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Rule that patients must finish antibiotics course is wrong, study says

Experts suggest patients should stop taking the drugs when they feel better rather than completing their prescription

Telling patients to stop taking antibiotics when they feel better may be preferable to instructing them to finish the course, according to a group of experts who argue that the rule long embedded in the minds of doctors and the public is wrong and should be overturned.

Patients have traditionally been told that they must complete courses of antibiotics, the theory being that taking too few tablets will allow the bacteria causing their disease to mutate and become resistant to the drug.

But Martin Llewelyn, a professor in infectious diseases at Brighton and Sussex medical school, and colleagues claim that this is not the case. In an analysis in the British Medical Journal, the experts say the idea that stopping antibiotic treatment early encourages antibiotic resistance is not supported by evidence, while taking antibiotics for longer than necessary increases the risk of resistance.

There are some diseases where the bug can become resistant if the drugs are not taken for long enough. The most obvious example is tuberculosis, they say. But most of the bacteria that cause people to become ill are found on everybodys hands in the community, causing no harm, such as E coli and Staphylococcus aureus. People fall ill only when the bug gets into the bloodstream or the gut. The longer such bacteria are exposed to antibiotics, the more likely it is that resistance will develop.

The experts say there has been too little research into the ideal length of a course of antibiotics, which also varies from one individual to the next, depending in part on what antibiotics they have taken in the past.

In hospital, patients can be tested to work out when to stop the drugs. Outside hospital, where repeated testing may not be feasible, patients might be best advised to stop treatment when they feel better, they say. That, they add, is in direct contravention of World Health Organisation advice.

Other experts in infectious diseases backed the group. I have always thought it to be illogical to say that stopping antibiotic treatment early promotes the emergence of drug-resistant organisms, said Peter Openshaw, president of the British Society for Immunology.

This brief but authoritative review supports the idea that antibiotics may be used more sparingly, pointing out that the evidence for a long duration of therapy is, at best, tenuous. Far from being irresponsible, shortening the duration of a course of antibiotics might make antibiotic resistance less likely.

Alison Holmes, a professor of infectious diseases at Imperial College London, said a great British authority, Prof Harold Lambert, had made the same point in a Lancet article entitled Dont keep taking the tablets as early as 1999. It remains astonishing that apart from some specific infections and conditions, we still do not know more about the optimum duration of courses or indeed doses in many conditions, yet this dogma has been pervasive and persistent.

Jodi Lindsay, a professor of microbial pathogenesis at St Georges, University of London, said it was sensible advice. The evidence for completing the course is poor, and the length of the course of antibiotics has been estimated based on a fear of under-treating rather than any studies, she said. The evidence for shorter courses of antibiotics being equal to longer courses, in terms of cure or outcome, is generally good, although more studies would help and there are a few exceptions when longer courses are better for example, TB.

But the Royal College of GPs expressed concerns. Recommended courses of antibiotics are not random, said its chair, Prof Helen Stokes-Lampard. They are tailored to individual conditions and in many cases, courses are quite short for urinary tract infections, for example, three days is often enough to cure the infection.

We are concerned about the concept of patients stopping taking their medication midway through a course once they feel better, because improvement in symptoms does not necessarily mean the infection has been completely eradicated. Its important that patients have clear messages and the mantra to always take the full course of antibiotics is well known. Changing this will simply confuse people.

The UKs chief medical officer, Prof Dame Sally Davies, said: The message to the public remains the same: people should always follow the advice of healthcare professionals. To update policies, we need further research to inform them.

[The National Institute for Health and Care Excellence] is currently developing guidance for managing common infections, which will look at all available evidence on appropriate prescribing of antibiotics.

The Department of Health will continue to review the evidence on prescribing and drug-resistant infections, as we aim to continue the great progress we have made at home and abroad on this issue.

Read more: https://www.theguardian.com/society/2017/jul/26/rule-patients-must-finish-antibiotics-course-wrong-study-says

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Hunger by Roxane Gay review how the world treats fat people

A catalogue of horrors and public humiliations, Gays memoir responds to societys condescension and disgust about her body size

This is a book its author Roxane Gay has, over many years, earned the right not to publish. Even though she has found great success as an essayist, writer of fiction and university teacher, and attracted a large, passionate online following, its clear from her account that her weight is still the first thing strangers notice about her, and that she must spend much of her time dealing with their unsolicited responses to it. These range from rude to abusive, encompassing all sorts of casual mockery, faux concern and outright aggression along the way.

Shopping for clothes or food, visiting a restaurant or getting on a plane frequently involve a humiliating ordeal. Doctors not only patronise her but routinely refuse her basic care. Simply leaving the house means navigating a physical and emotional obstacle course. No doubt Gay is thoroughly sick of being reduced to her body and of enduring constant inquiries, prejudices and criticism, and she has evidently worked hard to make space for herself to talk and write about other things. People asking those kinds of questions dont deserve an answer, and yet here Gay has decided to give them one.

Hunger comprises at least two stories: a partial but more or less linear telling of Gays life so far, and a more halting, spiralling description of her everyday experience as a fat woman. The first of these hinges on the horrifying rape visited on her as a 12-year-old by her boyfriend and several of his friends. Gay blames herself, and her suffering is compounded when the boys report their version of events to their peers at school; she keeps hers quiet, unable to say anything about it to her family. The brief evocation of her childhood before this point conjures an almost fairytale-like atmosphere of love and optimism, peopled with adoring parents and siblings. I fell asleep most nights, Gay writes, flush with the joy of knowing I belonged to these people and they belonged to me.

Afterwards, everything changes: she begins to overeat and her weight gain is swift and dramatic, to her familys dismay. Various attempts to reverse it, some undertaken willingly, others under parental pressure, never last long, and both the traumatic event and her highly visible response to it overshadow everything else that happens to her. Gays mother and father are well-to-do Haitian Americans who clearly have high expectations of their children. Gay, who attends an elite boarding school followed by Yale, drops out and moves to another state without letting anyone know where she is. She eventually completes a PhD and garners acclaim as a writer, but this book is still a catalogue of horrors large and small: there are abusive relationships and public humiliations. Particularly striking are the depictions of what its like for Gay to go to the gym or on a date. Unable to fit on a restaurant chair and denied a more comfortable booth, she spends an entire meal holding herself up in an excruciating squat. At the supermarket, random people entitle themselves to remove foods they deem unsuitable from her cart.

Gays tone shifts between a breezy, conversational style and something harsher, and she recounts painful events in short, almost incantatory sentences: There was a boy. I loved him. His name was Christopher. Thats not really his name. You know that. She occasionally makes light of the cliches that surround public discussion of weight loss (though she herself cant avoid some of these). Scoffing at Oprah Winfreys metaphor of the cheerful, skinny alter ego lurking inside every fat person, she notes, I ate that thin woman, and she was delicious but unsatisfying.

