What is the function of the cruciate ligament?

There is an anterior and a posterior cruciate ligament in both knees. They connect the femur to the tibia and stabilize the knee joint forwards and backwards, as well as during rotational movements. In addition to the cruciate ligaments, there are the medial and lateral collateral ligaments and the menisci [crescent-shaped cartilage discs between the lower and upper thigh bones].

All ligaments together limit the extension of the knee so that it is not overstretched under normal circumstances. They also restrict the rotation of the knee joint and are supported by the joint capsule, tendons and surrounding muscles. The better the stabilizing muscles are developed, the lower the risk of suffering a cruciate ligament rupture.

How does a cruciate ligament rupture occur?

If the cruciate ligaments are overloaded by a sudden twisting movement, hyperextension or bending the knee to the side, they can tear partially or completely. The anterior cruciate ligament (ACL) is affected ten times more frequently than the posterior cruciate ligament because it is longer and thinner. Most cruciate ligament tears are so-called non-contact injuries. This means that they occur without external influence or direct contact with the opponent, for example during a foul in football.

Landing on one leg, abrupt stops and sudden changes of direction are the most common causes of a rupture. The patient usually feels a stabbing pain in the knee. It usually swells in the hours following the injury because the tear causes fluid to collect in the joint.

What are the consequences?

The knee can usually no longer be moved well due to pain and swelling, and can only be bent slightly. Pain occurs when weight is placed on it. In addition, the knee joint is unstable due to the lack of function of the ligaments — it slips like a drawer when walking. In many cases, the cruciate ligament is not the only structure in the knee that has been damaged. The outer and inner ligaments, menisci and bones can also be affected.

In rare cases, however, a cruciate ligament may tear without the patient realising it. Such cruciate ligament ruptures often only become apparent later due to damage to the menisci or cartilage in the knee.

How are cruciate ligament ruptures treated?

A torn cruciate ligament is treated either surgically or conservatively. During surgery, also known as cruciate ligament plastic surgery, the torn parts of the cruciate ligament are removed and replaced with a transplant made from the body's own tendon material. However, there are also transplants made from donor material or synthetic material. The operation is usually not performed until weeks or even months after the injury until the swelling has subsided and the knee can move well again.

In conservative treatment, the knee is initially immobilised for several weeks and stabilized with a splint. If the ends of the torn cruciate ligament are still in close contact with each other, in rare cases the cruciate ligament can even grow back together on its own. However, this does not usually work with the anterior cruciate ligament. The chances are greater with the posterior cruciate ligament, which is shorter and more compact. Conservative treatment always includes targeted training of the muscles around the knee.They should stabilize the knee and thus take over the function of the missing cruciate ligament.

What are the long-term consequences of a cruciate ligament rupture?

Cruciate ligament ruptures can subsequently lead to altered statics in the knee joint, and thus to incorrect loading. This applies to both operated and untreated cruciate ligament ruptures, although the risk is higher in untreated cases. The load on the menisci and joint cartilage increases, which can lead to tears in the meniscus as well as osteoarthritis, the irreversible degradation of the cartilage surfaces in the knee joint that protect the joint. In the worst case scenario, an artificial knee joint will eventually be necessary.

Why do women have a higher risk of suffering a cruciate ligament rupture?

Anatomically, genetically and hormonally, women have less favourable conditions for ligament health. Because they have a wider pelvis, women tend to have a knock-kneed posture, which favours a cruciate ligament rupture if the knee is subjected to the corresponding force. The female musculature is generally weaker than the male musculature, meaning that the stabilizing function is also less strong.

Hormones also play a role: in the second half of the menstrual cycle, the sex hormone progesterone softens the ligaments in the female body and the risk of cruciate ligaments increases. Overall, the risk for women is around twice as high as for men.

How long are you out for with a cruciate ligament rupture?

This depends on the severity of the other injuries to the knee joint and the type of sport you play. In the case of a pure cruciate ligament rupture without involvement of other ligaments, bones or menisci, it usually takes six to nine months before you are able to compete again. Normally, there is nothing to stop you returning to sport after a healed cruciate ligament rupture.

With appropriate physiotherapy, you can train on a bicycle ergometer or go swimming about six weeks after the operation. Sports that do not involve sudden changes of direction and high force exerted by jumping and landing, such as running, swimming and cycling, can be resumed after six months. In team sports such as football and basketball, as well as tennis and alpine skiing, it usually takes two to three months longer to make a comeback. The psychological component also plays a major role as it takes time for patients to trust their healed knee again.

Can you play competitive sport without cruciate ligaments?

This is certainly possible in swimming, running, cycling or other sports with less stress on the knees, but is not recommended for sports with high knee stress. Former footballer Zlatan Ibrahimovic played with a torn cruciate ligament for six months in 2022, and although he won the Italian championship with AC Milan, he was barely able to train and only played a few minutes at a time. He underwent surgery at the end of the season.

Former Germany goalkeeper Toni Schumacher suffered a torn cruciate ligament at the age of 18 before his professional career, but Schumacher decided against an operation. He played his entire career (1973 to 1996) with a ‘wobbly knee', but paid for this decision with severe consequential damage and pain, which significantly reduced his quality of life after his career.

This article was translated from German.

The Canadian province of British Columbia is reversing its policy of allowing the open use of hard drugs in public.

Premier David Eby said Friday that police will soon have the power again to enforce drug use laws in all public places, including hospitals, restaurants, parks, and beaches.

It brings to an end a much-criticized pilot program that allowed the personal use of some illegal drugs, including cocaine, methamphetamine, MDMA, heroin, morphine, and fentanyl. 

The program launched in January last year, to remove the stigma associated with drug use that keeps people from seeking help, was supposed to run for three years. 

'Addiction a health issue'

On Friday, Premier Eby said he still believed addiction is a health issue and "not a criminal laws issue."

"But the compassion for people who are struggling does not mean anything goes," he said. He expressed empathy for those struggling with addiction, but insisted public safety is paramount.

"We’re taking action to give police the enforcement tools they need to keep parks, hospitals and transit safe from public drug use," the premier said on X, formerly Twitter.

Concerns over public disorder and drug use

The move comes after Vancouver's deputy police chief, Fiona Wilson, last week testified at a parliamentary committee about having "absolutely no authority to address problematic drug use" under the decriminalization pilot.

"If you have someone who is with their family at the beach, and there's a person next to them smoking crack cocaine, it's not a police matter," she told the House of Commons health committee.

Police will have the power to ask drug users to leave an area or seize drugs and "only arrest for simple possession of illicit drugs in exceptional circumstances." 

Drug use will still be allowed in private home or at supervised consumption or drug-checking sites.

ss/lo (AP, AFP, Reuters)

The United States Food and Drug Administration (FDA) said Friday that pasteurized milk is safe, despite the recent outbreak of bird flu affecting herds of cows in the country.

It comes a day after they said one in five retail milk samples tested positive for viral fragments.

Additional tests showed that the pasteurization process killed the Highly Pathogenic Avian Influenza (HPAI) causing concern.

Preliminary results indicated "pasteurization is effective in inactivating HPAI," the FDA said on Friday.

Risk to public remains low

The US Department of Agriculture (USDA) confirmed dairy cows in Colorado tested positive for bird flu, following earlier infections in Texas, Kansas, Michigan, Ohio, Idaho, New Mexico, North Carolina and South Dakota.

One person, a Texas farm worker, has been infected with bird flu and suffered mild symptoms.

However, the Centers for Disease Control and Prevention and the World Health Organization said the risk to the public remains low. It is higher for those who are near infected animals.

According to the FDA's Friday release, information continues "to show no uptick of human cases of flu and no cases of H5N1, specifically, beyond the one known case."

Congress seeking further action

Despite that the US lawmakers want a stronger response from President Joe Biden's administration.

"Containing this before it spreads among humans is critical," Republican Senator Mitt Romney said in a post on X, formerly Twitter.

"Given lessons learned from COVID, this federal response is insufficient."

Democratic Senator Tammy Baldwin of Wisconsin, a significant dairy state with no reported cases, has urged the USDA to "quickly deploy additional resources in states that have the opportunity to prevent the disease from entering herds."

In response, the White House has said that it is monitoring the avian flu situation.

An "immediate response team" had been launched to ensure the safety of the nation's food supply, monitor trends to mitigate risk and prevent the virus' spread.

Starting on Monday, the USDA will require dairy cows to test negative for bird flu before they are moved across state lines.

km/lo (AFP, Reuters)

The nationwide doctors' strike in Kenya began on March 12, with at least 4,000 medics demanding higher salaries as part of a 2017 collective bargaining agreement, better working conditions and the employment of intern doctors. Five weeks later, there is no sign of a compromise as the government claims it cannot allocate the necessary funds. DW has put together a timeline of the row so far.

Week 1: Demand for higher wages

Led by the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU), 1,210 intern doctors, medical doctors, pharmacists and dentists laid out their demands. These included a salary increase of up to 206,000 Kenyan shillings ($1,548, €1,451) per month.

The doctors also called on President William Ruto's government to fulfill its 2017 promise to increase their salaries. The government rejected the doctors' demands and made a counteroffer which was rejected by the doctors' union. 

Week 2: Health sector paralysis

In its second week, the strike caused widespread disruptions in healthcare services. With medical professionals absent from their posts, hospitals, and clinics, many patients were left unattended and desperate for medical assistance.

A 12-year-old boy taken to the hospital by his mother due to a broken leg wa s turned away from a hospital in Kakamega county in western Kenya because there were no doctors to assist.

Another patient affected by the ongoing doctors' strike told DW that he needed to raise money for an urgent spinal surgery.

Week 3: First casualty as doctors dig in

Kenyan doctors stopped offering emergency medical services at public hospitals as the strike entered its third week.

According to local media reports, a young man died from what first appeared to be a toothache but then advanced to a blood infection and malaria. He had been moved between several hospitals, seeking medical attention to no avail. 

Many patients began turning to private clinics, which are costlier than public hospitals, to receive medical attention.

Week 4: Catholic bishops urge government to take action

Bishops under the Kenya Conference of Catholic Bishops (KCCB) call on President Ruto to "speedily" resolve the concerns of the striking doctors.

Meanwhile, Kenyatta National Hospital, the country's largest referral hospital, laid off 100 of its striking doctors and announced it had hired new staff as replacement.

Week 5: President Ruto lashes out at strike supporters

President William Ruto has expressed dismay at leaders endorsing the strike: "If you support them [the doctors], pay the money they are asking for," the president said.

Ruto insists that the government's offer is final — a position the KMPDU firmly rejects. A Kenyan court has given the government and the medical union 48 hours to agree on a deal.

Edited by: Chrispin Mwakideu

More than 1,000 people have succumbed to cholera, while tens of thousands across Africa have been infected in a series of deadly cholera outbreaks since the beginning of 2024.

The hardest hit nations are the Democratic Republic of the Congo, Mozambique, Zimbabwe , Zambia in southern Africa, and Ethiopia further north.

Zambia is being battered by its worst outbreak ever, with more than 740 cholera deaths recorded since the onset of seasonal rains in October 2023.

The highly contagious bacterial disease can cause severe diarrhea and dehydration within hours of infection. When people are quickly treated, less than 1% die. But the death rate in Zambia, one of the world's poorest countries, is more than 3%.

How does cholera spread?

Cholera outbreaks often occur in disaster-hit areas or poorer communities lacking safe drinking water and proper sanitation. Those who depend on untreated water from rivers and ponds or live in slums and refugee camps are at particular risk.

