Deutsche Welle (English edition)
How has the pandemic affected mental health?
Throughout the pandemic, some people have experienced mood swings, irritability, and other symptoms of depression. Epidemiologist Elise Paul says people should look at how their symptoms are impacting their life.
Deutsche Welle: Some people with depression turned to social media as a tool to self medicate when therapy was not available. Do you think that's a good alternative?
Elise Paul: It certainly depends on what people are using social media for. If they are using it to disclose difficulties and seek support, it can be a positive thing, but if they're using it to avoid coping with their difficulties then it could be a negative thing.
We've also found that excessive looking for news and scrolling for news on COVID was related to declines in mental health, so it really does depend on how you're using social media.
How well are therapists actually prepared for dealing with the additional problems that their patients are experiencing now because of the pandemic?
I think it's difficult to say. As an epidemiologist I can't speak on behalf of therapists, but I would say that therapists are people too. Even though we've all been impacted in different ways, we have all gone through
the pandemic together over the past year and a half and there will be an increased need for therapy.
I hope that this will be an opportunity for governments, policymakers and even the general population to pay more attention to mental health and to direct more resources into that direction.
A lot of people are obviously feeling the weight of the pandemic. That cannot be compared to a real, serious, clinical depression. So people being moody now — is that just a phase or is there perhaps the danger that they'll actually fall into a proper depression?
I think that it's important to consider how mood swings and irritability are affecting one's life. If it is making it really difficult to carry out your activities, things that you need to do, if it's impacting your work, your parenting, your relationships, then it is important to seek help.
Whether or not you feel you meet some clinical threshold, I think it's important to consider how it is impacting one's life.
How can you di erentiate, also as an outsider, and say: "Okay this person now is really in danger, they're not just having a day o but are actually ill"?
Excessive days off from work are certainly one sign. Another sign that friends or family might notice is avoidance behaviours. Some people tend to withdraw and show some of the classic symptoms of depression, such as sleeping too much, reduced energy, lethargy.
Other people can be irritable, lash out, show a lot of anger. So it is important to acknowledge that it can look different in different people.
You mentioned that there is greater awareness of mental illness these days. Could that actually be an upside to the pandemic?
I think it's definitely a good thing, I hope that will come out of this pandemic. It's just unprecedented that we've been cut off from things that we enjoy. We've gotten the opportunity to think about the difference between attending a concert live versus seeing it online. What's it like to be in a room with five of your friends versus on a walk on a rainy day with one of your friends?
So we've really had the opportunity to think about, and as researchers, to study what is it about our daily lives that is necessary to maintain mental health, regardless of whether or not we've slipped into depression, but just on a daily basis.
How do you cope with the pressure of the pandemic?
As best I can, I try to do things every day that keep my body and mind able to cope. I drink lots of water, I try to go to bed every night at the same time and wake up at the same time, I eat healthily. I watch my caffeine and alcohol intake. I exercise every day and I also meditate every day.
I have meditation apps on my phone, even if it's just five minutes in the morning, it really helps me to internalize a calm, soothing voice.
Dr Elise Paus is an epidemiologist focusing on statistics, behavioural science and health at the Institute of Epidemiology & Health of the University College London (UCL).
Monika Jones conducted the interview
transports oxygen throughout the body, including to the muscles. Since hemoglobin levels follow testosterone levels, nontransgender men tend to have higher hemoglobin levels than cisgender women. But Harper's study found that testosterone suppressants reduced hemoglobin levels in trans women to that of cisgender women, thus eliminating the advantage.
For Tommy Lundberg, whose research at Sweden's Karolinska Institute focuses on skeletal muscle strength of trans people receiving hormone therapy, the advantages for trans women in strength are to the point where fairness cannot be ensured in most sports.
"The big problem right now is that the [hormone] therapy itself doesn't really remove the advantage to an extent that you can claim that fairness has been achieved," Lundberg told DW. "And actually, the IOC (International Olympic Committee) states that the overriding objective is, and remains, the guarantee of fair competition. That's what they say in their guidelines. So that's the problem right now: They don't go handin-hand."
