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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

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

Doctors at war

In the annals of military history, the valour and sacrifices of doctors who served alongside soldiers in combat zones often go unrecognised. Yet their stories, as retired colonel Robert Likeman poignantly illustrates in his Australian Doctors at War series, reveal a legacy of courage and commitment that is integral to understanding the full scope of wartime heroism. --- Winston Churchill, in his Sketches on Service During the Indian Frontier Campaign of 1897, wrote, “The spectacle of a doctor in action among soldiers, in equal danger and with equal courage, saving life where others are taking it, allaying pain where all others are causing it, is one which must always seem glorious, whether to God or man”. It is certainly true that doctors in a combat zone share the risks of shot and shell equally with the fighting soldier, but they also experience the added stress of taking responsibility for those wounded and dying on the battlefield, and in situations where the best of treatment cannot be readily given. Glorious or otherwise, the stories of our Australian Army doctors at war remain relatively unrecognised. Doctors have always been among the first to volunteer – in all 1,242 doctors served with the first Australian Imperial Force, careless for their own safety, and 55 of them failed to return. These men represented a significant proportion of the medical workforce in Australia, which by 1937 only reached 5,000. In World War 2, with the introduction of compulsory military service, the number of serving doctors exceeded 2,500. Hardly any of them are still with us today, but their children and grandchildren are our fellow citizens, and in many cases our local doctor may be one of these. It is a legacy not to be dismissed lightly. Those who have served in the Army know that treating the ailments of soldiers and preserving their health occupies much more time than dressing their wounds. In World War 1, fought over the agricultural lands of Europe, infectious diseases such as gas gangrene, tetanus and trench fever were common. In the deserts of World War 2, these were replaced by hepatitis, sandfly fever and eye infections. New Guinea presented a wholly different spectrum of disease, dominated by malaria, scrub typhus and amoebic dysentery. The maintenance of “fighting fitness” was a daily struggle for the doctors. The 2021 Interim Report of the Royal Commission into Defence and Veteran Suicide did not identify medical officers as being particularly at risk of psychological injury as a result of their service in a war zone. But in view of their exposure to mass trauma and death, they might be assumed to have a significant risk of Post Traumatic Stress Disorder, both from the chances of being wounded or killed, and from the guilt associated with the failure to preserve life. Two of the medical officers who served at Gallipoli shot themselves on their return to Egypt, perhaps because they had seen men die who might have been saved with better medical attention. Fourteen other doctors from the 1st Australian Imperial Force are known to have committed suicide after their return to Australia. Close to 3,000 Australian nurses served overseas with the Australian Army Nursing Service in World War 1, but female doctors were not permitted to enlist. A significant number of them however, at least 19, served in the British Army or in voluntary hospitals in Europe. One of them, Phoebe Chapple, was awarded the Military Medal for Bravery. In World War 2, 22 women doctors were commissioned in total – moreso due to the shortage of manpower than from egalitarian principles – though none of them were posted overseas. In recent overseas deployments, women doctors in the Army have quite properly taken their rightful place. The military service and civilian practice of all the Australian doctors who served in both World Wars has been meticulously documented in my six-volume series, Australian Doctors at War, published by Halstead Press. Your relatives may be among them. <img src="https://oversixtydev.blob.core.windows.net/media/2024/06/Robert_Likeman_01.jpg" alt="" width="1280" height="720" /> The Inevitable Hour is the sixth and final volume of my Australian Doctors at War series, covering the period from January 1943 to the disbanding of the Second Australian Imperial Force in April 1947. Even after the Japanese had been driven from Papua and New Guinea, they still retained most of the archipelago. The threat to Australia was great, and despite being a then small nation, the country mobilised quickly to disrupt Japanese holdings in Madang, Wewak and Wau. Overcoming the constant influx of wounded men needing treatment, suffering themselves from afflictions such as hepatitis, dysentery and depression, aggravated by extreme and tropical climates, Australia’s medical officers were under considerable pressure, during the war and in the monumental demobilisation of the 2nd AIF that followed Japanese defeat. ABOUT THE AUTHOR Robert Likeman is a graduate of Oxford University, where he studied Classics, Oriental Languages and Medicine. He is a specialist in obstetrics and gynaecology, in tropical medicine, and in rural and remote medicine. After service in the British Army he migrated to Australia in 1972. He is the author of seven books of military history and two biographies, and co-author of a textbook of obstetrics and gynaecology for doctors practising in developing countries. Images courtesy of Robert Likeman.