This is because the Vibrio cholerae bacteria that causes cholera is shed in the feces of the infected host, with the bacteria spreading rapidly if it gets into food or water supplies.

"Just imagine one household where the toilet is pretty close to the place where people fetch their water, so there is a transmission of contamination between the toilets and the water that people drink," explained epidemiologist Yap Boum, the head of the Pasteur Institute of Bangui, a non-profit research foundation in the Central African Republic.

"And then in settings like refugee camps, where you have a concentration of people, the water that is being used is highly contaminated."

What is fueling Africa's current cholera outbreaks?

There are a host of reasons for the rash of simultaneous cholera outbreaks across so many southern African countries, said epidemiologist Boum.

"Cholera is a marker of inequality, mostly affecting countries that are exposed to conflict, insecurity and poverty," he said. Those factors are all present in each of the African nations currently battling cholera outbreaks.

Another factor is climate change.

"Increasingly frequent and more severe flooding linked to climate change has an impact [on cholera outbreaks] too," wrote water management expert Anja du Plessis, an associate professor at the University of South Africa, in response to DW questions. "Cholera occurs more in the rainy season, which the region is currently experiencing."

"Flooding results in more run-off containing more pathogens, increasing the risk of contamination."

What about the cholera vaccine?

To make matters worse, stockpiles of the only available cholera vaccine are empty as demand soars.

Only one manufacturer, based in South Korea, currently makes an oral cholera vaccine. It is churning out 700,000 doses a week, but demand is four times greater than it can supply, according to Doctors Without Borders (MSF).

This despite an October 2022 International Coordinating Group (ICG) on Vaccine Provision recommendation to replace the long-standing two-dose regimen with a single dose of the cholera vaccine in an effort to preserve stocks.

Unlike routine childhood vaccinations, cholera vaccines are produced on a "needs basis," said Edina Amponsah-Dacosta, a vaccine expert with the Vaccines for Africa Initiative based at the University of Cape Town in South Africa.

"We tend to use cholera vaccines for mass vaccination programs whenever we have outbreaks — to control the outbreak of the disease. That means we tend to produce a limited amount for a limited number of countries."

Are vaccines the solution to cholera containment?

The past decade has seen a massive increase in cholera vaccines produced, jumping from roughly 2 million doses in 2013 — when the cholera stockpile was set up — to 36 million in 2022.

But that still isn't enough to keep up with the current unprecedented surge in global cholera cases.

"If cholera were similarly affecting Western countries, I believe we would have the highest amount of vaccine available, but that is not the case," said Boum, who previously headed MSF's research arm, Epicentre.

At the same time, every expert interviewed for this article warned that vaccines would never be the silver bullet that will stem the spread of cholera in southern Africa.

Rather, a vaccine is just one of many tools to help fight disease. Others include improving community health messaging about boiling water and good hygiene practices, like washing one's hands, providing safe and reliable water sources, and increasing water quality testing and monitoring.

Why isn't Africa producing its own cholera vaccine?

In 2022, the South African-based company Biovac signed a licensing contract to manufacture oral cholera vaccines in a deal heralded by international health experts. But Biovac's vaccines can't be used to curb current outbreaks because production isn't slated to start until 2026.

Having a regional manufacturer is an important step in the right direction though, say both Yap Boum and Edina Amponsah-Dacosta.

"Diseases are not prioritized the same way in all parts of the world," vaccinologist Amponsah-Dacosta told DW. "With cholera, we have just one manufacturer with limited global interest in a disease such as this one. It creates the situation that we're seeing now in terms of the dwindling stockpile."

"If you increase manufacturing capacity in parts of the world that experience the disease the worst, it just means that they are able to take ownership and rely on their own resources and better support their health programs. "That is critical."

Edited by: Chrispin Mwakideu

Nigeria has become the first country in Africa's "meningitis belt" to introduce the new Men5CV or 'MenFive' meningitis vaccine. It is the world's first vaccine to provide protection against all five strains of the meningococcal bacteria that cause meningitis.

Around half of meningitis cases and deaths occur in children under 5 years old, according to the World Health Organization (WHO). 

Since 2010, Africa, which sees the highest burden of meningitis infection in the world, has been fighting outbreaks using the MenAfriVac vaccine. Although it has successfully eradicated about 80% of meningitis infections across the continent, the vaccine only protects against a single strain of the meningococcal bacteria, serogroup A.

That means Africans haven't had protection against the four other strains of the bacteria (C, W, Y and X), all of which cause the disease. Cases of meningitis have continued to rise in meningitis-prone areas, and have been attributed to the C, W, Y, and X strains, but not the A strain. 

Last year, reported meningitis cases jumped 50% across Africa, according to the WHO.

"According to any standards, it's unbearable to keep this disease burden," Marie-Pierre Preziosi, an expert on meningitis at the WHO, told DW.

Between October 2023 and mid-March of this year, Nigeria experienced an outbreak of the C strain, which led to around 1,700 suspected meningitis cases and some 150 deaths across the country, the WHO reports. The vaccine was rolled out to address that epidemic.

Other countries, such as Togo, have seen similar outbreaks in past years. 

Meningitis belt

Africans located in the 26 countries considered part of the continent's meningitis belt are more susceptible than anyone in the world to meningitis. Preziosi said that is because of the area's climate.

At any given time, around 10% of the global population is carrying the bacteria that causes meningitis in the back of their throat or nose. The bacteria normally sits in mucus membranes, which protects against the spread of bacterial infection. Trouble only comes when the membrane is breached, allowing the bacteria to enter the bloodstream.

Preziosi said that when the dry season arrives in Africa's "meningitis belt" — generally between December and June — dry, dusty winds blow from east to west. When inhaled, the material that these winds carry can breach mucus membranes. Many studies have shown that meningitis outbreaks can be clearly tracked to dry season. 

Before the rollout of the MenAfriVac shot, countries in the belt saw major outbreaks of meningitis every five to 12 years, according to Gavi, the Vaccine Alliance, an international health organization that will help distribute the shot. During the worst of these outbreaks, up to one-in-100 people were infected. 

Africa's 1996-97 meningitis outbreak, which caused at least 25,000 deaths and 250,000 infections, remains one of the continent's worst. 

Meningitis causes serious long-term health issues

Even with early diagnosis and antibiotics, meningitis is deadly in about 10% of cases, and about 20% of those infected experience long-term health issues. 

"For those who survive, one-in-five can develop long-lasting disabilities — that can be neurological disabilities, loss of hearing, deafness, also losing limbs," said Preziosi. "So it's quite dramatic, and it can drive a whole community into poverty."

Meningitis is most commonly spread through droplets from coughing, sneezing or kissing. The incubation period is generally between three and four days.

Initial symptoms are usually non-specific and can look like the flu. If untreated, the carrier can develop high fever, light sensitivity, neck stiffness, bleeding in the skin and, in the worst cases, blood poisoning that can lead to sepsis. Infection leads to the inflammation of membranes surrounding and protecting the brain and spinal cord. 

By protecting people from all five strains of meningitis, experts hope the new Men5CV vaccine will prevent the burden of the disease initially in the African meningitis belt, but eventually in other meningitis-prone regions. 

Men5CV vaccine rollout

The Men5CV vaccine rolled out in Nigeria has been in the works for 13 years,, and uses the same infection fighting mechanism as the MenAfriVac. 

"When you get the vaccine … your body will react by creating antibodies, these are the defense mechanisms to protect from infectious diseases," said Preziosi. "Those antibodies could also generate some specific mucus antibodies at the surface of your nose or throat," she said, which prevent the bacteria from latching on.

At this point, the new Men5CV vaccine will only be used to address outbreaks. The WHO says it hopes countries can begin using it as preventative protection for all children two and older by 2025.

At $3 (€2.80) per shot, this vaccine is slightly more expensive than the MedAfriVac, which is less than $1 (€0.94). But Preziosi says that if there is broad uptake, the price could go down. 

Preziosi hopes the new five-strain vaccine will be as successful in eradicating all strains of meningitis as the A vaccine was in nearly ridding the meningitis belt of that particular type.

Edited by: Fred Schwaller

Sierra Leone's President Julius Maada Bio said Thursday that the West African nation was facing "an existential threat due to the devastating impact of drugs and drug addiction — in particular the devastating synthetic drug kush."

Scores of young Sierra Leoneans have become addicted to kush, a drug that threatens the lives of its users and others in their communities.

"It is my solemn duty as president ... to declare a national emergency on drug abuse," Bio said in an address to the nation.

A task force would be responsible for prevention, treatment, social services support, law enforcement and community engagement in Sierra Leone, reported AFP news agency.

Bio also said his government was working to take down drug trafficking networks.

The growing problem of kush

At the beachfront on the peninsula west of Freetown, DW was able to speak to some kush users. One of them identified herself as Mosquito Rambo.

"I'm a prostitute. After going out with different men, any money I make, I purchase a couple of kush, smoke it for the day so that I can be joyful and feel fine," she told DW.

Escapism from unemployment, poverty or other traumas is a big draw for the drug. 

Its users are well aware of its dangers. Estimates vary, but thousands have been hospitalized, and kush-related causes kill scores of people every week in Sierra Leone.

"Kush puts our lives backwards; young men are always behind," said Abass Kamara, who added that he used to smoke two joints a day. "Now it's one a day, so I will be able to abandon it. But you cannot just do so from one moment to another."

Common among kush users are the aches and pains that follow the high. Another young woman, who calls herself Sarah, said she would be happy if kush were to disappear.

"That the government plans to eliminate kush, we are happy, because sore feet, swollen feet and robbery would stop. So we would go back to normal life," Sarah told DW.

What is kush?

The exact ingredients that go into kush are not always the same, or even known. It is a synthetic drug, or polydrug, that combines several elements. Similar types of highly-addictive drugs known as nyoape and mandrax are found in southern Africa.

Currently, kush usage has been mostly recorded in the West African nations of Sierra Leone, Liberia and Guinea. 

By most accounts, it is a marijuana-based conconction which may include anything from fentanyl, tramadol or formalin, a substanstance used to embalm corpses, which seem to make kush extremely addictive. Most users smoke the drug, and joints can be shared.

What is known, however, is that drug is extremely cheap — even in areas where there is little disposable income. For the price of a pack of chewing gum, users can get a short high.

But mental health experts say kush intake can lead to permanent brain damage and suicidal actions. One mental health expert, Dr Abdul Jalloh of the Sierra Leone Medical and Dental Association, said that in 2023 that cases of drug abuse rose from 2% to 40% over a two-year period.

Graves robbed to add embalmed bones to the drug mix

Sierra Leone's Minister of Planning and Economic Development, Kenyeh Barlay, told DW that local investigations have found that kush is the "cheapest drug on the market."

The formalin found in the drug is rumored in local media to have been obtained from exhuming bodies from graveyards and crushing the bones into a powder, though this has not been scientifically proven.

Freetown's municipal authorities earlier this month said they would deploy overnight police patrols to protect cemeteries following a spate of grave robberies involving the removal of bones from dead bodies.

This is one of the reasons why Solomon Moses Sogbandi, director of Amnesty International in Sierra Leone, wants the drug kingpins to be stopped.

"Not much is done about the drug barons, who are financiers of those bringing the drugs or those manufacturing the drugs within the country," Sogbandi told DW.

"If the government should target the drug barons, to ensure that they cut off the supply route, I think the issue of intake will be really reduced, and we can see how we can manage those that are already affected."

Calls for stronger government response in Sierra Leone

In response to the growing kush problem — which is especially prevalent in urban areas — Sierra Leone's government in February established a rehabilitation center for victims of drug abuse and set up a ministerial task force. 

