How To Avoid Common Thinking Traps

The mind is a tricky thing. It can lead us to believe that we can confidently sing “Bohemian Rhapsody” at karaoke even though we haven’t heard the song in years, or that one terrible review on Yelp is reason enough not to go to a 4-star rated restaurant.

These thinking errors are what people in the psychology community call cognitive biases. And that’s the focus of a new book out this month, Thinking 101: How to Reason Better to Live Better, by Yale psychology professor Woo-kyoung Ahn. In the book, Ahn highlights some of the most pernicious cognitive slip-ups we make — and how biases can cloud our judgment and affect the people around us.

Researchers suspect that many of these biases are evolutionary, says Ahn. During times of scarcity, our ancestors had to make quick judgments in order to survive among predators or thrive in a difficult environment. But in a time of abundance, she adds, these quick judgments don’t always do us good.

However, we can do our best to try to correct these thinking traps, says Ahn, which she teaches her students how to do in her popular undergraduate course at Yale. In general, she says, the key is to pause before making assumptions — and be aware of our tendencies for different kinds of bias.

Ahn talks to Life Kit about three common cognitive biases and how to counteract them.

This is known in the field of psychology as an “illusion of fluency,” which describes our tendency to be overconfident in our abilities without sufficient evidence. This can lead us, for example, to bungle career-altering presentations because of inadequate preparation, or dramatically underestimate the time it takes to complete projects.

In her class at Yale, Ahn uses an experiment to illustrate this phenomenon with her students. She shows them a dance clip from the song “Boy with Luv” by the K-pop group BTS. After watching six seconds of the easiest choreography moves over and over again, she invites the students who believe they have the dance down to do it themselves. One after another stumbles.

“People can have overconfidence about what they can accomplish by watching other people do it so fluently,” Ahn says. When the pros dance in a way that looks effortless, they think they can do it effortlessly too.

How to counteract it: You can correct this bias, she says, by doing what the Yale students did: Try it out yourself. It will quickly put any feelings of overconfidence to rest.

You can also fight this tendency by over-preparing and considering potential obstacles beforehand, says Ahn. For example, if you’re working on a home remodeling project for the first time and have no idea how long it will take, don’t try to guess. Talk to friends who went through a recent remodel or consult with a few contractors to understand how long the project might take and what problems may arise. The more information you have, the better and more accurately you can assess a situation.

The bias: We tend to fixate on the negative

The concept of “negativity bias” illustrates our propensity to weigh negative events a lot more heavily than an equal amount of positive events. It explains why a friend’s unenthusiastic review of an Oscar-nominated movie, for example, might spur you to watch something else. Or why you might be less inclined to hire a potential employee after hearing one negative thing about them, despite positive referrals.

Negativity bias can be dangerous because it can lead us to make the wrong choices. It can hold us back from making a decision about something, say a big purchase like a house, or even a political candidate, out of fear there was once a negative event associated with an otherwise good choice.

How to counteract it: When making a choice, play up the positive attributes of your options, says Ahn. Marketers use this tactic all the time. For example, instead of saying that ground beef contains 11% fat, they label it is as 89% lean. These are both true and accurate descriptions of the same product, but flipping the framing of it can make it a more attractive choice for buyers concerned with fat intake.

The bias: We cherry-pick data to fit our worldview

Ahn considers “confirmation bias” — the tendency to seek out or interpret information to support what we already believe — the worst bias of all. That’s because of its potential to lead us to miss an entire range of possibilities for ourselves and others.

Ahn and Matthew Lebowitz, a psychology professor at Columbia University, conducted an experiment in 2017 to illustrate the pitfalls of this bias. They gathered a group of participants and told some of them they had a genetic predisposition to depression – even though they did not. The results of that group’s depression self-assessments showed much higher levels of depression than people in a control group who were told they did not have the predisposition.

Because of confirmation bias, the participants who were told they had a genetic risk of depression retrieved “only the evidence that fit with that hypothesis,” says Ahn. And in doing so, they managed to convince themselves that they were actually depressed. The study shows that if we believe something is a fact, even if it isn’t, our mind can find information to support those views.

Now imagine this bias at work on a societal level. Ahn says it can lead to under- or over-representation in say, leadership in politics, business and other industries, which can feed gender or racial inequality.

She shares an example. Let’s say you’re a male scientist and you’re looking to hire other scientists to join your company. Because you see that the most prominent scientists in your field are currently men, you’ve convinced yourself that the next generation of great scientists will also be men. This colors your decision-making in hiring — and so you fill the positions with men.

That choice will continue to have a ripple effect, says Ahn. For others looking at the new hires, it might perpetuate the idea that “only men can be great scientists — and that’s exactly how prejudice and stereotypes get formed in society.”

How to counteract it: Allow yourself to examine all possible explanations before you make a judgment. For example, if an actor landed a part but her parents were also in the entertainment business, many of us might attribute her employment to nepotism. Since we’ve seen many examples of parents giving their kids a leg up in business or politics, another example of a child benefiting from their parents’ success would fit that theory.

But could it also be true that she gave the best audition? By looking at the issue from many different viewpoints – not just your own – it challenges your confirmation bias. And you might realize that perhaps there is another side to the story.

By:

Source: A Yale psychologist explains how to avoid common thinking traps : Life Kit : NPR

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Critics by The Chelsea Psychology Clinic

Thinking traps are patterns of thought – usually with a negative swing – which prevent us from seeing things as they really are. Otherwise known as cognitive distortions, thinking traps are often deeply ingrained in our psyche. 

By twisting our thoughts, they can make us easily jump to conclusions and make bad decisions – preventing us from seeing the bigger picture. Like this, we can wind up trapped in a vicious cycle with the potential to alter both our mood and the way in which we experience the world around us.

Cognitive Behavioural Therapy (CBT) is a type of therapy which holds that our moods and the way we feel day-to-day is impacted by our thoughts and behaviours. In other words, if we can change the way we think, we’re going to change our behaviour which has the power to alter our mood and the way we navigate the world.

Mastering our thoughts, then, is one of the most powerful things we can do if we want to take ownership over our lives. Let’s take a closer look at some of the most common thinking traps. Understanding what a thinking trap looks like is going to help you get better at identifying them.

Common thinking traps – examples of thinking errors 

1.All-or-nothing thinking – seeing everything as black and white. An example might be, “I got fired. I’m rubbish at everything”. In other words, if a situation doesn’t go exactly to plan, you immediately deem it a failure. The problem is, life isn’t black and white – it’s important to be able to see the shades of grey in between.