Books

Boomers vs millennials? Free yourself from the phoney generation wars

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/bobby-duffy-98570">Bobby Duffy</a>, <a href="https://theconversation.com/institutions/kings-college-london-1196">King's College London</a> Generational thinking is a big idea that’s been horribly corrupted and devalued by endless myths and stereotypes. These clichés have fuelled fake battles between “snowflake” millennials and “selfish” baby boomers, with younger generations facing a “war on woke” and older generations accused of “stealing” the future from the young. As I argue in my book, <a href="https://atlantic-books.co.uk/book/generations/">Generations</a>, this is a real shame. A more careful understanding of what’s really different between generations is one of the best tools we have to understand change – and predict the future. Some of the great names in sociology and philosophy saw understanding generational change as central to understanding society overall. <a href="http://dhspriory.org/kenny/PhilTexts/Comte/Philosophy2.pdf">Auguste Comte</a>, for example, identified the generation as a key factor in “the basic speed of human development”. He argued that “we should not hide the fact that our social progress rests essentially upon death; which is to say that the successive steps of humanity necessarily require a continuous renovation … from one generation to the next”. We humans get set in our ways once we’re past our formative years, and we need the constant injection of new participants to keep society moving forward. Understanding whether, and how, generations are different is vital to understanding society. The balance between generations is constantly shifting, as older cohorts die out and are replaced by new entrants. If younger generations truly do have different attitudes or behaviours to older generations, this will reshape society, and we can, to some extent, predict how it will develop if we can identify those differences. But in place of this big thinking, today we get clickbait headlines and bad research on millennials “<a href="https://www.businessinsider.com/millennials-hate-napkins-2016-3?r=US&IR=T">killing the napkin industry</a>” or on how baby boomers have “<a href="https://www.theatlantic.com/ideas/archive/2019/06/boomers-are-blame-aging-america/592336/">ruined everything</a>”. We’ve fallen a long way. <h2>Myth busting</h2> To see the true value of generational thinking, we need to identify and discard the many myths. For example, as I outline in the book, gen Z and millennials are not lazy at work or disloyal to their employers. They’re also no more materialistic than previous generations of young: a focus on being rich is something we tend to grow out of. Old people are not uncaring or unwilling to act on climate change: in fact, they are more likely than young people to boycott products for social purpose reasons. And our current generation of young are not a particularly unusual group of “culture warriors”. Young people are always at the leading edge of change in cultural norms, around race, immigration, sexuality and gender equality. The issues have changed, but the gap between young and old is not greater now than in the past. Meanwhile, there are real, and vitally important, generational differences hidden in this mess. To see them, we need to separate the three effects that explain all change in societies. Some patterns are simple “lifecycle effects”, where attitudes and behaviours are to do with our age, not which generation we are born into. Some are “period effects” – where everyone is affected, such as in a war, economic crisis or a pandemic. And finally, there are “cohort effects”, which is where a new generation is different from others at the same age, and they stay different. It’s impossible to entirely separate these distinct forces, but we can often get some way towards it – and when we do, we can predict the future in a much more meaningful way. There are many real generational differences, in vitally important areas of life. For example, the probability of you owning your own home is hugely affected by when you were born. Millennials are around half as likely to be a homeowner than generations born only a couple of decades earlier. There is also a real cohort effect in experience of mental health disorders, particularly among recent generations of young women. Our relationship with alcohol and likelihood of smoking is also tied to our cohort, with huge generational declines in very regular drinking and smoking. Each of these point to different futures, from increased strain on mental health services to declining alcohol sales. But lifecycle and period effects are vitally important too. For example, there is truth in the idea that we grow more conservative as we age. One analysis suggests that this ageing effect is worth around <a href="https://www.sciencedirect.com/science/article/abs/pii/S0261379413000875">0.35% to the Conservatives each year</a>, which may not sound like a lot, but is very valuable over the course of a political lifetime. And, of course, the pandemic provides a very powerful example of how period effects can dramatically change things for us all. <h2>Reaching beyond the avocado</h2> When there is such richness in the realities, why are there so many myths? It’s partly down to bad marketing and workplace research – that is, people jumping on the generation bandwagon to get media coverage for their products or to sell consultancy to businesses on how to engage young employees. This has become its own mini-industry. In 2015, US companies spent up to US$70 million (£51 million) on this sort of “advice” <a href="https://www.wsj.com/articles/helping-bosses-decode-millennialsfor-20-000-an-hour-1463505666">according to the Wall Street Journal</a>, with some experts making as much as US$20,000 an hour. Over 400 LinkedIn users now describe themselves solely as a “millennial expert” or “millennial consultant”. Campaigners and politicians also play to these imagined differences. Our increasing focus on “<a href="https://www.kcl.ac.uk/policy-institute/assets/culture-wars-in-the-uk.pdf">culture wars</a>” often involves picking out particular incidents in universities, such as the <a href="https://www.bbc.co.uk/news/uk-england-manchester-45717841">banning of clapping</a> at events or the <a href="https://www.bbc.co.uk/news/uk-england-oxfordshire-57409743">removal of a portrait of the Queen</a> to exaggerate how culturally different young people today are. Maybe less obviously, politicians such as former US President Barack Obama repeatedly lionise coming generations as more focused on equality, when the evidence shows they’re often not that different. These assertions are not only wrong, but create false expectations and divides. Some have had enough, calling on the Pew Research Center in the US, which has been a champion of generational groups, to <a href="https://www.washingtonpost.com/opinions/2021/07/07/generation-labels-mean-nothing-retire-them/&data=04%257C01%257C">stop conducting this type of analysis</a>. I think that misses the point: it’s how it’s applied rather than the idea of generations that’s wrong. We should defend the big idea and call out the myths, not abandon the field to the “millennial consultants”.<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/167138/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/bobby-duffy-98570">Bobby Duffy</a>, Professor of Public Policy and Director of the Policy Institute, <a href="https://theconversation.com/institutions/kings-college-london-1196">King's College London</a> Image credits: Shutterstock 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/boomers-vs-millennials-free-yourself-from-the-phoney-generation-wars-167138">original article</a>. </div>