But in general theres not much to laugh about. Gay alludes to or summarises difficult conversations, but rarely recounts them in full, and the overall effect is often one of claustrophobic intensity, as if the reader is trapped inside her head much the way she describes feeling caged in her flesh. Some of the books repetitions may be due to its origin in shorter pieces written for various publications, but most reflect the near-constant frustrations of living in a body the world both fixates on and refuses to accommodate. One of the few scenes rendered in detail is the gruesome early description of her father taking her to a group consultation with a doctor who performs gastric bypass surgeries. They must watch a video of patients steamy red and pink and yellow insides being carved up in an exorbitantly expensive and devastating procedure that even in the best case scenario will leave them permanently malnourished.

Though Gay does not owe anyone a single explanation of her size, she gives her readers an abundance of them. If some can seem a little too neat and familiar, that effect is complicated by how many accumulate, often directly contradicting each other. She characterises her initial weight gain as an attempt to take up more space, growing bigger and more powerful, but also as an effort to disappear and avoid ever attracting male attention again. She deliberately eats to create a protective shield of flesh, or simply cannot resist using food to soothe unbearable emotions. Gays mixed feelings often feel inevitable, though, in a culture that gives fat women no safe place to stand: you must feel bad about your size, but not enough to make anyone else uncomfortable; you must feel good about yourself as you are, but not too good. I am a product of my environment, she writes, explaining why her feminist convictions cant protect her from the cycle of selfblame, from longing to be thinner and accusing herself of weakness or lack of discipline when her body doesnt change.

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Elna Bakers 2016 account of her own extreme weight loss sheds light on Hunger.

Most of what Gay endures is neither her fault nor within her control, but since she believes society will not change fast enough, if at all, she makes no apology for yearning to adjust herself to it. And of course, much of the more or less veiled fear and disgust expressed by others is a self-fulfilling reaction to their own conditioning: People know how they see and treat and think about fat people and dont want such a fate to befall them. The book is crammed with agonising ironies, some more strongly emphasised than others. Gay gains weight as an outward expression of her unhappiness, but those around her dont get the message, and only make her more miserable in their reactions to her changing body. In trying to develop a defence mechanism after her rape, she inadvertently invites half a lifetime of invasive threats to her physical autonomy and violations of her consent. When her parents want her to go on a liquid diet or to a fat camp, she agrees because I had learned that saying no meant nothing.

As she has before, in her hit essay collection Bad Feminist, Gay proclaims her refusal to represent anyone but herself. Among other things, that means she isnt interested in trying to make anyone feel better including other people of size who would rather not hear that she hates her body and blames herself for her inability to change it. This is not, as she notes repeatedly, a story of triumph neither of triumphant weight loss nor triumphant self-acceptance.

Stories that skirt those two possibilities are far rarer than they should be, and the exceptions, whatever their individual failings, stick in the mind. Reading Hunger reminded me of radio producer Elna Bakers 2016 account of her own extreme weight loss and its aftermath, which in some ways holds up a funhouse mirror to Gays experience. Its only after losing a huge amount of weight that Baker fully discovers the miseries the world inflicts on fat people. As a thin woman, she finds her love life, job prospects and everyday existence suddenly transformed. And she encounters head-on the stubborn denial that enables other people to enforce sadistic norms: when Baker insists to her husband that hed never have fallen for her at her previous weight, he tries to weasel out of it, suggesting that all the benefits Baker derives from being thin are simply due to how much happier and more confident she must now feel. But that isnt true, she says she was fine before, whereas now she must live with the knowledge that her new life and relationship require her to keep up an unnatural (and unhealthy) struggle with her weight for ever. Bakers story helps shed light on one of the most intractable knots in Hunger. Gay knows that losing the weight would not solve everything or grant her happiness, and yet she longs for the entirely different, less painful life she imagines she could have had without it.

Early in the book, Gay characterises it as a confession, that term so often flung as an insult at women who write about themselves. These, she writes, are the ugliest, weakest, barest parts of me. Its more a provocation than a promise. There are certainly flashes of confession, passages in which Gay lays out, say, the precise effects her rape has had on the formation of her sexual desires. But mostly she is not prepared to be so bare and weak as all that. Its the world around her that comes off as out of control in its appetites hate-filled, obsessed with womens body parts, eager to punish what it helps create.

Hunger is published by Harper. To order a copy for 11.89 (RRP 13.99) go to bookshop.theguardian.com or call 0330 333 6846. Free UK p&p over 10, online orders only. Phone orders min p&p of 1.99.

Read more: https://www.theguardian.com/books/2017/jul/19/hunger-by-roxane-gay-review

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Journalist under fire for calling it ‘crazy’ not to be disgusted by homeless people

Prominent Mother Jones writer Kevin Drum says critics deliberately misreading his response to study on peoples reaction to seeing homelessness

A high-profile Mother Jones writer has suggested that it would be crazy not to have a reflexive disgust of homeless people, stirring the anger of those who say he is perpetuating the worst kinds of stereotypes.

Writing on Friday, Kevin Drum was responding to a study which found that some people with a propensity for feeling disgust might experience it when faced with someone living on the street.

Glenn Greenwald reacted by posting photographs of homeless people who have performed altruistic acts alongside a screen shot from Drums story. The two authors of the study, meanwhile, say Drum glossed over subtleties in their work.

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He seemed to just be endorsing the worst stereotypes without any nuance or without any humanization of these people, said Scott Clifford, one of the authors and an assistant professor of political science at the University of Houston.

Drum said his critics were guilty of deliberately misreading what I wrote.

The authors of the study which is admittedly eyebrow-raising owing to its lexicon set out to untangle a contradiction. Across the country, cities seek to aid homeless people by providing shelters and millions of dollars in funding, while also passing laws against sitting or lying on sidewalks, or restricting where RVs can park, which serve to exclude them.

They examined survey data and focused on a particular feeling that seemed to play a role in perpetuating this paradox: While most of the public wants to help homeless people, they write, sensitivity to disgust drives many of these same people to support policies that facilitate physical distance from homeless people.

Disgust, they propose, might help explain nimbyism in this casea desire among housed people to prevent camps or housing being built in the vicinity of their own homes. And they argue that the media exacerbates disgust with stories that mention disease and unsanitary conditions.

But they do not say that this kind of reaction of reaction is universal: while some people are prone to feeling disgust in the presence of homelessness, others are less likely to.

In his brief response to a summary that the authors published in the Washington Post, Drum said he found their results unsurprising. About half the homeless suffer from a mental illness and a third abuse either alcohol or drugs, he wrote, before commenting how crazy it would be not to not to be disgusted by a population like that.

He finished by suggesting that it was the work of a decent human being to overcome these reflexive feelings and find empathy.

