5 Tips Dermatologists Swear by for Healthy, Glowing Skin

Scrolling through Instagram, it’s easy to assume that getting healthy, glowing skin requires overhauling your entire life and, probably, emptying your bank account. But it really doesn’t have to be a challenge! In fact, you can make big differences in your skin with some small changes to your routine.

The first step, though, is to make sure you’re nailing the basics: washing your face regularly, using a moisturizer that’s right for your skin type, and using sunscreen. From there, finding the right products and routine is a matter of what your individual skin needs and your personal preferences. So, we spoke with a few experts to get their top tips for healthier (and healthier-looking) skin.

1. Please, please, please wear sunscreen.

“The single most important tip for healthy, glowing skin is to apply a broad spectrum sunscreen with SPF 30 or higher every single day,” Shari Lipner, M.D., dermatologist at Weill Cornell Medicine and NewYork-Presbyterian, tells SELF. “Performing this daily routine will protect you from skin cancer, sun spots, and wrinkles,” she says. So, if you’re not already doing this, now is the time to start.

And that’s not just something you should be applying to your face—you should be putting sunscreen on all “exposed areas of skin every single day,” Nada Elbuluk, M.D. clinical assistant professor of dermatology (clinician educator), Keck School of Medicine of USC, tells SELF.

Although you should use whatever type of sunscreen that you like enough to wear regularly (provided it’s broad spectrum and at least SPF 30), Suzan Obagi, M.D., director of the UPMC Cosmetic Surgery & Skin Health Center, tells SELF that she usually recommends mineral sunscreens that rely on titanium dioxide and zinc oxide. “However, we know that this is not 100 percent effective [at blocking UV rays] no matter what the SPF is,” she says.

That’s also why it’s important to keep your other sun safety strategies in mind, such as wearing protective clothing and staying in the shade whenever possible. “I recommend avoiding any intentional sun exposure, including tanning and tanning beds, given that this will accelerate aging and wrinkling,” Jules Lipoff, M.D., an assistant professor of Clinical Dermatology in the Perelman School of Medicine at the University of Pennsylvania, tells SELF.

2. Find an exfoliation routine that works for you.

Exfoliation helps to remove dead skin cells, revealing the newer, smoother skin underneath. In general, dermatologists recommend using chemical exfoliators over physical ones because they tend to be gentler on the skin.

For normal and oily skin types, Binh Ngo, M.D., clinical associate professor of dermatology (clinician educator), Keck School of Medicine of USC, tells SELF that she recommends using products containing alpha hydroxy acids (AHAs) and beta hydroxy acids (BHAs). AHAs include ingredients like glycolic acid and lactic acid while salicylic acid is the main BHA in skin-care products.

Those with sensitive skin may want to look into the even gentler polyhydroxy acids (PHAs), Dr. Ngo says, and should avoid physical exfoliators like harsh scrubs containing pits or abrasive beads.

Along with retinoids (more on those in a bit), chemical exfoliants “optimize skin cell turnover and lead to a more even, glowing complexion,” Shilpi Khetarpal, M.D., dermatologist at Cleveland Clinic, tells SELF. But, because both types of products can cause irritation, avoid using them at the same time (e.g. alternate evenings or use one in the morning and one at night, depending on what your skin can handle).

3. Add an antioxidant or two to your skin-care regimen.

If you’ve ever wondered what exactly antioxidants are doing in your beauty products, here’s a quick explainer: Sun exposure leads to the formation of free radicals, which can cause oxidative stress and, in high enough amounts, can damage the skin. So, in skin-care products, antioxidants “clean up or ‘scavenge’ the [free radicals], thus minimizing damage to the cells,” Dr. Obagi explains.

One of the most common and effective antioxidants you’ll find in skin care is vitamin C, which “is a great antioxidant that reverses oxidative damage from sun exposure,” Emily Newsom, M.D., a board-certified dermatologist at Ronald Reagan UCLA Medical Center, tells SELF, “and there are several nice serums on the market.”

Vitamin E is another antioxidant option that’s also a good moisturizer, Dr. Newsom says. “But really any good moisturizer is important to keep your skin healthy and dewy,” she adds.

4. Invest in a vitamin A product.

“Vitamin A-related compounds (retinoids) are really good for giving that glow and brightening the skin,” Dr. Newsom says. You may know these ingredients as retinol or, in a prescription form, tretinoin or Retin-A. They all work by ramping up the normal skin cell turnover process, which can help with concerns like fine lines and dark spots as well as acne.

In addition to a normal skin-care routine and using a gentle exfoliator, using a retinoid at night is “the best way to get a healthy glow,” Dr. Khetarpal says. However, be advised that these ingredients are notorious for causing some irritation when first starting out, so it’s best to use them just a few days a week in the beginning.

5. Pay attention to your individual skin needs.

Above all, remember that what works for someone else may not work for you. “Know your own skin,” Jamie B. MacKelfresh, M.D., associate professor in the department of dermatology at Emory University School of Medicine, tells SELF.

If your skin tends to be dry or sensitive, you may need to prioritize extra moisturizer and hold back on the exfoliation to achieve a healthy glow, Dr. MacKelfresh says. But if your skin is on the oilier side, gentle exfoliation may be the key for you.

“Knowing your skin can help you find the right products to maximize your skin health and natural glow,” Dr. MacKelfresh says. And if you don’t know where to start or feel frustrated by a lack of results, talk to a board-certified dermatologist for guidance on caring for your unique skin.


Smartphone app makes parents more attuned to their babies’ needs, research shows

University of York researchers have designed an app to help new parents become more ‘tuned in’ to what their babies are thinking and feeling.

The app, called BabyMind, prompts the parent to think about things from their baby’s perspective and to consider what is going on in their baby’s mind at a specific point each day. It also provides parents with accurate information on babies’ psychological development.

Smartphone apps targeted at parents and parents-to-be are increasingly popular with users, but there is a lack of evidence on how effective they are at improving parenting behaviour.

Professor Elizabeth Meins, from the University of York’s Department of Psychology, said, “There are thousands of parenting apps available, but we don’t know whether any of them actually have a positive impact on parenting.

