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  • What Are the 8 “Rules” of Meditation?

    What Are the 8 “Rules” of Meditation?

    In a world that feels uncertain, chaotic, and often disconnected, people are seeking greater peace, clarity, and emotional balance. In that searching, many have found respite and healing in a regular meditation practice. However, if you’re brand new to meditating, it can be a little intimidating at first. Where do you begin? Are there foundational guidelines or rules of meditation that should be followed? 

    While there are many forms of meditation, some core principles guide successful practice. These principles act as a springboard to help you navigate your meditation journey more effectively. Whether you’re new to meditation or a seasoned practitioner, understanding these “8 rules of meditation” can deepen your practice and enhance its benefits. 

    And, if you read to the end, we’ve included a final guideline that might surprise you—and that might be the most important thing to remember as you explore the challenges and rewards of meditation. 

    Let’s dive into these key principles to discover how they can enrich your meditation experience.

    1. Find a Comfortable Posture

    One of the first and most important rules of meditation is finding a comfortable, stable posture. While many people envision sitting cross-legged on the floor, the truth is that meditation posture can vary. You don’t have to twist into complicated poses to meditate effectively. 

    The key is to find a position where your body feels supported and relaxed. That can be sitting on a chair, cushion, or even lying down. In fact, it can be a useful practice to simply tune into your body before each meditation session and determine which position might be the most comfortable for that day. This is a gentle way to start focusing your attention. 

    If you choose to sit, either in a chair, on the floor, or against a wall, remember to:

    • Keep your spine straight to encourage alertness.
    • Relax your shoulders and let your hands rest naturally.
    • Ensure you are not straining any part of your body.

    Comfort is key because physical discomfort can easily become a distraction during your practice. By settling into a comfortable posture, you allow your mind to focus more easily.

    2. Focus on Your Breath

    You’ll hear meditation teachers speak a lot about the power of the breath. 

    This is because the breath is a natural anchor for meditation. It’s always with you and can be observed without a lot of effort. Focusing on your breath helps quiet the mind and center your awareness in the present moment. This rule of meditation teaches you to tune into your body, observing how the breath moves in and out, without trying to control it.

    When meditating, pay attention to the sensation of air entering and leaving your nostrils or the rise and fall of your abdomen. If your mind wanders—which it inevitably will—gently bring your attention back to the breath. This act of returning to the breath is a key part of meditation, strengthening your mental focus.

    3. Accept What Arises Without Judgment

    A common misconception is that a quiet mind is the goal of meditation, but the reality is that thoughts will always arise. It’s not possible for meditation to be about controlling or suppressing your thoughts, because producing thoughts is just what the brain does. 

    That’s why much of the work of meditation is just learning to accept whatever arises in your mind without judgment. Whether it’s stress, irritation, or joy, let the thoughts and feelings  come and go like clouds passing through the sky. That can look like gently saying to yourself something like, I notice I’m thinking about work right now. I have a lot of worries about my job right now. That’s okay. I can think about work later, but right now, I’m choosing to return to the present. 

    The key here is non-resistance. Instead of fighting your thoughts, simply observe them. Recognize that thoughts are fleeting and don’t define who you are. Over time, you’ll learn how to detach from the endless stream of thoughts and emotions, allowing them to pass without becoming consumed by them.

    And remember that when your attention wanders and you bring it back, that is similar to doing a rep with a weight. The wandering and coming back is not a “failure”—it’s precisely what builds strength in your focus and attention over time. 

    4. Practice Regularly

    Consistency is crucial in meditation. As we mentioned above, strengthening focus and attention is like any skill: the more you practice, the more you’ll benefit. It’s better to meditate for a few minutes every day than for an hour once a week. Regular practice builds mental discipline and helps integrate mindfulness into your daily life.

    Start small if you’re new to meditation—perhaps with just five minutes a day—and gradually increase your time. Find a routine that works for you, whether it’s in the morning, during lunch, or before bed. The important thing is to establish a habit and stick to it. Even short, regular sessions will lead to noticeable improvements in your focus, clarity, and emotional regulation.

    5. Be Patient with Yourself

    As you might imagine, and perhaps have already experienced for yourself, frustration is a very normal part of starting and maintaining a meditation practice. 

    Meditation is a journey, not a destination. In Western culture especially, we’re training to approach everything as if it’s something to be perfected or conquered. It can be extremely strange to engage in a lifelong activity where “mastering” it isn’t the goal. 

    It’s normal to experience challenges, especially in the beginning. Your mind may feel restless, your body may feel almost unbearably uncomfortable at times, and might be surprised and annoyed by what pops into your head when you’re just trying to be still for a second. It’s easy to get discouraged when progress seems slow. This brings us to one of the most important rules of meditation: patience.

    Understand that meditation is a practice of observing the mind and its patterns. There will be good days where meditation feels effortless, and there will be days when your mind seems like a chaotic storm. Both experiences are part of the process and both are completely normal. Patience means accepting where you are today without judgment. Trust that with time and consistency, the benefits of meditation will reveal themselves.

    6. Let Go of Expectations

    A common pitfall in meditation is having expectations about what “should” happen. Many people sit down expecting immediate calm, profound insights, or even emotional or spiritual awakenings. When those expectations aren’t met, disappointment and frustration can follow. One of the core rules of meditation is to let go of expectations.

    Meditation is not about achieving a specific outcome but about being present with whatever arises. You might experience moments of peace, and at other times, you might face discomfort or boredom. The practice is about accepting each moment as it is without trying to manipulate the experience. By letting go of expectations, you create space for authentic, unfiltered awareness.