Replace this with: “Nothing in life is perfect. Even though I didn’t get the job, it doesn’t mean I’m a failure. There are better things to come”.

2. Emotional reasoning – believing emotions to be evidence of the truth. As we explained before, how you feel is normally closely tied to the way you think. So just because you’re feeling rubbish doesn’t mean life is rubbish. An example might be, “I feel useless, therefore I am useless”.

Replace this with: “My feelings are not objective evidence for reality. I can accept all of my feelings but still move forward”.

3. Mind-reading – immediately assuming that someone is thinking something negative about you without having any evidence for it. i.e. you’re jumping to conclusions. 

Replace this with: “I can’t read minds”.

4. Fortune-telling – predicting situations with only negative outcomes. An example might be, “I’m definitely going to fail the exam today”.

Replace this with: “No one can possibly predict the future”.

5. Labelling – wrongly attributing a negative label to either yourself or someone else. An example might be, “I’m a failure” instead of saying “I failed the exam”.

Replace this with: “No one deserves to be judged”.

6. Overgeneralisation – whenever something difficult happens you think it’s going to happen over and over again. An example might be saying, “why does this always happen to me?” This thinking trap particularly likes words like ‘never’, ‘every’ and always’ so look out for them.

Replace this with: “I’m overgeneralising here. It’s very possible that something different will happen next time”.

7. Personalisation – wrongfully assuming responsibility for something. An example might be, “It’s all my fault we didn’t have pudding because I forgot the ice cream”.

Replace this with: “It’s nobody’s fault”.

What if thinking and anxiety

Anxiety is very closely tied to a thinking trap known as catastrophising. Most people will catastrophise from time to time but this kind of thinking is going to be much more prominent in someone suffering from an anxiety disorder. Triggers often centre around ambiguity – perhaps receiving a vague text from a partner, getting ill and suspecting it’s something much worse etc.

This kind of thinking can often be traced back to childhood – for example, growing up with a lot of unpredictability and instability. CBT can be helpful in learning how to manage these thoughts but digging a bit deeper in longer-term therapy can also be beneficial in these cases.

Thinking traps psychology tools – steps to take

Acknowledge that difficult things happen in life – sometimes this acknowledgement alone can be liberating. We simply can’t control everything – ups and downs are an inevitable part of life – but what we can do is change the way we respond.

Identify your thinking traps – get really clear on the specific thinking traps you have a tendency to fall prey to. It can help to keep a mood diary to keep track of moments when you’ve been feeling happy/sad and what immediately preceded those feelings. 

Play devil’s advocate with yourself – ask as many questions as possible before jumping to conclusions. Ask yourself, “is this thought I’m having a fact or is it an opinion?” Most thoughts are actually opinions rather than fact. Not all thoughts need to be taken seriously.

Talk to yourself as you would a friend – most of us would never dream of speaking to a friend the way we speak to ourselves. Be kind to yourself, and try rooting for yourself in the same way you would do a friend. Try using a mantra like, “I believe in you” when self-doubt kicks in.

Say ‘stop’ when worry-ridden thoughts take over – when you notice yourself getting lost in anxious thoughts try saying ‘stop’ out loud as a cue to consciously interrupt your thoughts.

Practice self-care as much as possible – thinking traps tend to get worse the more rundown and tired we are. Make sure you’re doing things that top up your “energy bank” and fill you with a sense of enjoyment and wellbeing.

If left unchecked, thinking traps can spiral and play tricks on us – and leave us feeling trapped. If you’re feeling down or like you’ve fallen into a pattern of habitual negative thinking, it’s really important to seek help. A therapist can help you challenge and overturn thinking patterns that are holding you back so you can begin to realise your full potential.

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Allergic To The World: Can Medicine Help People With Severe Intolerance To Chemicals

Sharon calls herself a universal reactor. In the 1990s, she became allergic to the world, to the mould colonising her home and the paint coating her kitchen walls, but also deodorants, soaps and anything containing plastic. Public spaces rife with artificial fragrances were unbearable. Scented disinfectants and air fresheners in hospitals made visiting doctors torture. The pervasiveness of perfumes and colognes barred her from in-person social gatherings.

Even stepping into her own back garden was complicated by the whiff of pesticides and her neighbour’s laundry detergent sailing through the air. When modern medicine failed to identify the cause of Sharon’s illness, exiting society felt like her only solution. She started asking her husband to strip and shower every time he came home. Grandchildren greeted her through a window. When we met for the first time, Sharon had been housebound for more than six years.

When I started medical school, the formaldehyde-based solutions used to embalm the cadavers in the human anatomy labs would cause my nose to burn and my eyes to well up – representing the mild, mundane end of a chemical sensitivity spectrum. The other extreme of the spectrum is an environmental intolerance of unknown cause (referred to as idiopathic by doctors) or, as it is commonly known, multiple chemical sensitivity (MCS).

An official definition of MCS does not exist because the condition is not recognised as a distinct medical entity by the World Health Organization or the American Medical Association, although it has been recognised as a disability in countries such as Germany and Canada.

Disagreement over the validity of the disease is partially due to the lack of a distinct set of signs and symptoms, or an accepted cause. When Sharon reacts, she experiences symptoms from seemingly every organ system, from brain fog to chest pain, diarrhoea, muscle aches, depression and odd rashes. There are many different triggers for MCS, sometimes extending beyond chemicals to food and even electromagnetic fields. Consistent physical findings and reproducible lab results have not been found and, as a result, people such as Sharon not only endure severe, chronic illness but also scrutiny over whether their condition is “real”.

The first reported case of MCS was published in the Journal of Laboratory and Clinical Medicine in 1952 by the American allergist Theron Randolph. Although he claimed to have previously encountered 40 cases, Randolph chose to focus on the story of one woman, 41-year-old Nora Barnes. She had arrived at Randolph’s office at Northwestern University in Illinois with a diverse and bizarre array of symptoms.

A former cosmetics salesperson, she represented an “extreme case”. She was always tired, her arms and legs were swollen, and headaches and intermittent blackouts ruined her ability to work. A doctor had previously diagnosed her with hypochondria, but Barnes was desperate for a “real” diagnosis.

