-the-river-safe-for-olympic-swimmers-231705">original article</a>. </div>

Travel Trouble

“Is this illegal?”: Mum sparks debate over divisive rubbish bin tactic

A mother has reignited an age-old debate over neighbourhood etiquette, asking whether it is "illegal or frowned upon” to add rubbish to a neighbour’s wheelie bin if yours is completely full. Brooke Bliss, who lives on the NSW Mid North Coast, said that in her area bins were only collected once a fortnight and her outside bins fill up very quickly as a family of five. Often left with overflowing rubbish by the time collection day rolls around, Bliss admitted that she waits till the "dead of night" on the day before the bins are emptied and tosses a couple of bags of general waste into neighbours' bins. “Is this illegal or frowned upon?” the creator asked her followers in a video online. The mother-of-three explained to <a href="https://au.news.yahoo.com/mum-sparks-debate-over-widespread-rubbish-bin-tactic-everyone-does---but-is-it-illegal-004710089.html" target="_blank" rel="noopener">Yahoo News Australia</a>, “It’s actually super stressful, especially when you have young children… the bins fill up quite quickly.” “I find that my bin is full maybe like the fourth day after it’s just been collected and there’s still another eight or so days to go.” She added that she had “the most lovely neighbours” who would never have an issue with it, but she’d heard of other people being told not to do that by other residents. “I mean, if your neighbours aren’t letting you do that even if they have room in their bin, you then have the rubbish lying around your property because you have nowhere else to put it," Bliss added. Many fellow Aussies commenting on her video said they also sneak rubbish into their neighbours' bins and that once they were on the kerb they were fair game, with one adding, "as long as you're not putting rubbish in recycling or garden waste". “Both our neighbours know we do this to them,” one wrote, while another said, “I do it in broad daylight.” With a third adding, "everyone does this". While there are technically no laws against using your neighbours' bin, trespassing could be an issue unless you wait until the bin is on council land. A spokesman for Bliss's local council said that the move is generally frowned upon unless there is an agreement among neighbours. Image credits: Instagram / Shutterstock

Legal

“Greedy” landlord slammed for illegal act

A Victorian landlord has been slammed on social media after admitting to making her tenants pay an illegal pet bond amounting to $1000. The woman made the admission while replying to a post on a Facebook group for Victorian landlords after a member asked for advice about renting to tenants who have pets. "Not knowing everything but in my experience I would rather have pets than kids!" the landlord began. "I would ask for a pet bond. I have one it's $1000 for damages by the pet," she said Pet bonds are illegal in Victoria, and landlords who try to secure it illegally often describe it as a way to cover costs if their pet causes any damages to the property. When the poster replied saying that her tenant offered to provide a pet bond, but she knows they're not legal in Victoria, the landlord confessed that: "I know they are not legal but I always ask for them and my PM (property manager) has been great about them.” “I have lots of pets personally and don’t turn down animals. Again, kids have done more damage than animals in my experience,” she added. “Most renters are happy to do it as it means they can have animals.” In Victoria renters who want a pet on the property must ask the rental provider, and if they refuse the request, the landlord must provide a valid excuse, with assistance dogs being the exception. If a pet causes damages to a property, the cost of these damages can be taken out of the regular bond paid at the start of their tenancy, so a pet bond is not required. Western Australia is the only state where landlords can legally ask for a pet bond, but even then they can only charge a maximum of $260 regardless of how many pets there are. A screenshot of the landlords shocking admission was shared on X by by popular renter’s advocate, Jordie van den Berg with the caption: “Landlord: ‘yeah I know it’s not legal, but I do it anyway’." Outraged renters slammed the landlord's “greedy” and “vile” behaviour, with one calling it “emotional blackmail”. “‘Most renters are happy to pay’ – I’m sure none of them are happy but they need somewhere to live without having to give up their pet," one wrote. “I personally would not describe myself as ‘happy’ to be exploited over an illegal bond that I can’t dispute when you go ahead and invent some bulls**t to keep it because the alternative is that it’s almost impossible to get a rental with pets,” another added. “The most concerning thing is the manager, how many illegal bonds have they taken and where is the money being held? In the agents account, with the owner? It wouldn’t be with fair trading where legal bonds are lodged,” a third wrote. This comes after a recent Rental Affordability report shared by Anglicare Australia revealed that “the housing crisis is the worst it’s ever been." According to the report only 0.6 per cent out of 45,000 listings across the country were considered affordable for a person earning a full-time minimum wage. Image: Jordie Berg/ X/ Shutterstock

Legal

To tackle gendered violence, we also need to look at drugs, trauma and mental health