    7. Think of Mindfulness as Not Just an Activity, but An Approach to All of Life

    Meditation is not confined to your time on the cushion. One of the most powerful benefits of meditation is the ability to bring mindfulness into your everyday life. Meditation is one exercise that helps you stay aware and present in one particular moment, so that you can  stay aware and present throughout the day, no matter what you’re doing.

    Whether you’re eating, walking, working, or talking, try to bring mindful awareness to the present moment. Notice how your body feels, observe your surroundings, and pay attention to your thoughts and emotions without getting lost in them. 

    More good news? This is all a virtuous cycle: staying mindful during everyday activities deepens your meditation practice, which in turn helps to cultivate a sense of peace and clarity that extends out into all the little moments of your beautiful, imperfect human life.

    8. Allow Your Sense of Compassion to Grow

    One of the many side benefits of a regular meditation practice is an expanded capacity to hold compassion—for yourself and others. Meditation is not just about focusing the mind; it’s also about opening the heart. As you observe your thoughts and emotions, practice self-compassion. Recognize that it’s okay to struggle and be kind to yourself when things get tough.

    Likewise, extend that compassion to others. Over time, meditation helps you develop a sense of interconnectedness with the world around you. By practicing loving-kindness meditation or simply holding an attitude of empathy, you foster compassion for all beings. This rule reminds us that meditation is not just a personal practice but a way to connect with others and contribute to the well-being of the world.

    Like the rest of these rules of meditation, there is a kind of counter-intuitive and cyclical nature to expanding compassion. The more we make room for imperfection and mistakes in our meditation practice, the stronger our practice will become over time. The less we put pressure on ourselves to always “get it right”—and judge ourselves by a standard of perfection—the more room we have the ability to extend that grace to ourselves and others in the rest of our lives. 

    A Final Rule: Hold All the Rules of Meditation Lightly

    Mindfulness and meditation are counter-cultural in so many ways. 

    For example: 

    • Rather than a predetermined destination or outcome, we’re invited to relax into an unpredictable process. 
    • Rather than fixating on achievement, we’re invited to let go of our grip on staking our identity and value on perfection.  
    • Rather than trying to “fix” the feelings we don’t like, we’re invited to just be with them, and then we find that they pass through a lot faster. 

    When we see a phrase like “the eight rules of meditation,” it’s easy to slip into thinking about this process the way we think about so many things in life: through the lens of striving, achievement, mastery, and perfection. We can get attached and rigid—and that actually makes growing in the process more difficult. 

    So, in the end, here’s a final invitation: hold all of the rules of meditation lightly. Lean into them for support, guidance, and encouragement. Allow them to be gentle reminders of why you’re here. 

    But also remember that there is so much room for every day to be different. Some days will feel amazing, and some won’t, and that’s okay. It’s all part of the experience, and even the days when it feels like it’s not working…it’s still working. 

    Meditation is a journey, and each time you practice, you take a step closer to greater self-awareness and inner peace. Whether you’re just starting or have been meditating for years, these guidelines can serve as a compass to help you navigate your path with a little more awareness and grace.

    FAQs About the Rules of Meditation

    Q: What if sitting is uncomfortable or painful for me?

    A: The key is finding a position that works for you and your body’s needs. If sitting with your legs crossed is hard on your knees, for example, you can sit in a chair with your feel on the floor. It’s fine to lie down, as well. It can be a useful practice to simply tune into your body before each meditation session and determine which position might be the most comfortable for that day. This is a gentle way to start focusing your attention on your body and your breath before you even officially start your practice.

    Q: I can’t seem to keep my thoughts from racing in every direction. Is this normal?

    A: Yes, it’s completely normal! The mind does what it does: it generates thoughts, feelings, reactions, stories. That’s its job. You might find your mind wandering dozens of times in just the span of five or 10 minutes. Be patient with yourself, and be aware of how you respond to this very natural movement of the mind. Instead of harshly criticizing yourself, try noticing, thanking your mind for doing its thing, and then bringing your attention back to the breath. Each time you return your attention to the present moment, think of it like lifting a weight—you’re actually strengthening your focus each time your bring it back.

    Q: It doesn’t feel like my practice is really doing anything for me, even though I’m following the rules of meditation for the most part. How do I know if a practice is “working”?

    A: It can be super frustrating to start a practice and to hope to see and feel big results right away. The truth is, learning to meditate takes time, and most often the changes aren’t sudden or dramatic.

    One key way to notice shifts as a result of your practice is just to pay attention to how you respond to discomfort or disappointment. You might start to be aware that you’re less reactive, that you have just a moment between when something happens and when you respond that wasn’t there before. Or maybe you notice your inner dialogue shifting—maybe you’re more patient with yourself or others, maybe a little less critical when you make mistakes. You might notice that your focus is sharper, that you see and appreciate “little things” a bit more. Again, it might not be dramatic, but part of a mindfulness practice is becoming more aware of micro-changes in yourself over time.



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  • Leishmaniasis | Yellow Book | CDC

    Leishmaniasis | Yellow Book | CDC

    Infectious agent

    Leishmaniasis is caused by obligate intracellular protozoan parasites; >20 Leishmania species cause leishmaniasis. Leishmaniasis has different forms, including visceral leishmaniasis (VL), cutaneous leishmaniasis (CL), and mucosal leishmaniasis (ML). The presenting form varies by Leishmania species. For example, Leishmania infantum and Leishmania donovani are the most common causes of VL, while ML is most often associated with Viannia species.