Randolph noted that the drive into Chicago from Michigan had worsened her symptoms, which spontaneously resolved when she checked into her room on the 23rd floor of a hotel where, Randolph reasoned, she was far away from the noxious motor exhaust filling the streets. In fact, in his report Randolph listed 30 substances that Barnes reacted to when touched (nylon, nail polish), ingested (aspirin, food dye), inhaled (perfume, the “burning of pine in fireplace”) and injected (the synthetic opiate meperidine, and Benadryl).

He posited that Barnes and his 40 other patients were sensitive to petroleum products in ways that defied the classic clinical picture of allergies. That is, rather than an adverse immune response, such as hives or a rash where the body is reacting to a particular antigen, patients with chemical sensitivities were displaying an intolerance. Randolph theorised that, just as people who are lactose-intolerant experience abdominal pain, diarrhoea and gas because of undigested lactose creating excess fluid in their gastrointestinal tract, his patients were vulnerable to toxicity at relatively low concentrations of certain chemicals that they were unable to metabolise.

He even suggested that chemical sensitivity research was being suppressed by “the ubiquitous distribution of petroleum and wood products”. MCS, he believed, was not only a matter of scientific exploration, but also of deep-seated corporate interest. Randolph concludes his report with his recommended treatment: avoidance of exposure.

In that one-page abstract, Randolph cut the ribbon on the completely novel but quickly controversial field of environmental medicine. Nowadays, we hardly question the ties between the environment and wellbeing. The danger of secondhand smoke, the realities of climate change and the endemic nature of respiratory maladies such as asthma are common knowledge. The issue was that Randolph’s patients lacked abnormal test results (specifically, diagnostic levels of immunoglobulin E, a blood marker that is elevated during an immune response). Whatever afflicted them were not conventional allergies, so conventional allergists resisted Randolph’s hypotheses.

Randolph was in the dark. Why was MCS only now rearing its head? He also asked another, more radical question: why did this seem to be a distinctly American phenomenon? After all, the only other mention of chemical sensitivities in medical literature was in the US neurologist George Miller Beard’s 1880 textbook A Practical Treatise on Nervous Exhaustion (Neurasthenia).

Beard argued that sensitivity to foods containing alcohol or caffeine was associated with neurasthenia, a now-defunct term used to describe the exhaustion of the nervous system propagated by the US’s frenetic culture of productivity. Like Beard, Randolph saw chemical sensitivities as a disease of modernity, and conceived the origin as wear-and-tear as opposed to overload.

Randolph proposed that Americans, propelled by the post-second world war boom, had encountered synthetic chemicals more and more in their workplaces and homes, at concentrations considered acceptable for most people. Chronic exposure to these subtoxic dosages, in conjunction with genetic predispositions, strained the body and made patients vulnerable. On the back of this theory, Randolph developed a new branch of medicine and, with colleagues, founded the Society for Clinical Ecology, now known as the American Academy of Environmental Medicine.

As his professional reputation teetered, his popularity soared and patients flocked to his care. Despite this growth in interest, researchers never identified blood markers in MCS patients, and trials found that people with MCS couldn’t differentiate between triggers and placebos. By 2001, a review in the Journal of Internal Medicine found MCS virtually nonexistent outside western industrialised countries, despite the globalisation of chemical use, suggesting that the phenomenon was culturally bound.

MCS subsequently became a diagnosis of exclusion, a leftover label used after every other possibility was eliminated. The empirical uncertainty came to a head in 2021, when Quebec’s public health agency, the INSPQ, published an 840-page report that reviewed more than 4,000 articles in the scientific literature, concluding that MCS is an anxiety disorder.

In medicine, psychiatric disorders are not intrinsically inferior; serious mental illness is, after all, the product of neurological dysfunction. But the MCS patients I spoke to found the language offensive and irresponsible. Reducing what they felt in their eyes, throats, lungs and guts to anxiety was not acceptable at all.

As a woman I will call Judy told me: “I would tell doctors my symptoms, and then they’d run a complete blood count and tell me I looked fine, that it must be stress, so they’d shove a prescription for an antidepressant in my face and tell me to come back in a year.” In fact, because MCS is so stigmatising, such patients may never receive the level of specialised care they need.

In the wake of her “treatment”, Judy was frequently bedbound from crushing fatigue, and no one took her MCS seriously. “I think a lot of doctors fail to understand that we are intelligent,” she said. “A lot of us with chemical sensitivities spend a good amount of our time researching and reading scientific articles and papers. I probably spent more of my free time reading papers than most doctors.”

Judy grew up in Texas, where she developed irritable bowel syndrome and was told by doctors that she was stressed. Her 20s were spent in Washington state where she worked as a consultant before a major health crash left her bedbound for years (again, the doctors said she was stressed). Later, after moving to Massachusetts, a new paint job at her home gave her fatigue and diarrhoea.

She used to browse the local art museum every Saturday, but even fumes from the paintings irritated her symptoms. She visited every primary care doctor in her city, as well as gastroenterologists, cardiologists, neurologists, endocrinologists and even geneticists. Most of them reacted the same way: with a furrowed brow and an antidepressant prescription in hand. “Not one allopathic doctor has ever been able to help me,” Judy said.

Morton Teich is one of the few physicians who diagnoses and treats patients with MCS in New York. The entrance to his integrative medicine private practice is hidden away behind a side door in a grey-brick building on Park Avenue. As I entered the waiting room, the first thing to catch my eye was the monstrous mountain of folders and binders precariously hugging a wall, in lieu of an electronic medical record.

I half-expected Teich’s clinic to resemble the environmental isolation unit used by Randolph in the 1950s, with an airlocked entrance, blocked ventilation shafts and stainless-steel air-filtration devices, books and newspapers in sealed boxes, aluminium walls to prevent electromagnetic pollution, and water in glass bottles instead of a cooler. But there were none of the above. The clinic was like any other family medicine practice I had seen before; it was just very old. The physical examination rooms had brown linoleum floors and green metal chairs and tables. And there were no windows.

Although several of Teich’s patients were chemically sensitive, MCS was rarely the central focus of visits. When he introduced me, as a student writing about MCS, to his first patient of the day, a petrol-intolerant woman whose appointment was over the phone because she was housebound, she admitted to never having heard of the condition. “You have to remember,” Teich told me, “that MCS is a symptom. It’s just one aspect of my patients’ problems. My goal is to get a good history and find the underlying cause.” Later, when I asked him whether he had observed any patterns suggesting an organic cause of MCS, he responded: “Mould. Almost always.”

