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“It’s almost like people will say to you, ‘I want a strategy,’ and what they really mean is, ‘I want someone to understand,’” said Heather Havrilesky, an advice columnist and author of “What if This Were Enough?”

Be clear on the advice-seeker’s goals. When people approach Austin Kleon, author of “Steal Like an Artist,” for advice, he drills down and identifies the exact problem: “What do you want to know specifically that I can help you with?” This way, he won’t overwhelm the person with irrelevant information.

Consider your qualifications. People often go to those close to them for advice, even if family members and friends aren’t always in the best position to effectively assist, Dr. Tost said. Ask yourself: “Do I have the expertise, experience or knowledge needed to provide helpful advice in this situation?” If you do, fantastic! Advise away. If you don’t, rather than give potentially unhelpful advice, identify someone who is in a better position to help.

Words have power. Words can heal. A recent study found that doctors who simply offer assurance can help alleviate their patients’ symptoms. It’s essential to start the advice-giving conversation with this same reassuring tone.

People tend to resist when advice is preachy, Ms. Marshall said. Saying, “I’ve been there and here’s what I did,” makes people more receptive

Look for physical signs of relief. Examine facial cues and body language: eyes and mouth softening, shoulders lowering or letting breath out, for example. Those are good indicators your advice is resonating.

Identify takeaways (and give an out). It’s not realistic for people to act on every piece of advice you give. After discussing a problem and suggesting how to handle it, Ms. Marshall asks her clients what tidbit resonated with them the most.

“Your mileage may vary. Take what you need and leave the rest.”

Agree on next steps. Lastly, ask what kind of continued support is needed (if any) and what efforts should be avoided.

each of these is valuable in its own way.

The cult of randomized controlled trials also neglects a rich body of potential hypotheses.

Many philosophers and many departments simply ignore arguments for greater diversity; others respond with arguments for Eurocentrism that we and many others have refuted elsewhere. The profession as a whole remains resolutely Eurocentric.

Instead, we ask those who sincerely believe that it does make sense to organize our discipline entirely around European and American figures and texts to pursue this agenda with honesty and openness. We therefore suggest that any department that regularly offers courses only on Western philosophy should rename itself “Department of European and American Philosophy.”

We see no justification for resisting this minor rebranding (though we welcome opposing views in the comments section to this article), particularly for those who endorse, implicitly or explicitly, this Eurocentric orientation.

Some of our colleagues defend this orientation on the grounds that non-European philosophy belongs only in “area studies” departments, like Asian Studies, African Studies or Latin American Studies. We ask that those who hold this view be consistent, and locate their own departments in “area studies” as well, in this case, Anglo-European Philosophical Studies.

Others might argue against renaming on the grounds that it is unfair to single out philosophy: We do not have departments of Euro-American Mathematics or Physics. This is nothing but shabby sophistry. Non-European philosophical traditions offer distinctive solutions to problems discussed within European and American philosophy, raise or frame problems not addressed in the American and European tradition, or emphasize and discuss more deeply philosophical problems that are marginalized in Anglo-European philosophy. There are no comparable differences in how mathematics or physics are practiced in other contemporary cultures.

Of course, we believe that renaming departments would not be nearly as valuable as actually broadening the philosophical curriculum and retaining the name “philosophy.” Philosophy as a discipline has a serious diversity problem, with women and minorities underrepresented at all levels among students and faculty, even while the percentage of these groups increases among college students. Part of the problem is the perception that philosophy departments are nothing but temples to the achievement of males of European descent. Our recommendation is straightforward: Those who are comfortable with that perception should confirm it in good faith and defend it honestly; if they cannot do so, we urge them to diversify their faculty and their curriculum.

This is not to disparage the value of the works in the contemporary philosophical canon: Clearly, there is nothing intrinsically wrong with philosophy written by males of European descent; but philosophy has always become richer as it becomes increasingly diverse and pluralistic.

We hope that American philosophy departments will someday teach Confucius as routinely as they now teach Kant, that philosophy students will eventually have as many opportunities to study the “Bhagavad Gita” as they do the “Republic,” that the Flying Man thought experiment of the Persian philosopher Avicenna (980-1037) will be as well-known as the Brain-in-a-Vat thought experiment of the American philosopher Hilary Putnam (1926-2016), that the ancient Indian scholar Candrakirti’s critical examination of the concept of the self will be as well-studied as David Hume’s, that Frantz Fanon (1925-1961), Kwazi Wiredu (1931- ), Lame Deer (1903-1976) and Maria Lugones will be as familiar to our students as their equally profound colleagues in the contemporary philosophical canon. But, until then, let’s be honest, face reality and call departments of European-American Philosophy what they really are.