In another paper Lundberg co-authored that looked at untrained trans women, Lundberg and his colleague found that "muscular advantage enjoyed by transgender women is only minimally reduced when testosterone is suppressed."
The study, like any other — including Roberts and Harper's — has its limitations. Harper, who had also done a review of a similar set of studies to Lundberg's, said both of their studies found a "fairly modest change" in strength in non-athletic trans people. "But their review made it seem more definitive than our review did," she said.
"If you are looking for information on cisgender athletes, you'd never use studies on nonathletic trans people. You just wouldn't do that. It's just that we don't have any data on trans athletes. So I think you have to take the results with a certain grain of salt."
When do differences between sexes in athletic performance emerge?
Young boys and girls, regardless of the gender assigned at birth, have similar muscle mass. It's only once a child experiences puberty that the differences begin to emerge — and they become pronounced once boys experience a surge in testosterone.
"Typically, if you're 8 or 9 years old, there is no biological performance difference between boys and girls. So it starts at around age 11 where you start to see this disparity — and then it really kicks in during puberty. And then you have, basically, this big difference in muscle mass," said Lundberg.
Roberts, who is a pediatrician specializing in adolescent medicine, said: "Younger children before puberty — there is no reason to have divisions of sex between boys and girls. They're physiologically fairly equivalent. It's after puberty that you really see this divergence in athletic performance."
There have been no studies carried out on adolescent trans athletes. So there is no data on trans athletes who took puberty blockers or gender-affirming hormone therapy during puberty — and certainly none before puberty. Part of this comes down to following guidelines. The World Professional Association for Transgender Health requires trans adolescents to have begun puberty before undergoing puberty suppressants, the first stage before undergoing hormone therapy.
Trans adolescents in sport have made headlines in recent years, as more than a dozen US states have a policy that allows trans girls to compete competitively at the high school level as long as they self-identify as female. For Blair Hamilton, a Brighton University researcher on trans athletes, this doesn't go far enough to achieve an equal playing field.
"For example, Connecticut was allowing [trans female runners] to race unmedicated," said Hamilton, who is also a transgender footballer. "We don't agree with that."
Hamilton said athletes seeking eligibility to run in competitive races in the female category should first undergo hormone therapy to reduce the advantages.
To do otherwise, said Roberts, would give them an edge. "To compete against the females as soon as you socially transition — before you get any hormone blockers or hormone therapy — it's unfair."
"Tomorrow, if I said: 'I'm a woman and I'm going to go compete in the women's class.' It's unfair. I still have testosterone, I have all the advantages I started with," said Roberts.
What is the recommended testosterone for trans women to compete?
This is a thorny issue that sports scientists disagree on. The "normal" healthy range for cis women is between 0.3 and 2 nmol/L, according to Mayo Clinic estimates — though they vary among labs. Women with polycystic ovarian syndrome tend to have higher testosterone levels, which can reach 5.2 nmol/ L. "Healthy" male testosterone ranges from 8.3 mnol/L to 32.9 nmol/L.
The IOC's regulations say trans women can compete if their testosterone levels in serum are at 10 nanomoles per liter for a year for at least 12 months prior to their first competition.
With Roberts and Lundberg's recent papers, however, the IOC has faced renewed criticism following Hubbard's inclusion due to its eligibility criteria. But the IOC said it would not review its guidelines — set in place in 2015 — until after the Tokyo Games. World Athletics (IAAF) in 2019 changed its rules, requiring testosterone levels to be below 5 nmol/L continuously for at least 12 months. This criterion for trans women is backed by
Hamilton as well as Harper, who noted the IOC's current guidelines are based on outdated techniques measuring testosterone levels.
But the IAAF's criteria runs contrary to Roberts' study on trans military personnel, which suggests two years of hormone therapy is needed before competing.
Lundberg, however, said there is no sufficient evidence that two years would be enough to ensure fairness in the female category in most sports. "It would be an easy fix if you could just change regulation to two years, instead of one. But I don't think that'sa feasible solution either. Actually, right now, there is nothing to indicate that."
Do trans men have an advantage when competing in elite sport?
"What we've got in our study is, actually, the trans men dominated," said Roberts, referring to his study on trans US military personnel. After one year of masculinizing hormones, there was no difference in pushup or run times — however, the number of situps performed in one minute by trans men exceeded cisgender men, or nontransgender men.