Many people with MCS I encountered online also cited mould as a probable cause. Sharon told me about her first episode in 1998, when she experienced chest pain after discovering black mould festering in her family’s trailer home. A cardiac examination had produced no remarkable results, and Sharon’s primary care physician declared that she was having a panic attack related to the stress of a recent miscarriage. Sharon recognised that this contributed to her sudden health decline, but also found that her symptoms resolved only once she began sleeping away from home.

She found recognition in medical books such as Toxic (2016) by Neil Nathan, a retired family physician who argued that bodily sensitivities were the product of a hyper-reactive nervous system and a vigilant immune system that fired up in reaction to toxicities, much as Randolph had said. The conditions that Nathan describes are not supported by academic medicine as causes of MCS: mould toxicity and chronic Lyme disease are subject to the same critique.

Sharon went to see William Rea, a former surgeon (and Teich’s best friend). Rea diagnosed her with MCS secondary to mould toxicity. “Mould is everywhere,” Teich told me. “Not just indoors. Mould grows on leaves. That’s why people without seasonal allergies can become chemically sensitive during autumn.” When trees shed their leaves, he told me, mould spores fly into the air. He suspected that American mould is not American at all, but an invasive species that rode wind currents over the Pacific from China. He mentioned in passing that his wife recently died from ovarian cancer. Her disease, he speculated, also had its roots in mould.

In fact, Teich commonly treats patients with nystatin, an antifungal medication used to treat candida yeast infections, which often infect the mouth, skin and vagina. “I have an 80% success rate,” he told me. I was dubious that such a cheap and commonplace drug was able to cure an illness as debilitating as MCS, but I could not sneer at his track record. Every patient I met while shadowing Teich was comfortably in recovery, with smiles and jokes, miles apart from the people I met in online support groups who seemed to be permanently in the throes of their illness.

However, Teich was not practising medicine as I was taught it. This was a man who believed that the recombinant MMR vaccine could trigger “acute autism” – traditionally an anti-science point of view. When one of his patients, a charismatic bookworm I’ll call Mark, arrived at an appointment with severe, purple swelling up to his knees and a clear case of stasis dermatitis (irritation of the skin caused by varicose veins), Teich reflexively blamed mould and wrote a prescription for nystatin instead of urging Mark to see a cardiologist.

When I asked how a fungal infection in Mark’s toes could cause such a bad rash on his legs, he responded: “We have candida everywhere, and its toxins are released into the blood and travel to every part of the body. The thing is, most people don’t notice until it’s too late.” Moulds and fungi are easy scapegoats for inexplicable illnesses because they are so ubiquitous in our indoor and outdoor environments. A great deal of concern over mould toxicity (or, to use the technical term, mycotoxicosis) stems from the concept of “sick-building syndrome”, in which visible black mould is thought to increase sensitivity and make people ill.

This was true of Mark, who could point to the demolition of an old building across the street from his apartment as a source of mould in the atmosphere. Yet in mainstream medicine, diseases caused by moulds are restricted to allergies, hypersensitivity pneumonitis (an immunologic reaction to an inhaled agent, usually organic, within the lungs) and infection.

Disseminated fungal infections occur almost exclusively in patients who are immunocompromised, hospitalised or have an invasive foreign body such as a catheter. Furthermore, if “clinical ecologists” such as Teich are correct that moulds such as candida can damage multiple organs, then it must be spreading through the bloodstream. But I have yet to encounter a patient with MCS who reported fever or other symptoms of sepsis (the traumatic, whole-body reaction to infection) as part of their experience.

Teich himself did not use blood cultures to verify his claims of “systemic candidiasis”, and instead looked to chronic fungal infection of the nails, common in the general population, as sufficient proof.

“I don’t need tests or blood work,” he told me. “I rarely ever order them. I can see with my eyes that he has mould, and that’s enough.” It was Teich’s common practice to ask his patients to remove their socks to reveal the inevitable ridges and splits on their big toenails, and that’s all he needed.

Through Teich, I met a couple who were both chemically sensitive but otherwise just regular people. The wife, an upper-middle-class white woman I will call Cindy, had a long history of allergies and irritable bowel syndrome. She became ill whenever she smelled fumes or fragrances, especially laundry detergent and citrus or floral scents. Teich put both her and her husband on nystatin, and their sensitivities lessened dramatically.

What struck me as different about her case, compared with other patients with MCS, was that Cindy was also on a course of antidepressants and cognitive behavioural therapy, the standard treatment for anxiety and depression. “It really helps to cope with all the stress that my illness causes. You learn to live despite everything,” she said.

In contemporary academic medicine, stress and anxiety cause MCS, but MCS can itself cause psychiatric symptoms. Teich later told me, unexpectedly, that he had no illusions about whether MCS is a partly psychiatric illness: “Stress affects the adrenals, and that makes MCS worse. The mind and the body are not separate. We have to treat the whole person.”

To understand this case, I also spoke to Donald Black, associate chief of staff for mental health at the Iowa City Veterans Administration Health Care. He co-authored a recent article on idiopathic environmental intolerance that took a uniform stance on MCS as a psychosomatic disorder. In 1988, when Black was a new faculty member at the University of Iowa, he interviewed a patient entering a drug trial for obsessive-compulsive disorder.

He asked the woman to list her medications, and watched as she started unloading strange supplements and a book about environmental illness from her bag. The woman had been seeing a psychiatrist in Iowa City – a colleague of Black’s – who had diagnosed her with systemic candidiasis. Black was flummoxed. If that diagnosis was true, then the woman would be very ill, not sitting calmly before him.

Besides, it was not up to a psychiatrist to treat a fungal infection. How did he make the diagnosis? Did he do a physical or run blood tests? No, the patient told him, the psychiatrist just said that her symptoms were compatible with candidiasis. These symptoms included chemical sensitivities. After advising the patient to discard her supplements and find a new psychiatrist, Black made some phone calls and discovered that, indeed, his colleague had fallen in with the clinical ecologists.

Black was intrigued by this amorphous condition that had garnered an endless number of names: environmentally induced illness, toxicant-induced loss of tolerance, chemical hypersensitivity disease, immune dysregulation syndrome, cerebral allergy, 20th-century disease, and mould toxicity. In 1990, he solicited the aid of a medical student to find 26 subjects who had been diagnosed by clinical ecologists with chemical sensitivities and to conduct an “emotional profile”.