The vice chairman of Sierra Leone's Human Rights Commission, Victor Idrissa Lansana, told DW that the government should have declared an emergency at the same time.  

"With the public emergency in place, we would have increased awareness, get young people to understand the dangers of kush and how they could avoid it," Lansana told DW.

"We don't have to wait until many more lives are lost to kush. As we have said, it's about the right to life, the right to health and the right to education. We have to intervene as a country, co-ordinately, so as to address this issue of kush once and for all."

Lansana was also not the only voice calling for this measure.

Crushing the kush addiction across western Africa

Religious leaders like Father Peter Conteh, who heads the humanitarian aid organization Caritas Freetown, suggested that the same approach used during the COVID and Ebola health crises could be transferred to the fight against kush. 

"Collaboration between religious leaders and the health sector was instrumental in managing the spread of COVID-19," Conteh told DW. "This same collaboration can be applied in the fight against kush, with the religious leaders working hand-in-hand with the health professionals to provide education, intervention and support to those struggling with substance abuse."

Sierra Leone's neighbors, Guinea and Liberia, are also fighting to contain an increase in kush consumption.

Guinean authorities said that more than 10 young men have died after taking the substance. Many others are undergoing medical treatments due to kush side effects.

In Liberia, President Joseph Boakai declared drug abuse a public health emergency and announced a steering committee to tackle the "existential threat" during his first state of the nation address in January.

This article was adapted by Cai Nebe from a radio report that was broadcast on DW's daily podcast AfricaLink. It has been updated to reflect the latest news about Sierra Leone's president declaring drug abuse a "national emergency."

Edited by: Keith Walker

"Somebody tells you 'God, you look terrible, are you going to be sick?' and then suddenly you are," said Charlotte Blease, recalling a recent bus trip in Ireland, from Belfast to Dublin. "You have this expectancy and it ramps up the symptoms."

Blease ― a health researcher at Uppsala University, Sweden, and one of the authors of "The Nocebo Effect: When Words Make You Sick" ― was feeling nauseous with motion sickness. 

She was trying to distract herself with any other thought, and knew that if someone interrupted her, it would trigger the nocebo effect. 

"The nocebo effect [is] negative health outcomes that arise from negative expectations," Blease told DW. It can exacerbate feelings of pain, anxiety, nausea and fatigue.

Nocebo: Not placebo

The nocebo effect is the negative mirror image of the placebo effect.

Imagine a medical trial. One group is given a real medication to treat headaches. The other group gets sugar pills, without an active ingredient.

When patients in this second group report an alleviation of their headaches, doctors say the patients are experiencing a placebo effect ― because they thought they were taking painkillers, like the patients in group one, positive thinking led to a positive outcome in their treatment.

It's a medically recognized phenomenon. And the nocebo effect is slowly gaining a similar recognition by health professionals, except it's the exact opposite: it's when negative thinking influences your outcomes, negatively.

Nocebo effect, COVID and vaccine hesitancy

During the coronavirus pandemic, researchers found that people's expectations before a COVID-19 vaccination could be linked to how they felt afterwards.

A team of scientists from Israel and the UK looked at a group of 756 Israeli adults over the age of 60 years. Each had received a booster shot ― a third vaccine against COVID-19.

"We measured both vaccine hesitancy ― one's negative attitude or expectations towards the vaccine ― and the number of subjectively reported side effects," said Yaakov Hoffman, lead author of the study and a professor in the Department of Social and Health Sciences at Bar-Ilan University, Israel.

Published in the journal Scientific Reports in December 2022, their results indicated that people who had negative expectations before their second shot were more likely to experience side effects after their third.

"The more anxiety about the vaccine, its safety and its side effects [one felt], the greater one would actually experience side effects," Hoffman told DW. 

And when the nocebo effect and vaccine hesitancy were combined, he said, it had the potential to become a vicious circle: A person who was hesitant to get vaccinated, perhaps because they had read about side effects online, would be more likely to experience side effects. Those side effects would then be recorded and reported by their doctor. That, in turn, would contribute to more media coverage about side effects, and more people feeling hesitant about vaccines… and so on, and so on.

How doctors deal with the nocebo effect

Talking to patients without triggering the nocebo effect can be a challenge.

"Doctors are obligated not to harm the patient, or to mitigate harm where possible, but they also have an obligation to tell the truth," said Blease.

In the case of a vaccine with relatively minor side effects, said Hoffman, addressing the nocebo effect head-on could make sense.

"Perhaps it's better to call a spade a spade and say, 'There's a certain percent of side effects which you are experiencing that are nocebo effects. Which means you are really experiencing them, but it doesn't necessarily signify danger,'" he said.

Hoffman stressed, however, that this was only speculation and that further research was needed to provide firm evidence.

Importance of framing health information

Other experts in the field agree the way that doctors communicate with patients can help prevent nocebo effects.

"How doctors talk to patients can influence therapy outcomes," said Ulrike Bingel, a clinical neurosciences professor who heads a pain research unit at University Hospital Essen, Germany.

"So far, communication has been mostly viewed as a feel-good issue. We need a higher awareness of how crucial it is," Bingel said.

When it comes to vaccines, for example, doctors are required to disclose any possible side effects.

But instead of rattling off a list of side effects that might scare a patient, Bingel said doctors should frame side effects as a sign that the immune system is working well.

This way, the patient might have fewer negative expectations and experience fewer or less-pronounced side effects.

Nocebo effect may be evolutionary

But how can negative ideas in our mind affect what's going on in our body?

First, it's important to understand that the nocebo effect is real. It's not a figment of a patient's ― pessimistic — imagination. 

"The nocebo and placebo effects involve complex neuroscientific processes," Bingel told DW. "When you're experiencing a nocebo effect, your body stops pumping its pain brakes. Your brain receives more brain impulses and you feel more pain."

The problem is, researchers can't explain why this happens. Not yet. But they do believe it may have something to do with our evolution.

"It was important that our ancestors learned from coming into contact with a wild animal or a poisonous plant," said Bingel. "The body [got] prepared for next time."

In other words, an early human's negative expectations would have prepared them, just in case they had to run for their lives.

"The nocebo effect could be a hangover from the past," said Blease, [but] that's a mismatch for today's modern medical environment."

Edited by: Zulfikar Abbany

Sources:

The Nocebo Effect: When Words Make You Sick by Michael Bernstein, Charlotte Blease, Cosima Locher, Walter Brown. Mayo Clinic Press, March 19, 2024.

Vaccine hesitancy prospectively predicts nocebo side-effects following COVID-19 vaccination by Y.S.G. Hoffman, Y. Levin, Y. Palgi et al. Scientific Reports, 2022: https://doi.org/10.1038/s41598-022-21434-7

Protein is essential for a healthy diet. And you can get your protein from plants and animals — beans, peas, nuts and wholegrain seeds, and fish, poultry and other livestock.

Nutrition experts at the Harvard School of Public Health advise you take most of your proteins from plant-based sources. Red meats, such as beef, they say, "should be consumed on a more limited basis."

Meat production is, for one, considered environmentally unsustainable. But too much meat can also lead to health problems, including bowel cancer. Often, it's more a case of the way the meat is cooked than the meat itself, but still it is worth bearing in mind: You are what you eat, as the saying goes.

But many people enjoy eating meat. So the idea of lacing rice — a plant-based protein — with sustainable, lab-grown beef should be welcome news. That's what scientists in South Korea say they have created, and they are calling it "beef rice".

What is beef rice?

Researchers in Seoul, South Korea, took meat and fat cells from cows, coated with fish gelatin, and inserted them into rice grains, where they grew. 

The gelatin coating helped nutrients from the animal material — beef muscle and fat stem cells — to grow and enrich the rice.

It was grown in a culture for around 10 days, allowing the protein and fat from the animal cells to develop. And what resulted was a pink-white grain.

But does it taste good?

"The initial flavor is predominantly that of rice. However, there are multiple complex flavors intertwined. It had a somewhat chalky but nutty protein flavor, followed by a slightly creamy, buttery aftertaste," said Jinkee Hong, a lead author of the study into beef rice at Yonsei University.

How nutritious is beef rice?

Hong said his beef rice contained 8% more protein and 7% more fat than conventional rice. That would make it a rich source of essential amino acids, which produce proteins.

"Th[is] demonstrate[s] its potential as a future superfood but also offer[s] ideas for the development of new forms of hybrid food products," said Hong.

But some food experts have questioned the nutritional value of Hong's beef rice.

"The end product contains 4.8 grams (0.17 ounces) of cultivated bovine cells per 1 kg (35 oz) of rice. This means that 0.5% of the end product is cultivated meat and 99.5% is rice. For replacing meat, the percentage of the protein in the final product would need to be higher," said Hannah Tuomisto, a professor of sustainable food systems at the University of Helsinki in Finland.

Beef rice is only one of several experiments to modify rice with the goal of getting more nutrients into people's staple diets.

Golden rice, for example, is genetically engineered to contain a form of vitamin A, which was found to be lacking in some people's diets in parts of Asia and Africa.

How 'green' is beef rice?

Hong and his team said that cultivating their hybrid rice would produce fewer greenhouse gases than producing conventional beef protein. 

They say 100g of beef protein production releases about 50kg of carbon dioxide (a number substantiated by previous studies), while producing 100g of protein from hybrid rice would release less than 6.27kg of carbon dioxide.

"Cultivated meat is an extremely promising field due to its potential benefits for the environment, food security, sustainability and animal ethics," said Hong.

The team are not the first to work on lab-grown meat products, either. The first lab-grown meat burger was unveiled in 2013 by Dutch scientist Mark Post.

Less than a decade later, the lab-meat industry had grown to more than 150 companies worldwide. Most companies have focused on producing alternatives for common meats, such as pork, beef, and chicken.

Why is it so hard to buy lab-grown meat?

Hong said lab-grown meat is still too expensive for mass production and that means it's been tough to get it onto supermarket shelves.  

One of the main challenges is that lab-grown meat relies on animal products to grow the cells. In Hong's study, the researchers obtained their initial batches of muscle and fat cells from cattle slaughtered at a local abattoir.

"All lab-based meats rely on bovine serum, the blood of a cow, as a growth supplement. It's the best way we have to grow such a quantity of cells that you can make something with. But it brings in ecological arguments, issues of animal cruelty, and it's expensive," said Alfredo Franco-Obregon at the National University of Singapore. Franco-Obregon has also worked on lab-grown meat.

But producers also have some way to go to convince people to eat lab-grown, cultivated meats.

A UK-based survey by the Food Standards Agency found only a third of participants were willing to try lab-grown meat.

Almost half the participants reported that nothing could encourage them to try lab grown meat, but more than a quarter said they could be persuaded if they knew it was safe to eat.

Edited by: Zulfikar Abbany

Sources:

Rice grains integrated with animal cells: A shortcut to a sustainable food system. Published in the journal Matter by Sohyeon Park, Jinkee Hong, et al., 2024: https://doi.org/10.1016/j.matt.2024.01.015

Protein in The Nutrition Source by Harvard School of Public Health: https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/protein/

Greenhouse gas emissions per 100 grams of protein, Our World in Data: https://ourworldindata.org/grapher/ghg-per-protein-poore

People are facing famine and starvation on the Gaza Strip, a Palestinian territory, which has been the focus of the Israel-Hama war.

Tedros Adhanom Ghebreyesus, the Director-General of the World Health Organization, has described "severe levels of malnutrition" which have led to the deaths of at least 10 children. The Palestinian Health Ministry, which is run by Hamas, said meanwhile that 15 children had died of malnutrition and dehydration.