"But nobody's up in arms saying that trans men are going to dominate men's sports," said Roberts, adding that much of the advantage gained for a cisgender man occurs during puberty.
"Having gone through female puberty does not provide you with a baseline skeletal advantage over your average cis man. You're getting testosterone, which levels the playing field in large part because testosterone really produces a lot of differences, but there's not that extra anatomical advantage that a trans woman has over cis women — a trans man isn't going to have that over a cis man," he said.
Sports scientist Lundberg notes that trans men competing is "not as sensitive in sports."
"Even if they get testosterone, it's not a threat to fairness if they switch to the male category," he said. "The problem then is, of course, if they would want to stay in the women's category even when they get testosterone — because then it would become doping."
Is there a way to achieve both fairness and inclusion in sport?
None of the experts interviewed support a blanket ban on trans athletes, which is in line with a recent study. But experts, like Lundberg, say the regulations should be determined on a sport-by-sport basis, especially when safety is a factor, like in rugby.
"We don't have this easy fix or easy regulation that can be applied," said Lundberg. "You basically have to choose or prioritize either inclusion or fairness. They don't go hand-inhand right now."
"And in most sports, it's going to be problematic to include transgender women and achieve fairness. That's what the current research suggests," he said.
Lundberg's research has seen him come under fire on social media, with many accusing him of being transphobic. But he tells DW that is not the case.
"I think the transgender issue is very important. But protecting the women's category in sport is also very important. They have fought long enough to have fair competition in sport," he said.
In the meantime, sports scientists and researchers will continue to debate and advise on what the best steps forward will be.
"There's not very much information out there and even less that's really specific to trans athletes. But the Olympics are here, international sports are here, and trans people are around. So decisions have to be made," medical physicist Harper said. "So people have to make the best decisions they can with the data that are available now."
"And hopefully, as we get more — and better — data, it will lead to improved policies."
mRNA vaccines, Braun said.
This requires sequencing the DNA and RNA of a patient's tumor and finding out what makes it unique.
"Then you compare that to normal tissue and you look for differences in that particular cancer," said Houston Methodist Hospital's Cooke.
The ideal situation is that the proteins are expressed only by the cancer cells, but other parts of the body, like healthy tissue, can also produce the same proteins. This means it is possible that some kind of autoimmune response could occur if the immune system attacks healthy tissue that it believes is foreign.
to prevent
A vaccine cancer?
Depending on the type of cancer, it may be possible to create preventative vaccines for people at risk of developing certain types of cancer.
At Houston Methodist Hospital, a group of cancer biologists are making preventative cancer
vaccines for people who are at high risk of developing cancer. For example, people with a BRCA 2 mutation have a high risk of developing breast cancer.
The preventative vaccines are currently being tested in animal models as proteins, and the next step is making them as RNA, said Cooke.
Why mRNA?
It's not only the success of the COVID mRNA vaccines that has scientists interested in making mRNA vaccines for other diseases.
"RNA is a lot easier to make," Cooke told DW. A lot of vaccines are protein-based, but with mRNA vaccines, scientists just need to write the code for a protein, rather than making the proteins.
Phillip Sharp, a professor of biology at MIT, co-won the 1993 Nobel Prize in physiology or medicine for his discovery of split genes and spliced RNA in the 1970s. His work contributed to the COVID mRNA vaccines that people around the world are being injected with today.
"Anyone who's ever experimentally studied RNA knows that your skin is covered with nucleases that destroy it, your blood is full of nucleases that destroy it," Sharp told DW.
The fact that scientists discovered a way to protect the RNA and make it in a sufficient quantity to be used as a vaccine was a big technical step forward, he said.
"It took a lot of innovation to do that," said Sharp. "Once you develop a new technology, such as the mRNA technology, man will use it for as long as there are societies who can deal with technology,"
Cooke doesn't think it is likely that there will be a universal vaccine against cancer, but he does believe that just like scientists have been able to eradicate some infectious diseases, the same will happen for some cancers.
"We're going to have another arrow in our quiver against cancer," Cooke said.