It certainly is the work of of a good human being not to act fully based on immediate reactions, said Maria Foscarinis, executive director of the National Law Center on Homelessness & Poverty. She said the study seems to make sense, though she had some reservations. But she did not agree with Drum, calling the post really over the top and not true to what the paper is saying.

Its just a manifestation of the worst kinds of stereotypes. As a subscriber to this publication, Im really disappointed.

Pete White, head of the Los Angeles Community Action Network, said he thought Drums conclusions risked tarring an entire group of people, as if every houseless person is addicted to drugs and had a mental illness.

Both of the studys authors expressed displeasure. He appears to believe that everyone will in all circumstances feel disgust towards homeless people, said Spencer Piston, the other author and an assistant professor of political science at Boston University. Theres a clear irony here, which is that we argue that the connection between disgust and attitudes about the homeless depend in part on media coverage and the extent to which homeless people are portrayed as disgusting.

In an email, Drum said that he did not think his blogpost was unfaithful to the study. He also pushed back at those condemning him. Please note that I didnt say I was disgusted by the homeless, nor that they are inherently disgusting, he said. Only that, given the nature of the demographic, its not surprising that most people find them disgusting.

Clara Jeffery, the editor-in-chief of Mother Jones, said that the anger was fueled by the terms used in the study and not Drums writing itself. But it is one brief post about a study, she added in her email. Mother Jones has an extensive body of work on the homeless, the housing and mental health and opioid crisis fueling it.

Do you have an experience of homelessness to share with the Guardian? Get in touch

Read more: https://www.theguardian.com/us-news/2017/jul/17/homelessness-kevin-drum-mother-jones-disgust

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How the middle class hoards wealth and opportunity for itself

American society is dominated by an elite 20% that ruthlessly protects its own interests

When I was growing up, my mother would sometimes threaten my brother and me with electrocution. Well, thats not quite right. In fact, the threat was of lessons in elocution, but we wittily, we thought renamed them.

Growing up in a very ordinary town just north of London and attending a very ordinary high school, one of our several linguistic atrocities was failing to pronounce the t in certain words. My mother, who was raised in rural north Wales and left school at 16, did not want us to find doors closed in a class-sensitive society simply because we didnt speak what is still called the Queens English. I will never forget the look on her face when I managed to say the word computer with neither a p nor a t.

Still, the lessons never materialised. Any lingering working-class traces in my own accent were wiped away by three disinfectant years at Oxford University. (My wife claims the adolescent accent resurfaces when I drink, but she doesnt know what shes talking about shes American.) We also had to learn how to waltz. My mother didnt want us to put a foot wrong there either.

In fact, we did just fine, in no small part because of the stable, loving home in which we were raised. But I have always been acutely sensitive to class distinctions and their role in perpetuating inequality. In fact, one of the reasons I came to the United States was to escape the cramped feeling of living in a nation still so dominated by class. I knew enough not to think I was moving to a socially mobile utopia: Id read some of the research. It has nonetheless come as something of a shock to discover that, in some important respects, the American class system is functioning more ruthlessly than the British one I escaped.

In the upper-middle-class America I now inhabit, I witness extraordinary efforts by parents to secure an elite future status for their children: tutors, coaches and weekend lessons in everything from French to fencing. But I have never heard any of my peers try to change the way their children speak. Perhaps this is simply because they know they are surrounded by other upper-middle-class kids, so there is nothing to worry about. Perhaps it is a regional thing.

But I think there is a better explanation. Americans tend to think their children will be judged by their accomplishments rather than their accents. Class position is earned, rather than simply expressed. The way to secure a higher status in a market meritocracy is by acquiring lots of merit and ensuring that our kids do, too. What ones parents are like is entirely a matter of luck, points out the philosopher Adam Swift. But he adds: What ones children are like is not. Children raised in upper-middle-class families do well in life. As a result, there is a lot of intergenerational stickiness at the top of the American income distribution more, in fact, than at the bottom with upper-middle-class status passed from one generation to the next.

Drawing class distinctions feels almost un-American. The nations self-image is of a classless society, one in which every individual is of equal moral worth, regardless of his or her economic status. This has been how the world sees the United States, too. Historian Alexis de Tocqueville observed in the early 19th century that Americans were seen to be more equal in fortune and intelligence more equally strong, in other words than they were in any other country, or were at any other time in recorded history. So different to the countries of old Europe, still weighed down by the legacies of feudalism.

British politicians have often felt the need to urge the creation of a classless society, looking to America for inspiration as, what historian David Cannadine once called it, the pioneering and prototypical classless society. European progressives have long looked enviously at social relations in the New World. George Orwell noted the lack of servile tradition in America; the German socialist Werner Sombart noticed that the bowing and scraping before the upper classes, which produces such an unpleasant impression in Europe, is completely unknown.

This is one of many reasons socialist politics struggled to take root in the United States. A key attraction of socialist systems the main one, according to Orwell is the eradication of class distinctions. There were few to eradicate in America. I am sure that one reason Downton Abbey and The Crown so delight American audiences is their depictions of an alien world of class-based status. One reason class distinctions are less obvious in America is that pretty much everyone defines themselves as a member of the same class: the one in the middle. Nine in ten adults select the label middle class, exactly the same proportion as in 1939, according to the pollsters Gallup. No wonder that politicians have always fallen over each other to be on their side.

But in recent decades Americans at the top of the ladder have been entrenching their class position. The convenient fiction that the middle class can stretch up that far has become a difficult one to sustain. As a result, the modifications upper or lower to the general middle class category have become more important.

Class is not just about money, though it is about that. The class gap can be seen from every angle: education, security, family, health, you name it. There will also be inequalities on each of these dimensions, of course. But inequality becomes class division when all these varied elements money, education, wealth, occupation cluster together so tightly that, in practice, almost any one of them will suffice for the purposes of class definition. Class division becomes class stratification when these advantages and thus status endure across generations. In fact, upper-middle-class status is passed down to the next generation more effectively than in the past, and in the United States more than in other countries.

One benefit of the multidimensional nature of this separation is that it has reduced interdisciplinary bickering over how to define class. While economists typically focus on categorisation by income and wealth, and sociologists tend more towards occupational status and education, and anthropologists are typically more interested in culture and norms, right now it doesnt really matter, because all the trends are going the same way.

It is not just the top 1% pulling away, but the top 20%. In fact, only a very small proportion of US adults 1% to 2% define themselves as upper class. A significant minority about one in seven adopts the upper middle class description. This is quite similar to the estimates of class size generated by most sociologists, who tend to define the upper middle class as one composed of professionals and managers, or around 15% to 20% of the working-age population.