    Transmission

    Leishmania parasites are most often transmitted through the bites of infected female phlebotomine sand flies. Transmission risk is greatest from dusk to dawn because sand flies typically feed (i.e., bite) at night and during twilight hours. Vector activity might easily be overlooked because sand flies are small and silent, and their bites can go unnoticed. Travelers with potentially increased risk for leishmaniasis include adventure travelers, bird watchers, construction workers, ecotourists, military personnel, missionaries, Peace Corps volunteers, and people doing research or humanitarian work outdoors at night or twilight. However, even short-term travelers in leishmaniasis-endemic areas have developed leishmaniasis. Immigrants and refugees from endemic areas also might present with leishmaniasis. A less common mode of transmission for both CL and VL is accidental occupational (laboratory) exposures. For VL, uncommon modes include congenital transmission, blood transfusions, organ transplantation, and sharing of contaminated needles.

    Epidemiology

    In 2021, leishmaniasis was reported to be endemic in 99 countries. An estimated 600,000 to 1,000,000 new cases of CL and 50,000 to 90,000 new cases of VL occur annually. The ecologic settings for leishmaniasis transmission range from rainforests to arid regions.

    In the Eastern Hemisphere, CL is found in Africa, particularly the tropical region and North Africa; Asia, particularly Central and Southwest Asia; southern Europe, including southern France, Greece, Italy, Portugal, Spain, and the Mediterranean islands; and some countries of the Middle East. Leishmaniasis from these areas is often referred to as “Old World” leishmaniasis. In the Western Hemisphere, CL is found in parts of Mexico, all countries of Central America, and most of South America except Chile and Uruguay. Endemic transmission in the United States has been identified in Texas, especially among people living in areas bordering northeastern Mexico, and possibly in Arizona and Oklahoma. Leishmaniasis from these areas is often referred to as “New World” leishmaniasis. Endemic transmission of CL is not found in Canada. Visit the World Health Organization (WHO) cutaneous leishmaniasis endemicity map for more information.

    GeoSentinel Surveillance from 1997–2017 indicated that among patients with laboratory confirmed CL examined at specialized travel or tropical medicine clinics on 6 continents, including North America, common source countries for travel-associated CL were in the Amazon Basin (Brazil, Bolivia, Colombia, Ecuador, and Peru); Costa Rica; El Salvador; and Israel. Among immigrants, common source countries were Afghanistan and Syria. Cases of CL in U.S. service personnel have reflected military activities (e.g., in Afghanistan and Iraq). CL is usually more common in rural than urban areas but is found in some peri-urban and urban areas (e.g., in Kabul, Afghanistan).

    Although ML is uncommon, it has occurred in travelers and expatriates, including in people whose cases of CL were not treated or were treated inadequately. ML is most commonly associated with the Viannia subgenus found in Central and South America, particularly in infections acquired in Bolivia, Brazil, or Peru. However, ML has been documented on rare occasions with species of Leishmania found in various countries of the Eastern Hemisphere.

    VL is usually more common in rural than urban areas, but it is found in some peri-urban areas (e.g., in northeastern Brazil). In the Eastern Hemisphere, VL is found in Africa, particularly East Africa; parts of Asia, particularly the Indian subcontinent and Central and Southwest Asia; southern Europe; and the Middle East. In the Western Hemisphere, most cases occur in Brazil; some cases occur in scattered foci elsewhere in Latin America. Overall, VL is found in focal areas of >70 countries. In 2021, 97% of reported VL cases were from 11 countries: Brazil, Eritrea, Ethiopia, India, Kenya, Nepal, Somalia, South Sudan, Sudan, Uganda, and Yemen. Visit the 2020 WHO visceral leishmaniasis endemicity map for more information.

    The geographic distribution of VL cases evaluated in the United States and other countries reflects travel and immigration patterns. Although uncommon in most U.S. travelers, expatriates, and military personnel, VL has occurred in such short-term and long-term travelers returning from travel or deployment to endemic regions in European countries (e.g., France, Greece, Italy, Macedonia, and Spain) and the Middle East.

    Clinical presentation

    Clinical presentation depends on the form of leishmaniasis (i.e., CL, ML, or VL). Not all people with Leishmania infection develop symptoms.

    Cutaneous leishmaniasis

    CL can present with a broad variety of dermatologic manifestations ranging from small and localized skin lesions to large nodules or plaques covering multiple body surfaces. The clinical spectrum can mimic other skin conditions (e.g., leprosy, squamous cell cancer, fungal or other skin infections).

    Lesions typically develop on exposed areas of the skin within several weeks after infection. However, lesions may first appear months or years later, often in the context of trauma (e.g., skin wounds, surgery). The lesions can change in appearance and size over time, typically progressing from small, erythematous papules or nodular plaques to open sores with raised borders and central craters (i.e., ulcers), which can be covered with crusts or scales. Lesions usually are painless but can be painful if superinfected with bacteria. Satellite lesions, regional lymphadenopathy, and nodular lymphangitis can occur. Even without treatment, most lesions eventually heal; they can last for months or years, however, and typically result in scarring.

    Mucosal leishmaniasis

    Some Leishmania species are a potential concern because parasites might spread from the skin to the mucosal surfaces of the nose or mouth and cause lesions in these areas. Most often, these are Leishmania Viannia species in Central and South America. ML frequently appears years after the original skin lesions have healed but may also occur along with the skin lesions or as the initial presentation of a subclinical cutaneous infection. The initial clinical manifestations typically involve the nose, with bleeding, chronic stuffiness, and inflamed mucosa or lesions; less often the mouth or larynx are involved, manifesting as a brassy cough or hoarseness. In advanced cases, ulcerative destruction of the mouth, nose, larynx, and pharynx (e.g., perforation of the nasal septum, laryngeal damage, or tracheal damage) can occur.