Every participant in their study filled out a battery of questions that determined whether they satisfied any of the criteria for psychiatric disorders. Compared with the controls, the chemically sensitive subjects had 6.3 times higher lifetime prevalence of major depression, and 6.8 times higher lifetime prevalence of panic disorder or agoraphobia; 17% of the cases met the criteria for somatisation disorder (an extreme focus on physical symptoms – such as pain or fatigue – that causes major emotional distress and problems functioning).

In my own review of the literature, it was clear that the most compelling evidence for MCS came from case studies of large-scale “initiating events” such as the Gulf war (where soldiers were uniquely exposed to pesticides and pyridostigmine bromide pills to protect against nerve agents) or the terrorist attacks on the US of 11 September 2001 (when toxins from the falling towers caused cancers and respiratory ailments for years).

In both instances, a significant number of victims developed chemical intolerances compared with populations who were not exposed. From a national survey of veterans deployed in the Gulf war, researchers found that up to a third of respondents reported multi-symptom illnesses, including sensitivity to pesticides – twice the rate of veterans who had not deployed.

Given that Gulf war veterans experienced post-traumatic stress disorder at levels similar to those in other military conflicts, the findings have been used to breathe new life into Randolph’s idea of postindustrial toxicities leading to intolerance. The same has been said of the first responders and the World Trade Centre’s nearby residents, who developed pulmonary symptoms when exposed to “cigarette smoke, vehicle exhaust, cleaning solutions, perfume, or other airborne irritants” after 9/11, according to a team at Mount Sinai.

Black, who doubts a real disease, has no current clinical experience with MCS patients. (Apart from the papers he wrote more than 20 years ago, he had seen only a handful of MCS patients over the course of his career.) Despite this, he had not only written the article about MCS, but also a guide in a major online medical manual on how to approach MCS treatment as a psychiatric disease. When I asked him if there was a way for physicians to regain the trust of patients who have been bruised by the medical system, he simply replied:

“No.” For him, there would always be a subset of patients who are searching for answers or treatments that traditional medicine could not satisfy. Those were the people who saw clinical ecologists, or who left society altogether. In a time of limited resources, these were not the patients on which Black thought psychiatry needed to focus. It became clear to me why even the de facto leading professional on MCS had hardly any experience actually treating MCS.

In his 1990 paper, Black – then a young doctor – rightly observed that “traditional medical practitioners are probably insensitive to patients with vague complaints, and need to develop new approaches to keep them within the medical fold.  The study subjects clearly believed that their clinical ecologists had something to offer them that others did not: sympathy, recognition of pain and suffering, a physical explanation for their suffering, and active participation in medical care.”I wondered if Black had given up on these “new approaches” because few CS patients wanted to see a psychiatrist in the first place.

Physicians on either side of the debate agreed that mental illness is a crucial part of treating MCS, with one I spoke to believing that stress causes MCS, and another believing that MCS causes stress. To reconcile the views, I interviewed another physician, Christine Oliver, a doctor of occupational medicine in Toronto, where she has served on the Ontario Task Force on Environmental Health. Oliver believes that both stances are probably valid and true. “No matter what side you’re on,” she told me, “there’s a growing consensus that this is a public health problem.”

Oliver represents a useful third position, one that takes the MCS illness experience seriously while sticking closely to medical science. As one of few “MCS-agnostic” physicians, she believes in a physiological cause for MCS that we cannot know and therefore cannot treat directly due to lack of research. Oliver agrees with Randolph’s original suggestion of avoiding exposures, although she understands that this approach has resulted in traumatising changes in patients’ abilities to function. For her, the priority for MCS patients is a practical one: finding appropriate housing.

Often unable to work and with a limited income, many of her patients occupy public housing or multi-family dwellings. The physician of an MCS patient must act like a social worker. Facilities such as hospitals, she feels, should be made more accessible by reducing scented cleaning products and soaps. Ultimately, finding a non-threatening space with digital access to healthcare providers and social support is the best way to allow the illness to run its course.

Whether organic or psychosomatic or something in between, MCS is a chronic illness. “One of the hardest things about being chronically ill,” wrote the American author Meghan O’Rourke in the New Yorker in 2013 about her battle against Lyme disease, “is that most people find what you’re going through incomprehensible – if they believe you are going through it. In your loneliness, your preoccupation with an enduring new reality, you want to be understood in a way that you can’t be.”

A language for chronic illness does not exist beyond symptomatology, because in the end symptoms are what debilitate “normal” human functioning. In chronic pain, analgesics can at least deaden a patient’s suffering. The same cannot be said for MCS symptoms, which are disorienting in their chaotic variety, inescapability and inexpressibility. There are few established avenues for patients to completely avoid triggering their MCS, and so they learn to orient their lives around mitigating symptoms instead, whether that is a change in diet or moving house, as Sharon did. MCS comes to define their existence.

As a housebound person, Sharon’s ability to build a different life was limited. Outside, the world was moving forward, yet Sharon never felt left behind. What allowed her to live with chronic illness was not medicine or therapy, but the internet. On a typical day, Sharon wakes up and prays in bed. She wolfs down handfuls of pills and listens to upbeat music on YouTube while preparing her meals for the day: blended meats and vegetables, for easier swallowing.

The rest of the day is spent on her laptop computer, checking email and Facebook, watching YouTube videos until her husband returns home in the evening. Then bed. This is how Sharon has lived for the past six years, and she does not expect anything different from the future. When I asked her if being homebound was lonely, I was taken aback at her reply: “No.”

In spite of not having met most of her 15 grandchildren (with two more on the way), Sharon keeps in daily contact with all of them. In fact, Sharon communicates with others on a nearly constant basis. “Some people are very much extroverts,” Sharon wrote. “I certainly am. But there are also people who need physical touch … and I can understand why they might need to see ‘real people’ then … but it’s very possible to be content with online friends. This is my life!”

The friendships that Sharon formed online with other housebound people with chronic illnesses were the longest-lasting and the most alive relationships she had ever known. She had never met her best friend of 20 years – their relationship existed completely through letters and emails, until two years ago, when the friend died. That “was very hard for me”, Sharon wrote.

The pandemic changed very little of Sharon’s life. If anything, Covid-19 improved her situation. Sharon’s local church live-streamed Sunday service, telehealth doctor appointments became the default, YouTube exploded in content, and staying indoors was normalised. Sharon saw her network steadily expand as more older adults became isolated in quarantine.