In northern Gaza, an estimated 300,000 people are living with food and clean water shortages.

Prolonged hunger is an extreme burden for the body. But our evolution has trained the human body to survive without food for weeks if necessary.

It doesn't work for everyone, and when there are other factors, such as disease, that weaken the immune system even more than the lack of food, a person's chances of survival are poor.

Below, we look at how the body tries to survive hunger and starvation.

The body is programmed to survive

There's a "hunger center" in the brain's hypothalamus, a region that plays a central role when a person starves. It gets active as soon as blood sugar levels drop.

First, the hypothalamus instructs the kidney's adrenal glands to release the stress hormone adrenaline. This gives us strength to search for food.

But if we fail to find food, the brain resorts to Plan B: It scrounges around the rest of the body for glucose.

The brain needs glucose, a form of sugar — also known as blood sugar — to function. Glucose accounts for only 2% of a person's body mass, but the brain consumes about half of that.

In order to obtain this essential sugar, the brain tricks the body: It sends a signal to stop insulin secretion. That stops the body's muscles from getting glucose and allows the brain to get it instead.

During severe hunger, each organ shrinks to about half its original weight until the point that they fail and the person dies. The brain is the only exception: It decreases by a maximum of 4% due to its ability to store glucose.

The rest of the body turns to protein for energy production. This also comes at the expense of the muscles, which consist largely of protein. The body converts amino acids — which are proteins — into glucose.

Can you smell extreme hunger?

After eight to ten days, the body switches its metabolism to an energy-saving program.

Like an animal in hibernation, essential activities, such as heart rate, blood pressure and body temperature drop to run at a minimum. When food is limited, it's the best thing the body can do.

The body starts tapping into its fat reserves by converting fatty acids into so-called ketone bodies.

Ketone bodies are an extremely important source of energy. They are the only compounds the brain can use alongside glucose.

But when converts those fatty acids into ketone bodies, it can emit the distinct smell of nail polish. That's because acetone is among the ketone bodies excreted through the kidneys and breath.

The longer hunger lasts, the worse things become: The skin's barrier function decreases, the immune system weakens and inflammation spreads.

Why organs fail because of starvation

Gradually, the body converts all its vital organs into brain food. After a while, the person becomes nothing but skin and bones, and the organs start to fail. The heart often gives up first.

A person can only survive hunger for an extended period if the metabolism reprograms itself, as described above, to allow the brain to survive on less glucose. That makes it possible to maintain protein reserves in the vital organs.

In order for all of this to function smoothly, the body must give that initial hunger signal — the one that stops insulin secretion. But it doesn't always work.

For example, people with malaria, HIV/AIDS or other diseases have so many inflammatory substances in their blood that the pancreas will continue releasing insulin, blocking the so-called starvation metabolism.

Long-term physical impact of starvation

People do recover from starvation. But some face long-term physical and psychological effects. These can include irreversible organ damage or dysfunction, impaired immune function and a loss of bone density.

Starvation can affect hormones, including insulin, cortisol and thyroid.

People who have experienced starvation are often also more likely to develop gastrointestinal problems.

Starvation weakens the immune system, making the body more susceptible to infectious diseases, such as cholera, measles and malaria.

Starvation passes from mother to child

Malnourished pregnant mothers can pass on the negative effects of starvation to their babies.

In a 2022 study, researchers at Pennsylvania State University in the US examined individuals who had been exposed to the Dutch Hunger Winter, a famine at the end of World War II, to study the long-term effects of starvation on children.

Out of all the age groups studied, researchers found that malnutrition in utero caused the most severe negative long-term health effects.

Babies born under those circumstances had faced an increased risk of diabetes, cardiovascular disease and obesity later in life, as well as muscular-skeletal deficiencies and auditory impairment.

Starvation's psychological effect

In the mid-1940s, researchers set out to understand the physiology of starvation via an experiment would be inconceivable today.

Facilitated by American scientist Ancel Keys, the study tracked 36 study participants fed half the calories required for normal survival for three months.

The psychological effects of constant hunger became particularly clear. Many participants withdrew and became apathetic.

Hunger overshadowed everything. They were only interested in things related to food. Some even dreamed of cannibalism. Meanwhile, their senses sharpened: the subjects could smell and hear much better than before.

This article was originally published in German.

All around the world, more and more people are taking dietary supplements that promise better skin and hair, a strengthened immune system or improved performance. Magnesium, vitamin C and others are part of a market worth billions of euros.

Angela Clausen from the consumer advice center in North Rhine-Westphalia has been dealing with this topic for years.

"The problem is that a great many people see dietary supplements as a kind of natural medication, so they use them accordingly: for therapy, and to relieve or heal diseases," she said. "But dietary supplements are only really intended to supplement essential components that we don't get enough of from our diet."

In the best-case scenario, when consumers buy dietary supplements that don't offer any benefits, they're just wasting their money. However, some substances, such as vitamin D, iodine or selenium can be harmful if too much is consumed.

Food supplements are also subject to far fewer controls, precisely because they are not medications. They can be marketed without having been tested for safety, quality, or effectiveness. Consequently, dietary supplements don't always contain the ingredients indicated on the packet, or may not do so in the quantities stated. Sometimes they even contain substances that are dangerous or banned.

On social media, there is even less monitoring of these claims. False promises about the healthy properties of dietary supplements are found everywhere, as demonstrated by a random investigation of hundreds of posts and stories conducted in 2021.

DW Fact Check did its own search for claims about dietary supplements on social media, then took three examples and analyzed them.

Supplements to make you smarter?

Claim: In this TikTok video, which has been viewed around 1.7 million times, a user claims: "You're not stupid, you just don't have enough circulation going to your brain, which is preventing you from focusing, concentrating effectively and it's leading to really poor memory."

Her top four recommended supplements to help with this are ginkgo biloba, bacopa monnieri, L-theanine and magnesium L-threonate.

DW fact check: False

Better cognitive performance and concentration thanks to these dietary supplements — unfortunately, it's too good to be true. Nutritionist Friederike Schmidt from the University of Lübeck analyzed the video for DW.

"The TikToker talks about very specific metabolic mechanisms, and she does initially appear competent," said Schmidt. However, she pointed out that, with regard to many aspects of the preparations the woman mentions, "we actually have no idea what they do and whether they help at all."

For example, one of the claims made in the video is that the plant extract bacopa monnieri raises the level of the neurotransmitter acetylcholine in the brain, which improves memory.

"This is very far-fetched," said Schmidt. "As yet, there has been not one methodologically sound study, let alone several, in which people have been given this plant extract, had more acetylcholine in their brains, and were then better able to remember things."

Angela Clausen from the consumer advice center knows all too well that citing studies of little or no relevance or significance is a common tactic when advertising dietary supplements. "The studies presented are usually a disaster as far as the actual product is concerned," she said.

Overall, the TikToker's claims are not at all scientifically sound. There is no proof that her "top four supplement recommendations" improve cognitive performance in the way she describes.

Turmeric: A miracle cure?

Claim: According to this Spanish-language video, which has had more than 1.5 million views, powdered turmeric dissolved in water can help against eczema. It is also alleged to detoxify the body, prevent arthritis and reduce the risk of cancer. Similar claims can be found here and here, as well as elsewhere.

DW fact check: False

Used as a spice, turmeric has long been held to be good for the digestion. However, according to Clausen, "all these claims are inadmissible; there are no existing studies to support them."

There has indeed been research done into the active ingredient in turmeric, curcumin — but there are no "gold standard studies" relating to the imprecisely defined extracts used in the products. This would mean studies conducted in humans, in which neither the researchers nor the subjects knew who had received the placebo and who the active ingredient, and which have ideally been corroborated by at least one other study conducted by a different working group.

Studies have only shown that a specific turmeric extract, at a specific dosage, has an anti-inflammatory effect in laboratory tests, in a test tube. But these effects can only be attributed to precisely this extract, in precisely this dosage, not simply to turmeric. The effect in humans can be completely different to the effect in a test tube.

"We are very far from being able to say that turmeric definitely helps," said Schmidt. The nutritionist explained that a particular problem with curcumin is that it is very reactive, meaning that in the laboratory it interacts with many other substances — which is presumably also why it is said to be effective against so many different diseases and problems. But this doesn't necessarily mean it will be effective in people.

Better skin, hair, nails and joints with collagen?

Claim: Posts on social media also ascribe many positive attributes to collagen. This viral video claims it will give you firmer skin, stronger nails and shinier, stronger hair, while this TikTok clip asserts that it will also support your joints.

DW fact check: False

Collagen is a protein naturally produced by the body, and it's important for bones, joints, muscles and tendons. Dietary supplements containing collagen are therefore derived from animals, usually slaughterhouse waste.

It's not clear how well the body is able to process collagen received from external sources. Even the best-known supposed effect of collagen — a rejuvenating effect on the skin — is still in need of further research, according to a meta-study conducted in 2023.

"None of these advertising promises are approved for use in the EU, certainly not the one about joint health," said consumer adviser Clausen. There is no conclusive evidence it has this effect, she added. The consumer advice center even successfully sued the manufacturer of Glow25 Collagen Powder in 2022 for using the slogan "Healthy bones and joints."

The suppliers acknowledged that their promises with regard to its effects on skin, hair and nails were inadmissible. Nonetheless, many posts online still make these claims.

Conclusion: Consumers are being misled

With dietary supplements, it's not easy to separate the truth from the hype. Generally speaking, the claims made on social media are often exaggerated, unscientific or have even been prohibited.

"In many cases, we see that people are just spending money on things they don't need," said Schmidt. She described it as "a very tempting idea: that you can do something for your health with a few capsules or powders."

Additional reporting by Julia Vergin.

This article was originally written in German.

It's a common assumption that processed foods are unhealthy and a cause of overweight and obesity. And it is sometimes true: Processed foods can, for instance, contain four times more calories than unprocessed foods.

A meta-study published in the British Medical Journal on February 28, 2024, concluded that "greater exposure to ultra-processed food was associated with a higher risk of adverse health outcomes, especially cardiometabolic, common mental disorder, and mortality outcomes."  

Processed foods can be any kind of food that has been altered in production. It can be food that's had vitamins or coloring added, or food that's been made safe for human consumption, such as pasteurized milk.

Strictly speaking, a freshly-baked loaf of organic whole grain bread is processed, because the individual ingredients have been altered in the baking process. But we still tend to say that "processed foods" are bad for us, when in fact it depends on the extent to which the foods have been processed.

But the results of a study published in January 2024 aimed to show why processed foods, and even ultra-processed foods aren't unhealthy per se — but that they are far more likely to contain more calories and lack nutrients and vitamins. 

Processed foods: More calories on average

Published in the British Journal of Nutrition, the study from January found that ultra-processed foods in the UK contained more food energy than mildly processed foods.

On average, ultra-processed foods contained four times more calories than minimally processed foods — the ultra-processed foods contained on average 378 calories per 100g compared to 94 calories per 100g of minimally processed food.

Not all ultra-processed foods in the study contained high amounts of energy, however; a number of the products had similar nutritional values as mildly processed foods.

"[It's not] clear whether the effects can be attributed to the ultra-processing per se, or whether the effects of processing can be attributed to the nutrient profiles of the foods which tend to be ultra-processed [such as] ready-meals, pre-packaged cakes, crisps, biscuits, cookies, sweets chocolate," said Nerys Astbury, a nutrition scientist at the University of Oxford, in a statement.

Astbury was not directly involved in the study.