    Visceral leishmaniasis

    Among symptomatic people, the incubation period typically ranges from weeks to months. Illness onset can be abrupt or gradual. Stereotypical clinical manifestations of VL include fever, hepatosplenomegaly (especially splenomegaly), night sweats, and weight loss; lymphadenopathy can occur. Laboratory findings characteristic of VL include pancytopenia (anemia, leukopenia, thrombocytopenia), high total protein, low albumin, and hypergammaglobulinemia. If untreated, severe (advanced) cases of VL typically are fatal. Latent infection can clinically manifest years to decades after exposure in people who become immunocompromised through HIV infection, biologic immunomodulatory therapy, or immunosuppressive therapy.

    Diagnosis

    CDC can assist with the diagnostic evaluation of suspected leishmaniasis, including parasite species identification. For consultative services, contact CDC Parasitic Diseases Inquiries (404-718-4745; parasites@cdc.gov). CDC’s Parasitology Lab (404-718-4175; parasiteslab@cdc.gov) can provide helpful information regarding collection, storage, and shipping of samples for Leishmania diagnostic testing.

    Cutaneous and mucosal leishmaniasis

    Consider CL in people with chronic, non-healing skin lesions who have been in areas where leishmaniasis is found. Clinical signs and symptoms are not sufficiently specific to differentiate CL from other conditions. Obtain an explicit travel history, including, if possible, questioning fellow travelers about similar lesions. Obtain information about duration and progression of symptoms, whether the lesions are painful, prior treatment, and current medications (e.g., immunosuppressive agents); photographs are helpful to assess lesions over time. Conduct a careful physical examination, including evaluation of skin, lymph nodes, and mucosal surfaces.

    Any patient with CL caused by a species with risk of causing ML, primarily related to the Viannia subgenus species (Leishmania (V.) braziliensis, Leishmania (V.) guyanensis, and Leishmania (V.) panamensis), but also rarely related to some additional New World and Old World species, should undergo a careful examination of mucosal surfaces, including the vocal cords and oronasal pharynx, along with biopsy of any abnormal appearing tissue, to evaluate for ML. This mucosal exam should occur regardless of other symptoms. Referral to a specialist able to conduct an endoscopic laryngeal examination is warranted if ML is suspected.

    Laboratory confirmation of the diagnosis is achieved by detecting Leishmania parasites or DNA in infected tissue through light-microscopic examination of stained specimens, culture techniques, or molecular methods (e.g., polymerase chain reaction); conducting multiple tests on the specimen improves diagnostic yield. Because different Leishmania species have different management implications, species identification through molecular testing is important, particularly if >1 species is endemic to areas where the patient traveled. Serologic testing generally is not useful for CL because the assays are insensitive and cannot distinguish between active and past infection.

    Visceral leishmaniasis

    Consider VL in the differential diagnosis of people with a relevant travel history, even in the distant past, and a persistent, unexplained febrile illness, especially if accompanied by other suggestive manifestations (e.g., pancytopenia or splenomegaly). Hemophagocytic lymphohistiocytosis could be a complication and should prompt healthcare professionals to consider VL in patients with the appropriate travel history.

    Laboratory confirmation of the diagnosis is achieved by detecting Leishmania parasites or DNA in infected blood, bone marrow, liver, or lymph nodes through light-microscopic examination of stained specimens, molecular methods, or tissue culture techniques. Serologic testing can provide supportive evidence for the diagnosis.

    Treatment

    Treatment of leishmaniasis can be complex; healthcare professionals can receive expert consultation from CDC staff about treatment approaches (see the “Diagnosis” section of this chapter for contact information).

    Cutaneous and mucosal leishmaniasis

    The primary goal of CL and ML treatment is to prevent morbidity. Decisions about whether and how to treat CL, including whether to use a systemic (oral or parenteral) medication rather than a local or topical approach, should be individualized. All cases of ML should be treated with systemic therapy. The response to a particular regimen can vary not only among Leishmania species but also for the same species in different geographic regions. Expert consultation is advised for treatment of any patient with CL, ML, or VL.

    Some patients with CL may be candidates for local therapy depending on the risk of mucosal dissemination, patient characteristics, and the characteristics, number, and location of the lesion(s). Local therapy can include cryotherapy, heat therapy, topical paromomycin, or intralesional pentavalent antimonials. In the United States, topical paromomycin may be available through compounding pharmacies and its use is considered off-label. The oral agent miltefosine is approved by the U.S. Food and Drug Administration (FDA) to treat CL caused by 3 Western Hemisphere species of the Viannia subgenus: Leishmania (V.) braziliensis, L. (V.) guyanensis, and L. (V.) panamensis, as well as for ML caused by L. (V.) braziliensis in adults and adolescents ≥12 years old who weigh ≥30 kg and are not pregnant or breastfeeding during therapy or for 5 months after the last dose of miltefosine. Various parenteral options, including liposomal amphotericin B, are commercially available, although not FDA-approved to treat CL or ML. The pentavalent antimonial compound meglumine antimoniate (Glucantime) is not FDA-approved but can be acquired through an Investigational New Drug (IND) application. Glucantime can be administered intravenously, intramuscularly, or intralesionally; the route of administration should be individualized, and expert consultation is advised. Pentostam is no longer available, but sodium stibogluconate may be available in some countries outside of the United States.

    Visceral leishmaniasis

    All symptomatic patients with VL should be treated. Refer patients with VL to an infectious disease or tropical medicine specialist who can help direct care and provide individualized treatment. Risk for relapse and treatment failure is greater in immunocompromised VL patients compared with immunocompetent VL patients, particularly those living with HIV. Therefore, treatment of VL can differ between immunocompromised and immunocompetent VL patients. Relapse and treatment failure rarely might occur in immunocompetent patients.