Mind

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

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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West Side Story returns to Handa Opera on Sydney Harbour

Get ready to snap your fingers, tap your toes and experience the magic of Broadway in Sydney as Opera Australia presents the electrifying musical extravaganza West Side Story – making its triumphant return to the Handa Opera on Sydney Harbour stage in 2024. The 2019 production of West Side Story, if you were fortunate enough to grab seats, was an absolute smash hit. With record-breaking ticket sales and rave reviews, it's no wonder this show stole the hearts of over 65,000 theatre and musical buffs. Directed by the incomparable Francesca Zambello, West Side Story promises to once again whisk audiences away to the bustling streets of New York City, complete with iconic songs, heart-pounding dance numbers, and enough drama to fill the harbour twice over. Leonard Bernstein and Stephen Sondheim's musical masterpiece will once again take centre stage, accompanied by Jerome Robbins' legendary choreography – and this year, we were fortunate enough to be able to pose a few pre-performance questions to none other than Guy Simpson, the show’s musical director, and the all-singing, all-dancing Wayne Scott Kermond, who is playing “Doc” onstage. Let’s raise the curtain and see what they have to say! <img src="https://oversixtydev.blob.core.windows.net/media/2024/03/Guy-Simpson.jpg" alt="" width="1280" height="720" /> Guy Simpson Guy Simpson, a seasoned musical director with nearly 45 years of experience, boasts an illustrious career spanning global productions. Notably, his involvement with iconic shows like Miss Saigon and The Phantom of the Opera has taken him across continents, from Australia to Asia and beyond. Simpson's extensive repertoire includes serving as Musical Supervisor and Director for Opera Australia's acclaimed productions such as Evita, My Fair Lady, and of course West Side Story. Additionally, his contributions as an orchestrator and producer of cast recordings further solidify his stature in the musical theatre realm. With credits ranging from beloved classics like Les Misérables to contemporary hits like Muriel's Wedding, Simpson's versatile talent continues to enrich the world of musical theatre on an international scale. OverSixty: What memories do you have of your first time working on West Side Story – when was it and what was the experience like? Guy: “I was a rehearsal pianist for the 1983 production of West Side Story. The conductor was Dobbs Franks, who came from the US to conduct the first production of the show in 1960. So I was lucky to learn the show from him. I wasn’t in the orchestra and had tickets to watch opening night but during the afternoon of that day I received a call to play in the orchestra that night because the pianist was unwell. I’ll never forget that! Since then I have conducted three seasons of the show and learn more and more about it each time.” OverSixty: What were Bernstein’s influences and what impact did Bernstein’s score have when the musical first premiered? And why do you think it remains so recognised today? Guy: “Bernstein was influenced by many things. There is an <a href="https://www.wrti.org/arts-desk/2018-08-23/the-surprising-backstory-to-west-side-story" target="_blank" rel="noopener">excellent article by Debra Lew Harder</a> that outlines these influences. I love the combination of Jewish themes, Puerto Rican rhythm, Mexican dance music and of course American jazz. His classical roots also come in here – especially the music of Aaron Copland and George Gershwin. The genius is Bernstein's ability to blend all this into a score that tells the story so brilliantly." OverSixty: What’s your favourite moment in the music that audiences might not always notice but could listen out for? Guy: I like what is known as ‘THE BALCONY SCENE’. Most people will know it as the iconic love duet ‘TONIGHT’. In the show this scene moves between spoken dialogue (with underscoring), into the song and back into dialogue in a wonderfully cohesive way. It is so well crafted and is quite a challenge for the conductor to fit the music with the dialogue in a seamless way. I