Are processed foods bad for my health? 

Previous research suggests there is no evidence that processing food has an adverse impact on health.

But it may affect what the food is made of and, possibly, its texture. And food texture has been shown to affect the rate at which people eat food. This can result in overeating, and overeating can be bad for your health.

The most common processed foods with healthier profiles in the study included packet sandwiches, plant-based milk alternatives and high-fiber breakfast cereals.

But the study was limited, said Thomas Sanders, a professor of nutrition sciences at King's College London, in a statement. It did not look at the nutritional value of processed foods.

"It does not show the contribution made by the different processed food categories to key nutrients, such as protein, calcium, iron, vitamins and fiber," said Sanders.

That means it's hard to know whether the calorific content of different foods can be linked to their nutritional value.

Sanders was not directly involved in the study.

What is ultra-processed food?

Ultra-processed food is an industrially created food, derived from natural and/or synthesized foods. Most ultra-processed foods contain a lot of calories but very little nutritional value.

Think frozen pizzas, donuts and chips — they are far from their raw ingredients: wheat, tomatoes, dairy and potatoes.

Processed foods often contain high levels of chemical additives and can be addictive as well. 

In a study published in 2021, scientists linked the consumption of high levels of ultra-processed foods to deficiencies in nutrients , such as potassium, zinc, and magnesium, and vitamins such as:

• Vitamin A: important for defense against colds and for good eyesight 
• Vitamin C: important for skin and bones
• Vitamin D: important for bones, teeth and muscles
• Vitamin E: important for the immune system
• Vitamin B12: important for red blood cells and the nervous system

Foods that are high in fat, sugar and salt — whether they are ultra-processed or not — have been linked to many illnesses, from obesity to cardiovascular disease, cancer, a decline in cognitive health and increased all-cause mortality. About 40% of the global population is overweight or obese, and experts say that processed foods are largely to blame. 

But the causes of obesity are complex: "Consuming a diet containing lots of ultra-processed foods can also be a sign of other unhealthy dietary patterns and lifestyle behaviors," Astbury said.

Sources:

Nutrients or processing? An analysis of food and drink items, British Journal of Nutrition, 2024

Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses, British Medical Journal, 2024

Ultra-Processed Foods and Nutritional Dietary Profile: A Meta-Analysis of Nationally Representative Samples, Nutrients, 2021

Edited by: Zulfikar Abbany

Andrea, a woman living in Berlin, was dating a supportive, kind and creative guy named Ben. She felt they were intellectually compatible and communicated well. But there was a problem from the very start: he wanted less sex than she did.

At first, she thought this just meant he wasn't interested in her. But he insisted he was — sex was just lower on his list of priorities.

"In terms of our connection as humans, there was not much to work on," she said. But she still felt lonely in the relationship, like something was missing.

DW has changed their names to protect the couple's privacy, but their story is real — and more common than you might think. Here's why sex drive mismatch happens and how you and your partner can handle it for a happy relationship. 

Sexual desire is not a fixed 'trait'

Sex drive mismatch is "pretty inevitable in long-term relationships," said Kristen Mark, a sex and relationships researcher and professor of family medicine and community health at the University of Minnesota Medical School.

To understand the factors underpinning mismatched sex drive in relationships, such as in the case of Andrea and Ben, the researcher said it was important to understand that sexual desire is not fixed.

"We used to think about sexual desire as this trait, this thing that's stable over time, like an 'I'm just a low sex drive person' sort of thing," said Mark. "That's not really the case."

Instead, she said, sex drive shifts over time.

"If you have two people whose sex drives are fluctuating over their lifetime … there are going to be moments ... sometimes longer periods of time, where you may have a mismatch," said Mark.

Factors that influence sex drive fluctuation

Mark groups the things that influence libido into three categories: individual, interpersonal and societal factors.

Individual factors are things like stress, health or lack of sleep.

"For some people, stress really dampens their desire. For other people, stress actually increases [it]," said Mark.

Interpersonal factors relate to the relationship itself — whether you are happy in your relationship or your level of attraction. This can be basic, Mark said. "We hear from lots of people who think they have low desire, but really, it's just like, 'No, I just don't really like my partner that much.'"

But these factors can also include issues with communication around sex within an otherwise happy relationship, said the researcher.

"In long-term relationships especially, some couples get into [a] pattern of how to initiate sex that can become a pretty sensitive dance. If you get rejected a few times, for example, that can have a really negative impact on your sexual desire. Because you just don't really want to approach anymore."

Andrea mentioned experiencing this in her relationship with Ben. She abstained from initiating sex with him out of fear of appearing pushy, she said, or getting rejected.

Societal factors, such as gender inequality, can also influence sex drive, said Mark.

Women who take on the bulk of household duties may feel less inclined to have sex with partners they feel are not doing their fair share around the home — or that their partners are actively contributing to their feelings of stress.

Sexual desire isn't always spontaneous

Mark said it was also important for couples to understand that sexual desire is often not what we think it is: A spontaneous drive to have sex out of the blue. This exists, said Mark, but it's less common than responsive desire: A desire in response to stimuli.

"You may not feel like having sex before you start having sex, but then once you start having sex, it feels great, and you're really rewarded, and then the cycle begins where it's, like, quite beneficial," she said.

Ways to bridge the libido gap

While the partner with a higher sex drive can end up feeling lonely in a mismatched sex drive dynamic, the other partner may "end up being sort of pathologized or thought of as the one having a problem," said Mark.

This results in a lot of pressure on the partner with the lower sex drive to bring their desire up, while little or no pressure is placed on the other to bring theirs down, she explained.

"For couples who navigate this well, what they do is they meet in the middle," said Mark.

Couples experiencing a mismatched sex drive, one that is causing problems in the relationship, should have a "really frank conversation about sexual needs," said Mark: You should try to figure out how your individual needs can be met in ways that work for both of you.

For many people, Mark said, the desire for sex is really about a desire for closeness and intimacy. Good sex in a relationship can serve as confirmation of being wanted.

Verbal reassurances and touching that doesn't lead to sex, like hugging, holding hands, kissing, or showing affection in public, are ways some couples are able to bridge this gap, she said.

Andrea's relationship with Ben wasn't the first time she had experienced sexual mismatch. Years earlier, Andrea dated a man who could not have penetrative sex for health reasons. But with him, said Andrea, she never saw the mismatch as a problem.

"He made me feel very wanted. He complimented me a lot. And I knew he was attracted to me. I knew he thought I was a beautiful woman. And there were ways in which he was flirting with me or trying to satisfy me with any kind of alternative to conventional penetration," said Andrea.

There is no 'normal' sex drive

Mark said there was no "normal" amount of times to be having sex with your partner per week. 

In her work, Mark encourages couples to relieve themselves of the pressure that their sex life is "abnormal" or worse than that of the couple next door.

Some research indicates that sex once per week is the sweet spot, said Mark, but "it's really individual."

Edited by: Zulfikar Abbany

Lisa, a Scottish woman living in Abu Dhabi, was in the middle of what seemed like a normal pregnancy. Her blood pressure was normal. And at her regular checkups, everything else seemed to be progressing normally as well.

But at around 20 weeks in, Lisa received a single sign that something could be awry: the fetus was smaller than it should have been at that stage. Lisa's doctor said they would keep an eye on it, but that it was nothing to worry about.

Four weeks later, Lisa started feeling what she thought was heartburn. A few days later, the sensation was still there, so she went to the doctor.

They ran some tests, including urine and blood pressure, and sent Lisa home. Everything looked fine, the doctor said.

But the pain grew over the course of the next 24 hours, eventually becoming so intense that Lisa knew she needed to go to the emergency room.

There, after more tests, Lisa was rushed to a larger regional hospital. Upon arrival, she had a seizure. They wheeled her into surgery to deliver the baby.

Two days later, she woke up to her child, a baby boy named Angus, and news that while she was asleep, her liver had ruptured — a very rare complication of HELLP syndrome, which has a 50% survival rate for mothers. HELLP syndrome stands for hemolysis, elevated liver enzymes and low platelet count.

Their babies are at risk as well: Born between 23 and 24 weeks, babies are so small and fragile they often do not survive. Lisa's baby, Angus, lived a mere seven days.

"When my dad took me to [the emergency room] on that Monday night at 8 p.m., I did not think that was ever going to be the outcome, that Angus was going to be born," said Lisa. "I don't know what I thought they were going to do, but I certainly didn't think it was going to be that."

Subtle signs of HELLP

Stories such as Lisa's are emblematic of the danger when HELLP strikes.

HELLP is generally characterized by doctors as a severe form of preeclampsia, said Brian Brocato, physician and professor of maternal fetal medicine at the University of Alabama.

Although many women who develop HELLP have symptoms of preeclampsia, such as high blood pressure early on in their pregnancy, a number of women do not have such symptoms. HELLP frequently seems to come out of the blue, as it did with Lisa.

"A woman's not going to know always via symptoms that her platelet count has dropped, her liver function is elevated," said Brocato, outlining the classic signs of HELLP syndrome. "The [extreme] symptoms of pain up on their right side or bleeding from the gums … may not happen until laboratory [results] are very abnormal."

Doctors need to be aware of this, said Brocato. They need to understand that common pregnancy symptoms like heartburn, increased swelling, headaches and slightly raised blood pressure are not necessarily signs of preeclampsia or HELLP, but they could be and they require extra surveillance.

"A lot of patients — and I will even say [health care] providers — will blow off very subtle symptoms because they could be normal pregnancy symptoms," said Brocato.

The vast majority of pregnancies are "normal" and healthy and people "may lose some awareness" of rare complications like HELLP, especially when the woman seems to have had a healthy pregnancy up to that point.

DW spoke with two other women who described similar experiences with HELLP.

Sandra told us the majority of her pregnancy had been healthy, but that she delivered her baby five weeks early after developing HELLP. It was just a day after a routine checkup and blood tests had indicated everything was fine.

Another woman, Katie, developed HELLP syndrome in her third pregnancy. Her first two pregnancies had been healthy, and although she did have high blood pressure during her third, HELLP came on rapidly and with little warning, resulting in the delivery of her baby at 28 weeks.

The World Health Organization defines preterm as babies born alive before 37 weeks of pregnancy are completed. In the US, a full-term pregnancy is after 39 weeks.

HELLP: Things 'we don't understand'

HELLP syndrome involves hemolysis, elevated liver enzymes and low platelet count.

Hemolysis means red blood cells are breaking down, while elevated liver enzymes indicate an injury to the liver.

"We don't completely understand why each of those things happen," said Brocato, adding that doctors suspect it's a consequence of the process of preeclampsia.

Preeclampsia classically involves elevated blood pressure, which is caused by the constriction of blood vessels. This can decrease blood flow to the liver and contribute to a lower platelet count.

Current research indicates that preeclampsia and HELLP both stem from complications in the development of the placenta. That's likely why Angus, Lisa's baby, was measuring small at 20 weeks, said Brocato. "We often see growth restriction and preeclampsia go hand in hand."

Hindered development of the placenta will at some point show itself as a complication of the pregnancy, said Brocato, explaining that in most cases, this presents as preeclampsia that develops near a mother's due date. In these cases, a healthy baby can typically be delivered.

"But there's a subset of women, and we're talking about things that we don't understand, that are going to develop that severe disease very quickly, or very early in pregnancy. And I don't have a reason [why]," said Brocato. This can include women who do not appear to have any risk factors for preeclampsia.

Doctors also don't fully understand why a small percentage of women develop HELLP syndrome or severe preeclampsia after delivering the baby, when the placenta has been removed.