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/siobhan-odean-1356613">Siobhan O'Dean</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/lucinda-grummitt-1531503">Lucinda Grummitt</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/steph-kershaw-1466426">Steph Kershaw</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> After several highly publicised alleged murders of women in Australia, the Albanese government this week pledged <a href="https://ministers.pmc.gov.au/gallagher/2024/helping-women-leave-violent-partner-payment">more than A$925 million</a> over five years to address men’s violence towards women. This includes up to $5,000 to support those escaping violent relationships. However, to reduce and prevent gender-based and intimate partner violence we also need to address the root causes and contributors. These include alcohol and other drugs, trauma and mental health issues. <h2>Why is this crucial?</h2> The World Health Organization estimates <a href="https://iris.who.int/bitstream/handle/10665/341604/WHO-SRH-21.6-eng.pdf?sequence=1">30% of women</a> globally have experienced intimate partner violence, gender-based violence or both. In Australia, <a href="https://www.abs.gov.au/statistics/people/crime-and-justice/partner-violence/latest-release#key-statistics">27% of women</a> have experienced intimate partner violence by a co-habiting partner; <a href="https://pubmed.ncbi.nlm.nih.gov/37004184/">almost 40%</a> of Australian children are exposed to domestic violence. By gender-based violence we mean violence or intentionally harmful behaviour directed at someone due to their gender. But intimate partner violence specifically refers to violence and abuse occurring between current (or former) romantic partners. Domestic violence can extend beyond intimate partners, to include other family members. These statistics highlight the urgent need to address not just the aftermath of such violence, but also its roots, including the experiences and behaviours of perpetrators. <h2>What’s the link with mental health, trauma and drugs?</h2> The relationships between mental illness, drug use, traumatic experiences and violence are complex. When we look specifically at the link between mental illness and violence, most people with mental illness will not become violent. But there <a href="https://theconversation.com/bondi-attacker-had-mental-health-issues-but-most-people-with-mental-illness-arent-violent-227868">is evidence</a> people with serious mental illness can be more likely to become violent. The use of alcohol and other drugs also <a href="https://theconversation.com/alcohol-and-drug-use-exacerbate-family-violence-and-can-be-dealt-with-69986">increases the risk</a> of domestic violence, including intimate partner violence. About <a href="https://www.aihw.gov.au/family-domestic-and-sexual-violence/understanding-fdsv/factors-associated-with-fdsv">one in three</a> intimate partner violence incidents involve alcohol. These are more likely to result in physical injury and hospitalisation. The risk of perpetrating violence is even higher for people with mental ill health who are also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525086/">using alcohol or other drugs</a>. It’s also important to consider traumatic experiences. Most people who experience trauma do not commit violent acts, but there are <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(23)00075-0/fulltext">high rates</a> of trauma among people who become violent. For example, experiences of childhood trauma (such as witnessing physical abuse) <a href="https://www.sciencedirect.com/science/article/pii/S1359178915000828?via%3Dihub">can increase the risk</a> of perpetrating domestic violence as an adult. Early traumatic experiences can affect the brain and body’s <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0895-4">stress response</a>, leading to heightened fear and perception of threat, and difficulty regulating emotions. This can result in aggressive responses when faced with conflict or stress. This response to stress increases the risk of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9675346/">alcohol and drug problems</a>, developing <a href="https://pubmed.ncbi.nlm.nih.gov/30798897/">PTSD</a> (post-traumatic stress disorder), and <a href="https://psycnet.apa.org/record/2015-17349-001">increases the risk</a> of perpetrating intimate partner violence. <h2>How can we address these overlapping issues?</h2> We can reduce intimate partner violence by addressing these overlapping issues and tackling the root causes and contributors. The early intervention and treatment of <a href="https://doi.org/10.1186/s12905-019-0728-z">mental illness</a>, <a href="https://doi.org/10.1177/1541204020939645">trauma</a> (including PTSD), and <a href="https://doi.org/10.1016/j.avb.2015.06.001">alcohol and other drug use</a>, could help reduce violence. So extra investment for these are needed. We also need more investment to <a href="https://www.sciencedirect.com/science/article/pii/S2212657023000508">prevent mental health issues</a>, and preventing alcohol and drug use disorders from developing in the first place. <a href="https://www.sciencedirect.com/science/article/pii/S074937972200023X?via%3Dihub">Preventing trauma</a> from occuring and supporting those exposed is crucial to end what can often become a vicious cycle of intergenerational trauma and violence. <a href="https://journals.sagepub.com/doi/10.1177/070674371105600505">Safe and supportive</a> environments and relationships can protect children against mental health problems or further violence as they grow up and engage in their own intimate relationships. We also need to acknowledge the widespread <a href="https://store.samhsa.gov/product/practical-guide-implementing-trauma-informed-approach/pep23-06-05-005">impact of trauma</a> and its effects on mental health, drug use and violence. This needs to be integrated into policies and practices to reduce re-traumatising individuals. <h2>How about programs for perpetrators?</h2> Most existing standard intervention programs for perpetrators <a href="https://journals.sagepub.com/doi/10.1177/1524838018791268">do not consider</a> the links between trauma, mental health and perpetrating intimate partner violence. Such programs tend to have <a href="https://psycnet.apa.org/doi/10.1037/a0012718">little</a> or <a href="https://doi.org/10.1016/j.cpr.2021.101974">mixed effects</a> on the behaviour of perpetrators. But we could improve these programs with a <a href="http://rcfv.archive.royalcommission.vic.gov.au/MediaLibraries/RCFamilyViolence/Reports/RCFV_Full_Report_Interactive.pdf">coordinated approach</a> including treating mental illness, drug use and trauma at the same time. Such “<a href="https://www.sciencedirect.com/science/article/pii/S014976341930449X?via%3Dihub">multicomponent</a>” programs show promise in meaningfully reducing violent behaviour. However, we need more rigorous and large-scale evaluations of how well they work. <h2>What needs to happen next?</h2> Supporting victim-survivors and improving interventions for perpetrators are both needed. However, intervening once violence has occurred is arguably too late. We need to direct our efforts towards broader, holistic approaches to prevent and reduce intimate partner violence, including addressing the underlying contributors to violence we’ve outlined. We also need to look more widely at preventing intimate partner violence and gendered violence. We need developmentally appropriate <a href="https://theconversation.com/4-things-our-schools-should-do-now-to-help-prevent-gender-based-violence-228993">education and skills-based programs</a> for adolescents to prevent the emergence of unhealthy relationship patterns before they become established. We also need to address the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7278040/">social determinants of health</a> that contribute to violence. This includes improving access to affordable housing, employment opportunities and accessible health-care support and treatment options. All these will be critical if we are to break the cycle of intimate partner violence and improve outcomes for victim-survivors. <hr /> The National Sexual Assault, Family and Domestic Violence Counselling Line – 1800 RESPECT (1800 737 732) – is available 24 hours a day, seven days a week for any Australian who has experienced, or is at risk of, family and domestic violence and/or sexual assault. If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14. In an emergency, call 000.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/229182/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/siobhan-odean-1356613">Siobhan O'Dean</a>, Postdoctoral Research Associate, The Matilda Centre for Research in Mental Health and Substance Use, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/lucinda-grummitt-1531503">Lucinda Grummitt</a>, Postdoctoral Research Fellow, The Matilda Centre for Research in Mental Health and Substance Use, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/steph-kershaw-1466426">Steph Kershaw</a>, Research Fellow, The Matilda Centre for Research in Mental Health and Substance Use, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/to-tackle-gendered-violence-we-also-need-to-look-at-drugs-trauma-and-mental-health-229182">original article</a>. </div>

Caring

Two-up, Gallipoli and the ‘fair go’: why illegal gambling is at the heart of the Anzac myth