also love the scene in the bridal shop that includes the song ‘ONE HAND ONE HEART’. <img src="https://oversixtydev.blob.core.windows.net/media/2024/03/Wayne-Scott-Kermond-as-Doc.jpg" alt="" width="1280" height="720" /> Wayne Scott Kermond Wayne Scott Kermond, hailing from a rich lineage of Australian Vaudeville performers, epitomises the essence of musical theatre, comedy and cabaret. With a repertoire spanning from Anything Goes to Hairspray, including acclaimed performances in several productions of West Side Story, Kermond's versatility shines through. Additionally, he's showcased his creative prowess as the creator and star of captivating cabaret shows such as Candy Man and Jive Junkys. Beyond the stage, Kermond's talents extend to film, where he's contributed to projects like Happy Feet 1 & 2, and as a respected scriptwriter and director for various musicals, cabarets and corporate events. With accolades including a Green Room Award and Mo Award, alongside nominations for Helpmann Awards, Kermond's exceptional abilities and esteemed showbiz heritage solidify his status as an extraordinary Australian talent. OverSixty: You and Guy first worked on this musical 40 years ago, how does it feel to be coming back together on the Handa Opera version? Wayne: “I first performed in West Side Story at the old Her Majesty’s Theatre (Sydney), 40 years ago playing the youngest member of the Jets gang, ‘Baby John’, and then again in another fabulous production touring Australia / New Zealand in the mid-nineties playing Arab. And so it was lovely to be reminded by Guy on the first day of rehearsals for this season how special it is to us both, here we are, doing it again, just a little greyer." “We shared a few laughs about ‘where did that time go?’, and how ‘young’ we still look after all these years. It’s so great to work with Guy again, I think the last show we did together was Chicago, back in the late nineties. So with Guy's huge amount of expertise and experience at the helm as our Musical Director the show is in great hands. Wait till you hear the amazing Orchestra.” OverSixty: What about this musical’s story, lyrics, etc resonate with you and why do you think it keeps being seen on stage? Can it appeal to all ages? Wayne: “West Side Story is as iconic to music theatre as Swan Lake is to ballet. All great musicals such as West Side have to have a great love story; West Side certainly has that. And to add to that, also an incredible score, dynamic original choreography and a beautifully written book makes it a triple threat. That's why it stands the test of time – it's an inter-generational piece, whose story and message still stands today, which is the reason why I’m now getting the opportunity to play an adult character ‘Doc’ in this OA production 40 years later, as it will be for another artist, in another 40 years' time.” OverSixty: What’s your favourite moment in the show and why? Wayne: It is very difficult to say there is a favourite moment as there are so many. The whole journey of the show is something everyone who loves theatre should experience. The Prologue, Dance at the Gym, America, Cool, Tonight, Something's Comin, and not forgetting the Quintet powerhouse... Every part of this show is special, whether you're seeing the show for the first time or for the tenth time, it’s exhilarating, poignant and moving." “It’s especially wonderful for me to have been given the opportunity to revisit the show, after all these years later as a performer. And it’s very exciting to watch another generation of performers being given the opportunity to experience such an exceptional piece of theatre.” So, mark your calendars, Sydney-siders, because Handa Opera on Sydney Harbour is about to serve up a theatrical experience like no other. With world-class performances, breathtaking views of the harbour, and enough fireworks to make New Year's Eve jealous, this is one event you won't want to miss. So grab your tickets, grab your friends, and get ready to experience the magic of West Side Story like never before. See you at the opera! For more information and ticket sales, check out <a href="https://opera.org.au/productions/west-side-story-on-sydney-harbour/" target="_blank" rel="noopener">opera.org.au/harbour</a> All images: Supplied