    Liposomal amphotericin B (AmBisome) is approved by the FDA to treat VL and is generally the drug of choice for U.S. patients. The oral agent miltefosine is approved by the FDA to treat VL in patients infected with L. donovani who are ≥12 years old, who weigh ≥30 kg, and who are not pregnant or breastfeeding during therapy or for 5 months after treatment. Pentavalent antimonials (e.g., meglumine antimoniate [Glucantime], sodium stibogluconate) are used in endemic areas, except for India, where developing resistance is a concern. See the “Cutaneous and Mucosal Leishmaniasis” section above for further information on the availability of pentavalent antimonials.

    Prevention

    No vaccines or drugs to prevent infection are available. Travelers can reduce the risk of CL by using personal protective measures to avoid sand fly bites (see Mosquitoes, Ticks, and Other Arthropods chapter). Advise travelers to avoid outdoor activities, especially from dusk to dawn when sand flies are the most active; wear protective clothing and apply insect repellent to exposed skin and under the edges of clothing (e.g., shirt sleeves, pant legs) according to the manufacturer’s instructions; and sleep in air-conditioned or well-screened areas. Spraying sleeping quarters with insecticide might provide some protection, and fans or ventilators might inhibit the movement of sand flies, which are weak fliers.

    Sand flies are small (approximately 2–3 mm,

    Acknowledgments

    The following authors contributed to the previous version of this chapter: Paul Cantey and Mary Kamb.

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  • Why Use Stents When They Don’t Work? 

    Why Use Stents When They Don’t Work? 

    Again and again, studies have shown that doctors tend to make clinical decisions for patients based on how much they themselves will get paid.

    In 2007, we learned from the COURAGE trial that angioplasty and stents—percutaneous coronary intervention (PCI)—don’t reduce the risk of death or heart attack, but patients didn’t seem to get the memo. Only 1 percent realize there was no mortality or heart attack benefit, perhaps because most cardiologists fail to mention that fact. One can imagine that if patients actually understood that symptomatic relief was all they were going to get, with “no additional mortality benefits,” they’d be less likely to go under the knife. Then, ten years later, the ORBITA trial was published, showing even the promise of symptom relief was an illusion.

    “The implications of ORBITA are profound and far-reaching. First and foremost, the results of ORBITA show unequivocally that there are no benefits for PCI compared with medical therapy for stable angina,” that is, heart disease. Basically, patients would be risking “harm for no benefit. It is hard to imagine a scenario where a fully informed patient would choose an additional invasive treatment for no added benefit.” Remember the stent consent form I discussed previously, shown below and at 1:17 in my video Why Are Stents Still Used If They Don’t Work?: 

    Now, it looks like this, seen below and at 1:21.

    So, is the ORBITA trial the “last nail in the coffin for PCI in stable angina?” That is, for stents in non-emergency situations? An editorial in the journal Cardiovascular Revascularization Medicine disagreed, pointing to “the broad angina relief that occurred in both arms.” In other words, stents helped—even if the sham operation without stents helped just as much. So, “if the patient is treated with PCI and is benefiting from the ‘placebo effect,’ who am I to interfere with that benefit of this ‘therapy’?” In that case, why not perform fake surgeries? Stent placement can cost around $40,000. It’d be cheaper to just fake it all. The reason we shouldn’t keep electively stenting people is because there’s a body count. During stent placement, 2 percent of patients develop bleeding or blood vessel damage, while another 1 percent die or have a heart attack or a stroke. And because something is stuck in your chest, 3 percent of patients have a bleeding event from the blood thinners that must be taken. Or the blood thinners don’t work and the stent clots off and causes a heart attack.

    Why are they still done when we not only don’t have evidence of benefit but, in many cases, we have explicit “evidence of no benefit”? One of the sources of resistance may be all the financial gain. These procedures make a lot of money for hospitals. Don’t expect them to begin promoting “lifestyle changes to combat heart disease. Nor will physicians quickly abandon a practice that both supports their income and seems to make sense.” Is it that simple? Is it that famous Upton Sinclair quote: “It is difficult to get a man to understand something when his salary depends upon his not understanding it.” Think that’s just cynicism? Let’s ask doctors themselves.

    Thousands of physicians were surveyed, and 70 percent “believed that physicians provide unnecessary procedures when they profit from them.” That’s what doctors themselves believe. And the data bear this out. Doctors have been shown to make clinical decisions for patients based on how much they get paid. For example, when choosing which chemotherapy to treat breast cancer, increasing a physician’s margin by 10 percent can yield up to a 177 percent increase in the likelihood of choosing one drug over another.

    That may be why Caesarean sections “are more likely to be performed by for-profit hospitals as compared with non-profit hospitals.” “Operating on commission.” Pay surgeons per procedure, and you can increase surgery rates by 78 percent. Could that explain why we do 101 percent more angioplasties than any other affluent country? A study on “physicians’ financial incentives and treatment choices in heart attack management” found that they do indeed “respond positively to the payments they receive and that the response is quite large…Unconditionally, plans that pay physicians more for more invasive treatments are associated with a larger fraction of such treatments,” seeming to result in more invasive treatments. So, it may actually be quite common for patients to receive different treatments based on whether the doctor is getting paid per procedure.

    One of my heroes, Dr. Caldwell Esselstyn—who always tries to see the best in people—had to admit that compensation may be playing a role. Evidence surfaced that “doctors have run up millions of dollars in medical bills by doing unnecessary stent implants,” doctors like Mark Midei who inserted 30 stents in a single day. That could be about a million dollars worth of billing. As a token of gratitude, a sales representative from the stent company spent more than $2,000 to buy “a whole slow-smoked pig, peach cobbler, and other fixings for a barbecue dinner at Dr. Midei’s home.”

    “The US is just about the only developed country where health care is delivered on a fee-per-service basis and we very liberally incentivize physicians for doing invasive procedures,” explained the chief of cardiovascular medicine at the Cleveland Clinic. “The economic incentives are just too strong.” 