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/bruce-moore-291912">Bruce Moore</a>, <a href="https://theconversation.com/institutions/australian-national-university-877">Australian National University</a> Two-up is an Australian gambling game in which two coins are placed on a small piece of wood called a “kip” and tossed into the air. Bets are laid as to whether both coins will fall with heads or tails uppermost. It is one of the core activities of Anzac Day celebrations - and a beloved tradition. The word <a href="https://www.britannica.com/topic/ANZAC">ANZAC</a> was created in 1915 as an acronym from Australian and New Zealand Army Corps. By 1916 it was being used emblematically to reflect the traditional view of the virtues displayed by those in the <a href="https://www.britannica.com/event/Gallipoli-Campaign">Gallipoli campaign</a>, especially as these are seen as national characteristics. This cluster of national characteristics includes mateship, larrikin daredevilry, anti-authoritarianism, and egalitarianism. The game of two-up became indicative of these qualities. Mateship was evident in the way the game brought together people of disparate backgrounds. Larrikinism was evident in the defiant rejection of authority and convention. Two-up was always illegal, because the game is an unregulated form of gambling (although from the 1980s it became legal in most Australian states on Anzac Day). But in spite of the illegality, it was widely regarded as the fairest of gambling games, and at the time of the First World War the verbal command for the coins to be spun was not “come in spinner” (as it is now) but “fair go”. Indeed, the important Australian concept of the “fair go” was in part cemented by its role in the game. Two-up was the common pastime of the urban working-class man, and it feeds into the elements of egalitarianism and anti-authoritarianism that are central to both the Anzac myth and the Australian myth. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/458543/original/file-20220419-17-6mgarp.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/458543/original/file-20220419-17-6mgarp.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/458543/original/file-20220419-17-6mgarp.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=466&fit=crop&dpr=1 600w, https://images.theconversation.com/files/458543/original/file-20220419-17-6mgarp.jpg?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=466&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/458543/original/file-20220419-17-6mgarp.jpg?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=466&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/458543/original/file-20220419-17-6mgarp.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=585&fit=crop&dpr=1 754w, https://images.theconversation.com/files/458543/original/file-20220419-17-6mgarp.jpg?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=585&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/458543/original/file-20220419-17-6mgarp.jpg?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=585&fit=crop&dpr=3 2262w" alt="" /></a><figcaption>Two original 1915 Australian pennies in a kip from which they are tossed. Roland Scheicher/ Wikimedia</figcaption></figure> <h2>Two-up and wartime life</h2> From the very early period of the First World War, two-up assumed great importance among the Australian troops. Soldiers reported that two-up was played on the battlefield during the Gallipoli campaign, even when under shellfire. As the war dragged on, numerous stories were told about Australian soldiers’ obsession with playing it. In 1918 the <a href="https://www.awm.gov.au/collection/P10676229">war correspondent Charles Bean</a> studied the daily life of a company of Australian soldiers stationed at a brewery in Querrieu in northern France. He places great emphasis on two-up, writing in his diary in 1918: "Two-up’ is the universal pastime of the men. … It is a game which starts in any quarter of an hour’s interval or lasts the whole afternoon. The side road outside becomes every evening a perfect country fair with groups playing these games in it - a big crowd of 70 or 80 at the bottom the street, in the middle of the road; a smaller crowd of perhaps twenty on a doorstep further up. … The game is supposed to be illegal, I think; but at any rate in this company they wink at it." Two-up was important not just in taking soldiers’ minds off the realities of the war, but also in creating a strong sense of community. Photographs from the war that show the men playing two-up reveal how it brought them together physically in a communal activity. This helps explains why men, who in civilian life may have had little or no interest in gambling, joined in the camaraderie and fun of the two-up fair, and by so doing blotted out the boredom, isolation, and loneliness of much wartime experience. <h2>Anzac Day and tradition</h2> Playing two-up became an integral part of the diggers’ memories of the experience of war, especially when commemorated on Anzac Day. By the 1930s the playing of two-up outdoors after the Anzac Day march had become an entrenched tradition. As the ranks of diggers from the two world wars declined, so the structure of Anzac Day changed in emphasis. In recent years the Dawn Service has increased greatly in popularity, while the Anzac Day march has <a href="https://www.abc.net.au/news/2019-04-07/concern-over-australias-dwindling-number-of-world-war-veterans/10911602">suffered from dwindling numbers</a> of veterans. The streets of Sydney and similar cities are no longer dotted with two-up games in the afternoon. The games have shifted to pubs and clubs, and they are largely played by people with no experience of war. Those people who play the game on this day do so not for any deep-seated gambling impulse or because they would love to play the game on every other day of the year. They play two-up because it has become part of the meaning of Anzac Day. Anzac Day has always combined solemnity and festivity. The Dawn Service commemorates the landing at Gallipoli, and the sacrifices that ensued. Its mood is solemn. In the past, returned soldiers reminisced, told war yarns, drank, and played two-up. The soldiers have passed on, but their larrikinism survives in the tradition of the game they have bequeathed to their descendants. We should not underestimate the significance of rituals of this kind—the playing of two-up is a way in which Australians can become not just observers of, but participants in, their history and their myths. Two-up is a ritual that links the present with the past on this one day of the year.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/181337/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/bruce-moore-291912">Bruce Moore</a>, Honorary Associate Professor in the School of Literature, Languages, and Linguistics, <a href="https://theconversation.com/institutions/australian-national-university-877">Australian National University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/two-up-gallipoli-and-the-fair-go-why-illegal-gambling-is-at-the-heart-of-the-anzac-myth-181337">original article</a>. </div>