“There are many advantages of using apps as a means of intervention — they’re low-cost, easy to use and already integrated into people’s lives — but we wanted to establish whether an app can have a demonstrable effect on the quality of parent-baby interaction.”

The team recruited a group of mothers who started using the app as soon as their babies were born and followed up with them when their babies were six months of age.

The researchers observed the parents playing with their babies and assessed how attuned they were to their babies’ thoughts and feelings. The mothers were compared against a control group of mothers with 6-month-olds who had not used the app. Compared with the control group mothers, the app users were significantly more attuned to their babies’ thoughts and feelings.

The study included a wide age range of mothers, and the results for teenage mothers were particularly interesting. Professor Meins explained, “Previous research has shown that teenage mothers show less attunement to their babies’ thoughts and feelings compared with mothers in their mid-twenties or older. Our study showed that young mothers who had used BabyMind were just as attuned as the older mothers who’d used the app.

“Even more impressive was the fact that the young app users were more attuned to their babies than the older mothers who had not used the BabyMind app. This suggests that using our app is associated with younger motherhood no longer being a disadvantage.”

NICE data show that uptake of antenatal and postnatal services is poor in younger parents, so this research may be useful in designing interventions to support families in hard-to-reach populations.

The research is funded by the Economic and Social Research Council (grant ES/K010719/1) and published in the journal PLOS ONE.

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We Asked 5 People Why They Cut Back on Alcohol

If you’ve ever sworn off alcohol only to dive into your drink of choice soon after, you might have gathered that cutting back on booze can be both alluring and, well, hard. Overall, we are a nation of pretty prolific drinkers. Think I’m exaggerating? Research from the 2015 National Survey on Drug Use and Health, which polled over 68,000 Americans above the age of 12, indicated that 56 percent of respondents 18 and over had consumed alcohol in the past month. About 27 percent of people 18 or older had engaged in binge drinking (having four to five drinks within two hours) in the past month.

Our love of drinking seeps into our social lives; quality time often involves making toasts, attending happy hours, and participating in boozy brunches. It’s no wonder that cutting back might prove harder than it seems.

Since you clicked on this article, chances are something about your drinking isn’t sitting well with you. You might even wonder if your alcohol use meets the threshold of alcoholism, or alcohol use disorder. This essentially means you drink compulsively, lack control over your drinking, and experience a strong urge to drink because going without alcohol feels crappy in one way or another, according to the National Institute of Alcohol Abuse and Alcoholism (NIAAA). But also, you don’t need to have alcohol use disorder to decide you don’t want to drink as much (or at all). Maybe you’re a mostly moderate drinker (up to one drink per day for women and up to two drinks per day for men), but you still don’t love something about how alcohol makes you feel or the effect it has on your life.

Whether artisan cocktails are draining your wallet or hangovers are draining your life force, it can be hard to change your drinking habits. So, we talked to five people about what made them cut back and what advice they have for people looking to do the same. Hopefully, their stories provide a little guidance if you’re hoping to sit out the rest of frosé season and beyond.

1. “I stopped liking who I was when I would drink.”

“In my early 20s, I was all about going to bars or having a few glasses of wine to unwind after a long day. But, somewhere along the way, I stopped liking who I was when I would drink. I’d say or do something awful and then I would spend days regretting it. As I get older, the stakes are too high. I have a great relationship and a good job. I am not going to blow this over alcohol. Plus, that two-day hangover is real. Now, I try to drink only on special occasions, like weddings or other celebrations.

When I first cut back, not keeping alcohol in the house unless guests were coming over was really helpful. I also rewarded myself. For instance, if I went out and everyone was drinking beer but I abstained, then I would get to have an extra cookie or some ice cream. It helped me not feel so deprived.

The hardest part has been fielding questions from people who don’t understand why I don’t drink much anymore. When I decided to do 30 days of no alcohol, my fiancé’s college friends came into town and met us at a bar. I’d never met them before, and they immediately asked why I wasn’t drinking. I lied and said, ‘Surprise! This guy got me pregnant!’

Eventually, I told them it was a joke, but I doubt they’ll ask anyone why they aren’t drinking anytime soon.” —Amanda T., 30, cut back in June 2017

2. “My relationship with alcohol wasn’t healthy.”

“I used to consider myself to be a social drinker, but when I turned to drinking alone on a daily basis, I had to be honest with myself: My relationship with alcohol wasn’t healthy, and it was time to cut back. For me, cutting back means that I pay attention to my body, and I know my limits. I used to consume anywhere from four to six drinks a night. Now it’s two or three, max, on special occasions.

Drinking less has also been part of the fitness and weight loss journey I’ve embarked upon since January. I’ve been paying more attention to what I’ve been putting into my body and how it impacts me negatively or positively. I’ve lost a lot of weight in these past eight months. I know that’s mostly due to changes in my activity and overall nutrition, but cutting back on alcohol specifically has also helped. Also, my mind is clear, and I now face my problems head on instead of coping with alcohol.

That said, being around my relatives can be a bit challenging because we are a drinking family. We might hang out and have wine or have dinner and drinks. I don’t impose my lifestyle on my family, but when I’m with them now, it’s water or tea, and an alcoholic beverage every so often instead of at every Sunday dinner. ” —Chineye E., 34, cut back in January 2019

3. “It’s expensive to drink.”

“Before I cut back, I drank with friends for any and every occasion, and I drank my way through the dating scene. A few drinks felt necessary to deal with all the ridiculousness that’s out there. But it’s expensive to drink.

Now, I’ll still drink, but I just make sure to be smart about it. Instead of ripping shots, I’ll nurse a beer or a cocktail for a while. I also ask myself if I’ve fulfilled all of my financial obligations before I start drinking. If I’m having a tight month, I’ll abstain. But if I’m in a good place, I might have a couple of drinks to unload a little.

The hardest thing about being sober is having ridiculous conversations with someone who’s already wasted. I’ve always felt that no one wants to be the sober person at a party. And why is this? Because drunk people are kind of the worst. They can’t speak, and if they do, most of the time they repeat their stories over and over. But when you’re the sober person, you are a walking tome for the events of that evening and are totally allowed to laugh at the people making fools of themselves. As long as no one is in danger, of course.