Domestic Travel

Legendary Star Wars and James Bond actor passes away

The galaxy far, far away has dimmed a little with the passing of Michael Culver, a distinguished British actor whose name became etched in the annals of cinematic history, particularly for his role in the iconic 1980 film Star Wars: Episode V - The Empire Strikes Back. Culver, who portrayed Captain Needa, the unfortunate Imperial officer, met his demise in one of the franchise's most memorable scenes at the hands of Darth Vader. However, his legacy extends far beyond the realms of science fiction, encompassing a career spanning over five decades of stage, screen and political activism. Born in 1938 in Hempstead, North London, to esteemed parents within the theatre industry, Culver was destined for a life under the spotlight. His father, Roland Culver, was a notable West End stage actor, while his mother, Daphne Rye, served as a casting director in London-based theatre. Following in their footsteps, Culver honed his craft at the London Academy of Music and Dramatic Art, laying the foundation for a prolific acting career. Culver's journey in the performing arts began in the late 1950s, with appearances on Broadway in Shakespearean classics such as King Henry V, Hamlet, and Twelfth Night. His talent soon graced the West End stage in 1962, marking the start of a distinguished theatrical career. Transitioning to the small screen, Culver made his onscreen debut in 1961, captivating audiences with his versatile performances in British television series and movies. However, it was Culver's portrayal of Captain Needa in The Empire Strikes Back that solidified his status as a cultural icon. Despite his character's brief appearance, Culver left an indelible mark on audiences worldwide, immortalised in one of cinema's most unforgettable moments. His confrontation with Vader, culminating in a chilling demise, remains etched in the memories of countless fans, a testament to Culver's ability to captivate audiences with his presence. Beyond his intergalactic exploits, Culver's talents graced a multitude of productions, including notable roles in Sherlock Holmes, A Passage to India, Secret Army, and even appearing in two James Bond movies – From Russia With Love and Thunderball – in uncredited roles. His versatility and dedication to his craft earned him admiration and respect from peers and audiences alike. Yet, Culver's contributions extended beyond the realms of entertainment; in the early 2000s, he shifted his focus to political activism, leveraging his platform to advocate for causes close to his heart. Despite bidding farewell to the limelight, Culver's legacy endures through the countless lives he touched and the memories he forged on stage and screen. An extended message on the Alliance Agents Facebook page, who represented Culver, read as follows: "We are very sad to confirm the passing of our friend and client Michael Culver. A career spanning over 50 years with notable roles in Sherlock Holmes, A Passage to India, Secret Army and of course one of the most memorable death scenes in the Star Wars franchise. Michael largely gave up acting in the early 2000's to concentrate his efforts into his political activism. It's been an honor to have represented Michael for for the last decade and to have taken him to some of the best Star Wars events in the UK and Europe. A real highlight was taking Michael to Celebration in Chicago in 2019. He was lost for words when he saw his queue line with nearly 200 people waiting to see him. We worked with Michael just 3 weeks ago at his last home signing with our friends at Elite Signatures. Michel died on Tuesday 27th February at the age of 85." "We miss him." His passing leaves a void in the hearts of fans and colleagues, a reminder of the fleeting nature of life's curtain call. As we reflect on his remarkable journey, let us celebrate the life and legacy of Michael Culver, an actor whose talents transcended galaxies and whose spirit will continue to inspire generations to come. In his memory, let us heed the timeless words of Captain Needa himself: "We shall double our efforts." Rest in peace, Michael Culver. The force will always be with you. Images: IMDB / Wookiepedia