Money & Banking

What happens when I stop taking a drug like Ozempic or Mounjaro?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Drugs like Ozempic are very <a href="https://dom-pubs.pericles-prod.literatumonline.com/doi/10.1111/dom.12932">effective</a> at helping most people who take them lose weight. Semaglutide (sold as Wegovy and Ozempic) and tirzepatide (sold as Zepbound and Mounjaro) are the most well known in the class of drugs that mimic hormones to reduce feelings of hunger. But does weight come back when you stop using it? The short answer is yes. Stopping <a href="https://jamanetwork.com/journals/jama/fullarticle/2812936">tirzepatide</a> and <a href="https://doi.org/10.1111/dom.14725">semaglutide</a> will result in weight regain in most people. So are these medications simply another (expensive) form of yo-yo dieting? Let’s look at what the evidence shows so far. <h2>It’s a long-term treatment, not a short course</h2> If you have a bacterial infection, antibiotics will help your body fight off the germs causing your illness. You take the full course of medication, and the infection is gone. For obesity, taking tirzepatide or semaglutide can help your body get rid of fat. However it doesn’t fix the reasons you gained weight in the first place because obesity is a chronic, complex condition. When you stop the medications, the weight returns. Perhaps a more useful comparison is with high blood pressure, also known as hypertension. Treatment for hypertension is lifelong. It’s the same with obesity. Medications work, but only while you are taking them. (Though obesity is more complicated than hypertension, as many different factors both cause and perpetuate it.) Therefore, several concurrent approaches are needed; taking medication can be an important part of effective management but on its own, it’s often insufficient. And in an unwanted knock-on effect, stopping medication can undermine other strategies to lose weight, like eating less. <h2>Why do people stop?</h2> Research trials show anywhere from <a href="https://asean-endocrinejournal.org/index.php/JAFES/article/view/1771">6%</a> to <a href="https://pubmed.ncbi.nlm.nih.gov/35015037/">13.5%</a> of participants stop taking these drugs, primarily because of <a href="https://www.health.harvard.edu/staying-healthy/glp-1-diabetes-and-weight-loss-drug-side-effects-ozempic-face-and-more">side effects</a>. But these studies don’t account for those forced to stop because of cost or <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023">widespread supply issues</a>. We don’t know how many people have needed to stop this medication over the past few years for these reasons. Understanding what stopping does to the body is therefore important. <h2>So what happens when you stop?</h2> When you stop using tirzepatide or semaglutide, it takes several days (or even a couple of weeks) to <a href="https://pubmed.ncbi.nlm.nih.gov/30565096/">move out of your system</a>. As it does, a number of things happen: <ul> <li>you start feeling hungry again, because both <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4119845/">your brain and your gut</a> no longer have the medication working to make you feel full</li> </ul> <ul> <li> blood sugars increase, because the medication is no longer acting on the pancreas to help control this. If you have diabetes as well as obesity you may need to take other medications to keep these in an acceptable range. Whether you have diabetes or not, you may need to eat foods with a <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/carbohydrates-and-the-glycaemic-index">low glycemic index</a> to stabilise your blood sugars </li> <li> over the longer term, most people experience a return to their <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10092593/">previous blood pressure and cholesterol levels</a>, as the weight comes back </li> <li> weight regain will mostly be in the form of fat, because it will be gained faster than skeletal muscle. </li> </ul> While you were on the medication, you will have lost <a href="https://academic.oup.com/jes/article/5/Supplement_1/A16/6240360">proportionally less skeletal muscle than fat</a>, muscle loss is inevitable when you lose weight, no matter whether you use medications or not. The problem is, when you stop the medication, your body preferentially puts on fat. <h2>Is stopping and starting the medications a problem?</h2> People whose weight fluctuates with tirzepatide or semaglutide may experience some of the downsides of <a href="https://pubmed.ncbi.nlm.nih.gov/21829159/">yo-yo dieting</a>. When you keep going on and off diets, it’s like a rollercoaster ride for your body. Each time you regain weight, your body has to <a href="https://www.jomes.org/journal/view.html?doi=10.7570/jomes.2017.26.4.237">deal with</a> spikes in blood pressure, heart rate, and how your body handles sugars and fats. This can <a href="https://cardiab.biomedcentral.com/articles/10.1186/s12933-022-01735-x">stress</a> your heart and overall cardiovascular system, as it has to respond to greater fluctuations than usual. Interestingly, the risk to the body from weight fluctuations is greater for people who are <a href="https://jech.bmj.com/content/74/8/662">not obese</a>. This should be a caution to those who are not obese but still using tirzepatide or semaglutide to try to lose unwanted weight. <h2>How can you avoid gaining weight when you stop?</h2> Fear of regaining weight when stopping these medications is valid, and needs to be addressed directly. As obesity has many causes and perpetuating factors, many evidence-based approaches are needed to reduce weight regain. This might include: <ul> <li> getting quality <a href="https://www.hindawi.com/journals/ije/2010/270832/">sleep</a> </li> <li> exercising in a way that builds and maintains muscle. While on the medication, you will <a href="https://pubmed.ncbi.nlm.nih.gov/32628589/">likely have lost muscle</a> as well as fat, although this is not inevitable, especially if you <a href="https://www.europeanreview.org/article/34169">exercise regularly</a> while taking it </li> </ul> <ul> <li> addressing emotional and cultural aspects of life that contribute to over-eating and/or eating unhealthy foods, and how you view your body. Stigma and shame around body shape and size is not cured by taking this medication. Even if you have a healthy relationship with food, we live in a culture that is <a href="https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2009.159491">fat-phobic and discriminates</a> against people in larger bodies </li> <li> eating in a healthy way, hopefully continuing with habits that were formed while on the medication. Eating meals that have high nutrition and fibre, for example, and lower overall portion sizes. </li> </ul> Many people will stop taking tirzepatide or semaglutide at some point, given it is expensive and in short supply. When you do, it is important to understand what will happen and what you can do to help avoid the consequences. Regular reviews with your GP are also important. <hr /> Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/224972/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, General Practitioner, PhD Candidate, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-happens-when-i-stop-taking-a-drug-like-ozempic-or-mounjaro-224972">original article</a>. </div>

Body

No, taking drugs like Ozempic isn’t ‘cheating’ at weight loss or the ‘easy way out’