If you’re thinking of cutting back, my advice would be to remind yourself why. It’s going to be tough, and there might be days ahead where you totally fall off, but a couple of bad days won’t ruin the process. Keep your head up and start again. The friends that are nearest to you will understand, and the others will fall by the wayside.” —Bobby M.*, 35, cut back in April 2014

4. “My mental strength goals were more important to me than drinking.”

“I used to drink Thursday through Saturday. I probably had like 15 drinks or so a week. I drank because I enjoyed how it made me feel in the short-term: sexy and free-spirited. But I was not being healthy about it mentally. I was using it to find confidence.

My biggest motivator in cutting back was the sadness I knew was linked to drinking in order to feel better about myself. After talking it through with my therapist, I realized that my mental strength goals were more important to me than drinking. I made the decision to stop drinking out of emotion and decided to put my energy into weight training, and that’s helped me develop a stronger sense of self. Now, I barely have one drink on the weekends. I save drinking for when I am on vacation or at a nice dinner. My energy level is better and I don’t feel sluggish.

Most of my friends are either supportive or impressed, but there are a few who try to coerce me to drink. Even then, I don’t. I grab a soda or seltzer, stick some lime in it, and if someone asks, I’ll tell them I am not drinking.

Ultimately, I think cutting back on any habit that isn’t making you a better person is a good thing. If having drinks doesn’t make you feel good about yourself and you have feelings of guilt, then you should start to make choices that feel right for you.” —Kayla S.*, 36, cut back in Fall 2017

5. “I was unhappy and using alcohol to cope.”

“I cut back after going through a divorce and feeling that I needed to become a healthier version of myself. I never had more than three drinks in a night, but I felt alcoholic beverages would further depress me.

What surprised me about drinking less in the beginning was how my true introverted personality started to reveal itself. Not drinking made going out with friends who still drank heavily hard for me. And I’m a chef, so drinking is basically like tasting food, but going to events for free drinks didn’t have the same appeal.

Instead of going out drinking, I started to use hot yoga, indoor cycling classes, and jogging to fill my time. I also started reading more books to improve my career ambitions and my spiritual life, and to help me understand my own behavior patterns. I concentrated on nurturing myself and didn’t focus on what I was missing by not drinking. Instead, I focused on what I was beginning to gain, which was the clarity I needed to move forward without wearing my wedding ring. Now I sometimes still have a drink, but usually, after one, I will drink seltzer with lime for the remainder of the night. I feel happy and stay hydrated that way.

My advice to anyone who might be thinking about cutting back? If you can, just do it, and don’t dwell on it. If it seems too hard to cut back on your own, then perhaps a meeting or counseling will help. Never be too proud to stop, and try not to deny when drinking may be a problem that potentially masks deeper issues. Looking back, I realize that I was unhappy and using alcohol to cope.” -Tia C., 43, cut back in June 2013

*Names have been changed upon request. Quotes have been edited for clarity.
If you’d like more information about cutting back on alcohol, check out the NIAAA’s support and treatment resources guide or call the Substance Abuse and Mental Health Administration’s National Helpline at 1-800-662-4357.


Scratching the surface of how your brain senses an itch

Light touch plays a critical role in everyday tasks, such as picking up a glass or playing a musical instrument. The sensation is also an essential part of the body’s protective defense system, alerting us to objects in our environment that could cause us to fall or injure ourselves. In addition, it is part of the detection system that has evolved to protect us from biting insects, such as those that cause malaria and Lyme disease, by eliciting a feeling of an itch when an insect lands on your skin.

Salk researchers have discovered how neurons in the spinal cord help transmit such itch signals to the brain. Published in the journal Cell Reports on July 16, 2019, their findings help contribute to a better understanding of itch and could lead to new drugs to treat chronic itch, which occurs in such conditions as eczema, diabetes and even some cancers.

“The takeaway is that this mechanical itch sensation is distinct from other forms of touch and it has this specialized pathway within the spinal cord,” says Salk Professor Martyn Goulding, holder of the Frederick W. and Joanna J. Mitchell Chair and a senior author of the new work.

Goulding and his colleagues had previously discovered a set of inhibitory neurons in the spinal cord that act like cellular brakes, keeping the mechanical itch pathway in the spinal cord turned off most of the time. Without these neurons, which produce the neurotransmitter neuropeptide Y (NPY), the mechanical itch pathway is constantly on, causing chronic itch. What the researchers didn’t know was how the itch signal, which under normal circumstances is suppressed by the NPY neurons, is transmitted to the brain to register the itch sensation.

David Acton, a postdoctoral fellow in the Goulding lab, hypothesized that when the NPY inhibitory neurons are missing, neurons in the spinal cord that normally transmit light touch begin to act like an accelerator stuck in the “on” position. Acton then identified a candidate for these “light touch neurons,” a population of excitatory neurons in the spinal cord that express the receptor for NPY, the so-called Y1 spinal neurons.

To test whether these neurons were indeed acting like an accelerator, Acton undertook an experiment that involved selectively getting rid of both the NPY “brake” and Y1 “accelerator” neurons. Without Y1 neurons, mice didn’t scratch, even in response to light-touch stimuli that normally make them scratch. Moreover, when Acton gave the animals drugs that activated the Y1 neurons, the mice scratched spontaneously even in the absence of any touch stimuli. The Goulding team was then able to show that the NPY neurotransmitter controls the level of Y1 neuron excitability; in other words, NPY signaling acts as a kind of thermostat to control our sensitivity to light touch. Data from other labs has found that some people with psoriasis have lower than average levels of NPY. This may mean their brakes on mechanical itching are less effective than other people’s, a potential cause of their itching.

While Y1 neurons transmit the itch signal in the spinal cord, other neurons are thought to be responsible for mediating the final response in the brain but more research is needed to continue mapping out the full pathway, according to the researchers. Understanding this will help suggest targets for drugs to turn down the sensation of itch in people who are overly responsive and could lead to ways to address chronic itch.