For demographic, political and historical reasons, the change to a more multicultural conception of philosophy in the United States seems inevitable. Heed the Stoic adage: “The Fates lead those who come willingly, and drag those who do not.”

prescription testosterone doesn’t just give your T level a boost: it may also increase your risk of heart attack. It can add huge numbers of red blood cells to your bloodstream and shrink your testes. In some men, it increases aggression and irritability.

In addition to the cardiac risks, prescription T can mean a permanent shut-off in men’s own, albeit diminished, testosterone production. In other words, once you start, you may well be hooked for life.

Used clinically since 1937 and approved by the F.D.A. since 1953, testosterone is now administered in at least five forms, including patches, gels and injections

a large study published in the journal PLoS ONE found that, within three months, taking the hormone doubled the rate of heart attacks in men 65 and older, as well as in younger men who had heart disease. The Food and Drug Administration has begun an investigation.

men should address the leading cause of the problem. Losing weight is a tried and true way to naturally boost testosterone levels. According to findings presented at the annual meeting of the Endocrine Society in 2012, obese men who lost an average of 17 pounds saw their testosterone levels increase by 15 percent. In general, a man’s waist should be half his height.

At the end of the day, eating more of the right foods and fewer junk foods improves mood and energy — which may be the only fix many men need.

"We waited for a full match but it did not come. By the grace of God, we took the decision to have the treatment.

There are currently about 1,600 people in the UK waiting for a bone-marrow transplant and 37,000 worldwide.

The statin trials, which involved tens of thousands of people, found no more muscle aches, the most common complaint, in patients who took statins than in those who took placebos.

The widely held belief that statins affect memory also has not been borne out in clinical trials, said Dr. Jane Armitage of the University of Oxford. She and her colleagues studied memory problems in 20,000 patients randomly assigned to take a statin or a placebo. “There was absolutely no difference,” she said.

In a separate study, they looked at mood and sleep patterns and again found statins had no effect. Another study, in Scotland, detailed cognitive testing of older people taking statins or a placebo, and also found no effect.

In a demonstration of the technology, the team analysed blood from 569 people in the US, South Africa, Thailand and Peru. The test found that, on average, people had been infected with 10 species of viruses, though at least two people in the trial had histories of 84 infections from different kinds of viruses.

The test could bring about major benefits for organ transplant patients. One problem that can follow transplant surgery is the unexpected reawakening of viruses that have lurked inactive in the patient or donor for years. These viruses can return in force when the patient’s immune system is suppressed with drugs to prevent them rejecting the organ. Standard tests often fail to pick up latent viruses before surgery, but the VirScan procedure could reveal their presence and alert doctors and patients to the danger.

“The studies were biased,” he says. “Sometimes they were overtly biased. Sometimes it was difficult to see the bias, but it was there.” Researchers headed into their studies wanting certain results—and, lo and behold, they were getting them. We think of the scientific process as being objective, rigorous, and even ruthless in separating out what is true from what we merely wish to be true, but in fact it’s easy to manipulate results, even unintentionally or unconsciously. “At every step in the process, there is room to distort results, a way to make a stronger claim or to select what is going to be concluded,” says Ioannidis. “There is an intellectual conflict of interest that pressures researchers to find whatever it is that is most likely to get them funded.”

Ioannidis laid out a detailed mathematical proof that, assuming modest levels of researcher bias, typically imperfect research techniques, and the well-known tendency to focus on exciting rather than highly plausible theories, researchers will come up with wrong findings most of the time.

if you’re attracted to ideas that have a good chance of being wrong, and if you’re motivated to prove them right, and if you have a little wiggle room in how you assemble the evidence, you’ll probably succeed in proving wrong theories right. His model predicted, in different fields of medical research, rates of wrongness roughly corresponding to the observed rates at which findings were later convincingly refuted: 80 percent of non-randomized studies (by far the most common type) turn out to be wrong, as do 25 percent of supposedly gold-standard randomized trials, and as much as 10 percent of the platinum-standard large randomized trials.