<a href="https://theconversation.com/profiles/clare-collins-7316">Clare Collins</a>, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Obesity medication that is effective has been a long time coming. Enter semaglutide (sold as Ozempic and Wegovy), which is helping people improve weight-related health, including <a href="https://pubmed.ncbi.nlm.nih.gov/37952131/">lowering the risk</a> of a having a heart attack or stroke, while also silencing “<a href="https://theconversation.com/some-ozempic-users-say-it-silences-food-noise-but-there-are-drug-free-ways-to-stop-thinking-about-food-so-much-208467">food noise</a>”. As demand for semaglutide increases, so are <a href="https://www.smh.com.au/lifestyle/health-and-wellness/in-a-fat-phobic-world-ozempic-is-hardly-the-easy-way-out-20240401-p5fgjd.html">claims</a> that taking it is “cheating” at weight loss or the “easy way out”. We don’t tell people who need statin medication to treat high cholesterol or drugs to manage high blood pressure they’re cheating or taking the easy way out. Nor should we shame people taking semaglutide. It’s a drug used to treat diabetes and obesity which needs to be taken long term and comes with risks and side effects, as well as benefits. When prescribed for obesity, it’s given alongside advice about diet and exercise. <h2>How does it work?</h2> Semaglutide is a <a href="https://en.wikipedia.org/wiki/GLP-1_receptor_agonist">glucagon-like peptide-1</a> receptor agonist (GLP-1RA). This means it makes your body’s own glucagon-like peptide-1 hormone, called <a href="https://en.wikipedia.org/wiki/Glucagon-like_peptide-1">GLP-1</a> for short, work better. GLP-1 gets secreted by cells in your gut when it <a href="https://pubmed.ncbi.nlm.nih.gov/38218319/">detects increased nutrient levels</a> after eating. This stimulates insulin production, which lowers blood sugars. GLP-1 also slows gastric emptying, which makes you feel full, and reduces hunger and feelings of reward after eating. <iframe id="tc-infographic-1031" class="tc-infographic" style="border: none;" src="https://cdn.theconversation.com/infographics/1031/c11b606581d4bc58a71f066492d7f740b52c04e1/site/index.html" width="100%" height="400px" frameborder="0"></iframe> GLP-1 receptor agonist (GLP-1RA) medications like Ozempic help the body’s own GLP-1 work better by mimicking and extending its action. Some studies have found less GLP-1 gets released after meals in <a href="https://pubmed.ncbi.nlm.nih.gov/38218319/">adults with obesity or type 2 diabetes mellitus</a> compared to adults with normal glucose tolerance. So having less GLP-1 circulating in your blood means you don’t feel as full after eating and get hungry again sooner compared to people who produce more. GLP-1 has a very short half-life of about <a href="https://pubmed.ncbi.nlm.nih.gov/28443255/">two minutes</a>. So GLP-1RA medications were designed to have a very long half-life of about <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">seven days</a>. That’s why semaglutide is given as a weekly injection. <h2>What can users expect? What does the research say?</h2> Higher doses of semaglutide are prescribed to treat obesity compared to type 2 diabetes management (up to 2.4mg versus 2.0mg weekly). A large group of <a href="https://pubmed.ncbi.nlm.nih.gov/36691309/">randomised controlled trials</a>, called STEP trials, all tested weekly 2.4mg semaglutide injections versus different interventions or placebo drugs. Trials lasting 1.3–2 years consistently found weekly 2.4 mg semaglutide injections <a href="https://pubmed.ncbi.nlm.nih.gov/36691309/">led to 6–12% greater weight loss</a> compared to placebo or alternative interventions. The average weight change depended on how long medication treatment lasted and length of follow-up. Weight reduction due to semaglutide also leads to a <a href="https://pubmed.ncbi.nlm.nih.gov/36769420/">reduction in systolic and diastolic blood pressure</a> of about 4.8 mmHg and 2.5 mmHg respectively, a reduction in <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/triglycerides">triglyceride levels</a> (a type of blood fat) and <a href="https://pubmed.ncbi.nlm.nih.gov/38041774/">improved physical function</a>. Another recent trial in adults with pre-existing heart disease and obesity, but without type 2 diabetes, found adults receiving weekly 2.4mg semaglutide injections had a <a href="https://pubmed.ncbi.nlm.nih.gov/37952131/">20% lower risk</a> of specific cardiovascular events, including having a non-fatal heart attack, a stroke or dying from cardiovascular disease, after three years follow-up. <h2>Who is eligible for semaglutide?</h2> Australia’s regulator, the Therapeutic Goods Administration (TGA), has <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023">approved</a> semaglutide, sold as Ozempic, for treating type 2 diabetes. However, due to shortages, the TGA had advised doctors not to start new Ozempic prescriptions for “off-label use” such as obesity treatment and the Pharmaceutical Benefits Scheme doesn’t currently subsidise off-label use. The TGA has <a href="https://www.tga.gov.au/resources/prescription-medicines-registrations/wegovy-novo-nordisk-pharmaceuticals-pty-ltd">approved Wegovy to treat obesity</a> but it’s not currently available in Australia. When it’s available, doctors will be able to prescribe <a href="https://pubmed.ncbi.nlm.nih.gov/36934408/">semaglutide to treat obesity</a> in conjunction with lifestyle interventions (including diet, physical activity and psychological support) in adults with obesity (a BMI of 30 or above) or those with a BMI of 27 or above who also have weight-related medical complications. <h2>What else do you need to do during Ozempic treatment?</h2> Checking details of the <a href="https://pubmed.ncbi.nlm.nih.gov/36691309/">STEP trial intervention components</a>, it’s clear participants invested a lot of time and effort. In addition to taking medication, people had brief lifestyle counselling sessions with dietitians or other health professionals every four weeks as a minimum in most trials. Support sessions were designed to help people stick with consuming 2,000 kilojoules (500 calories) less daily compared to their energy needs, and performing 150 minutes of <a href="https://www.healthdirect.gov.au/tips-for-getting-active">moderate-to-vigorous physical activity</a>, like brisk walking, dancing and gardening each week. STEP trials varied in other components, with follow-up time periods varying from 68 to 104 weeks. The aim of these trials was to show the effect of adding the medication on top of other lifestyle counselling. A <a href="https://pubmed.ncbi.nlm.nih.gov/38041774/">review of obesity medication trials</a> found people reported they needed less <a href="https://pubmed.ncbi.nlm.nih.gov/28652832/">cognitive behaviour training</a> to help them stick with the reduced energy intake. This is one aspect where drug treatment may make adherence a little easier. Not feeling as hungry and having environmental food cues “switched off” may mean less support is required for goal-setting, self-monitoring food intake and <a href="https://theconversation.com/9-ways-wont-power-is-better-than-willpower-for-resisting-temptation-and-helping-you-eat-better-71267">avoiding things that trigger eating</a>. <h2>But what are the side effects?</h2> Semaglutide’s side-effects <a href="https://pubmed.ncbi.nlm.nih.gov/38041774/">include</a> nausea, diarrhoea, vomiting, constipation, indigestion and abdominal pain. In one study these <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">led to</a> discontinuation of medication in 6% of people, but interestingly also in 3% of people taking placebos. More severe side-effects included gallbladder disease, acute pancreatitis, hypoglycaemia, acute kidney disease and injection site reactions. To reduce risk or severity of side-effects, <a href="https://pubmed.ncbi.nlm.nih.gov/36934408/">medication doses are increased very slowly</a> over months. Once the full dose and response are achieved, research indicates you need to take it long term. Given this long-term commitment, and associated <a href="https://www.health.gov.au/topics/private-health-insurance/what-private-health-insurance-covers/out-of-pocket-costs#:%7E:text=An%20out%20of%20pocket%20cost,called%20gap%20or%20patient%20payments">high out-of-pocket cost of medication</a>, when it comes to taking semaglutide to treat obesity, there is no way it can be considered “cheating”. <hr /> Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/219116/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/clare-collins-7316">Clare Collins</a>, Laureate Professor in Nutrition and Dietetics, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/no-taking-drugs-like-ozempic-isnt-cheating-at-weight-loss-or-the-easy-way-out-219116">original article</a>.