As David Azerrad of the Heritage Foundation writes: There is little appetite in America for policies that significantly restrict the ability of parents to do all they can, within the bounds of the law, to give their children every advantage in life. That is certainly true. But then Azerrad has also mis-stated the problem. No one sensible is in favour of new policies that block parents from doing the best they can for their children. Even in France the suggestion floated by the former president, Franois Hollande, to restore equality by banning homework, on the grounds that parents differ in their ability and willingness to help out, was laughed out of court. But we should want to get rid of policies that allow parents to give their children an unfair advantage and in the process restrict the opportunities of others.

Most of us want to do our best for our children. Wanting ones childrens life to go well is part of what it means to love them, write philosophers Harry Brighouse and Adam Swift in their 2014 book Family Values: The Ethics of Parent-Child Relationships. But our natural preference for the welfare and prospects of our own children does not automatically eclipse other moral claims. We would look kindly on a father who helps his son get picked as starting pitcher for his school baseball team by practising with him every day after work. But we would probably feel differently about a father who secures the slot for his son by bribing the coach. Why? After all, each father has sacrificed something, time in one case, money in the other, to advance his child. The difference is team selection should be based on merit, not money. A principle of fairness is at stake.

So, where is the line drawn? The best philosophical treatment of this question I have found is the one by Swift and Brighouse. Their suggestion is that, while parents have every right to act in ways that will help their childrens lives go well, they do not have the right to confer on them a competitive advantage in other words, to ensure not just that they do well but that they do better than others. This is because, in a society with finite rewards, improving the situation of one child necessarily worsens that of another, at least in relative terms: Whatever parents do to confer competitive advantage is not neutral in its effects on other children it does not leave untouched, but rather is detrimental to, those other childrens prospects in the competition for jobs and associated rewards.

The trouble is that in the real world this seems like a distinction without a difference. What they call competitive advantage-conferring parental activities will almost always be also helping-your-kid-flourish parental activities. If I read bedtime stories to my son, he will develop a richer vocabulary and may learn to love reading and have a more interesting and fulfilling life. But it could also help him get better grades than his classmates, giving him a competitive advantage in college admissions. Swift and Brighouse suggest a parent should not even aim to give their child a competitive advantage: It would be a little odd, perhaps even a little creepy, if the ultimate aim of her endeavours were that her child is better off than others.

I think this is too harsh. In a society with a largely open, competitive labour market, it is not creepy to want your children to end up higher on the earnings ladder than others. Not only will this bring them a higher income, and all the accompanying choices and security, it is also likely to bring them safer and more interesting work. Relative position matters it is one reason, after all, that relative mobility is of such concern to policymakers. Although I think Brighouse and Swift go too far, they are on to something important with their distinction between the kind of parental behaviour that merely helps your own children and the kind that is detrimental to others. Thats what I call opportunity hoarding.

Opportunity hoarding does not result from the workings of a large machine but from the cumulative effect of individual choices and preferences. Taken in isolation, they may feel trivial: nudging your daughter into a better college with a legacy preference [giving applicants places on the basis of being related to alumni of the college]; helping the son of a professional contact to an internship; a single vote on a municipal council to retain low-density zoning restrictions. But, like many micro-preferences, to borrow a term from economist Thomas Schelling, they can have strong effects on overall culture and collective outcomes.

Over recent decades, institutions that once primarily served racist goals legacy admissions to keep out Jewish students, zoning laws to keep out black families have not been abandoned but have been softened, normalised and subtly re-purposed to help us sustain the upper-middle-class status. They remain, then, barriers to a more open, more genuinely competitive and fairer society. I wont insult your intelligence by pretending there are no costs here. By definition, reducing opportunity hoarding will mean some losses for the upper middle class.

But they will be small. Our neighbourhoods will be a little less upmarket but also less boring. Our kids will rub shoulders with some poorer kids in the school corridor. They might not squeak into an Ivy League college, and they may have to be content going to an excellent public university. But if we arent willing to entertain even these sacrifices, there is little hope. There will be some material costs, too. The big challenge is to equalise opportunities to acquire human capital and therefore increase the number of true competitors in the labour market. This will require, among other things, some increased public investment. Where will the money come from? It cant all come from the super-rich. Much of it will have to come from the upper middle class. From me andyou.

This is an extract from Dream Hoarders: How the American Upper Middle Class is Leaving Everyone Else in the Dust, Why That is a Problem, and What To Do About It by Richard V Reeves (Brookings Institution Press, 2017)

HOW TO STAY AHEAD – OR PLAY FAIR

As parents, we naturally want our children to flourish. But that laudable desire slides into opportunity hoarding when we use our money, power or position to give our own children exclusive access to certain goods or chances. The effect is to strengthen class barriers.

1. Fix an internship using our networks. Internships are becoming more important but are too often stitched up privately. Its worse if theyre unpaid. Instead: insist on paid internships, openly recruited.

2. Take our own kids to work for the day. Children learn what work is from adults. Instead: try bringing somebody elses kid to work, perhaps by partnering with local charities.

3. Be a Nimby. By shutting out low-income housing from our neighbourhoods with planning restrictions, we keep less affluent kids away from our local schools and communities. Instead: be a Yimby, vote and argue for more mixed housing in your area.

4. Write cheques to PTA funds. Many of us want to support the school our children attend. This tilts the playing field, however, since other schools cant do the same. Instead: get your PTA to give half the donations to a school in a poor area.

Read more: https://www.theguardian.com/inequality/2017/jul/15/how-us-middle-classes-hoard-opportunity-privilege

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Health effects of coffee: Where do we stand?

(CNN)It’s one of the age-old medical flip-flops: First coffee’s good for you, then it’s not, then it is — you get the picture.