People within the online MCS community call themselves “canaries”, after the birds historically used as sentinels in coalmines to detect toxic levels of carbon monoxide. With a higher metabolism and respiratory rate, the small birds would theoretically perish before the less-sensitive human miners, providing a signal to escape. The question for people with MCS is: will anyone listen?

“Us canaries,” said a woman named Vera, who was bedbound from MCS for 15 years after a botched orthopaedic surgery, “we struggle and suffer in silence.” Now, in the information age, they have colonised the internet to find people like themselves. For our part, we must reimagine chronic illness – which will become drastically more common in the aftermath of the pandemic – where what matters to the patient is not only a scientific explanation and a cure, but also a way to continue living a meaningful life.

This calls into action the distinction between illness and disease that the psychiatrist and anthropologist Arthur Kleinman made in his 1988 book The Illness Narratives. Whereas a disease is an organic process within the body, illness is the lived experience of bodily processes. “Illness problems,” he writes, “are the principal difficulties that symptoms and disability create in our lives.”

By centring conversations about MCS on whether or not it is real, we alienate the people whose illnesses have deteriorated their ability to function at home and in the world. After all, the fundamental mistrust does not lie in the patient-physician relationship, but between patients and their bodies. Chronic illness is a corporeal betrayal, an all-out assault on the coherent self. Academic medicine cannot yet shed light on the physiological mechanisms that would explain MCS. But practitioners and the rest of society must still meet patients with empathy and acceptance, making space for their narratives, their lives, and their experience in the medical and wider world.

After two years of wrangling, false starts and disappointments, it finally happened: America has passed its first-ever climate legislation, moving the country closer to its goal of a decarbonized future and taking a significant step toward helping the planet avert the worst scenarios of climate catastrophe.

But it’s not a time to rest. We have always held power to account – on climate and  every other major issue – from the fossil fuel companies responsible for heating the planet to the politicians representing their interests. The country responsible for the most greenhouse gas emissions in history has indicated it will change course; we will relentlessly report on what comes next, who will benefit and the remaining obstacles to progress.

With daily reporting and analysis on the climate emergency, we aim to ensure that even more people are made aware of the dangers – and opportunities – of this moment.

By

Source: Allergic to the world: can medicine help people with severe intolerance to chemicals? | Health & wellbeing | The Guardian

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People Who Lack Compassion For The Environment Are Also Less Emotional In General

People who show less compassion and emotion toward images of environmental disasters are generally less empathetic and emotional overall. People who respond less emotionally to images of damage to the environment are also less emotional and empathic in general, according to a new University of Michigan study.

Differences in political ideology can limit policy adjustments that address climate change. Researchers and practitioners often raise concern by appealing to people’s empathy. However, some people appear less emotionally impacted by environmental destruction—particularly those who are more ideologically conservative and less pro-environmental, the study showed.

In a series of online experiments in the U.S., U-M graduate student Logan Bickel and psychology professor Stephanie Preston examined the emotional responses of more than 600 people in a variety of contexts. People not concerned when viewing pictures of damage to the environment—such as oil spills on fire in a gulf—also did not feel bad about other images including crying babies, officers in distress, injured athletes, wounded soldiers and even moldy food.

Consistent with this lack of contagious distress, more “impassive” people said that they felt less empathy for those in daily life and were less pro-environmental and less awed by nature. This group also responded less to positive images such as happy babies, ice cream and stacks of money, the research showed.

The study’s results suggest that some people’s lack of concern for the environment may not be particularly political or reflect a specific disinterest in the environment. It is instead a characteristic of their broader emotional palette, Preston said. “Given that our sense of risk and decisions are strongly guided by emotions, more impassive people are less inclined to dedicate resources to this slowly building crisis,” she said.

Appeals to help the environment must consider variation in people’s emotional make-up and devise new tactics for those who are unpersuaded by appeals to emotion, Logan said. The average American believes in climate change, worries about it, and supports related policy, but there are still considerable differences—across individuals and with political ideology—that limit the ability to foster change.

Researchers and practitioners often increase concern and action for others through feelings of empathy, which also increases pro-environmentalism. However, some people appear less emotionally impacted by environmental destruction—particularly more ideologically conservative and less pro-environmental individuals.

To determine why some people appear to be impassive to environmental destruction, we conducted 3 online studies to measure beliefs and emotional processes in political liberals versus conservatives. Across 3 studies, we replicated the link between impassivity and conservatism, and found that more impassive people acknowledge our negative impact on the environment but are less concerned about it and more confident in an eventual solution. Impassivity, however, is not specific to the environment.

People who are more impassive about the environment also respond less emotionally to positive and negative images that are unrelated to the environment, including human suffering and hedonic reward. They also report reduced trait empathy, perspective taking, and daily emotional expression and experience. Impassivity is not linked to differences in trait personal distress, anxiety, psychopathy (apart from low empathy), or trouble appreciating consequences.

Impassivity is not associated with deficits in processing others’ facial emotion during early perceptual decoding but is associated with the later suppression of emotion. Everyone will not respond to emotional appeals to help a distressed environment. Other strategies are recommended to reach a broad audience.

By: Morgan Sherburne

Source: People Who Lack Compassion for the Environment Are Also Less Emotional in General – Neuroscience News

Critics by Six Seconds

Empathy has been regarded by environmental thinkers as a key in conservation efforts. Nevertheless, systematic research on empathy toward nature, particularly from the personality perspective, has been lacking in psychology. The present research thus provides this needed investigation by testing four propositions regarding a new construct—dispositional empathy with nature (DEN), which refers to the dispositional tendency to understand and share the emotional experience of the natural world.

In five studies with 817 participants in total (including university students and working adults from two societies), DEN robustly and uniquely predicted conservation behavior (Proposition 1). Females, respondents who felt close to nature, and participants who considered nature to be sentient exhibited stronger DEN (Propositions 2–4). DEN was distinct from empathy with humans and a number of known determinants of conservation behavior (including personality traits, values, emotional involvement with nature, environmental concern, and social desirability bias).

Taken together, these findings highlight the possibility of developing a theory of empathy with nature by referring to the existing understanding about empathy with humans. The construct of DEN has much theoretical utility, as it sheds new light on several under-explored issues in conservation psychology (including the gender gap in environmentalism, the role of connection to nature, and the role of anthropomorphism), and bears practical implications for the promotion of environmentalism.