Body

Drugs like Ozempic won’t ‘cure’ obesity but they might make us more fat-phobic

<a href="https://theconversation.com/profiles/emma-beckett-22673">Emma Beckett</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Many have <a href="https://www.economist.com/leaders/2023/03/02/new-drugs-could-spell-an-end-to-the-worlds-obesity-epidemic">declared</a> drugs like Ozempic could “end obesity” by reducing the appetite and waistlines of millions of people around the world. When we look past the hype, this isn’t just untrue – it can also be harmful. The focus on weight, as opposed to health, is a feature of <a href="https://www.sciencedirect.com/science/article/abs/pii/S0277539521001217">diet culture</a>. This frames the pursuit of thinness as more important than other aspects of physical and cultural wellbeing. The Ozempic buzz isn’t just rooted in health and medicine but plays into ideas of <a href="https://butterfly.org.au/weight-bias-fatphobia-diet-culture/#:%7E:text=Weight%20bias%2C%20sometimes%20also%20called,or%20being%20around%20fat%20people.">fat stigma and fat phobia</a>. This can perpetuate fears of fatness and fat people, and the behaviours that <a href="https://link.springer.com/article/10.1186/S12916-018-1116-5">harm people who live in larger bodies</a>. <h2>Not the first ‘miracle’ weight-loss drug</h2> This isn’t the first time we have heard that weight-loss drugs will change the world. Ozempic and <a href="https://www.ncbi.nlm.nih.gov/books/NBK551568/">its family</a> of GLP-1-mimicking drugs are the <a href="https://theconversation.com/ozempic-is-in-the-spotlight-but-its-just-the-latest-in-a-long-and-strange-history-of-weight-loss-drugs-209324">latest in a long line of weight loss drugs</a>. Each looked promising at the time. But none have lived up to the hype in the long term. Some have even been withdrawn from sale due to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5126837/">severe side effects</a>. Science does improve <a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(20)30028-8/fulltext">incrementally</a>, but diet culture also keeps us on a cycle of hope for the next <a href="https://sahrc.org/2022/04/diet-culture-a-brief-history/">miracle cure</a>. So drugs like Ozempic might not deliver the results individuals expect, continuing the cycle of hope and shame. <h2>Ozempic doesn’t work the same for everyone</h2> When we talk about the results of studies using Ozempic, we often <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719041/">focus on the average</a> (also known as the mean) results or the maximum (or peak) results. So, studies might <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">show</a> those using the drug lost an average of 10.9% of their body weight, but some lost more than 20% and others less than 5% What we don’t talk about as much is that responses are variable. Some people are “<a href="https://www.sciencedirect.com/science/article/pii/S2212877820301769">non-responders</a>”. This means not everyone loses as much weight as the average, and some don’t lose weight at all. For some people, the side-effects will outweigh the benefits. When people are on drugs like Ozempic, their blood sugar is better controlled by enhancing the release of insulin and reducing the levels of another hormone called glucagon. But there is greater variability in the amount of <a href="https://www.sciencedirect.com/science/article/pii/S2212877820301769#bib88">weight lost</a> than the variability in blood sugar control. It isn’t clear why, but is likely due to differences in genetics and lifestyles, and weight being more complex to regulate. <h2>Treatment needs to be ongoing. What will this mean?</h2> When weight-loss drugs do work, they are only effective while they’re being taken. This means that to keep the weight off people need to keep taking them long term. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9542252/">One study found</a> an average weight loss of more than 17% after a year on Ozempic became an average net weight loss of 5.6% more than two years after stopping treatment. Short-term side effects of drugs like Ozempic include dizziness, nausea, vomiting and other gastrointestinal upsets. But because these are new drugs, we simply don’t have data to tell us if side effects will increase as people take them for longer periods. Nor do we know if <a href="https://www.medicalnewstoday.com/articles/why-weight-loss-drugs-stop-working-how-to-break-past-ozempic-plateau#:%7E:text=A%20lifetime%20commitment%20to%20Ozempic&text=By%20these%20standards%2C%20such%20drugs,long%2Dterm%20risk%20is%20unknown.">effectiveness will be reduced</a> in the long term. This is called <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/drug-tolerance#:%7E:text=A%20condition%20that%20occurs%20when,or%20different%20medicine%20is%20needed.">drug tolerance</a> and is documented for other long-term treatments such as antidepressants and chemotherapies. <h2>Biology is only part of the story</h2> For some people, using GLP-1-mimicking drugs like Ozempic will be validating and empowering. They will feel like their biology has been “normalised” in the same way that blood pressure or cholesterol medication can return people to the “normal” range of measures. But biologically, obesity <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202176/#:%7E:text=Obesity%20behaves%20as%20complex%20polygenic,about%2080%25%20(3).">isn’t solely about GLP-1 activity</a> with <a href="https://www.worldobesity.org/what-we-do/our-policy-priorities/the-roots-of-obesity">many other</a> hormones, physical activity, and even our gut microbes involved. Overall, <a href="https://www.ncbi.nlm.nih.gov/books/NBK278977/">obesity is complex and multifaceted</a>. Obesity isn’t just driven by personal biology and choice; it has social, cultural, political, environmental and economic determinants. <h2>A weight-centred approach misses the rest of the story</h2> The weight-centred approach <a href="https://butterfly.org.au/body-image/health-not-weight/#:%7E:text=Health%20and%20wellbeing%20are%20multi,on%20their%20size%20or%20appearance.">suggests that leading with thinness means health will follow</a>. But changing appetite is only part of the story when it comes to health. Obesity often <a href="https://www.sciencedirect.com/science/article/pii/S2667368123000335#:%7E:text=Obesity%20related%20malnutrition%20can%20also,%5D%2C%20%5B7%5D%5D.">co-exists with malnutrition</a>. We try to separate the effects in research using statistics, but focusing on the benefits of weight-loss drugs without addressing the underlying malnutrition means we aren’t likely to see the <a href="https://www.wsj.com/articles/ozempic-diet-exercise-healthy-43eee86c">improved health outcomes in everyone who loses weight</a>. <h2>Obesity isn’t an issue detached from people</h2> Even when it is well-intentioned, the rhetoric around the joy of “ending the obesity epidemic” can <a href="https://theconversation.com/ozempic-the-miracle-drug-and-the-harmful-idea-of-a-future-without-fat-211661">harm people</a>. Obesity doesn’t occur in isolation. It is people who are obese. And the celebration and hype of these weight-loss drugs can reinforce harmful fat stigma. The framing of these drugs as a “cure” exacerbates the binary view of thin versus fat, and healthy versus unhealthy. These are not binary outcomes that are good or bad. Weight and health exist on a spectrum. Ironically, while fat people are told they need to lose weight for their health, they are also <a href="https://www.dailytelegraph.com.au/news/nsw/ozempic-shame-why-users-are-embarrassed-to-admit-using-weight-loss-wonder-drug/news-story/ee52a819c69459afe6576d25988f9bd6">shamed for “cheating” or taking shortcuts</a> by using medication. <h2>Drugs are tools, not silver bullets</h2> The creation of these drugs is a start, but they remain expensive, and the hype has been followed by <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023#:%7E:text=Consumer%20Medicine%20Information%20.-,Why%20the%20Ozempic%20shortage%20happened,label%20prescribing%20for%20weight%20loss.">shortages</a>. Ultimately, complex challenges aren’t addressed with simple solutions. This is particularly true when people are involved, and even more so when there isn’t even an agreement on what the challenge is. Many organisations and individuals see obesity is a disease and believe this framing helps people to seek treatment. Others think it’s unnecessary to attach medical labels to body types and <a href="https://www.forbes.com/sites/geoffreykabat/2013/07/09/why-labeling-obesity-as-a-disease-is-a-big-mistake/?sh=5ca95cc2103b">argue</a> it confuses risk factors (things that are linked to increased risk of illness) with illness itself. Regardless, two things will always remain true. Drugs can only ever be tools, and those tools need to be applied in a context. To use these tools ethically, we need to remain mindful of who this application harms along the way. <hr /> Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/219309/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/emma-beckett-22673">Emma Beckett</a>, Adjunct Senior Lecturer, Nutrition, Dietetics & Food Innovation - School of Health Sciences, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/drugs-like-ozempic-wont-cure-obesity-but-they-might-make-us-more-fat-phobic-219309">original article</a>.