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  • Why a Platform Approach Outperforms Point Solutions with Pritesh Patel, COO of Andor Health

    Why a Platform Approach Outperforms Point Solutions with Pritesh Patel, COO of Andor Health

    As artificial intelligence (AI) continues to reshape industries, healthcare remains pivotal. While many health systems have attempted to implement AI through point solutions—single-use applications that address specific needs—these fragmented tools often fail to deliver lasting value. The real potential of AI lies in a platform approach, where a unified system can repurpose AI capabilities across multiple functions, streamlining care delivery and operational efficiency at scale.

    At the forefront of this transformation is Andor Health, whose AI-first ThinkAndor® platform eliminates the inefficiencies of point-based AI solutions. According to Pritesh Patel, Chief Operating Officer of Andor Health, by scaling across a healthcare system, ThinkAndor’s® AI enables organisations to extend its benefits beyond single-use cases, unlocking new opportunities in clinical workflow orchestration, ambient documentation and enhanced AI vision capabilities.

    Why Point Solutions Fall Short

    The healthcare industry has seen cycles of adopting and replacing fragmented technologies, which have struggled to provide sustainable ROI. Many health systems initially implemented healthcare applications as a point solution, only to realise that managing disparate systems created more complexity rather than reducing it. The advent of AI-based point solutions puts healthcare organisations in a similar place – implementing singular AI features rather than a platform for the last scale. This approach places systems in the same situation as before.

    A platform approach, on the other hand, allows AI-enhanced use cases to be systematically deployed across an entire health system, creating a framework for scale and innovation. Once AI is approved and implemented at scale, it can be responsibly repurposed for use cases, providing a centralised and unified agent that enhances efficiency across various functions.

    Beyond Single-Use: The Power of AI at Scale

    Rather than being confined to one-off applications, AI-first ThinkAndor® delivers enterprise-wide value by supporting diverse functions across the care continuum.

    Clinical Documentation (AI feature)

    Through automated ambient documentation, ThinkAndor® improves documentation efficiency by 47% across various nursing workflows. For an inpatient admission, the platform also reduces ~200 EHR clicks per patient admission and boosts overall staff productivity by 15%. By tripling nursing capacity, this AI-driven documentation system allows clinicians to spend more time on patient care than administrative tasks.

    Machine Learning & Care Coordination

    Leveraging machine learning, ThinkAndor® supports predictive modelling that goes beyond traditional tools. AI-powered models, such as those used to predict post-operative recovery outcomes (e.g., urinary continence and erectile function following robotic-assisted radical prostatectomy), demonstrate significant potential for personalised patient care without increased administrative burdens. In one study, AI-based ANN models achieved AUCs of 0.74 for potency and 0.68 for continence, outperforming other predictive models. These models provide clinicians with data-driven insights to better manage patient expectations and guide shared decision-making throughout the patient care journey.

    ThinkAndor® also integrates neural vision insights to support ambient observation without requiring health systems to invest in proprietary hardware or edge-based computing. By leveraging existing endpoints, the platform uses AI agents to continuously scan for key conditions such as bed availability, cleaning status, provider identification, hand washing, patient falls, elopement, and more—enabling proactive workflows and improved care team coordination. Furthermore, these use cases can be tethered to ancillary systems (EMR, CRM, HR), automatically allowing the data transfer and action to happen.

    By integrating responsible AI at the enterprise level, Andor Health enables health systems to scale AI adoption efficiently, improving operational effectiveness and patient outcomes.

    Sustainable Healthcare Through AI Innovation

    AI is not just a tool for improving efficiency—it is also a key driver of a sustainable future in healthcare. ThinkAndor® optimises care coordination, reduces administrative burden, and enables data-driven decision-making, all while ensuring compliance with regulatory standards.

    As health systems look to the future, embracing a platform approach over point solutions is critical.

    By leveraging an AI Infrastructure at scale, healthcare organisations can maximise impact, improve workforce efficiency, and ultimately enhance the quality of patient care in a meaningful and sustainable way – not just now but for decades to come.

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  • Ultra-processed foods | Dietitian Connection

    Ultra-processed foods | Dietitian Connection


    We’re continuing our deep dive into ultra-processed foods – this time through the lens of patient and client perspectives. What are people saying in consults? What questions are coming up? And how can dietitians guide informed, balanced conversations? In today’s episode, Clara Nosek, registered dietitian and creator of Your Dietitian BFF, shares some of the very real conversations she and fellow dietitians are having about ultra-processed foods and how to support informed decision making in today’s food landscape. 

    Hosted by Kristin Houts

    Biography

    Clara  Nosek is a Registered Dietitian Nutritionist and the creator behind Your Dietitian BFF. Clara works through the lens of non-diet, providing fun and educational messages that remain in alignment with her commitment to accessible wellness and nutrition. Meet Clara on socials @yourdietitianbff, where she excels in making sustainable nutrition relatable, engaging, and honest, serving up evidence-based advice with a pinch of cheekiness.

    In this episode, we discuss:

    • The concerns patients raise about ultra-processed foods and other trending nutrition topics
    • Where patients get nutrition information
    • How to address misinformation without judgement
    • The “stickiness” of making food choices
    • A team approach to educating the public on social media

    Additional resources

    • Click here to watch our Dietitian to Dietitian discussion on ultra-processed foods
    • Click here to visit Clara’s webpage
    • Connect with Clara on Instagram, tiktok, and substack at @yourdietitianbff

     

    The content, products and/or services referred to in this podcast are intended for Health Care Professionals only and are not, and are not intended to be, medical advice, which should be tailored to your individual circumstances. The content is for your information only, and we advise that you exercise your own judgement before deciding to use the information provided. Professional medical advice should be obtained before taking action. The reference to particular products and/or services in this episode does not constitute any form of endorsement. Please see  here  for terms and conditions.