Today, the verdict is thumbs up, with study after study extolling the merits of three to five cups of black coffee a day in reducing risk for everything from melanoma to heart disease, multiple sclerosis, type 2 diabetes, Parkinson’s disease, liver disease, prostate cancer, Alzheimer’s, computer-related back pain and more.
To stay completely healthy with your coffee consumption, you’ll want to avoid packing it with calorie laden creams, sugars and flavors. And be aware that a cup of coffee in these studies is only 8 ounces; the standard “grande” cup at the coffee shop is double that at 16 ounces.
    And how you brew it has health consequences. Unlike filter coffee makers, the French press, Turkish coffee or the boiled coffee popular in Scandinavian countries fail to catch a compound called cafestol in the oily part of coffee that can increase your bad cholesterol or LDL.
    Finally, people with sleep issues or uncontrolled diabetes should check with a doctor before adding caffeine to their diets, as should pregnant women, as there is some concern about caffeine’s effect on fetal growth and miscarriage. And some of the latest research seems to say that our genes may be responsible for how we react to coffee, explaining why some of us need several cups to get a boost while others get the jitters on only one.
    But as you know, the news on coffee has not always been positive. And the argument over the merits of your daily cup of joe dates back centuries. Let’s take a look at the timeline.
    1500’s headline: Coffee leads to illegal sex
    Legend has it that coffee was discovered by Kaldi, an Ethiopian goatherd, after he caught his suddenly frisky goats eating glossy green leaves and red berries and then tried it for himself. But it was the Arabs who first started coffeehouses, and that’s where coffee got its first black mark.
    Patrons of coffeehouses were said to be more likely to gamble and engage in “criminally unorthodox sexual situations,” according to author Ralph Hattox. By 1511 the mayor of Mecca shut them down. He cited medical and religious reasons, saying coffee was an intoxicant and thus prohibited by Islamic law, even though scholars like Mark Pendergrast believe it was more likely a reaction to the unpopular comments about his leadership. The ban didn’t last long, says Pendergrast, adding that coffee became so important in Turkey that “a lack of sufficient coffee provided grounds for a woman to seek a divorce.”
    1600’s headline: Coffee cures alcoholism but causes impotence
    As the popularity of coffee grew and spread across the continent, the medical community began to extol its benefits. It was especially popular in England as a cure for alcoholism, one of the biggest medical problems of the time; after all, water wasn’t always safe to drink, so most men, women and even children drank the hard stuff.
    Local ads such as this one in 1652 by coffee shop owner Pasqua Rose popularized coffee’s healthy status, claiming coffee could aid digestion, prevent and cure gout and scurvy, help coughs, headaches and stomachaches, even prevent miscarriages.
    But in London, women were concerned that their men were becoming impotent, and in 1674 The Women’s Petition Against Coffee asked for the closing of all coffeehouses, saying in part: “We find of late a very sensible Decay of that true Old English Vigour. … Never did Men wear greater Breeches, or carry less in them…”
    1700’s headline: Coffee helps you work longer
    By 1730, tea had replaced coffee in London as the daily drink of choice. That preference continued in the colonies until 1773, when the famous Boston Tea Party made it unpatriotic to drink tea. Coffeehouses popped up everywhere, and the marvelous stimulant qualities of the brew were said to contribute to the ability of the colonists to work longer hours.
    1800’s headline: Coffee will make you go blind. Have a cup of hot wheat-bran drink instead
    In the mid-1800s America was at war with itself and one side effect is that coffee supplies ran short. Enter toasted grain-based beverage substitutes such as Kellogg’s “Caramel Coffee” and C.W. Post’s “Postum” (still manufactured). They advertised with anti-coffee tirades to boost sales. C.W. Post’s ads were especially vicious, says Pendergrast, claiming coffee was as bad as morphine, cocaine, nicotine or strychnine and could cause blindness.
    1916 headline: Coffee stunts your growth
    While inventions and improvements in coffee pots, filters and processing advanced at a quick pace throughout the 1900s, so did medical concerns and negative public beliefs about the benefits of coffee.
    Good Housekeeping magazine wrote about how coffee stunts growth. And concerns continued to grow about coffee’s impact on common aliments of the era, such as nervousness, heart palpitations, indigestion and insomnia.
    1927 headline: Coffee will give you bad grades, kids
    In Science Magazine, on September 2, 1927, 80,000 elementary and junior high kids were asked about their coffee drinking habits. Researchers found the “startling” fact that most of them drank more than a cup of coffee a day, which was then compared to scholarship with mostly negative results.
    1970’s and ’80’s headline: Coffee is as serious as a heart attack
    A 1973 study in the New England Journal of Medicine of more than 12,000 patients found drinking one to five cups of coffee a day increased risk of heart attacks by 60% while drinking six or more cups a day doubled that risk to 120%.
    Another New England Journal of Medicine study, in 1978, found a short-term rise in blood pressure after three cups of coffee. Authors called for further research into caffeine and hypertension.
    A 38-year study by the Johns Hopkins Medical School of more than a 1,000 medical students found in 1985 that those who drank five or more cups of coffee a day were 2.8 times as likely to develop heart problems compared to those who don’t consume coffee. But the study only asked questions every five years, and didn’t isolate smoking behavior or many other negative behaviors that tend to go along with coffee, such as doughnuts. Or “Doooonuts,” if you’re Homer Simpson.
    Millennium headline: Coffee goes meta
    Now begins the era of the meta-analysis, where researchers look at hundreds of studies and apply scientific principles to find those that do the best job of randomizing and controlling for compounding factors, such as smoking, obesity, lack of exercise and many other lifestyles issues. That means that a specific study, which may or may not meet certain standards, can’t “tip the balance” one way or another. We take a look at some of the years. The results for coffee? Mostly good.
    2001 headline: Coffee increases risk of urinary tract cancer
    But first, a negative: A 2001 study found a 20% increase in the risk of urinary tract cancer risk for coffee drinkers, but not tea drinkers. That finding was repeated in a 2015 meta-analysis. So, if this is a risk factor in your family history, you might want to switch to tea.
    2007 headline: Coffee decreases risk of liver cancer
    Some of these data analyses found preventive benefits for cancer from drinking coffee, such as this one, which showed drinking two cups of black coffee a day could reduce the risk of liver cancer by 43%. Those findings were replicated in 2013 in two other studies.
    2010 headline: Coffee and lung disease go together like coffee and smoking
    A meta-analysis found a correlation between coffee consumption and lung disease, but the study found it impossible to completely eliminate the confounding effects of smoking.
    2011 headline: Coffee reduces risk of stroke and prostate cancer
    A meta-analysis of 11 studies on the link between stroke risk and coffee consumption between 1966 and 2011, with nearly a half a million participants, found no negative connection. In fact, there was a small benefit in moderate consumption, which is considered to be three to five cups of black coffee a day. Another meta-analysis of studies between 2001 and 2011 found four or more cups a day had a preventive effect on the risk of stroke.
    As for prostate cancer, this 2011 study followed nearly 59,000 men from 1986 to 2006 and found drinking coffee to be highly associated with lower risk for the lethal form of the disease.
    2012 headline: Coffee lowers risk of heart failure
    More meta-analysis of studies on heart failure found four cups a day provided the lowest risk for heart failure, and you had to drink a whopping 10 cups a day to get a bad association.
    2013 headline: Coffee lowers risk of heart disease and helps you live longer
    For general heart disease a meta-analysis of 36 studies with more than 1.2 million participants found moderate coffee drinking seemed to be associated with a low risk for heart disease; plus, there wasn’t a higher risk among those who drank more than five cups a day.
    How about coffee’s effects on your overall risk of death? One analysis of 20 studies, and another that included 17 studies, both of which included more than a million people, found drinking coffee reduced your total mortality risk slightly.
    2015 headline: Coffee is practically a health food
    As a sign of the times, the U.S. Department of Agriculture now agrees that “coffee can be incorporated into a healthy lifestyle,” especially if you stay within three to five cups a day (a maximum of 400 mg of caffeine), and avoid fattening cream and sugar. You can read their analysis of the latest data on everything from diabetes to chronic disease here.
    2017 headline: Yes, coffee still leads to a longer life
    The largest study to date on coffee and mortality surveyed 520,000 people in 10 European countries and found that regularly drinking coffee could significantly lower the risk of death.
    Another study with a focus on non-white populations had similar findings. That study surveyed 185,000 African-Americans, Native Americans, Hawaiians, Japanese-Americans, Latinos and whites. The varying lifestyles and dietary habits of the people observed in both studies led the authors to believe that coffee’s impact on longevity doesn’t have to do with how its prepared or how people drink it — it has to do with the beverage’s biological effect on the body.
    But stay tuned. There’s sure to be another meta-study, and another opinion. We’ll keep you updated.