Brocato said this is particularly dangerous because after birth, women are not monitored nearly as closely as during their pregnancies, and signs of preeclampsia can be missed.

"We may see someone once or twice a week, right before the baby is born. And then the baby is born and we may not see them for several weeks … no one is watching," said Brocato.

It's critical, he said, that women and their health care providers keep an eye on any potential symptoms of preeclampsia that develop after birth, including headaches or increased swelling.

Surviving HELLP depends on where you live

HELLP is a rare pregnancy complication. It's very hard to measure how common it is globally, said Peter von Dadelszen, professor of global women's health at King's College London, because in many countries there is no word in the local language for preeclampsia or HELLP.

Risk factors include: people with underlying hypertension prior to pregnancy, a family history, such as a mother who experienced high blood pressure in pregnancy, diabetes, obesity, past cases of preeclampsia, infertility treatments and autoimmune conditions, such as lupus.

Both experts, Brocato and von Dadelszen, said Black women seem more likely to develop preeclampsia.

In general, research shows that around 3% to 8% of pregnant women will experience preeclampsia. But that can vary based on a woman's location.

Brocato, who works in the state of Alabama — which has the United States' sixth highest poverty rate, sixth highest obesity rate and the third highest rate of hypertension — said the figure there is closer to 20%.

Of those women, said Brocato, around 5% of the preeclampsia patients he sees develop HELLP.

Some estimates suggest HELLP has a mortality rate of 25%. But von Dadelszen said HELLP death rates are also place-dependent.

"I've not had a maternal death in my practice in almost 40 years. That's probably just because I'm lucky rather than good, and I've seen lots of HELLP syndrome. So in high income countries, if you have HELLP syndrome and you go to [the hospital], I can almost guarantee you survive," von Dadelszen said.

"If you pitch up with HELLP in a district hospital in rural Africa, that's a less certain outcome."

Edited by: Zulfikar Abbany

American media personality Wendy Williams has been diagnosed with primary progressive aphasia and frontotemporal dementia (FTD), her care team announced in a press release on Thursday.  

"Over the past few years, questions have been raised at times about Wendy's ability to process information and many have speculated about Wendy's condition, particularly when she began to lose words, act erratically at times and have difficulty understanding financial transactions," her team wrote.  

Williams, the former host of "The Wendy Williams Show," received her diagnosis last year, according to the statement.  

Her care team explained they chose to share the news to "to raise awareness about aphasia and frontotemporal dementia."

"Unfortunately, many individuals diagnosed with aphasia and frontotemporal dementia face stigma and misunderstanding, particularly when they begin to exhibit behavioral changes but have not yet received a diagnosis," the team wrote. 

Other stars have faced the same conditions. Hollywood actor Bruce Willis announced his retirement from acting in 2022 after receiving an aphasia diagnosis. In 2023, his family also announced he had FTD.  

Aphasia affects all linguistic abilities

Aphasia is the acquired inability to formulate words or comprehend language. It can occur after damage to the left side of the brain. Aphasias are usually caused by a stroke. However, brain hemorrhages or craniocerebral injuries, like those that occur after an accident, brain tumors or inflammatory processes can also result in aphasia. From one day to the next, a person loses the ability to communicate with words.

The sudden loss of speech affects all linguistic abilities. This means speaking and understanding, as well as reading and writing are affected.

Aphasia is strictly a language disorder; thought processes or intellectual abilities are not or only slightly disturbed.

For those affected and their loved ones, the situation is extremely stressful. Patients can no longer name even the most mundane things in life. They know what an object is, but simply lack the words for it.

Different forms of aphasia

There are many types of aphasia. They can be distinguished from each other based on the extent of the damage.

Amnestic aphasia

Amnestic aphasia is the mildest form of aphasia, in which those who suffer from it have word-finding difficulties when naming objects directly. They mask the speech disorder by, for example, paraphrasing the words or using figures of speech.

Broca aphasia

People who speak in a staccato or telegram style, using very short, simple sentences or stringing together individual key words, may suffer from Broca aphasia. Although the flow of speech is strained and slowed down by the search for suitable words, the affected person can still be understood comparatively well.

Wernicke aphasia

People who suffer from Wernicke aphasia form very long, convoluted sentences in which individual passages are sometimes repeated. Those affected seem to speak fluently, but it is very difficult for them to find the right words, and often their sentences do not make sense. That makes them difficult to understand.

Global aphasia

People with global aphasia often speak only single words or repeat the same phrases. With this, the most severe form of aphasia, the patient can hardly be understood at all.

Therapy partially possible

Aphasia, an acquired speech disorder, is not irreversible, but it requires a lot of training in targeted speech therapy to learn to speak, and often also to write again.

Especially after a first stroke, about one third of the patients experience a largely normalization of speech functions within the first four weeks. After that, however, the chance of improvement declines steadily.

What is FTD? 

Frontotemporal dementia, or FTD, is an umbrella term for a group of brain diseases that impact the size of the brain's frontal and temporal lobes, which are associated with personality, behavior and language.  

When a person experiences FTD, parts of those lobes shrink. This can result in behavior that can read as socially inappropriate or impulsive, depending on which part of the brain is affected. According to the Mayo Clinic in the US, FTD generally affects people who are younger than those typically diagnosed with Alzheimer's, a disease that's often misdiagnosed as FTD. Williams is 59.  

Symptoms of FTD worsen over time. It is largely unknown what causes it, although some research has indicated a genetic link. Many patients who develop FTD are the first in their family to receive the diagnosis.  

This article was originally written in German.

Edited by: Andreas Illmer, Derrick Williams

Measles has been in decline around the world since the 1980s. The World Health Organization (WHO) says that is largely due to vaccination programs, which — in the past 20 years alone — saved more than 50 million lives.

In the 1980s, there were as many as 4 million cases of measles per year. By the early 2020s, infection rates were down to a few hundred thousand.

But measles is not gone yet. And the WHO says that that is largely due to people — especially children — not getting vaccinated: "Where children are unvaccinated, outbreaks occur."

On February 20, 2024, the WHO said more than half the world population was at risk of a measles outbreak in 2024:  "We've got these big gaps in our immunization programs and if we don't fill them really quickly with the vaccine, measles will just jump into that gap," said the WHO's Natasha Crowcroft, a Senior Technical Adviser on Measles and Rubella, at a press briefing.

That follows an earlier analysis (February 16, 2024) from the European Centre for Disease Prevention and Control (ECDC) which said measles vaccination rates have been "sub-optimal."

According  to the ECDC, measles cases were expected to continue increasing in the European Union and European Economic Area in the coming months due to sub-optimal vaccination coverage for measles-containing vaccines (MCV).

The health authority also said there was a "high probability of importation [of measles] from areas experiencing high circulation and […] the coming months represent the seasonal peak of the virus."

"Nobody should die from measles. Vaccines are a safe and effective way to […] avoid unnecessary loss of life," said the ECDC’s Director, Andrea Ammon.

Decrease in vaccinations during the COVID-19 pandemic

Measles is highly contagious and potentially deadly, but there is no specific treatment. So prevention through vaccination is seen as the best way to stop it spread.

But, then, the COVID-19 pandemic put a dent in those efforts, and we've seen a spike in cases as a result.

The US Centers for Disease Control and Prevention (CDC) writes that about 61 million doses of measles vaccine were postponed or missed during the first two years of the pandemic.

That tallies with other data from the WHO that states an estimated 128,000 people died due to measles in 2021, and most were unvaccinated or insufficiently vaccinated children under the age of 5 years.

What is measles and who is most at risk?

Measles is a disease caused by a virus that can cause pneumonia, diarrhea, deafness, blindness, brain damage, and in the worst cases death.

It is often described in combination with rubella and mumps because the illnesses they cause are similar. Children can also get a vaccine that protects against all three viral infections together.

Anyone can get infected with measles but children are most at risk.

The WHO says refugees are also at a particularly high risk of measles. Take, for instance, the Gaza Strip in the Palestinian Territory: The UN's International Children's Emergency Fund (UNICEF) has highlighted its concern about the spread of measles, as well as other preventable diseases like polio.

Nearly 19,000 children in Gaza — living among "1.9 million internally displaced people" — have missed routine vaccinations since October 2023 because of fighting in the region. 

Measles outbreaks: Where is it spreading now?

In a joint report published in November 2023, the WHO and CDC said that deaths due to measles had risen by 40% that year.

John Vertefeuille, the director of the CDC's Global Immunization Division, described the increase as "staggering, but unfortunately, not unexpected given the declining vaccination rates we've seen in the past few years."

Its spread in 2023 led to epidemics in 37 countries and made 9 million children sick. The disease killed 136,00 people, mostly in poorer countries, said the WHO and CDC.

They are calling on health systems to ramp up their vaccination efforts, including in richer regions such as the United States and Europe.

In Europe, measles cases rose to more than 42,000 in 2023 — a 45-fold increase over the previous year.

How do you get infected with measles?

As with many other viral infections, a common route of "transmission" is via coughs and sneezes — "droplets."

But it can also spread in poorly ventilated rooms because the virus remains active and contagious in the air, and on surfaces, for up to two hours.

The WHO says the virus can spread from one infected person to a further nine out of 10 unvaccinated people, with whom the infected person has close contact. Vaccinated people are protected from the virus.

Symptoms are similar to those of a common cold — high fever, cough, runny nose — but are specially characterized by the appearance of a rash all over the body.  

Prevention: The measles vaccine

The measles vaccine can be given alone, but is often combined with vaccines for mumps, rubella and/or varicella (chickenpox) — that's the so-called "MMR" jab.

The WHO recommends that children receive two doses of the vaccine to ensure immunity — two shots, irrespective of whether it's a measles-only vaccine or the combined MMR jab.

How is measles treated in patients?

There is no treatment for measles. But health experts say patients should rest, drink plenty of water to prevent dehydration, especially if they experience diarrhea or vomiting, and can take painkillers if required.

Doctors may also prescribe antibiotics to treat associated conditions, such as pneumonia, and ear and eye infections.

But since measles is a virus, antibiotics — which only fight bacterial infections — will not fight off a measles infection. And misuse of antibiotics is leading to growing antimicrobial resistance, rendering the drugs useless.

So, all you can do is let the virus run its course.

Edited by: Fred Schwaller

Editor's note: This article was originally published February 1, 2024, and was updated February 16, 2024, to include comments from the European Centre for Disease Prevention and Control (ECDC).

"I wanted a nose job since turning 13. I heard Turkish doctors were good at them. A few girlfriends of mine had similar surgeries; they were very satisfied."

Benita Paloja, a 28-year-old woman from the US, decided to do as her friends had done and flew to Turkey to get cosmetic surgery on her nose. She says she paid just $5,000 (€4,600) and was able to fly home a week later.

Paloja, who works in the finance industry and as a part-time model, is pleased she had the surgery. She says she feels more confident today and has been hired for more modelling gigs.

She also enthusiastically recalls the comprehensive care she received at the clinic. She says she is still in touch with the medical team. "I could have had the same surgery in the US for $30,000 (€27,800), though I certainly wouldn't have received the kind of attention and care I did in Turkey," says Paloja.

Turkey has seen a medical tourism boom since the COVID-19 pandemic. In 2021, over 670,000 foreigners visited Turkey to receive medical treatment, according to the country's state-owned International Health Services (USHAS) agency. One year later, that number rose to over 1.25 million, an increase of 88%. In the first six months of 2023, the figures remained similarly high. 