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  • Childhood Exposure To Common Gut Bacteria To Blame?

    Childhood Exposure To Common Gut Bacteria To Blame?

    Colorectal cancer rates are climbing globally, with a particularly alarming rise among young adults under 50. Researchers now believe they may have uncovered a hidden culprit behind the medical mystery. A recent study suggests that early exposure to a toxin produced by harmful strains of E. coli could be a possible driver behind the surge.

    In the latest study published in the journal Nature, researchers found that childhood exposure to colibactin, a toxin produced by certain strains of E.coli, damages DNA and these mutations raise the risk of bowel cancer before the age of 50.

    In a large-scale genome analysis of 981 colorectal cancer across 11 countries, researchers noted a distinct pattern of DNA mutations caused by colibactin. These specific DNA patterns were over three times more common in patients under 40 compared to those over 70.

    Interestingly, these genetic fingerprints were not just seen in young adults, but more often in countries with the highest rates of early-onset colorectal cancer, pointing to a possible link between bacterial exposure and the rising number of young adults affected worldwide.

    “These mutation patterns are a kind of historical record in the genome, and they point to early-life exposure to colibactin as a driving force behind early-onset disease,” said study senior author Ludmil Alexandrov in a news release.

    “If someone acquires one of these driver mutations by the time they’re 10 years old, they could be decades ahead of schedule for developing colorectal cancer, getting it at age 40 instead of 60,” Alexandrov explained.

    While earlier studies including prior research from the same team had linked colibactin to 10 to 15 percent of all colorectal cancer cases, they did not differentiate between younger and older patients.

    “When we started this project, we weren’t planning to focus on early-onset colorectal cancer. Our original goal was to examine global patterns of colorectal cancer to understand why some countries have much higher rates than others. But as we dug into the data, one of the most interesting and striking findings was how frequently colibactin-related mutations appeared in the early-onset cases,” said the first author Marcos Díaz-Gay.

    Researchers are now exploring innovative ways to translate these findings into early detection and prevention tools. One promising idea is a stool test designed to detect colibactin-related markers, which could help identify individuals at higher risk for early-onset colorectal cancer. They are also investigating the potential of probiotic therapies aimed at rebalancing the gut microbiome in children to reduce the risk later in life.

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  • Recurrent Cancer – NCI

    Recurrent Cancer – NCI

    When cancer comes back after treatment, doctors call it a recurrence or recurrent cancer. Finding out that cancer has come back can cause feelings of shock, anger, sadness, and fear. But you have something now that you didn’t have before—experience.

    You’re in Control

    Maybe in the back of your mind, you feared that your cancer might return. Now you might be thinking, “How can this be happening to me again? Haven’t I been through enough?” But you’ve lived through cancer once. You know a lot about what to expect and how to prepare. You know the health care team and people at the hospital. 

    Remember that treatments may have improved since your first cancer. New drugs or methods may help with your treatment or in managing side effects. In some cases, improved treatments have helped turn cancer into a chronic disease that people can manage and live with for many years.

    Cancer that returns can affect all parts of your life. You may feel weak and no longer in control. But you don’t have to feel that way. You can take part in your care and in making decisions. You can also talk with your health care team and loved ones as you decide about your care. This may help you feel a sense of control and well-being.

    Why Cancer Comes Back

    Recurrent cancer starts with cancer cells that the first treatment didn’t fully remove or destroy. This doesn’t mean that the treatment you received was wrong. It just means that a small number of cancer cells survived the treatment and were too small to show up in follow-up tests. Over time, these cells grew into tumors or cancer that your doctor can now detect.

    Sometimes, a new type of cancer will occur in people who have a history of cancer. When this happens, the new cancer is known as a second primary cancer. Second primary cancer is different from recurrent cancer.

    Types of Recurrent Cancer

    Doctors describe recurrent cancer by where it develops and how far it has spread. The different types of recurrence are:

    • Local recurrence means that the cancer is in the same place as the original cancer or very close to it.
    • Regional recurrence means that the tumor has grown into lymph nodes or tissues near the original cancer.
    • Distant recurrence means the cancer has spread to organs or tissues far from the original cancer. When cancer spreads to a distant place in the body, it is called metastasis or metastatic cancer. When cancer spreads, it is still the same type of cancer. For example, if you had colon cancer, it may come back in your liver. But, the cancer is still called colon cancer.

    Staging Recurrent Cancer

    To figure out the type of recurrence you have, you will have many of the same tests you had when your cancer was first diagnosed, such as lab tests and imaging procedures. These tests help determine where the cancer has returned in your body, if it has spread, and how far. Your doctor may refer to this new assessment of your cancer as “restaging.”

    After these tests, the doctor may assign a new stage to the cancer. An “r” will be added to the beginning of the new stage to reflect the restaging. The original stage at diagnosis does not change.

    See our information on Diagnosis to learn more about the tests that may be used to assess recurrent cancer.

    Treatment for Recurrent Cancer

    The steps you go through for treatment most likely will be the same as when you first had cancer, even if your treatment changes. Many people have a treatment team of health providers who work together to help them. This team may include doctors, nurses, social workers, dietitians, or other specialists. 

    There are many treatment choices for recurrent cancer. You may have the same or a different treatment than you did for the first cancer. This will depend partly on the type of cancer and the treatment you had before. It will also depend on where the cancer has recurred, whether it has spread, and how your health is now.

    Chemotherapy, surgery, radiation, biological therapies, or a combination of treatments may be options for you. Your doctor may also suggest a clinical trial that you may benefit from. It’s important to ask your doctor questions about all your treatment choices. You will want to know all the risks and benefits of treatment. And if you choose not to go through treatment again, palliative care can provide comfort care for you. 