“By working out mechanisms by which mechanical itch is signaled under normal circumstances, we might then be able to address what happens in chronic itch,” says Acton.

Other researchers on the study were Xiangyu Ren, Stefania Di Costanzo, Antoine Dalet and Steeve Bourane of the Salk Institute; and Ilaria Bertocchi and Carola Eva of the University of Torino.

The study was supported by the National Institutes of Health and the Caterina Foundation.

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Physical activity at any intensity linked to lower risk of early death

Clear evidence that higher levels of physical activity — regardless of intensity — are associated with a lower risk of early death in middle aged and older people, is published by The BMJ today.

The findings also show that being sedentary, for example sitting still, for 9.5 hours or more a day (excluding sleeping time) is associated with an increased risk of death.

Previous studies have repeatedly suggested that sedentary behaviour is bad and physical activity is good for health and long life.

Guidelines recommend at least 150 minutes of moderate intensity or 75 minutes of vigorous physical activity each week, but are based mainly on self reported activity, which is often imprecise. So exactly how much activity (and at what intensity) is needed to protect health remains unclear.

To explore this further, researchers led by Professor Ulf Ekelund at the Norwegian School of Sport Sciences in Oslo analysed observational studies assessing physical activity and sedentary time with death (“all cause mortality”).

Studies used accelerometers (a wearable device that tracks the volume and intensity of activity during waking hours) to measure total activity in counts per minute (cpm) of wear time. Intensity is usually separated into light, moderate and vigorous — and the time in these intensities is then estimated.

Examples of light intensity activity includes walking slowly or light tasks such as cooking or washing dishes. Moderate activity includes brisk walking, vacuuming or mowing the lawn, while vigorous activity includes jogging, carrying heavy loads or digging.

Data from eight high quality studies involving 36,383 adults aged at least 40 years (average age 62) were included. Activity levels were categorised into quarters, from least to most active, and participants were tracked for an average of 5.8 years.

During follow-up, 2149 (5.9%) participants died. After adjusting for potentially influential factors, the researchers found that any level of physical activity, regardless of intensity, was associated with a substantially lower risk of death.

Deaths fell steeply as total activity increased up to a plateau at 300 cpm, similar to the average activity levels in a population-based sample of US men and about 10-15% lower than that observed in Scandinavian men and women.

A similarly steep decrease in deaths occurred with increasing duration of light physical activity up to a plateau of about 300 minutes (5 hours) per day and of moderate intensity physical activity of about 24 minutes per day.

The largest reduction in risk of death (about 60-70%) was between the first quarter (least active) and the fourth quarter (most active), with approximately five times more deaths in those being inactive compared with those most active. This strengthens the view that any physical activity is beneficial and likely achievable for large segments of the population say the researchers.

In contrast, spending 9.5 hours or more each day sedentary was associated with a statistically significant increased risk of death.

The researchers point to some limitations. For example, all studies were conducted in the US and western Europe, and included adults who were at least 40 years old, so findings may not apply to other populations or to younger people.

Nevertheless, they say the large sample size and device based measures of sedentary time and physical activity provide more precise results than previous studies.

As such, they say their results provide important data for informing public health recommendations, and suggest that the public health message might simply be “sit less and move more and more often.”

These findings are important and easy to interpret, say researchers in a linked editorial. However, questions remain, particularly over whether the effect of physical activity continues above a certain threshold.

They acknowledge that increasing activity at the population level is challenging, but say walking is one promising target for intervention, as it is simple, affordable (free), achievable even for older adults, and rarely contraindicated.

“Developing ways to limit sedentary time and increase activity at any level could considerably improve health and reduce mortality,” they conclude.

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Omega-3 fats have little or no effect on type 2 diabetes

Increasing omega-3 fats in the diet has little or no effect on risk of type 2 diabetes, finds an evidence review published by The BMJ today.

As such, the researchers say omega-3 supplements should not be encouraged for diabetes prevention or treatment.

Type 2 diabetes is a leading cause of illness and death, with annual costs estimated at over US $800 billion worldwide. The rise in type 2 diabetes is mainly due to increased body fatness and inactivity so diet and body weight are key in treating, preventing, and delaying its onset.

Previous studies have suggested that polyunsaturated fatty acids (PUFAs) derived from oily fish (long-chain omega-3) and from plants (alpha-linolenic acid and omega-6) may have beneficial effects on the body that could help protect against type 2 diabetes but results are inconclusive.

Many countries also recommend a diet high in polyunsaturated fats for a range of conditions, including diabetes.

To explore this further, researchers at the University of East Anglia analysed the results of 83 randomised controlled trials involving 121,070 people with and without diabetes, all of at least six months duration.

Trials assessed the effects of increasing long-chain omega-3, alpha-linolenic acid, omega-6 or total PUFAs on new diabetes diagnoses or measures of glucose metabolism (how well the body processes sugars) taken either as supplements or via enriched or naturally rich foods. The quality of evidence for each trial was also measured.

The researchers found that increasing long-chain omega-3 fats (LCn3, from fish oils, by 2g per day LCn3 over a mean trial duration of 33 months) had little or no effect on likelihood of diabetes diagnosis or on glucose metabolism, and this did not change with longer duration.

Effects of alpha-linolenic acid (or ALA, another type of omega-3), omega-6 and total PUFAs on diabetes diagnosis were unclear (as the evidence was of very low-quality). Meta-analysis (combining the results of the trials) suggested little or no effect of these fats on measures of glucose metabolism.

There was a suggestion that high doses of long-chain omega-3 fats (more than 4.4g per day) may have negative effects on diabetes risk and glucose metabolism, but the researchers stress that this finding should be interpreted with caution.

The researchers point to some weaknesses, including missing data and risk of bias in some trials. Nevertheless, when they restricted their analyses to only include the highest quality trials (those at lowest risk of bias) there was still no effect on diabetes risk or glucose metabolism.

The researchers say this is the most extensive review to date assessing the effects of polyunsaturated fats on diabetes and glucose metabolism in long-term randomised controlled trials.