Turkish health care facilities are generating considerable revenue from this international business, totaling more than $2 billion (€1.85 billion) in 2022. Revenue fell slightly in the first half of 2023, though experts believe this was primarily due to Turkey's devastating February earthquake, which claimed the lives of more than 50,000 people.

Germans top the list

In 2022, most foreigners seeking medical treatment in Turkey hailed from Germany, followed by Britain and Switzerland, according to the International Society of Aesthetic Plastic Surgery (ISAPS). Botox and hyaluronic acid treatments for combating wrinkles were the most popular nonsurgical procedures among foreigners in Turkey. The top three surgical procedures were liposuction, rhinoplasty and breast augmentation.

Turkey has also become ever more attractive for leg lengthening procedures. It is especially popular with men from the West who want to be taller.

One of those who underwent the procedure is 31-year-old Ash (not his actual name) from the US, who until recently was dissatisfied with his body proportions. After undergoing surgery, he has gained 12 centimeters (4.7 inches) in height and is now 184 centimeters (just over 6 feet) tall.

Ash says he feels much better now, though he admits that "it was a very painful procedure and the recovery phase took an incredibly long time." Even so, he says it was worth it. Ash says his chances when flirting have improved, and he now enjoys more respect from others. 

Suffering for beauty's sake

Yunus Oc, an experienced Istanbul-based orthopedic surgeon, says he has performed more than 200 leg lengthening procedures in the past two years alone.

"I used to mainly perform this procedure for medical reasons following accidents or because of growth disorders or short stature," he says. In recent years, however, more and more people have sought him out for cosmetic rather than medical reasons, Oc says.

He thinks the number of these surgeries will continue to rise over the next three to five years. But he warns that, unlike with nose or breast surgeries, leg lengthening procedures can have very serious consequences if the desired results are not achieved.

There has been a growing number of reports about complications resulting from cosmetic surgery performed in Turkey. A year ago, Germany's public health agency, the Robert Koch Institute, reported that some 27 people had suffered poisoning following a botox stomach treatment. The procedure involves injecting botox into the stomach lining to create a prolonged feeling of satiety. The treatment caused serious side effects in some patients, including muscle weakness, blurred vision, breathing difficulties and sometimes paralysis.

In mid-January, a Brazilian butt lift had deadly consequences for a British woman. The mother of three went to Istanbul for the cosmetic surgery and suffered a fatal heart attack four days later that was triggered by a fat embolism, according to British media. The procedure involves removing fat from the patient's body and using it plump up and enlarge the buttocks.

Experts urge caution

Do such incidents indicate that Turkish doctors or clinics are not professional enough?

Dr. Susanne Punsmann, an expert with the North Rhine-Westphalia Consumer Advice Center in Germany, advises against generalizations, saying "there are good and bad [health care] facilities in Turkey, just like everywhere else."

Punsmann points out that the title of "cosmetic surgeon" is not protected by law, which is why she recommends that anyone interested in getting treatment in Turkey thoroughly check the doctors' qualifications or find out how often they have already performed the planned procedure.

Punsmann also says that doctors with the relevant qualifications are known as "specialists in plastic and aesthetic surgery." She adds, however, that "other doctors — usually surgeons, dermatologists or gynecologists — are also allowed to perform cosmetic surgery."

She says it is also important to check whether the doctor or clinic is certified according to European standards, such as the ISO standards, indicating that the clinic is regularly inspected, among other things. Patients should also find out about the materials or laboratory used, according to Punsmann.

Ali Ihsan Okten of the Turkish Medical Association (TTB) says one should be careful about noncertified clinics. He warns that the health tourism boom is causing an increasing commercialization of the industry.

The market is highly competitive. Clincs are using aggressive advertising tactics, sending out text and WhatsApp messages and promoting their low prices to attract customers around the world.

"The key criterion for getting treatment in Turkey is often the low cost," says Punsmann. "Savings of up to 70% are possible."

She says that while a breast augmentation procedure will cost at least €4,500 ($4,800) in Germany, such a procedure can be had for as little as €2,500 ($2,700) in Turkey. In Düsseldorf, Germany, getting a surgical procedure to reduce the size of one's stomach costs around €12,500 ($13,400), whereas in Turkey it costs only a third of that price.

This means you can save a lot of money in Turkey, especially on expensive procedures. But these savings may increase the willingness of some people to take greater risks. 

This article was translated from German

Conjunctivitis, also known as the "pink eye" or "red eye" disease, which has been spreading across East Africa, appears to have hit Kenya the hardest.

Most cases have been reported along the Kenyan coast, but there have also been reports of infections in Tanzania, Uganda and Rwanda.

Viruses, bacteria and allergens cause inflammation of tissue lining the eyelid and give eyes the appearance of being bloodshot. Symptoms include swollen or reddened eyes, persistent pain and a yellowish discharge.

How is 'red eye' spread?

Conjunctivitis can spread rapidly, and is quick to infect children, who then pass it onto adults. Close contact or sharing personal items with infected people can pass the illness on more easily.

While initially confined to Tanzania, and coastal Kenyan areas such as Kilifi, the infection has spread, even causing Kenya Railways to issue an advisory.  

Marsabit county in north-western Kenya, which borders Ethiopia, also confirmed cases of conjunctivitis.

In the Kenyan capital Nairobi, victims of the illness like Rashid Abdi, told DW that it could cause severe discomfort. 

"When I returned from work, I was perfectly healthy. My child hugged me, calling out 'daddy, daddy,' but I could see he was in pain, his eyes infected," Abdi said.

"That very night, I started experiencing symptoms myself. Neither my son or I slept well; we were both in discomfort. By the next morning, even my wife had caught the infection."

Abdi told DW that some of his relatives from coastal Kenya had advised him to use boiled tea leaves or ocean water as remedies, but both methods proved ineffective.

Health professionals warn against unproven cures

Health officials stress the importance of preventive measures, such as regular handwashing and avoiding eye contact, to curb further transmission.

"You are supposed to use normal eye drops or boric acid which is perfect. It will just clear but in case somebody feels like the eye is sticky and there are discharges then he needs to go to a clinic nearby," said Nairobi-based Dr. Abdalla Deleno, who urged people to only use proper medication. 

"We've already started school health programs where all our public health officers are in the schools and sensitize the communities around," he added.

Cases have surfaced in major cities across East Africa. Kenya's government spokesman, Isaac Mwaura, advised people to  "frequently wash their hands and keep off touching their face, disinfect well-used touch surfaces and not share personal items like towels." Mwaura also advised infected indiviuals to self-isolate. 

Conjunctivitis, while uncomfortable and visually noticeable, is not considered a dangerous illness, although symptoms of the eye infection could result from deeper-lying health problems.

This article has been adapted from a radio report that was originally broadcast on DW's daily podcast AfricaLink

German prosecutors said on Wednesday that they had charged a sixth suspect in an alleged far-right plot to kidnap Health Minister Karl Lauterbach over COVID-19 restrictions. Prosecutors added that the groups also allegedly intended to overthrow the government as a whole.

The 61-year-old male suspect was charged with "the preparation of a treasonous enterprise and membership in a terrorist organization," Frankfurt prosecutors said in a statement.

Five other people from the group, which called itself "United Patriots," have already been charged in connection with the alleged plot and went on trial in the western city of Koblenz in May 2023.

What is the man suspected of doing?

The man charged Wednesday, who comes from the central western state of Hesse, allegedly "participated in meetings of the group and worked on the concretization of the plans."

The plans reportedly included strikes on the energy grid to cause a prolonged power outage that would provide cover for a coup attempt, investigators said.

The latest suspect also said he was ready to help kidnap Lauterbach, according to prosecutors.

The alleged plotters envisaged abducting the health minister "at gunpoint," while potentially killing his bodyguards, prosecutors said. 

In addition, the suspect allegedly offered the use of his garage as a weapons store for the group. 

The man also offered to "sail" to Russia after the planned coup "as a member of a delegation to negotiate an 'alliance' with Russian state authorities and to procure military equipment," prosecutors said. 

Opposition to democracy

The alleged plot was envisaged during the coronavirus pandemic, during which many far-right activists vigorously opposed the government's measures to rein in infections.

Lauterbach, in particular, was a much-hated figure in the scene because of his vehement support for many of the restrictions imposed.

The government's actions appear to have reinforced the view among a number of far-right groups, including the so-called Reichsbürger, of which the "United Patriots" are an offshoot, that the Federal Republic of Germany is an illegitimate institution.

The "United Patriots," like the Reichsbürger, aimed to replace the government with an authoritarian system, in this case, one "modelled on the constitution of the German Empire of 1871," investigators said.

tj/sms (dpa, AFP) 

While you're here: Every Tuesday, DW editors round up what is happening in German politics and society. You can sign up here for the weekly email newsletter Berlin Briefing.

It was one of the biggest challenges since World War II, and not just for the German government. In early 2020, the COVID-19 pandemic resulted in the suspension of some basic rights and lockdowns around the world. Schools, kindergartens, and many businesses were forced to close temporarily. And once vaccines finally became available in mid-2021, there was tremendous public pressure to make sure everyone was vaccinated.

Now, four years later, there is a debate underway in Germany about how to come to terms with this intense period and the political decisions that were made. Many politicians are calling for an "Enquête-Commission," a committee appointed by the Bundestag, consisting of members of parliament and experts, which would eventually present its findings publicly.

Jens Spahn and the question of forgiveness

Jens Spahn, Angela Merkel's health minister during the pandemic and a senior figure in the conservative Christian Democratic Union (CDU), knew that the pandemic would have lasting consequences when he said in the Bundestag in April 2020: "In a few months' time, we will probably have a lot to forgive each other for."

Indeed, the negative effects of the pandemic are still being felt today. Many people still suffer from the debilitating symptoms of long-COVID, and many businesses, especially small ones, never survived the lockdown. And there is almost unanimous agreement among politicians that they were too strict, especially with children and young people.

One such politician is Janosch Dahmen, a doctor and member of parliament for the Green Party. "On the whole, Germany fared well during the pandemic, considering its very old population," he told DW. "The very strict measures taken during the first wave, when there was no vaccination and too little protective equipment, were particularly instrumental in saving lives."

Dahmen also pointed out that numerous research institutions, including bodies such as the German Ethics Council, have already taken stock of the pandemic in numerous reports. He believes that it would make little sense for the Bundestag to set up yet another committee: "Neither an Enquête-Commission or a Special Committee, which doesn't include experts, would be the right instrument at the moment," he said. "It would primarily be misused by political parties to score points. That wouldn't help anyone."

What do people think today about the pandemic, which according to official statistics has so far resulted in 39 million infections and almost 183,000 deaths in Germany? Last week, DW conducted interviews on the streets of Berlin, asking what went well and what went wrong during the pandemic.

"It was a difficult situation, so there was probably no one right solution. Decisions had to be made," one man, Mr. Weidinger, said. "But I thought that total isolation and confinement at home was too harsh." Most of all, Jacquelina remembered the hostility between those who opposed vaccination and those who supported it: "People who didn't allow themselves to be vaccinated, which included me, were put through a lot publicly and portrayed as conspiracy theorists."

Neyran, meanwhile, is still angry that many people, including politicians, made a fortune during the pandemic, for example in the frantic search for millions of masks: "There was so much scheming and too much hiding. A lot of people made a lot of money, but what can be done about it now? I think an investigation would just be throwing a lot of money away again. And for what purpose?"

Leading politicians call for a public appraisal

Current Health Minister Karl Lauterbach, a Social Democrat, has said he wouldn't want to hinder an evaluation process, and Economy Minister Robert Habeck has also said he could also warm to the idea: "I don't think it's slanderous at all to say that the pandemic needs to be reviewed and reassessed," the Green Party politician said in Berlin.