Caring

War in Ukraine affected wellbeing worldwide, but people’s speed of recovery depended on their personality

<a href="https://theconversation.com/profiles/luke-smillie-7502">Luke Smillie</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> The war in Ukraine has had impacts around the world. <a href="https://mitsloan.mit.edu/ideas-made-to-matter/ripple-effects-russia-ukraine-war-test-global-economies">Supply chains</a> have been disrupted, the <a href="https://news.un.org/pages/wp-content/uploads/2022/06/GCRG_2nd-Brief_Jun8_2022_FINAL.pdf?utm_source=United+Nations&utm_medium=Brief&utm_campaign=Global+Crisis+Response">cost of living</a> has soared and we’ve seen the <a href="https://www.unhcr.org/hk/en/73141-ukraine-fastest-growing-refugee-crisis-in-europe-since-wwii.html">fastest-growing refugee crisis since World War II</a>. All of these are in addition to the devastating humanitarian and economic impacts within Ukraine. Our international team was conducting a global study on wellbeing in the lead up to and after the Russian invasion. This provided a unique opportunity to examine the psychological impact of the outbreak of war. As we explain in a new study published in <a href="https://www.nature.com/articles/s41467-024-44693-6">Nature Communications</a>, we learned the toll on people’s wellbeing was evident across nations, not just <a href="https://ijmhs.biomedcentral.com/articles/10.1186/s13033-023-00598-3">in Ukraine</a>. These effects appear to have been temporary – at least for the average person. But people with certain psychological vulnerabilities struggled to recover from the shock of the war. <h2>Tracking wellbeing during the outbreak of war</h2> People who took part in our study completed a rigorous “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2773515/">experience-sampling</a>” protocol. Specifically, we asked them to report their momentary wellbeing four times per day for a whole month. Data collection began in October 2021 and continued throughout 2022. So we had been tracking wellbeing around the world during the weeks surrounding the outbreak of war in February 2022. We also collected measures of personality, along with various sociodemographic variables (including age, gender, political views). This enabled us to assess whether different people responded differently to the crisis. We could also compare these effects across countries. Our analyses focused primarily on 1,341 participants living in 17 European countries, excluding Ukraine itself (44,894 experience-sampling reports in total). We also expanded these analyses to capture the experiences of 1,735 people living in 43 countries around the world (54,851 experience-sampling reports) – including in Australia. <h2>A global dip in wellbeing</h2> On February 24 2022, the day Russia invaded Ukraine, there was a sharp decline in wellbeing around the world. There was no decline in the month leading up to the outbreak of war, suggesting the change in wellbeing was not already occurring for some other reason. However, there was a gradual increase in wellbeing during the month after the Russian invasion, suggestive of a “return to baseline” effect. Such effects are commonly reported in psychological research: situations and events that impact our wellbeing often (<a href="https://www.researchgate.net/publication/237535630_Adaptation_and_the_Set-Point_Model_of_Subjective_Well-BeingDoes_Happiness_Change_After_Major_Life_Events">though not always</a>) do so <a href="https://www.researchgate.net/publication/7062343_Beyond_the_Hedonic_Treadmill_Revising_the_Adaptation_Theory_of_Well-Being">temporarily</a>. Unsurprisingly, people in Europe experienced a sharper dip in wellbeing compared to people living elsewhere around the world. Presumably the war was much more salient for those closest to the conflict, compared to those living on an entirely different continent. Interestingly, day-to-day fluctuations in wellbeing mirrored the salience of the war on social media as events unfolded. Specifically, wellbeing was lower on days when there were more tweets mentioning Ukraine on Twitter/X. Our results indicate that, on average, it took around two months for people to return to their baseline levels of wellbeing after the invasion. <h2>Different people, different recoveries</h2> There are <a href="https://pubmed.ncbi.nlm.nih.gov/31944795/">strong links</a> between our wellbeing and our individual personalities. However, the dip in wellbeing following the Russian invasion was fairly uniform across individuals. None of the individual factors assessed in our study, including personality and sociodemographic factors, predicted people’s response to the outbreak of war. On the other hand, personality did play a role in how quickly people recovered. Individual differences in people’s recovery were linked to a personality trait called “stability”. Stability is a broad dimension of personality that combines low neuroticism with high agreeableness and conscientiousness (three traits from the <a href="https://www.sciencedirect.com/topics/social-sciences/big-five">Big Five</a> personality framework). Stability is so named because it reflects the stability of one’s overall psychological functioning. This can be illustrated by breaking stability down into its three components: <ol> <li> low neuroticism describes <a href="https://www.pnas.org/doi/full/10.1073/pnas.2212154120">emotional stability</a>. People low in this trait experience less intense negative emotions such as anxiety, fear or anger, in response to negative events </li> <li> high agreeableness describes <a href="https://psycnet.apa.org/record/2018-63285-010">social stability</a>. People high in this trait are generally more cooperative, kind, and motivated to maintain social harmony </li> <li> high conscientiousness describes <a href="https://doi.org/10.1016/j.paid.2023.112331">motivational stability</a>. People high in this trait show more effective patterns of goal-directed self-regulation. </li> </ol> So, our data show that people with less stable personalities fared worse in terms of recovering from the impact the war in Ukraine had on wellbeing. In a supplementary analysis, we found the effect of stability was driven specifically by neuroticism and agreeableness. The fact that people higher in neuroticism recovered more slowly accords with a wealth of research linking this trait with <a href="https://pubmed.ncbi.nlm.nih.gov/10573882/">coping difficulties</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5428182/">poor mental health</a>. These effects of personality on recovery were stronger than those of sociodemographic factors, such as age, gender or political views, which were not statistically significant. Overall, our findings suggest that people with certain psychological vulnerabilities will often struggle to recover from the shock of global events such as the outbreak of war in Ukraine.<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/224147/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/luke-smillie-7502">Luke Smillie</a>, Professor in Personality Psychology, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</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/war-in-ukraine-affected-wellbeing-worldwide-but-peoples-speed-of-recovery-depended-on-their-personality-224147">original article</a>.