As such, they say “there is no convincing evidence to suggest that altering our LCn3, ALA, omega-6 or total PUFA intakes alters glucose metabolism or risk of diabetes.” And they suggest that supplements “should not be encouraged for diabetes prevention or treatment.

Larger, high quality trials of at least 12 months duration looking at the effects of ALA, omega-6, oily fish and total PUFA on diabetes diagnosis and measures of glucose metabolism would be helpful, they conclude.

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Trump Administration’s Domestic Gag Rule on Abortion: What You Need to Know

The latest major headline about the ongoing attack on abortion rights is one of the most upsetting yet. You may have seen news swirling about a “domestic gag rule” on abortion and the fact that Planned Parenthood decided to pull out of the Title X program as a result of that gag rule. But you might not know what all of that means, and especially what it might mean for your right to a safe, legal abortion.

It’s a lot of political and legal jargon to work through on your own, which can conceal the stark reality here: This is a huge deal, and reproductive rights nationwide are in even more jeopardy than before. Here’s what you need to know.

Is this a domestic gag rule on abortion?

According to this new rule, health clinics can’t receive certain funding if they provide abortions or even if they refer patients to other health centers where they can receive abortions. The federal funding we’re talking about here is Title X funding, which makes family planning and other preventive health services more affordable and accessible, but has never been used to directly fund abortion. (We’ll explore Title X in more detail in the next section.) President Donald Trump first released a proposal for the rule in May 2018, and the U.S. Department of Health and Human Services (HHS) released the final rule in February 2019.

The rule requires “financial and physical separation” between facilities or programs that provide any kind of health service using Title X funds and those that provide abortions. It also “[prohibits] referral for abortion as a method of family planning.” The rule says that providers can still offer “non-directive counseling on abortion,” but as SELF previously reported, non-directive counseling is already the medical standard. That simply means that doctors go over all treatment options, along with the pros and cons, in an effort to make sure patients have all the information they need to best look after their health. Because of the limitations of this rule, though, non-directive counseling would mean a doctor wouldn’t actually be able to tell a patient where they could go to access an abortion, unless it is a medical emergency.

According to the HHS, this is not a gag rule, because providers can still counsel their patients on abortion. However, the rule states that providers are only allowed to give abortion referrals in cases of medical emergencies. So, hypothetically, if a patient is seeking an abortion for any other reason, their provider is not allowed to tell them where they can get one. That sounds like a gag rule to us, so we’ll be referring to it as such from here on out.

We have a precedent for this internationally: the Mexico City Policy, often referred to as the global gag rule on abortion, as it affects U.S. funds going to international health organizations. You may remember that in 2017, President Trump reinstated this policy, which prevented U.S. money from funding international health organizations that offer abortions or even just information about abortions—even if U.S. dollars aren’t paying for the actual abortion-related services, as they don’t in the United States. The ban was introduced by President Reagan in 1984, and it’s been rescinded and reinstated many times since then.

The domestic gag rule leaves Title X facilities that provide abortions as well as other health services in a maddening bind: Either they forgo the funding they receive through Title X, or they stop providing some information and services related to abortion. The resulting outcry has been swift and fierce.

“Restrictions on funding family planning services is a targeted attack on patients, and that is infuriating to me both as a mother who timed pregnancy and as a physician who helps other women to control their reproductive futures,” Katie McHugh, M.D., board member with Physicians for Reproductive Health and an ob/gyn in Indiana, tells SELF. “There are no other types of patients or medical procedures that are regulated in this way.”

Cutting Title X funding to health clinics unless they pretend abortion doesn’t exist will make affordable health care even harder to access. “This rule is quite dangerous,” Fabiola Carrion, senior staff attorney with the National Health Law Program, tells SELF. “It rolls back progress that is already in place to ensure that all women and people have access to quality care, including birth control and other reproductive health care.”

While it’s clear that this rule is aimed at restricting access to abortions, the HHS says that the goal is to make sure that providers “are not required to choose between participating in the [Title X] program and violating their own consciences by providing abortion counseling and referral.” By this, they’re referring to the fact that the previous Title X rules required providers to answer a patient’s questions about abortion if asked and to refer them to somewhere that does provide abortions, if requested. However, the fact that the new rules now prohibit referrals for abortions that aren’t deemed “medical emergencies” presents a new dilemma for providers: They’re now required to choose between participating in the Title X program and providing their patients with all of the information that they’re requesting.

How does Title X work?

The Title X program is a pool of federal funds dedicated to ensuring access to family planning and other preventive health services like birth control, screening for sexually transmitted infections, breast and cervical cancer screening, family planning counseling, and other reproductive health services. Just over $286 million is designated for Title X use in 2019, according to the Congressional Research Service.

As the only federal grant program earmarked for this cause, it’s impossible to overstate how crucial Title X is for people’s health nationwide. Around 4,000 clinics receive this funding (that is, before clinics started leaving the program due to the gag rule), which allowed them to help over 4 million people each year, according to the Guttmacher Institute.

Those who use Title X-funded clinics are often low-income people of color who are underinsured or uninsured, leaving these groups especially vulnerable to reduced access to care.

“This attack is devastating to the future prospects of these people,” Dr. McHugh says. “Without access to health care and contraception, they are not empowered to control their futures or invest in society.”

One of the most frustrating aspects of this news is that federal law already doesn’t allow Title X money to directly fund abortion. Using these federal funds to pay for an abortion in any way is simply not happening. (Thanks to the controversial Hyde Amendment, federal Medicaid funding also does not cover abortion costs outside of very narrow exceptions.) So, despite any claims to the contrary, this gag rule is not about limiting federal funds going to abortion—that is already prohibited.

What the gag rule actually does is threaten to revoke Title X funding for any health center that provides abortions or even talks to patients about abortions. This gag rule means that if a provider at a clinic even answers a patient’s questions about how to access an abortion, they can’t receive this Title X funding for the other important health services they provide, like affordable birth control methods that would prevent unwanted pregnancies. It also means that they need to stop providing abortions altogether, or stop receiving their Title X funding altogether—again, even though that funding was not being used for abortions.