    Read more: http://www.cnn.com/2015/08/14/health/coffee-health/index.html

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    Meningitis vaccine may also cut risk of ‘untreatable’ gonorrhoea, study says

    Bacteria causing two different illnesses belong to the same family and share much of the same genetic code providing unexpected cross protection

    Hopes to fight untreatable strains of gonorrhoea have risen after it emerged that a new vaccine against meningitis unexpectedly reduced the risk of people getting the sexually transmitted infection.

    Some strains of gonorrhoea are resistant to all available drugs, making vaccine development an urgent global health priority. But according to a study in The Lancet, a vaccine has offered protection against the sexually transmitted disease for the first time.

    Gonorrhoea spreads through unprotected vaginal, oral or anal sex and many of those who contract the disease experience no symptoms. If left untreated, the disease can cause infertility and can increase the transmission of HIV infection.

    A New Zealand meningitis epidemic in the early 2000s prompted the mass vaccination of a million people and fortuitously set the scene for the current study. The vaccine used, known as MeNZB, was designed to protect against meningococcal group B infection the cause of the most deadly form of meningitis.

    But intriguingly, over the next few years, scientists noticed fewer gonorrhoea cases than expected in those who had been vaccinated against meningitis.

    Dr Helen Petousis-Harris, a vaccine specialist from the University of Auckland who led the study, was optimistic: Some types of gonorrhoea are now resistant to every antibiotic we have, and there appeared [to be] little we could do to prevent the steady march of gonorrhoea to superbug status. But now theres hope, she added.

    The research team studied over 14,000 people aged 15-30 whod been diagnosed with gonorrhoea at sexual health clinics across New Zealand and who had been eligible for the MeNZB vaccine during the emergency vaccination programme. They found vaccinated individuals were over 30% less likely to develop gonorrhoea.

    Despite meningitis and gonorrhoea being very different illnesses, both are caused by bacteria from the same family and share much of the same genetic code, providing a possible explanation for the cross-protection that the team observed.

    More than 78 million people worldwide get gonorrhoea each year with most infections in men and women under the age of 25. It is the second most common bacterial sexually transmitted infection in the UK after chlamydia. In England alone, almost 35,000 people were affected in 2014.

    British Association for Sexual Health and HIVs President, Dr Elizabeth Carlin, who was not involved in the study, was more sceptical: These early findings are to be welcomed but its important to keep in perspective that the vaccine offered only moderate protection …. an individual receiving this vaccine remains susceptible to gonorrhoea but just less so than if unvaccinated.

    The MeNZB vaccine used in the current study is no longer manufactured, but Petousis-Harris has high hopes for a similar meningitis vaccine called 4CMenB, available in many countries.

    Petousis-Harris was clear about what needed to happen next. We need an urgent assessment of current meningitis vaccines to see if they protect against gonorrhoea. It may be possible to eliminate many gonorrhoea infections using a vaccine with only moderate protection. It does not need to be perfect, she added.

    Read more: https://www.theguardian.com/science/2017/jul/10/meningitis-vaccine-may-also-cut-risk-of-untreatable-gonorrhoea-study-says

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    Why I wrote the sex manual Id have loved as a teenager

    The Spanish YouTuber Chusita gives young people honest, down-to-earth advice on sex in her new book, This Is Not a Sex Book

    At a recent book signing in Barcelona, Spanish YouTuber Chusita was approached by two parents with their teenage daughter.Although Chusitas book is a sex guide for her teenage fansand followers, she sometimes hears from parents who thank her for writing it, and for helping them broach a difficult subject. Some have told her theyve sat down with their teenage children and read it together. This time, though, the parents wished to thank her for a different reason.

    Loudly, in front of the whole crowd, they said theyd bought the book for their daughter, but decided to read it first to check it was OK, says Chusita. They then told everyone how much they loved the book and that it had rekindled their sex life. Their daughter stood beside them, completely mortified!

    In some ways, Mara Jess Cama, Chusitas real name, is similar to the UK vlogging sensation Zoella although a much less polished version. The apartment she shares with a friend in Madrid is a long way from Zoellas 1m house in Brighton. When we talk, she wears no makeup and her YouTube channel, Chusita Fashion Fever, is a fun, imperfect mix of unsophisticated pop covers (Adeles Hello in Spanish anyone?), confessionals, random musings and straight-talking agony aunt-style advice.

    Her book This Is Not a Sex Book: The Uncensored Manual for All Things Intimate was published last year in Spain, where it sold well. It has since been published across Latin America, as well as the US, Holland, Germany, Italy, Slovenia, the Czech Republic the list goes on. Next week its published in the UK.

    Its an odd read. In some ways its sweet, almost innocent with cute quizzes, comic-strip storylines, emojis and fun facts such as the worlds largest penis or the mating habits of seahorses. There are chapters to help teens to navigate todays complex modern relationships (hook-ups, sexting, friends with benefits, etc). And then theres the lowdown on actually doing it masturbation (male, female and mutual), sex toys (real and improvised), sex (vaginal, oral and anal) Perhaps its pitched perfectly at todays youth, the internet generation, who on one level know everything, yet In Real Life (#IRL) may be no more sophisticated than the generations before them.

    According to Chusita, its aimed at young people aged 14 to 20 (her fanbase) who havent had much or any sexual experience, but who want to be fully informed when they do. She based it on the kinds of questions she is asked on her channel and also what she wished shed known herself but had to learn by trial and error.

    Chusita, 30, who dropped out of school, certainly never imagined or planned this career path. She grew up in Madrid, the youngest of six siblings, and was educated in a convent primary school and a secular state secondary.

    The vlogging began when she was 21, living with her then boyfriend and his family, and working as a receptionist. My boyfriend and I werent getting on well. Work was busy. Problems piled up and I started to get depressed, she says. I went on antidepressants and for seven months lay around feeling low.

    An
    An illustration from This is Not A Sex Book.

    On a night out with a friend, they met a group of boys. There was a bit of sexual tension, and the next day Chusita made her first video back when few people did about sexual tension in clubs. She sent it to her friend to watch; her friend passed it about. Chusita made more about the music she liked, what happened in the supermarket, her thoughts on her daily life. It was a kind of confidence booster, a sort of therapy. Her following grew.