Mind

War veteran loses $18,000 to Netflix scam

Shane Arnold, 71, was left with nothing after he fell for an elaborate Netflix scam, allegedly run by a teenager. The war veteran was robbed of $18,000 when he thought he was entitled to a refund after receiving a fake Netflix email. After he entered his personal banking details, the accused scammer allegedly used this information to call Arnold the following day claiming to be a security officer from Commonwealth Bank. "(It was) extremely convincing," Arnold told 9News. "He spoke in a posh English accent." Arnold was allegedly told by a 19-year-old, whose voice had been disguised with AI, that his account had been compromised and ordered to put his bank cards in a bag, to be collected by a driver. Hours later, the accused teen who is from Braybrook, Melbourne allegedly withdrew thousands of dollars from ATMs in Braybrook and West Footscray, and purchased dozens of gift cards from Kmart. He also allegedly filled up on fuel, bought a new iPhone, and some strawberry milk and ice cream. The teen has since been charged over the incident, but Arnold is still fighting hard to get his money back. "I've worked for 50-odd years to get that money," he told the publication, adding that he felt "like my heart had been ripped out". The senior also claimed that the bank was partly to blame, and has lodged a report to the Australian Financial Complaints Authority (AFCA) who are currently managing his case. Arnold added that Commonwealth Bank had only offered to reimburse him $1000, and said that everyone who'd been scammed deserved to have their money returned to them. "I hope all those people get their money back," he said. "None of them deserved to be scammed and none of them did anything wrong." Images: Nine News

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West Side Story returns to Handa Opera on Sydney Harbour

Legendary Star Wars and James Bond actor passes away

War in Ukraine affected wellbeing worldwide, but people’s speed of recovery depended on their personality

War veteran loses $18,000 to Netflix scam

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