He zoomed in on 49 of the most highly regarded research findings in medicine over the previous 13 years, as judged by the science community’s two standard measures: the papers had appeared in the journals most widely cited in research articles, and the 49 articles themselves were the most widely cited articles in these journals

Ioannidis was putting his contentions to the test not against run-of-the-mill research, or even merely well-accepted research, but against the absolute tip of the research pyramid. Of the 49 articles, 45 claimed to have uncovered effective interventions. Thirty-four of these claims had been retested, and 14 of these, or 41 percent, had been convincingly shown to be wrong or significantly exaggerated. If between a third and a half of the most acclaimed research in medicine was proving untrustworthy, the scope and impact of the problem were undeniable.

But these concepts are difficult for many to swallow. Specialists like urologists, radiologists and oncologists, who see patients who are sick and dying from cancer, often resist the idea of doing less screening. General practitioners, who may agree with the new guidelines, worry about getting involved in long conversations with patients trying to explain why they might reconsider having a mammogram every year or a P.S.A. test at all. Some doctors fear lawsuits if they do not screen and a patient develops a fatal cancer. Patients often say they will take their chances with screening’s harms if a test can save their lives.

And comments like Dr. Brawley’s give rise to other questions as well. Is all this happening now because of worries over costs? And in any case, is all this simply an academic argument, since most doctors, faced with real patients, still suggest frequent screening and their patients agree?

How much of this kind of reality can the public take? Producers clearly see no end in sight, and the results are increasingly becoming more questionable.

This is what's called a ''reality-based'' series, a label that has less to do with reality than comforting formula. The cameras do not go to a real hospital. But three real doctors are on the production staff.

''What you are about to see is real,'' we were told once again.

His life shattered, he now has the dubious pleasure of knowing that, for some 20 minutes, he was the star of a television reality entertainment.

''On Trial'' opens with an announcer exclaiming that viewers are about to see ''Real people! Real Cases! Real Life!'' Mr. Clooney, a distinguished-looking fellow, fills in the pertinent facts.

Everything is designed, they say, to ''give the show its docudrama look.'' The show's regular staff of three doctors are depicted by actors.

Needless to say, medical problems and crises have long been popular on television, especially on soap operas. ''Family Medical Center'' merely dispenses with extraneous plot and character developments and goes right to the medical core. A press release is candid about the show's interpretation of reality: ''It will have suspense, conflict and a resolution, which in almost all cases will be a happy one.''

The show looks as real as television entertainment can possibly make it. Alert viewers, however, will note whizzing by in the final credits the following advisory: '' 'Family Medical Center' is a dramatization. The characters are fictional and bear no resemblance to persons living or dead.''

Television reality wears many masks. A key to the overall picture was provided by one of those actors who deceived Oprah Winfrey and Geraldo Rivera with false impersonations on air. Why not, he shrugged, it's all entertainment. Frightening but not beyond comprehension.

To some extent, the brain remains a bit of a black box, as puzzling to modern-day psychiatrists as it was to turn-of-the-century charlatans. The difference is, most doctors today have the humility to admit what they don't know.

Gowers often taught his students to begin their diagnosis from the moment a patient walked through the door

“Did you notice him as he came into the room? If you did not then you should have done so. One of the habits to be acquired and never omitted is to observe a patient as he enters the room; to note his aspect and his gait. If you did so, you would have seen that he seemed lame, and you may have been struck by that which must strike you now – an unusual tint of his face.”

the importance of the seemingly inconsequential that seems to inspire both men. “It has long been an axiom of mine that the little things are infinitely the most important,” Conan Doyle wrote

Both Gowers and Holmes also warned against letting your preconceptions fog your judgement. For both men, cool, unprejudiced observation was the order of the day. It is for this reason that Holmes chastises Watson in The Scandal of Bohemia: “You see, but you do not observe. The distinction is clear.”