Why did Planned Parenthood pull out of the Title X program?

On August 19, Planned Parenthood Federation of America announced that it was pulling out of the Title X grant program rather than halting abortion services and referrals. Planned Parenthood serves around 1.5 million Title X patients every year, or about 40 percent of all people who receive care from a Title X clinic, the organization says in a statement. Monday was the deadline for Title X grantees to agree that they’d follow the domestic gag rule and provide a plan for doing so, according to the HHS.

“I want our patients to know: while the Trump administration may have given up on you, Planned Parenthood never will,” Alexis McGill Johnson, acting president and CEO of Planned Parenthood Federation of America, says in a statement. “Our doors are open today, and our doors will be open tomorrow.”

Planned Parenthood isn’t the only group that has decided to leave the Title X program instead of providing a limited spectrum of care. According to the Associated Press, the Maine Family Planning network of clinics also announced that it will no longer use Title X funds. And earlier this month, Public Health Solutions, a group of clinics in New York, announced that they would leave the Title X program instead of complying with the gag rule, as reported by Vice.

What happens next?

By September 18, all clinics intending to comply with these rules must submit a statement to that effect and “supporting evidence with compliance requirements,” according to the HHS. By March 4, 2020, they would need to submit a statement along with evidence that they’ve separated facilities providing Title X services from those providing abortion services or referrals.

Clearly, if the domestic gag rule goes into effect, it will impact the ability to receive a safe and legal abortion or information about how to access one.

“With the changes in the Title X rules and Planned Parenthood being forced out, anti-abortion and abstinence-only fake health centers will be emboldened to target even more young people, especially those young people who are specifically needing low-cost care,” Diana Thu-Thao Rhodes, director of Public Policy at Advocates for Youth, tells SELF.

But the impact could be even more devastating than that.

Clinics that opt not to comply and therefore lose Title X funding might struggle to stay open or provide as wide a range of care as many do, Hal Lawrence, M.D., ACOG executive vice president and CEO, tells SELF in a statement. “This endangers women’s health, leaving them with fewer options for safe, timely, and comprehensive preventive care, and is certain to delay provision of care or altogether deter women from seeking care at all,” he says.

The exact impact this might have will vary from clinic to clinic. As the Associated Press explains, some states, like Illinois and Vermont, will use state funds to make up for any lost Title X money. Some health clinics are also coming up with ways to technically stay in the Title X program while hoping the rule will be overturned. As POLITICO reports, Essential Access Health, California’s main Title X grantee, could use up to $250,000 of state funds per clinic as a one-time assistance program. But the impact could be greater in states that don’t have this type of contingency plan and rely heavily on Planned Parenthood as a Title X grantee, such as Minnesota, where Planned Parenthood serves 90 percent of Title X patients, per the Associated Press.

However heartening they may be, these stop-gap measures can’t undo the cruel inanity of this ruling. Overall, “there aren’t enough Title X clinics to absorb all the patients from clinics that are pulling out of the program,” Dr. McHugh says. “Young women, youth of color, low-income [people], LGBT youth, immigrant youth⁠—all deserve better,” Rhodes adds.

“Those that can afford it will need to travel farther for their care, endure longer wait times, take more time off work and away from their families, or even accept substandard care. They will not have access to the same health care that others do, simply because they are low-income, and this is unacceptable,” Dr. McHugh says.

As with so much that the Trump administration has put forth, this rule is being challenged in the courts. The National Family Planning & Reproductive Health Association is suing to overturn the rule, resulting in an extensive legal volley. Organizations such as the American Medical Association and Planned Parenthood have joined the legal battle against this rule as well. Oral arguments in the case to overturn the gag rule are scheduled for the week of September 23 before San Fransisco’s 9th Circuit Court of Appeals, the Washington Post reports.

“We are continuing to fight this rule in court, and we will do everything we can to make sure our patients don’t lose care,” Erica Sackin, senior director of communications for Planned Parenthood Federation of America, tells SELF. “With the help of our 13 million supporters, we will be on the ground urging Congress to act now to stop the gag rule, and protect birth control and reproductive health care for millions of people.”


Most patients willing to share medical records for research purposes

As medicine becomes both bigger and more personalized, the need for massive databases of patient records, such as the 1 million person All of Us Research Program, become increasingly essential to fueling both new discoveries and translational treatments.

But the looming, lingering question is to what degree are individual patients willing to share medical records and biospecimens with researchers and institutions beyond their personal physician or health care system? And more specifically, how should patients be asked and what information are they most likely to share?

In a novel attempt to answer these questions, researchers at University of California San Diego School of Medicine, with collaborators in California, North Carolina and Texas, asked patients at two academic hospitals to respond to a variety of different approaches seeking to share their medical data with other researchers.

The findings are published in the August 21, 2019 online issue of JAMA Network Open.

The survey was conducted at two academic hospitals — UC San Diego Health and UC Irvine Health between May 1, 2017 and September 31, 2018. Participants were randomly selected to one of four options with different layouts and formats for indicating sharing preferences: opt-in simple, opt-in detailed, opt-out simple and opt-out detailed. In the simple forms, there were 18 categories where participants could choose to share information; in the detailed forms, there were 59 items. The items ranged from demographics like age, sex and race and socioeconomic status to lab results (genetic tests, drug screening, etc.), imaging (x-rays, MRI) and biospecimens (blood, urine, tissue).

Participants were also asked to what degree they would be willing to share their medical data: with researchers only in the same health care organization or with those working at other nonprofit or for-profit institutions.

Among 1,800 eligible participants, 1,246 completed the data sharing survey and were included in the analysis and 850 responded to a satisfaction survey. Slightly less than 60 percent were female and slightly less than 80 percent were white. The mean age was 51 years old.

More than 67 percent of survey participants indicated they would share all items with researchers from the home institution (which patients presumably already trust with their health care), with progressively smaller percentages for sharing with other nonprofit institutions or with other for-profit institutions. Many of the respondents indicated that they were only unwilling to share a few items.