In addition, the newly developed scale for DEN is potentially useful for assessing the efficacy of environmental education programs. Other research studies have backed up the incredible research on greenery in urban environments. The results are clear: A lack of connection to nature results in crime and social breakdown. And conversely, efforts to greenify urban areas leads to better neighborly relations, more empathy, and less crime.

Police records confirm this anecdotal relationship between green space and social breakdown, providing an even more objective measure than the resident’s memories. Research from Columbia and Penn found that “cleaning and greening” vacant lots led to a 9% reduction in gun assaults. A 9% reduction in gun assaults! Greenery has also been linked to better long-term health outcomes – mentally and physically. Physically, greenery has been linked to less obesity, diabetes and hypertension.

Mentally, research in London found that a neighborhood’s greenery predicted how many medications related to mood disorders that the neighborhood pharmacy prescribed. Taken altogether, the findings suggest that connection to nature, Vitamin N, is an essential component of human health and wellbeing. Humans are incredibly adaptable, but we’re still deeply wired to our original habitat, the natural world. Should these findings change how we build our cities? Or within existing cities, where we choose to eat, work and spend free time?

While this research on making cities green is powerful and thought provoking, I found this research on nature’s effects on the individual level to be equally powerful, and even more actionable. You don’t have to become a farmer to reap the benefits of increased connection to nature. Research has found that even looking at nature through a window changes our brains and bodies on a cellular level.

“When you look out at a green landscape, even from indoors, your heart rate will go down,” explains Kuo, “and you’ll change from sympathetic nervous activity over to parasympathetic nervous activity, which is basically going from what we call ‘fight or flight’ into ‘tend and befriend’ mode. So it has these very systematic physiological impacts on us, which have long-term health outcomes associated with them.”…

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Accelerate Customer Success And Brand Loyalty With Data

Recently, financial services and telecommunication providers have experienced significant challenges. They encountered digitally savvy competitors, increased expectations for online customer service (pre-and post-pandemic), and higher case volumes of agitated customers. Meanwhile, remote work affected the productivity of service staff, daily operations, and more. But they aren’t the only service-driven industries reacting to disruption and increasing consumer expectations.

Quality of service can mean the difference between keeping or losing customers, so organizations need to examine how, where, and when they engage with them. A single customer view looking at experiences across service, marketing, and commerce is essential. Unfortunately, many businesses struggle with disparate data and disconnected applications that obfuscate that view. That means service fulfillment and relevant technologies must step up to help organizations deliver more consistent, seamless, swift, and personalized experiences for customers who agree “good enough” service won’t suffice.

Transforming your service strategy and operations with data leads to better business results. A data-driven service approach is making a positive difference in the financial services and telecommunications industries and can also help your business achieve these benefits:

1. Enhanced, personalized customer experiences across all channels

2. More productive, empowered service agents influencing success

3. Increased efficiency, prioritization, and automation throughout service operations

4. Reduced IT complexity and costs leading to higher margins

The Risks Of Poor Customer Experience

If customers experience less-than-stellar service, there’s a greater risk of switching to competitors. In fact, 80% of consumers will switch after just one poor experience1—driving businesses to compete on more than price and choice. There are other serious downstream effects: increased customer churn, diminished reputation and trust, stalled growth, and attrition of employees, agents, or leadership.

Business circumstances can change instantly. Customer interactions can portend issues with serious implications (i.e., costly compliance or regulatory fines or sharp declines in satisfaction scores). Each problem puts a company at greater risk for stolen market share you can’t afford to lose.

With a commitment to data-driven and digitally driven service operations—from the contact center to the field—you are better positioned with customers and can reduce or eliminate most risks. In digital environments, engagement barriers are often reduced or eliminated allowing customers to gain more service access, and brands to gain increased opportunities for better customer service delivery.

How To Unlock Data And Transform Customer Service End-To-End

Transitioning to data-driven service starts with leaders’ commitment to building and maintaining a cohesive data strategy spanning people, processes, and technologies that support business resilience and future growth. The next step is unifying data sources with intuitive and flexible analytics to achieve a single source of truth.

When you infuse analytics across service operations (and the business), agents and leaders gain that invaluable, complete customer view to impact personal, swift, effective service, and transform the call center from a siloed operation to an agile changemaker that affects marketing, sales, product development, and more. Tangible results include:

For financial services…

· Up to 31% increase in customer satisfaction

· Up to 29% increase in agent and user productivity

· Up to 27% reduction in customer retention

For telecommunications…

· 37% faster time to resolution

· 55% decrease in cost to serve

· 53% increase in average revenue per user (ARPU)

Let’s examine the four benefits of data-driven service and relevant resources as you focus on protecting the bottom line.

1. Enhanced, personalized customer experiences across channels

Customers are precious business assets, so carefully nurturing and protecting each relationship is key. Regardless of how they engage, each expects a personal interaction resulting in swift resolution. Maybe there’s a service issue and they made several attempts to get help. Or maybe there’s an opportunity to upsell their existing products and services. Unfortunately, the siloed data systems sitting inside and outside of your organization’s customer relationship management (CRM) system make it more complicated to deliver best-in-class service.

Data, analytics, and AI are foundational to digital enterprises where functional insights drive positive business outcomes. According to McKinsey, many companies using data-driven practices report above-market growth of +15%2—especially in the B2B market, but the same practices apply to B2C enterprises.

Charles Schwab relies on data to answer financial planning questions, improve customer experiences, drive operational leverage, and more. Shifting from a static to dynamic customer view with Tableau helps their call centers, branches, and headquarters staff see data errors or inconsistencies and discover insights to make product adjustments so clients’ money goes further and their engagement stays positive.

“Now those receiving and handling the customer calls are making their own impact, helping maintain higher customer satisfaction levels. They’re transitioning into a role where they’re looking at the data behind customer engagement.” Senior Data Analyst, Charles Schwab

2. More productive, empowered service agents influencing success

When agents shift from system to system trying to access information and manually perform processes, customers feel and react to the effects of disengaged communication, fragmented experiences, and long wait times. They want meaningful interaction from service staff seeing a complete view of customer and business data to influence smarter responses and actions.