    A popular section of her channel is If I Were You, where fans send in problems and Chusita reads them out and gives advice. Its not all about sex but a lot is. I get loads of different questions, every possible sort, she says. Many times, itll be my boyfriend is insisting he wants to have sex and Im not sure or my boyfriend wants to have anal sex but I dont like the idea of it. I think its horrible. How do I handle this?. Often, the questions will revolve around saying no or setting limits.

    Sitting on her bed, giant cuddly toys in the background, Chusita dispenses refreshingly sensible advice on her vlogs. Her repeated message is finding whats right for you (whatever that is) and not being pushed around. She shares plenty of personal experience in her posts. My First Kiss aged 16, on the school bus, she remembers a lot of saliva. My First Time she was the last of her friends to have sex, nearly 19, as she preferred to wait until she was with a person she felt comfortable with. Nonetheless, the sex was forgettable.

    Other popular If I Were You posts include Sex with my cousin (from a teenage boy who was seduced by his cousin and is debating whether to go the whole way) and I cant orgasm (an 18-year-old who lost her virginity to her boyfriend four months ago and has yet to orgasm with him though she can do it fine on her own). Chusitas advice on the cousin question is to think years ahead, at family events this cousin will be in his life for ever. Of course, being sexual feels good, she says. Thats normal, but personally, shed find someone who wasnt in her family to do it with. On the orgasm problem, she wonders if the couple are trying too hard, focusing on the problem instead of relaxing and letting herself go. She also urges her to tell her boyfriend what she likes, give it time, be patient.

    Why does she think people come to her with their questions? I think its partly the fact that people prefer to listen to someone they dont know, she says, someone outside their circle who doesnt have any preconceptions or ideas about them. Someone with no agenda. Ill also tell it clearly theres no holding back, no taboos. Ill talk about anything.

    In Catholic Spain, says Chusita, theres a huge gap in sex education waiting to be filled. Sex education was non-existent when I was at school and its the same now, she says. Theyll talk to you about reproduction but not about sex. Theyll talk about how to make babies but not how to avoid making babies but still have sex.

    Nor is it talked about much at home. The only thing I was told by my parents was Dont get pregnant and If you do get pregnant, you will have the baby. I talked about sex to friends, of course, but they were as clueless as I was. We could share experiences, but the only way we could really learn was by doing it.

    According to Chusita, little has changed since then. Young people still have a lot of questions What am I supposed to do? How am I supposed to feel? and no one is covering them. Teachers and parents are too embarrassed to raise it and teenagers are too embarrassed to ask.

    And into this void steps pornography, available everywhere at the tap of a phone. I dont have a problem with porn, but its no way to learn, says Chusita. Watching a porn film is like watching an action movie. You might think, Wow! That looks amazing. Id love to do that but its not the reality. You cant jump from buildings. Porn is not a portrayal of reality so when you start having sex with someone, you shouldnt think youre going to experience a porn film.

    She doesnt pretend to be an expert, or even to know any more than the average woman. But thats her appeal. Shes like the warm, wise big sister any teen would wish for.

    Im not a professional and I dont have very different sexual experiences to anyone else, she says. I think probably everyone finds it harder to talk about sex honestly when theyre starting out than when they get older and realise its not such a big deal. Probably anyone who has had sex a few times could write the book. Its just that Im the one who did.

    This Is Not a Sex Book is, says Chusita, a more careful, more considered account of the advice and information she gives on her channel.

    I had more time to think about it. Its better conveyed than in the videos, she says. Its the book Id have loved to have read when I was a teenager, written in young peoples language, in a way thats accessible to them. I want it to be part of peoples libraries, the book teenagers go to. And from time to time, their parents too.

    This Is Not a Sex Book by Chusita Fashion Fever (Head of Zeus, 14.99). To order a copy for 12.74, go to bookshop.theguardian.com or call 0330 333 6846. Free UK p&p over 10, online orders only. Phone orders minimum p&p of 1.99.

    Read more: https://www.theguardian.com/lifeandstyle/2017/jul/08/why-i-wrote-the-sex-manual-id-have-loved-as-a-teenager

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    People taking heartburn drugs could have higher risk of death, study claims

    Research suggests people on proton pump inhibitors are more likely to die than those taking different antacid or none at all

    Millions of people taking common heartburn and indigestion medications could be at an increased risk of death, research suggests.

    The drugs, known as proton pump inhibitors (PPIs), neutralise the acid in the stomach and are widely prescribed, with low doses also available without prescription from pharmacies. In the UK, doctors issue more than 50m prescriptions for PPIs every year.

    Now researchers say the drugs can increase risk of death, both compared with taking a different type of acid suppressant and not taking any at all.

    We saw a small excess risk of dying that could be attributed to the PPI drug, and the risk increased the longer they took them, said Ziyad Al-Aly, an epidemiologist from the University of Washington and co-author of the study.

    The team say the study suggests those who take the drugs without needing to could be most at risk. They urged people taking PPIs to check whether this was necessary.

    Previous research has raised a range of concerns about PPIs, including links to kidney disease, pneumonia, more hip fractures and higher rates of infection with C difficile, a superbug that can cause life-threatening sepsis, particularly in elderly people in hospitals.

    But the latest study is the first to show that PPIs can increase the chance of death. Published in the journal BMJ Open, it examined the medical records of 3.5 million middle-aged Americans covered by the US veterans healthcare system.

    The researchers followed 350,000 participants for more than five years and compared those prescribed PPIs to a group receiving a different type of acid suppressant known as an H2 blocker. They also took into account factors such as the participants age, sex and conditions ranging from high blood pressure to HIV.

    The results show that those who took PPIs could face a 25% higher risk of death than those who took the H2 blocker.

    In patients on [H2 blocker] tablets, there were 3.3 deaths per 100 people over one year. In the PPI group, this figure was higher at 4.7 per 100 people per year, said Al-Aly.

    The team also reported that the risk of death for those taking PPIs was 15% higher than those taking no PPIs, and 23% higher than for those taking no acid suppressants at all.

    Similar levels of increased risk were seen among people who used PPIs but had no gastrointestinal conditions, a result which the authors speculated might be driving the higher risk seen overall.

    Gareth Corbett, a gastroenterologist from Addenbrookes hospital in Cambridge who was not involved with the study, cautioned against panic, pointing out that in most cases the benefits of PPI far outweighed any risk. What was more, he said, while the increased risk sounded high, it was still very low for each person.

    PPIs are very effective medicines, proven to save lives and reduce the need for surgery in patients with bleeding gastric and duodenal ulcers and several other conditions, he said.

    The studys authors said it was important that PPIs were used only when necessary and stopped when no longer needed.