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Astonishing drug and prostitute claims surface as Lehrmann case reopened

The ongoing defamation case involving Bruce Lehrmann, a central figure in the Brittany Higgins saga, has been thrust back into the spotlight with shocking new allegations. The reopening of the case stems from claims made by former Seven Network producer Taylor Auerbach, which seek to shed light on a series of dealings surrounding Lehrmann's interactions with various media outlets. The allegations put forth by Auerbach paint an astonishing picture of Lehrmann's recruitment by Seven Network for an exclusive tell-all interview. It's alleged that Lehrmann, in a bid to secure his cooperation, was lavishly reimbursed for expenses that included not only extravagant meals and travel but also expenditures on illicit drugs and prostitutes. The details emerged through affidavits filed by Auerbach with the Federal Court, just days before a judgment was expected in Lehrmann's defamation case against Network Ten and journalist Lisa Wilkinson. The case originated from a February 2021 report on The Project, where Brittany Higgins accused Lehrmann of rape within a Parliament House office in 2019. According to Auerbach's affidavits, Lehrmann breached a so-called Harman undertaking by leaking private and confidential texts from Higgins to Seven Network, violating an agreement that restricted the use of evidence from an abandoned criminal case against him. These texts allegedly facilitated Lehrmann's negotiations with Seven Network and formed a crucial part of his interview on the Spotlight program. The allegations take a darker turn with claims of financial reimbursement for illicit activities. Auerbach asserts that Seven Network reimbursed Lehrmann for expenses related to drug purchases and visits to brothels, implicating the network in what can only be described as deeply troubling conduct. "I recall that monies paid by (Lehrmann) for illicit drugs and prostitutes that evening at the Meriton and the following evening at a brothel in Surry Hills were reimbursed to (Lehrmann) by Seven," Auerbach states in his affidavit, according to <a href="https://au.news.yahoo.com/lehrmann-defamation-case-reopened-evidence-163000287.html" target="_blank" rel="noopener">Yahoo News</a>. The reopening of Lehrmann's defamation case underscores the gravity of these allegations and their potential implications. Justice Michael Lee's decision to admit fresh evidence indicates the seriousness with which the court regards these claims and the need for a thorough examination of the facts. In response to these allegations, both Lehrmann and Seven Network have vehemently denied any wrongdoing. Lehrmann maintains his innocence, asserting that he did not leak texts to Seven Network and denying any involvement in the misconduct alleged by Auerbach. Seven Network, for its part, denies authorising or condoning the alleged payments to Lehrmann and says that any unauthorised expenses were promptly rectified. Image: Getty

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Considering taking a weight-loss drug like Ozempic? Here are some potential risks and benefits