As noted in the “State of Service” report from Salesforce Research, 91% of customers say they’ll make another purchase if the service is good1. With intuitive analytics, your agents can access and catalog data, then analyze it for valuable and trusted insights, and also share it with others to act in customers’ best interests. Access to pre-built dashboards like Tableau’s Call Center Accelerator gives your service team deeper views of overall service levels and helps all business leaders analyze agent performance—good and bad. Feel confident knowing data is at their fingertips to make better, quicker decisions in all customer interactions.

workforce

Thousands of customers depend on internet, cable, and phone providers to deliver reliable service. When customers use these services, ample data is created and can be collected. Verizon analyzes it with Tableau to ensure customers are satisfied, problems get handled, and departments like marketing or call centers can see patterns and behaviors to improve service. A Center for Excellence is critical as they perform analyses, support data management, and deliver insights to stakeholders for improved decision-making.

“Insights from dashboards help us optimize call center operations to reduce multiple customer calls. Monitoring these timely dashboards shows us that as the resolution rate and satisfaction index of customers go up, volumes for calls and dispatches—key cost drivers—go down. Senior Manager of Data Analytics, Verizon

3. Increased efficiency and prioritization of more complex cases throughout service operations

Before 2020, contact centers could manage traditional customer demand and service spikes. But these spikes are usually short-lived and predictable versus the unforeseen changes and new expectations growing from digital engagement and the pandemic. With a smaller workforce also handling call center cases due to downsizing, data-driven technologies that support efficiency, prioritization, and automation are necessary to the experience equation—particularly for large, dispersed enterprises.

Today, interactive analytics with built-in AI help your staff confidently understand all customer data and service performance in their workflows, which helps them be more predictive and proactive when choosing how to act on behalf of customers. AI-powered analytics also fuel speed to insights for better contact routing, improved call center and field staff capacity, and automaton of more cumbersome, time-intensive processes.

For example, a single dashboard displaying call center KPIs in Tableau can help management see and know where to optimize operations—from streamlining or eliminating multisystem dependencies to automating low-value processes that hamper productivity and communication. This frees up service staff to help more customers and address more complex cases.

Inconsistent, fragmented data at Telstra made pipeline, revenue forecasting, and quicker delivery of new technologies to customers difficult. But the combination of Sales Cloud and CRM Analytics transformed how they deliver customers new solutions and measure business value. Sales Cloud provides a complete view of enterprise customers and enables sales to forecast and collaborate for more meaningful interactions. CRM Analytics also helps line of business managers and service staff stay focused on how to achieve their business KPIs.

4. Reduced IT complexity and costs leading to higher margins

By using a self-service solution like Tableau, gain highly configurable, manageable, and customizable analytics to increase performance clarity and create faster, more accurate business decisions or predictions. IT is no longer a bottleneck, and service operations staff, business analysts, and executives have a clear understanding with direct visibility of the customer journey and what factors extend or detract from success.

This can translate to better planning with staffing, forecasting, and seasonality to reduce service costs and maintain high-quality, year-round customer engagement.

Growing through mergers and acquisitions, strategic data became vital to business operations for JPMC. IT made data easily accessible for business teams through Tableau so domain experts could keep up with industry changes, regulations, and risks, and optimize for customer success. For example, marketing operations analyze the customer journey to inform promotional materials and products like the mobile application and branch managers examine retail data to implement better banking experiences.

“We put Tableau on our robust customer data sets…to quickly ask questions like ‘How many customers have a Freedom and a checking account, and use the mobile wallet.’ ” Director of Analytics, JPMorgan Chase

Embrace Data-First Service And Win With Customers

In the competitive, highly regulated environment facing financial services, telecommunications, and other industries, leading with data-first service creates a winning position. Grow and protect valued customer relationships with the help of a world-leading analytics solution like Tableau combined with Salesforce, the leading CRM, to connect with customers in more meaningful ways across every channel—every time.

Allison (Ally) Witherspoon Johnston, Senior Vice President, Product Marketing, Tableau. Allison leads the Tableau product marketing team and has worked at Salesforce

Source: Accelerate Customer Success And Brand Loyalty With Data

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PFAS Forever Chemicals Linked To Liver Cancer In First of Its Kind Study

New research has reported a link between elevated blood levels of perfluooctane sulfate (PFOS) and increased risk of liver cancer. The study is the first to directly associate exposure from this “forever chemical” to liver cancer in humans.There are thousands of different chemicals under the umbrella of per- and polyfluoroalkyl substances, or PFAS. These substances are often informally referred to as “forever chemicals” because they can persist in the environment for decades.

For much of the 20th century PFAS chemicals were used in a broad variety of manufacturing contexts. However, over the past 20 years an increasing body of evidence has revealed exposure to PFAS can contribute to a number of deleterious health effects, from low birth weight to hypothyroidism.

Following on from animal and lab-based studies suggesting PFAS exposure is potentially damaging to liver cells, this new research offers the first robust investigation into the relationship between the chemicals and liver cancer in humans.

The power of this new research is in its leveraging of data from a multi-decade health study following more than 200,000 people since the early 1990s. This allowed the researchers to look at historic blood levels of PFAS in subjects years before they presented with cancer.“Part of the reason there has been few human studies is because you need the right samples,” explained Veronica Wendy Setiawan, an author on the new study. “When you are looking at an environmental exposure, you need samples from well before a diagnosis because it takes time for cancer to develop.”

Several types of PFAS were found in blood samples from subjects who ultimately went on to develop liver cancer. But one particular chemical stood out, perfluooctane sulfate (also known as PFOS). Those subjects with the highest blood levels of PFOS were 4.5 times more likely to develop liver cancer compared to the group with the lowest PFOS blood levels.

The study also homed in on some potential mechanisms by which PFOS exposure could be causing liver cancer. Four particular metabolites were found to link PFOS levels with liver cancer: “glucose, butyric acid (a short chain fatty acid), α-Ketoisovaleric acid (a branched-chain α-keto acid), and 7α-Hydroxy-3-oxo-4-cholestenoate (a bile acid).”

“We believe our work is providing important insights into the long-term health effects that these chemicals have on human health, especially with respect to how they can damage normal liver function,” explained lead researcher on the project Leda Chatzi. “This study fills an important gap in our understanding of the true consequences of exposure to these chemicals.”

The new findings come just days after another study found levels of PFAS in rainwater often exceed new safety limits set by the Environmental Protection Authority (EPA). That research called for a global phase-out of PFAS from all manufacturing contexts as soon as possible. An expert committee formed by the United Nations to review persistent pollutants in 2019 also called for the elimination of all use of PFAS chemicals to, “protect human health and the environment from its harmful impacts.”

Source: PFAS “forever chemicals” linked to liver cancer in first-of-its-kind study

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