    Corbett agreed that many people take PPIs unnecessarily. They could get rid of their heartburn by making lifestyle changes, such as losing weight and cutting back on alcohol, caffeine and spicy foods, he said.

    The authors said the study was observational, meaning it did not show that PPIs were the cause of the increased risk of death, and that it was unclear how the drugs would act to affect mortality. They said the drugs could affect components within cells, known as lysosomes, that help break down waste material, or shortening protective regions at the end of chromosomes, known as telomeres.

    Aly said people on PPIs should check with their GP whether the drugs were still needed, adding: In some cases we expect that PPIs can be safely stopped, particularly in patients who have been taking them for a long time.

    Read more: https://www.theguardian.com/science/2017/jul/04/people-taking-heartburn-drugs-could-have-higher-risk-of-death-study-claims

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    Brain game: how quitting routine tasks can help you learn new tricks

    Daniel Glaser explains the benefits of taking on new challenges in middle age

    Although his previous attempt at a career break, by becoming an apprentice shoemaker in Florence, didnt last long, it seems Daniel Day-Lewis is serious about retiring this time.

    Maybe hes looking for a newchallenge. As we get older, work can feel more routine andeasy, which is born out in terms of brain activity.

    Scans show tasks we are practised at often use less energy than novel activities we tend to do them more efficiently, and the mental energy required decreases. Were all familiar with this as our careers advance.

    We also get more skilled at spotting our mistakes and rectifying them; as an old hand, you can notice when the edge has gone but you have enough tricks in the bag to make amends. This neuroprotective effect may be behind some of the results that show an apparent delay in symptoms of age-related cognitive decline for those more active in middle age. In this light a preemptive move, like Day-Lewiss, may be more sensible as we become over familiar with what we do.

    It is perhaps typical of this most uncompromising of actors that hes quitting while ahead.

    Dr Daniel Glaser is director of Science Gallery at Kings College London

    Read more: https://www.theguardian.com/lifeandstyle/2017/jul/02/brain-game-quitting-routine-tasks-to-learn-new-tricks

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    In Seattle US old-timers rediscover the high life on cannabis tours

    Retirement home residents take a trip to a producer

    Forget bingo, tea dances and seaside trips. Residents from a chain of Seattle retirement homes are going on Pot for Beginners tours to learn about and buy cannabis in the city, where its now legal.

    Connie Schick said her son roared with laughter when he heard she was joining a field trip to a cannabis-growing operation, an extraction plant and shop. The 79-year-old, who smoked the odd joint in the 70s, wanted to know how legalisation has changed the way the drug is used and produced.

    Schick was one of eight women, from their late 60s to mid-80s, who descended from a minibus emblazoned with the name of their assisted living centre, El Dorado West, outside Vela cannabis store last Tuesday.

    You can only play so many games of bingo, said Schick. My son thought it was hilarious that I was coming here, but Im open-minded and want to stay informed. Cannabis has come so far from the days when you smoked a sly joint and got into trouble if they found out. We used to call it hemp then and didnt know its strength. It just used to make me sleepy, so I didnt see the point.

    Schick, who uses a wheelchair after suffering a stroke, is interested in the therapeutic effects of cannabis. Its so different now. There are so many ways you can take it, and all these different types to help with aches and pains.

    They used to say it was a gateway drug to other things, like cocaine Lots of peoples views are changing.

    Certainly, the number of people aged 65 or older taking cannabis in the US is growing. The proportion of this age group who reported cannabis use in the past year rose more than tenfold from 0.2% to 2.1% between 2002 and 2014, according to the National Survey on Drug Use and Health. A Gallup poll last year showed that 3% of those over 65 smoke cannabis.

    Much of this is attributed to the ageing of the baby-boomer generation, who dabbled with the drug when they were young and are returning to it for medical or recreational use as it becomes legal and more normalised. Cannabis is now legal for medical use in 29 states and for medical and recreational use in eight (since 2012 in Seattle and the rest of Washington state).

    Most of the women on the tour were more interested in the medical use, although Denise Roux, 67, said: I would like to buy it to get high too but Im a cheap high, it doesnt take much.

    A seminar over sandwiches was held for thegroup as they sat in front of the large windows of the cultivation room, where they could see scores of plants growing under intense lighting.

    They were told about the different strains: uplifting sativa plants and more sedating indicas. They learned about tetrahydrocannabinol (THC), which gives a high, and cannabidiol (CBD) which does not, making CBD-rich cannabis appealing for medical use. A scientist in a lab coat who worked in the processing facility spoke about terpenes fragrant oils secreted by glands in the flower that give strains their different smells and flavours. Vials were sniffed and various ways to take cannabis were also covered, including smoking, vaporising and eating it.

    Roux, a retired administrative assistant, said: Im a big Google girl, but I wanted to talk to people who know about it so I can understand it all better. I have an autoimmune disease, which stops my appetite, and Im interested in marijuana from that standpoint. She added she had used cannabis recreationally in the 80s and had returned to it to help with her illness. I use a vape. It makes me sleepy and its a pain control, and it gives me an appetite.

    After the briefing, it was time for shopping. The store looked like an upmarket jewellers, with muted lighting and art on the walls, except the glass cabinets in the store were stocked with pre-rolled joints, edibles including chocolates and sweets, vape pens and bags of different strains of cannabis rather than diamond rings and necklaces.

    Darlene Johnson, 85, a former nurse, perused their contents. On the advice of a bearded bud tender, she bought a deep tissue and joint gel and a tincture to put in drinks, which she hopes will help with her severe neck pain. I wanted a non-psychoactive option, she said. I dont want to get high. I used to work in the emergency room and saw people come in sick from taking too many drugs, though not usually marijuana.

    Her friend, Nancy Mitchell, 80, has never tried cannabis. She has MS and had read that cannabis could help with her symptoms. I wanted to know more details, she said. My kids keep telling me, Mom, try it. I dont want to smoke things, but I see there are other ways.

    Smoking is not allowed at El Dorado West. Village Concepts, which runs the chain, has a no-smoking policy and it is illegal to consume cannabis in public in the state.

    The chains director of corporate development, Tracy Willis, said: There was one man who was smoking it on his patio and he refused to stop, so he had to leave. If youre using an edible, we dont have any issue with it, thats your own business. We treat it as a recreational thing.

    The tours began in response to questions from residents.They wanted to know where it was sold, how much money was made from it, where it was grown, said Willis. Weve had a good reaction [to the tours] from nine out of 10 relatives, but some are horrified. One angry daughter said we were encouraging marijuana use. Her mother told her to butt out.

    Participants
    Participants on the tour learned about different ways to use cannabis. Photograph: Jason Redmond/Reuters

    Read more: https://www.theguardian.com/society/2017/jul/01/seattle-retirement-home-cannabis-tours