“These results are important because data from a single institution is often insufficient to achieve statistical significance in research findings,” said the study’s senior author, Lucila Ohno-Machado, MD, PhD, professor of medicine, associate dean for informatics and technology in the UC San Diego School of Medicine and chair of the Department of Biomedical Informatics at UC San Diego Health. “When sample sizes are small, it is unclear whether the research findings generalize to a larger population. Additionally, in alignment with the concept of personalized medicine, it is important to see whether it is possible to personalize privacy settings for sharing clinical data.”

Generally speaking, the current state of affairs concerning the sharing of “anonymized” patient health data for secondary research is uneven and unsettled. It has been shown that anonymization methods — in which data sets are either encrypted or stripped of personally identifiable information — are not 100 percent effective. Since 2013, newly enrolled patients are required to proactively consent to sharing their personal health information for research studies or future secondary use. In California, a patient’s specific permission is required to share mental health, substance abuse, HIV status and genetic information, but other items or conditions are not specified. In many states, there is no requirement for a patient’s specific permission on these types of items before they can be shared. Today, for practical purposes, patients have the option to decline any part of their medical record be used for research. They cannot indicate what types of research or researcher should be able to obtain their records.

Almost three-quarters of respondents — 67.1 percent — said they would be willing to share all items with researchers from their health care institutions; almost one-quarter said they would be willing to share all items with all interested researchers, a finding the authors said was reassuring and could help in the planning of studies based on EHRs and biospecimens that would be expected to be broadly shared.

Equally encouraging: Less than 4 percent of participants said they were not willing to share any information with anyone.

Ohno-Machado said the way in which preferences are elicited also has an influence. There was greater sharing per item when respondents were asked to opt-out than when they were asked to opt-in. Whether the form had details about the items or used broad categories did not have an influence on sharing.

“This is important because a simple form could be used in the future to elicit choices from all patients, saving their time without significantly affecting their privacy preferences,” said Ohno-Machado. “However, different rates of sharing are expected for opt-in and opt-out of sharing clinical records for research.”

A key finding was that a majority of survey participants identified at least one item that they did not want to share with a particular type of researcher (for example, a scientist at another for-profit institution), though they were willing to share other items.

“This finding is important,” wrote the authors, “because the item to withhold may not be of relevance to a certain study, but the current all-or-nothing option, if chosen, would remove that patient’s data from all research studies.”

The authors said the survey’s tiered-permission system that allows specific removal of data items or categories proves both doable and appealing to patients, in part because there are differences among individuals in where and with whom they share what.

The findings, said the authors, trigger further questions about the ideal balance between giving patients the ability to choose what portions of their data they want to share for research and with whom and the “greater good,” i.e., how fast research can be accelerated for the benefit of all.

“Institutions currently make decisions on sharing on behalf of all patients who do not explicitly decline sharing. It is possible that asking patients directly would increase the amount of data shared for research. On the other hand, it is also possible that some types of research would suffer from small sample sizes if patients consistently decline certain categories of items,” Ohno-Machado said.

Lower back pain? Self-administered acupressure could help

A recent study finds that acupressure, a traditional Chinese medicine technique, can improve chronic pain symptoms in the lower back.

“Acupressure is similar to acupuncture, but instead of needles, pressure is applied with a finger, thumb or device to specific points on the body,” says Susan Murphy, ScD, OTR, an associate professor of physical medicine and rehabilitation at Michigan Medicine and lead author of the study.

Murphy says that while acupressure has been previously studied — and found to be beneficial — in people with cancer-related or osteoarthritis pain, there are few studies that have examined acupressure in people with back pain.

In the study, published in Pain Medicine, the research team randomly assigned 67 participants with chronic low back pain into three groups: relaxing acupressure, stimulating acupressure or usual care.

“Relaxing acupressure is thought to be effective in reducing insomnia, while stimulating acupressure is thought to be effective in fatigue reduction,” Murphy says.

Participants in the acupressure groups were trained to administer acupressure on certain points of the body, and spent between 27 and 30 minutes daily, over the course of six weeks, performing the technique.

Participants in the usual care group were asked to continue whatever treatments they were currently receiving from their care providers to manage their back pain and fatigue.

“Compared to the usual care group, we found that people who performed stimulating acupressure experienced pain and fatigue improvement and those that performed relaxing acupressure felt their pain had improved after six weeks,” Murphy says.

“We found no differences among the groups in terms of sleep quality or disability after the six weeks.”

Potential treatment option

Murphy notes that chronic pain is difficult to manage and people with the condition tend to have additional symptoms such as fatigue, sleep disturbance and depression.

“Better treatments are needed for chronic pain,” Murphy says. “Most treatments offered are medications, which have side effects, and in some cases, may increase the risk of abuse and addiction.”

She says this study highlights the benefits of a non-pharmacological treatment option that patients could perform easily on their own and see positive results.

“Although larger studies are needed, acupressure may be a useful pain management strategy given that it is low risk, low cost and easy to administer,” Murphy says.

“We also recommend additional studies into the different types of acupressure and how they could more specifically be targeted to patients based on their symptoms.”

What to Do After a Facial: 11 Things You Should Definitely Skip

Wondering what to do after a facial? Smart move. Ideally, your skin is super smooth and soft after a facial—but it may also be super sensitive. That’s why treating your skin to the proper post-facial care is especially important.

I totally get why many skin experts consider facials to be regular complexion maintenance—kind of like car tune-ups for our face. Regular facials may help combat the toll that stress, the environment, and some of our daily habits take on our skin. And there is plenty to be said for that fresh, dewy glow and satin-soft skin post-facial (not to mention the relaxation of an hour of me-time and a mini-massage).

But even as a beauty writer, I’m always surprised by the cost of a good facial. When you’re spending as much as $150 or more per session, whose budget can afford to keep up regular facial appointments—especially when most aestheticians, and even some dermatologists, recommend getting one every four to six weeks?

My freelancer budget can’t quite handle a monthly trip to the spa, but I knocked a few fancy dinners and happy hours off my calendar recently to treat myself to an appointment with my aesthetician. While I was lying face-up on the massage table with a steamer staring me in the face, I steered our conversation to the best ways for me to maintain the effects of the treatment until the next time my facial-fund jar was full. What ensued was a laundry list of the things I shouldn’t do upon leaving the spa.