<a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> and <a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> After weight-loss drugs like Ozempic exploded onto the market, celebrities and social media influencers were quick to spruik their benefits, leading to their rapid rise in use. In the last three months of 2022, clinicians in the United States alone wrote <a href="https://www.washingtonpost.com/business/2023/09/27/ozempic-prescriptions-data-analysis/">more than nine million prescriptions</a> for these drugs. As they’ve grown in popularity, we’ve also heard more about the potential side effects – from common gastrointestinal discomforts, to more serious mental health concerns. But what does the science say about how well Ozempic and Wegovy (which are both brand names of the drug semaglutide) work for weight loss? And what are the potential side effects? Here’s what to consider if you or a loved one are thinking of taking the drug. <h2>Potential benefits</h2> 1) It’s likely to help you lose weight The largest, well-conducted <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">research study</a> of semaglutide was from United Kingdom in 2021. Some 1,961 people who were classified as “overweight” or “obese” were randomly assigned to have either semaglutide or a placebo and followed for 68 weeks (about 1.3 years). All participants also had free access to advice about healthy eating and physical activity. The study found those taking semaglutide lost weight – significantly more than people who had the placebo (-14.9% of their body weight compared with -2.4% of body weight). In another <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">study</a> in the United States, one health-care clinic gave 408 people weekly injections of semaglutide. Over the first three months, those included in the final analysis (175 people) lost an average of 6.7kg. Over the first six months, they lost an average of 12.3kg. Large weight losses have been found in a more <a href="https://www.nature.com/articles/s41591-022-02026-4">recent trial</a> of semaglutide, suggesting weight loss is a very likely outcome of ongoing use of the medication. 2) It may reduce your chronic disease risk factors When people in the overweight or obese weight categories lose <a href="https://www.sciencedirect.com/science/article/pii/S1550413116300535">at least 5%</a> of their body weight, physiological changes often occur beyond a change in weight or shape. This <a href="https://www.nih.gov/news-events/nih-research-matters/research-context-obesity-metabolic-health">might include</a> lowered cholesterol levels, lowered blood pressure and lowered blood glucose levels, which all reduce the risk of chronic diseases. In one of the semaglutide <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">trials</a>, most people (87.3%) lost at least 5% of their body weight. Although most of the large studies of semaglutide excluded people with metabolic health conditions such as type 2 diabetes, metabolic health gains were <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">observed</a>, including lowered blood pressure, blood glucose levels and fasting blood lipid (fat) levels. In the UK <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">study</a> from 2021, people taking semaglutide had greater improvements in physical capabilities and risk factors for heart disease and diabetes, including reductions in waist circumference, markers of inflammation, blood pressure and blood glucose levels. 3) It might improve your quality of life, emotional wellbeing or sense of achievement The original trial of semaglutide did not focus on this bundle of benefits, but further follow-ups show additional benefits associated with the medication. Compared to the placebo, people taking semaglutide saw significant <a href="https://www.tandfonline.com/doi/full/10.1080/00325481.2022.2150006">improvements</a> in their physical functioning and perceptions of their general health, social functioning and mental health. Anecdotally (not based on scientific research), people using semaglutide, such as <a href="https://people.com/oprah-winfrey-reveals-weight-loss-medication-exclusive-8414552">Oprah Winfrey</a>, report a reclaiming or turning point of their life, social situation and body image. <h2>What about the risks?</h2> 1) You may experience gastrointestinal symptoms In the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">US clinical trial</a>, nearly half (48.6%) of people taking semaglutide reported experiencing adverse effects. Nausea and vomiting were the most frequently experienced (36.6%) followed by diarrhea (8.6%), fatigue (6.3%) and constipation (5.7%). In the UK study, nausea and diarrhoea were also commonly reported. In <a href="https://www.nejm.org/doi/10.1056/NEJMoa2032183?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">another trial</a>, many participants (74.2%) using semaglutide reported gastrointestinal symptoms. However, nearly half (47.9%) using the placebo also reported gastrointestinal symptoms, indicating that symptoms may be similar to those experienced during normal daily living. Most gastrointestinal symptoms were mild to moderate in severity, and resolved for most people without the need to stop participating in the study. 2) You might feel fatigued Fatigue was the second most common side effect for participants in the US <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">clinical trial</a>, affecting 6.3% of participants. 3) You might be among the minority who don’t tolerate the drug Australia’s Therapeutic Goods Administration (TGA) has <a href="https://www.tga.gov.au/news/safety-alerts/compounding-safety-information-semaglutide-products">approved</a> Ozempic as safe to use, for the treatment of type 2 diabetes but it has not yet been approved for weight loss. The TGA has also <a href="https://www.tga.gov.au/resources/prescription-medicines-registrations/wegovy-novo-nordisk-pharmaceuticals-pty-ltd">approved Wegovy</a> (a higher dose of semagtlutide) for weight loss, however it’s not yet available in Australia. In the US <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">clinical trial</a>, no unexpected safety issues were reported. However, five patients (2.9%) had to stop taking the medication because they could not tolerate the adverse effects. Fifteen (8.6%) had to either reduce the dose or remain on the same dose to avoid the adverse effects. In <a href="https://www.nejm.org/doi/10.1056/NEJMoa2032183?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">other studies</a>, some patients stopped the trial due to gastrointestinal symptoms being so severe they could not tolerate continuing. More severe safety concerns reported in <a href="https://www.nejm.org/doi/10.1056/NEJMoa2032183?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">studies</a> include gallbladder-related disorders (mostly cholelithiasis, also known as gallstones) in 34 patients (2.6%) and mild acute pancreatitis in three patients (0.2%). All people recovered during the trial period. A 2024 European <a href="https://link.springer.com/article/10.1007/s11096-023-01694-7">study</a> analysed psychiatric adverse events associated with semaglutide, liraglutide and tirzepatide (which work in a similar way to semaglutide). Between January 2021 and May 2023, the drug database recorded 481 psychiatric events (about 1.2% of the total reported) associated with these drugs. About half of these events were reported as depression, followed by anxiety (39%) and suicidal ideation (19.6%). Nine deaths and 11 life-threatening outcomes were reported during the study period. Due to the severity and fatal outcomes of some of these reports, <a href="https://www.fda.gov/drugs/drug-safety-and-availability/update-fdas-ongoing-evaluation-reports-suicidal-thoughts-or-actions-patients-taking-certain-type">the US Food and Drug Administration</a> investigated further but did not find evidence that use of these medicines caused suicidal thoughts or actions. 4) It might be difficult to access Despite being considered safe, the TGA has <a href="https://www.tga.gov.au/safety/shortages/medicine-shortage-alerts/update-prescribers-advised-not-start-new-patients-ozempic#:%7E:text=Ozempic%27s%20TGA%2Dapproved%20indication%20is,consult%20the%20appropriate%20prescribing%20guidelines.">warned</a> significant Ozempic access barriers are likely to continue throughout 2024. To manage the shortage, pharmacists are instructed to give preference to people with type 2 diabetes who are seeking the medication. 5) You might not always get clear information from vested interests Given the popularity of Ozempic and Wegovy, health organisations such as the World Obesity Federation have expressed <a href="https://www.theguardian.com/society/2023/mar/12/orchestrated-pr-campaign-how-skinny-jab-drug-firm-sought-to-shape-obesity-debate">concern</a> about the medication’s marketing, PR and strong <a href="https://www.theguardian.com/australia-news/2023/jan/06/tga-investigates-influencers-after-diabetes-drug-ozempic-promoted-as-weight-loss-treatment">social media presence</a>. Some journalists have <a href="https://www.theguardian.com/society/2023/mar/12/orchestrated-pr-campaign-how-skinny-jab-drug-firm-sought-to-shape-obesity-debate">raised conflict of interest concerns</a> about the relationship between some obesity researchers and Novo Nordrisk, Ozempic and Wegovy’s manufacturer. The worry is that researchers might be influenced by their relationship with Novo Nordrisk to produce study results that are more favourable to the medications. <h2>Bottom line</h2> Ozempic is a medication that should be used in conjunction with your health care provider. But remember, weight is only one aspect of your health and wellbeing. It’s important to take a holistic view of your health and prioritise eating well, moving more and getting enough sleep. <hr /> Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-132745">Ozempic series</a> here.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/219312/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, Professor of Community Health and Wellbeing, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> and <a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, Lecturer, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/considering-taking-a-weight-loss-drug-like-ozempic-here-are-some-potential-risks-and-benefits-219312">original article</a>.

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Considering taking a weight-loss drug like Ozempic? Here are some potential risks and benefits

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