Gowers: “The method you should adopt is this: Whenever you find yourself in the presence of a case that is not familiar to you in all its detail forget for a time all your types and all your names. Deal with the case as one that has never been seen before, and work it out as a new problem sui generis, to be investigated as such.”

both men “reasoned backwards”, for instance, dissecting all the possible paths that may have led to a particular disease (in Gowers’ case) or murder (in Holmes’)

Holmes’ most famous aphorism: “When you have eliminated the impossible, whatever remains, however improbable, must be the truth.”

the most important lesson to be learned, from both Gowers and Holmes, is the value of recognising your errors. “Gentlemen – It is always pleasant to be right, but it is generally a much more useful thing to be wrong,” wrote Gowers

This humility is key in beating the ‘curse of expertise’ that afflicts so many talented and intelligent people.

University College London has documented many instances in which apparent experts in both medicine and forensic science have allowed their own biases to cloud their judgements – sometimes even in life or death situations.

Even the most advanced technology can never replace the powers of simple observation and rational deduction.

The living, breathing source of the data and images we juggle, meanwhile, is in the bed and left wondering: Where is everyone? What are they doing? Hello! It’s my body, you know

How we salivated at the idea of searchable records, of being able to graph fever trends, or white blood counts, or share records at a keystroke with another institution — “interoperability”

I can get cash and account details all over America and beyond. Yet I can’t reliably get a patient record from across town, let alone from a hospital in the same state, even if both places use the same brand of E.H.R

the leading E.H.R.s were never built with any understanding of the rituals of care or the user experience of physicians or nurses. A clinician will make roughly 4,000 keyboard clicks during a busy 10-hour emergency-room shift

In the process, our daily progress notes have become bloated cut-and-paste monsters that are inaccurate and hard to wade through. A half-page, handwritten progress note of the paper era might in a few lines tell you what a physician really thought

so much of the E.H.R., but particularly the physical exam it encodes, is a marvel of fiction, because we humans don’t want to leave a check box empty or leave gaps in a template.

For a study, my colleagues and I at Stanford solicited anecdotes from physicians nationwide about patients for whom an oversight in the exam (a “miss”) had resulted in real consequences, like diagnostic delay, radiation exposure, therapeutic or surgical misadventure, even death. They were the sorts of things that would leave no trace in the E.H.R. because the recorded exam always seems complete — and yet the omission would be glaring and memorable to other physicians involved in the subsequent care. We got more than 200 such anecdotes.

The reason for these errors? Most of them resulted from exams that simply weren’t done as claimed. “Food poisoning” was diagnosed because the strangulated hernia in the groin was overlooked, or patients were sent to the catheterization lab for chest pain because no one saw the shingles rash on the left chest.

I worry that such mistakes come because we’ve gotten trapped in the bunker of machine medicine. It is a preventable kind of failure

Our $3.4 trillion health care system is responsible for more than a quarter of a million deaths per year because of medical error, the rough equivalent of, say, a jumbo jet’s crashing every day.

Much of that is a result of poorly coordinated care, poor communication, patients falling through the cracks, knowledge not being transferred and so on, but some part of it is surely from failing to listen to the story and diminishing skill in reading the body as a text.

What if the computer gave the nurse the big picture of who he was both medically and as a person?

a professor at M.I.T. whose current interest in biomedical engineering is “bedside informatics,” marvels at the fact that in an I.C.U., a blizzard of monitors from disparate manufacturers display EKG, heart rate, respiratory rate, oxygen saturation, blood pressure, temperature and more, and yet none of this is pulled together, summarized and synthesized anywhere for the clinical staff to use

What these monitors do exceedingly well is sound alarms, an average of one alarm every eight minutes, or more than 180 per patient per day. What is our most common response to an alarm? We look for the button to silence the nuisance because, unlike those in a Boeing cockpit, say, our alarms are rarely diagnosing genuine danger.

By some estimates, more than 50 percent of physicians in the United States have at least one symptom of burnout, defined as a syndrome of emotional exhaustion, cynicism and decreased efficacy at work

It is on the increase, up by 9 percent from 2011 to 2014 in one national study. This is clearly not an individual problem but a systemic one, a 4,000-key-clicks-a-day problem.

The E.H.R. is only part of the issue: Other factors include rapid patient turnover, decreased autonomy, merging hospital systems, an aging population, the increasing medical complexity of patients. Even if the E.H.R. is not the sole cause of what ails us, believe me, it has become the symbol of burnou

burnout is one of the largest predictors of physician attrition from the work force. The total cost of recruiting a physician can be nearly $90,000, but the lost revenue per physician who leaves is between $500,000 and $1 million, even more in high-paying specialties.