Nearly everything she said was included in my afternoon plans (sunbathing myself to sleep with a cocktail in hand before showering and heading out for the night). Here I was dropping $200 on a hydrafacial, and I was an hour away from possibly undoing all the benefits I was counting on it to bestow. Nuh-uh. I followed my aesthetician’s advice, then called in more experts to find out exactly what to do after a facial—and what not to do. Keep reading to get their top after-facial tips.

What to do after a facial: Day 1

1. Avoid picking at your skin.

True, you really should try to avoid this all the time, but your skin is especially sensitive after a facial. Though it’s tempting to pop every tiny blackhead or whitehead that rears its ugly face on yours, keep your hands off if you want beautiful skin. There’s a reason your facialist didn’t nix them herself. “If I’ve done extractions on a client, I don’t want them picking at their skin any further, as it can cause irritation and potential scarring,” Chicago-based aesthetician Meghana Prasad tells SELF. “Sometimes, there will be a lesion that I leave without extracting because it’s not ready to come out yet.”

2. Skip the heavy makeup and skin-care products.

If your face is looking red from the exfoliation or extractions in your facial, you might be tempted to whip out your heaviest full-coverage concealer. Resist. Sejal Shah, M.D., board-certified dermatologist and RealSelf contributor, tells SELF that because your facial provides such a deep cleanse, it’s smart to give your skin a break from makeup and heavy products for a day or so, because your pores are more open than normal and, therefore, susceptible to more bacteria. Taking a break from makeup will also allow the serums, creams, or peels that were used to be more effective.

Don’t worry, you can resume your usual makeup routine the following day. The first time you do apply makeup after a facial, make sure you’ve given your brushes and applicators a solid scrubbing to avoid post-facial breakouts.

3. Go easy on your face when washing it.

Remember, your skin is ultra sensitive after a facial so you’ll want to go easy on it. “Often times, the serums and physical manipulation of the skin during the facial can disrupt the skin barrier so it’s best to stick to gentle, hydrating cleansers,” Joshua Zeichner, M.D., director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City tells SELF. His go-to recommendation: Dove Sensitive Skin Body Wash, which he says “removes dirt without compromising the integrity of the skin barrier and hydrates skin at the same time.” Though it’s marketed as body wash, it’s gentle enough to use on your face, notes Zeichner.

4. Skip the toner.

“I do not recommend applying toners to the skin for a day or two after a facial, especially if they are alcohol-based or contain exfoliating or astringent ingredients,” says Zeichner. “These can cause irritation or dryness of the skin.” After a facial, you shouldn’t need to use toner anyway since your aesthetician already did a deep clean and brought your skin back in balance.

5. Resist the sauna.

It’s tempting since most spas often have some kind of steam room or sauna available for customers to use, but it’s in your skin’s best interest to enjoy this amenity pre-treatment. Once you’ve had your facial, keep away from hot rooms of any kind for at least a day. Your skin has already been steamed to the max during your facial, and adding any more could lead to sensitivity and broken capillaries, Shah explains.

6. Rethink that post-facial massage.

“I would be cautious about getting a traditional massage on a table right after getting a facial,” says Zeichner. “You can certainly do it, but the masseuse would need to be very careful about your face and should definitely avoid a facial massage.” So if you’re treating yourself to a full spa day, your best bet is to get a massage before your facial so you don’t have to worry about your delicate post-facial skin rubbing against the massage table. Or, go for an upright neck and back massage in a chair, suggests Zeichner.

7. Reschedule your workout.

If you didn’t get the chance to work out before your facial, you might be tempted to sneak it in right after, but wait at least a day. “The increased heat in the skin and sweat can be irritating to your freshly exfoliated skin,” says Prasad. “If my clients are adamant about working out, I usually suggest they make sure to make their trip to the gym before their appointment so their skin has time to heal.”

What to do after a facial: Days 2 and 3

8. Lay off any exfoliators or face scrubs.

Over-exfoliating can damage your skin’s protective layer and can lead to inflammation. Since most facials incorporate an exfoliant—either chemical or physical—Zeichner recommends skipping anything that could irritate your skin for several days after getting one. Stick with a gentle facial cleanser instead.

9. Stay away from acne products and other at-home treatments.

When it comes to post-facial care, it’s best not to overdo it on products, and this is especially true when it comes to harsh, potentially irritating products. This includes retinols, at-home peels, and cleansers and toners with salicylic acid. These products can turn that fresh post-facial radiance into redness.

It’s also best to avoid most face masks. “Many face masks designed to brighten, exfoliate, or treat acne may cause inflammation to skin that is sensitive from a facial,” explains Zeichner. “The ingredients in these treatments can irritate already sensitive skin.” One exception to this rule is hydrating masks that contain ingredients like hyaluronic acid. Try Zeichner’s pick—Neutrogena Hydroboost Hydrogel Sheet Mask—which he says is a great option post-facial.

If you’re feeling unsure about what products to use post-facial, experts agree it’s a good idea to ask your aesthetician for recommendations of what to use on your face once they’re done with your treatment.

10. Stay out of the sun.

At the very least, you should cancel any plans to sit pool- or beachside after your facial—unless you plan on hiding behind a wide-brimmed hat the whole time. “Because your skin has just been exfoliated, it is more sensitive and vulnerable to the sun’s harmful rays,” Prasad explains. After a few days, you can worry less about your skin reacting negatively to the sun, but it’s still smart to wear a sunscreen with an SPF of 30 or higher every day.

What to do after a facial: Days 4-7

11. Postpone any wax or laser treatments on your face.

When your aesthetician gives you the green light for hair-removal procedures on your face will depend on how intensely you were exfoliated during your facial, but Prasad says a good rule of thumb is to wait at least a week. “Waxing, especially, exfoliates the skin, and over-exfoliation will make it more likely that the wax will lift the skin and leave you with an ugly scab instead of beautifully groomed brows,” she says.