    To learn about the treatments that may be used to treat your recurrent cancer, find your type of cancer among the PDQ® cancer treatment summaries for adult and childhood cancers.

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  • Steel Flow Pro – Presentation

    Steel Flow Pro – Presentation

    Product Name: Steel Flow Pro – Presentation

    Click here to get Steel Flow Pro – Presentation at discounted price while it’s still available…

    All orders are protected by SSL encryption – the highest industry standard for online security from trusted vendors.

    Steel Flow Pro – Presentation is backed with a 60 Day No Questions Asked Money Back Guarantee. If within the first 60 days of receipt you are not satisfied with Wake Up Lean™, you can request a refund by sending an email to the address given inside the product and we will immediately refund your entire purchase price, with no questions asked.

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  • An Interbeing Meditation for Connection and Understanding

    An Interbeing Meditation for Connection and Understanding

    In this guided interbeing meditation, Shalini Bahl explores our interdependence as a pathway to better understanding, compassion, and cooperation, especially when conflict feels overwhelming.

    Summary

    • Through the practice of interbeing meditation, we explore our inherent connection to the whole world.
    • Interbeing is one word for our basic interconnectedness and interdependence as living beings.
    • When we consider both our own needs and the needs of other people, we can be more understanding and kind, even during difficult interactions.

    If you’ve faced challenging or polarizing conversations lately, you likely know how difficult it can be to connect and cooperate with the person on the other side of that interaction.

    In today’s guided interbeing meditation, Dr. Shalini Bahl invites us to explore our innate interconnectedness by recognizing our needs and those of others, so that we can be empowered to work together in new and creative ways that benefit all involved.

    An Interbeing Meditation for Connection and Understanding

    Read and practice the guided meditation script below, pausing after each paragraph. Or listen to the audio practice.

    1. Welcome to Interbeing, a guided practice for connection and understanding. Zen master and peace activist Thich Nhat Hanh coined the word interbeing to describe a basic interconnectedness and interdependence as living beings. This practice invites us to explore this interconnectedness, especially when facing challenging conversations or polarizing situations. By recognizing our needs and those of others, we can foster greater understanding. This compassionate awareness can empower us to work together in new and creative ways that benefit all involved. 
    2. Let’s begin by coming to a comfortable sitting posture that allows you to be alert and relaxed. Gently close your eyes, or simply soften your gaze. Rest your awareness on the breath moving in and out of your body, naturally and effortlessly. Invite your mind to be here with your breath and body. Feel the spaciousness in your chest with each inhale and exhale. 
    3. Now picture a vast open sky filled with white fluffy clouds. See these clouds gathering to become larger and darker, heavy with life-giving rain. Feel the cool drops falling, sinking deep into the earth below. Sense the trees drinking deeply, their roots reaching deep down into the earth and the branches lifting towards the sky. 
    4. Think of these trees, well nourished by the rain water, by this earth, offering their fibers to be transformed into the very paper we use in our everyday lives. Just as this rain nourishes the earth and the earth nourishes the trees, so too are we nourished by this web of life around us. Each breath we take connects us to the trees, the rain, the earth, and all living beings. 
    5. Take a few moments to connect with this sense of awe and wonder in whatever way feels most authentic to you. Sense this interconnectedness with this web of life and all beings. 
    6. In this spirit of interbeing, bring to mind someone you are or will be interacting with—at home, work, or in your community—for whom you want to feel compassion. This could be someone you want to connect with more deeply as someone you’re having a conflict with. 
    7. Once you have the person and this interaction in mind, return to your present moment. Experience the breath moving in and out of your body. If your mind feels especially active today, place one hand on your chest and one hand on your belly as you feel the rising and falling of your body under the gentle touch of your hands. 
    8. Every time your mind wanders away, which it will, bring it back with kindness to your breath moving in and out of your body. Once your mind is stabilized, listen within to your needs in this interaction. Quietly ask yourself, What are my needs in this interaction? Stay here with kindness without forcing an answer. Listen then with patience. What would you like to get from this interaction? What are your needs? What are your intentions? What would you like to see happen? 
    9. Don’t go with the first response. Wait. Listen. Notice any kind of rushing judgments or fears. About what you may discover, making space for it all. Allow yourself to see, to feel whatever is your experience.  
    10. Feel free to pause this recording and journal or if you need a little more time. Once you feel ready, quietly ask yourself the following: What are the other person’s needs? Again, no need to search for answers. Just make room in your mind and your heart to listen within. 
    11. What is coming up for you as you make room for the other person’s perspectives? Their lived experiences? What might be going on for the other person, and what are their needs? If possible, see that person, the whole person beyond the situation. The ways in which they, too, care about the things that you care about. The ways that they, too, have suffered, just like you have in your life. 
    12. You’re not assuming you know everything. You’re just trusting yourself to know what you need to know. All we’re doing is making room, with the intention to see this other person. 
    13. When you find yourself overly distracted, or getting into a thinking mode, return to your breath. Your breath is an anchor to your natural place of connection with your body, yourself, and others. From this place of connection, open your mind to listen to the other person’s needs. 
    14. Again, if you like, you can pause this recording to do some journaling. Even the subtlest of shifts in your perspective can have a big impact on how you show up. 
    15. Based on your reflection today, how might you show up for yourself and the other person? Take some time to create an intention for showing up with understanding and kindness. And before you begin your interaction with that person, remember to return to your contemplation of interbeing, your intentions, and trusting your natural goodness. May this interbeing meditation help us navigate challenging interactions with grace, compassion, and wisdom. May our practice together benefit us and all beings. 



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