I hold out hope that artificial intelligence and machine-learning algorithms will transform our experience, particularly if natural-language processing and video technology allow us to capture what is actually said and done in the exam room.

as with any lab test, what A.I. will provide is at best a recommendation that a physician using clinical judgment must decide how to apply.

True clinical judgment is more than addressing the avalanche of blood work, imaging and lab tests; it is about using human skills to understand where the patient is in the trajectory of a life and the disease, what the nature of the patient’s family and social circumstances is and how much they want done.

The seriously ill patient has entered another kingdom, an alternate universe, a place and a process that is frightening, infantilizing; that patient’s greatest need is both scientific state-of-the-art knowledge and genuine caring from another human being. Caring is expressed in listening, in the time-honored ritual of the skilled bedside exam — reading the body — in touching and looking at where it hurts and ultimately in localizing the disease for patients not on a screen, not on an image, not on a biopsy report, but on their bodies.

As he was nearing death, Avedis Donabedian, a guru of health care metrics, was asked by an interviewer about the commercialization of health care. “The secret of quality,” he replied, “is love.”/•/

One way alcohol may lead to cancer is because the body metabolizes it into acetaldehyde, which causes changes and mutations in DNA, Dr. Gapstur said. The formation of acetaldehyde starts when alcohol comes in contact with bacteria in the mouth, which may explain the link between alcohol and cancers of the throat, voice box and esophagus

The guilt I felt about this compelled me to objectively review the literature on mRNA vaccines. Not being an expert in virology or biochemistry, I realized I had to quickly master unfamiliar words like “transfection” and concepts about gene sequences. Slowly, the information I was devouring started changing my beliefs.

I learned that research into using mRNA for vaccinations and cancer therapies has been ongoing for the past 30 years. Trial and error have refined this modality so that it was almost fully fledged by the time Covid hit

The mRNA from the vaccine is broken down quickly in our cells, and the coronavirus spike protein is expressed only transiently on the cell surface.

Furthermore, this type of vaccine is harnessing a technique that viruses already use.

It was humbling to have to change my mind. As I booked my vaccination time slot, I realized how lucky I am to have access to all this research, as well as the training to understand it.

As medical professionals, we cannot afford to be paternalistic and trust that people will follow advice without all the facts. This is especially true in Australia, where the vast majority of us have never witnessed firsthand the ravages that this disease can inflict.

Like all new converts, I am now a true believer: I’d like everyone to be vaccinated. But autonomy is a precious tenet of a free society, and I’m glad the ethicists have advised against mandating the vaccine

just hope that with more robust discussion and the wider dissemination of scientific knowledge, we may sway people like me — who have what may be valid reservations — to get the vaccine.

Some of the aggressive measures China took to control the epidemic – confining people to their homes, for example — have been described as "draconian" and a violation of civil rights, even if they ultimately proved effective.

According to Abraar Karan, a doctor at the Brigham and Women's Hospital and Harvard Medical School, the notion persists in global health that "the West is the best."

Some public health practitioners say the global health system is partially responsible for perpetuating these ideas.

According to a separate report by the Center for the Study of Hate and Extremism, anti-Asian hate crimes in 16 U.S. cities increased 149 percent in 2020, from 49 to 122.

"What you're seeing in the U.S. is this pre-existing, deep-seated bias [against Asians and Asian Americans] – or rather, racism – that is now surfacing," says D'Silva. "COVID-19 is just an excuse."

there's a sense among Western health workers that epidemics occur in impoverished contexts because the people there engage in primitive behaviors and just don't care as much about health.

"[Western health workers] come in with a bias that in San Francisco or Boston, we would never let [these crises] happen,"

doctors initially only considered a possible COVID-19 diagnosis among people who had recently flown back from China. That narrow focus caused the U.S. to misdiagnose patients who presented with what we now call classic COVID symptoms simply because they hadn't traveled from China.

In the case of COVID-19 and other outbreaks, Western countries often think of them as a national security issue, closing borders and blaming the countries where the disease was first reported. This approach encourages stigmatization, he says.

reframing the discussion to focus on global solidarity, which promotes the idea that we are all in this together.

the global health community – and Western society as a whole – has to discard its deep-rooted mindset of coloniality and tendency to scapegoat others

Instead of blaming Asians for the virus, blame the systems that weren't adequately prepared to respond to a pandemic.