Michael Kretschmer, the Christian Democrat state premier of Saxony, remembers how any criticism of the hardline course taken by the government of Chancellor Angela Merkel was considered unacceptable: "I got so much scorn from the other parties when I tried to talk to those who were critical at the time. It was clear to me that there can't be just one opinion in a democracy."

For Malu Dreyer, state premier of Rhineland-Palatinate, it was the young and the elderly who suffered the most in the pandemic, far too much: "With the knowledge we have today, I think we can say that in our efforts to protect human life, we asked too much of children and young people in particular, as well as those at the end of their lives who were unable to say goodbye to their loved ones due to contact restrictions," she said recently.

If Germany does indeed begin to examine the lessons of the pandemic, it will be one of the first countries to do so. And one thing is already certain: The disruption caused by COVID-19 was far greater elsewhere. Just over two weeks ago, the UN Development Program (UNDP) presented a report in Berlin that also discussed the impact of the pandemic, particularly on the world's poorest countries. Presenting the report, UNDP Director Achim Steiner said: "Since the shock of COVID, which turned economies and societies upside down, we have made progress overall. But more than half of the world's poorest countries are not recovering. They are stuck at pre-crisis levels, and in some cases have even fallen behind."

While you're here: Every Tuesday, DW editors round up what is happening in German politics and society. You can sign up here for the weekly email newsletter Berlin Briefing. 

 

"Somebody tells you 'God, you look terrible, are you going to be sick?' and then suddenly you are," said Charlotte Blease, recalling a recent bus trip in Ireland, from Belfast to Dublin. "You have this expectancy and it ramps up the symptoms."

Blease ― a health researcher at Uppsala University, Sweden, and one of the authors of "The Nocebo Effect: When Words Make You Sick" ― was feeling nauseous with motion sickness. 

She was trying to distract herself with any other thought, and knew that if someone interrupted her, it would trigger the nocebo effect. 

"The nocebo effect [is] negative health outcomes that arise from negative expectations," Blease told DW. It can exacerbate feelings of pain, anxiety, nausea and fatigue.

Nocebo: Not placebo

The nocebo effect is the negative mirror image of the placebo effect.

Imagine a medical trial. One group is given a real medication to treat headaches. The other group gets sugar pills, without an active ingredient.

When patients in this second group report an alleviation of their headaches, doctors say the patients are experiencing a placebo effect ― because they thought they were taking painkillers, like the patients in group one, positive thinking led to a positive outcome in their treatment.

It's a medically recognized phenomenon. And the nocebo effect is slowly gaining a similar recognition by health professionals, except it's the exact opposite: it's when negative thinking influences your outcomes, negatively.

Nocebo effect, COVID and vaccine hesitancy

During the coronavirus pandemic, researchers found that people's expectations before a COVID-19 vaccination could be linked to how they felt afterwards.

A team of scientists from Israel and the UK looked at a group of 756 Israeli adults over the age of 60 years. Each had received a booster shot ― a third vaccine against COVID-19.

"We measured both vaccine hesitancy ― one's negative attitude or expectations towards the vaccine ― and the number of subjectively reported side effects," said Yaakov Hoffman, lead author of the study and a professor in the Department of Social and Health Sciences at Bar-Ilan University, Israel.

Published in the journal Scientific Reports in December 2022, their results indicated that people who had negative expectations before their second shot were more likely to experience side effects after their third.

"The more anxiety about the vaccine, its safety and its side effects [one felt], the greater one would actually experience side effects," Hoffman told DW. 

And when the nocebo effect and vaccine hesitancy were combined, he said, it had the potential to become a vicious circle: A person who was hesitant to get vaccinated, perhaps because they had read about side effects online, would be more likely to experience side effects. Those side effects would then be recorded and reported by their doctor. That, in turn, would contribute to more media coverage about side effects, and more people feeling hesitant about vaccines… and so on, and so on.

How doctors deal with the nocebo effect

Talking to patients without triggering the nocebo effect can be a challenge.

"Doctors are obligated not to harm the patient, or to mitigate harm where possible, but they also have an obligation to tell the truth," said Blease.

In the case of a vaccine with relatively minor side effects, said Hoffman, addressing the nocebo effect head-on could make sense.

"Perhaps it's better to call a spade a spade and say, 'There's a certain percent of side effects which you are experiencing that are nocebo effects. Which means you are really experiencing them, but it doesn't necessarily signify danger,'" he said.

Hoffman stressed, however, that this was only speculation and that further research was needed to provide firm evidence.

Importance of framing health information

Other experts in the field agree the way that doctors communicate with patients can help prevent nocebo effects.

"How doctors talk to patients can influence therapy outcomes," said Ulrike Bingel, a clinical neurosciences professor who heads a pain research unit at University Hospital Essen, Germany.

"So far, communication has been mostly viewed as a feel-good issue. We need a higher awareness of how crucial it is," Bingel said.

When it comes to vaccines, for example, doctors are required to disclose any possible side effects.

But instead of rattling off a list of side effects that might scare a patient, Bingel said doctors should frame side effects as a sign that the immune system is working well.

This way, the patient might have fewer negative expectations and experience fewer or less-pronounced side effects.

Nocebo effect may be evolutionary

But how can negative ideas in our mind affect what's going on in our body?

First, it's important to understand that the nocebo effect is real. It's not a figment of a patient's ― pessimistic — imagination. 

"The nocebo and placebo effects involve complex neuroscientific processes," Bingel told DW. "When you're experiencing a nocebo effect, your body stops pumping its pain brakes. Your brain receives more brain impulses and you feel more pain."

The problem is, researchers can't explain why this happens. Not yet. But they do believe it may have something to do with our evolution.

"It was important that our ancestors learned from coming into contact with a wild animal or a poisonous plant," said Bingel. "The body [got] prepared for next time."

In other words, an early human's negative expectations would have prepared them, just in case they had to run for their lives.

"The nocebo effect could be a hangover from the past," said Blease, [but] that's a mismatch for today's modern medical environment."

Edited by: Zulfikar Abbany

Sources:

The Nocebo Effect: When Words Make You Sick by Michael Bernstein, Charlotte Blease, Cosima Locher, Walter Brown. Mayo Clinic Press, March 19, 2024.

Vaccine hesitancy prospectively predicts nocebo side-effects following COVID-19 vaccination by Y.S.G. Hoffman, Y. Levin, Y. Palgi et al. Scientific Reports, 2022: https://doi.org/10.1038/s41598-022-21434-7

GirlZ Off Mute is a video and radio format produced in English, French, Kiswahili, Portuguese, Hausa, and Amharic. 

GirlZ Off Mute: DW launches girl reporter series in four African languages

In the 1990s, charities, governments and individual philanthropists invested billions of dollars into one goal: malaria control. They wanted to halve the global number of malaria deaths by 2010.

At the time, malaria represented one of the biggest health threats in the world. At least 1 million people were dying of the disease each year, the vast majority of them young children.

The "Roll Back Malaria" campaign officially launched in 1998. With billions of dollars in funding from global organizations like the World Health Organization and World Bank, partners started dispersing mosquito bed nets and indoor insecticide sprays in affected regions. They also introduced new drugs to treat patients in areas where the mosquitoes had grown resistant to chloroquine, the main antimalarial used at the time.

These efforts worked to nearly halve the number of malaria deaths in less than two decades.

Stagnation, then sharp increase in malaria case numbers

But in 2015, things started to stagnate. For the next few years, estimated cases stayed the same ― and then they started to rise.

In 2020, global malaria deaths hit their highest level in six years. And in 2022, the number of estimated global malaria cases shot up to more than 248 million, from around 230 million in 2014 .

These disappointing estimates prompted Nicholas White, a malaria scientist and professor of tropical medicine at the University of Oxford, to publish an appeal to the WHO in the Lancet medical journal. According to their own numbers, he said, the number of estimated malaria cases in 2000 were the exact same as the 2022 figure.

If this was true, he said, what was going wrong? Was it really the case that after billions of dollars of global investment, years of research on preventative therapies and the disbursement of billions of treatments, the number of cases had not budged?

The WHO responded to White's question, saying he had falsely interpreted the numbers because he hadn't taken global population growth into account.

"If the global malaria incidence and mortality rate in 2000 were applied to populations at risk annually to 2020, the investments made over the past 20 years would have contributed to an estimated 11 million lives saved and 1.7 billion cases averted since 2000," the WHO wrote.

Still, the organization acknowledged in the headline of their response that "the message on malaria is clear: progress has stalled."

'Arms race' to control malaria

The reasons for this stall are "complex," the organization said. In its response to White, it explained that sub-Saharan Africa, the area most threatened by malaria, is seeing less funding for interventions and a lack of access to quality care. Available tools are compromised by "biological threats," they said.

Experts consulted by DW said it's likely the stagnation is due, at least in part, to the ability of malaria-spreading mosquitoes to quickly adapt to and circumvent interventions.

Across the globe, many of the mosquitoes which spread malaria have become resistant to the main insecticide used. In some regions, the parasite which causes malaria has become resistant to the drugs used to treat the disease, Jackie Cook, a co-director of the Malaria Center at the London School of Hygiene and Tropical Medicine, told DW.

Additionally, a new mosquito, the Anopheles stephensi, has emerged in East Africa over the past 10 years. Unlike other malaria vectors, it is able to spread in cities, posing a threat to populations living in tight urban areas.

"Malaria control, you have to see it as an arms race," Umberto D'Alessandro, a malaria researcher and leader of the London School of Hygiene and Tropical Medicine's medical research unit in Gambia, told DW.

As quickly as insecticide sprays, medications or rapid tests are developed, the mosquitoes or parasites adapt, he said. "It's a continuous search for intervention."

On top of this, researchers said, malaria research funding is down. In 2022, the most recent year available on record, funding for malaria research and development reached its lowest recorded level in the past 15 years, according to the WHO.

"In 2007, Bill and Melinda Gates announced they wanted it [malaria] eliminated... in their lifetime, which I think is extremely unlikely, but there was a big push to try and do that," said Cook. "Obviously there have been successes, but I think people are starting to realize it's not going to be a very straightforward thing."

Calling for an in-depth look into malaria crisis

White, the malaria researcher at Oxford, pushed back on the idea that the stagnation can be conclusively explained by vector ability to quickly circumvent interventions.

"There's been no in-depth analysis, at least that I'm aware of — and I should be aware of it — which really explains why they estimate malaria has got worse since 2015," White told DW, speaking about the WHO's malaria case estimates.

He said he suspects much of the stagnation is related to factors that are not under the gambit of health systems, like "war, privation and economic downturn" and things, he said, "that nobody wants to talk about, such as corruption and inefficiencies."

DW approached the WHO for a comment. They referred the question to the author of the response to White, Abdisalan Noor, who is no longer working at the WHO. He did not respond to a request for comment.

In its 2023 world malaria report, the WHO attributed the stagnation in the 11 most-affected countries to limited access to health care, ongoing conflicts, COVID's effect on service delivery, lack of funding and issues with interventions, like insecticide resistance.

Vaccines are also starting to play a role in the fight against the disease. Two malaria vaccines, the RTS,S and the R21/Matrix M, have been approved by the WHO so far. Distribution of the RTS,S has already begun, while the rollout of the R21 is set to start in May 2024. Experts are optimistic, but have warned that vaccination is not a silver bullet. 

Edited by: Carla Bleiker

The International Atomic Energy Agency (IAEA) has repeatedly raised concerns about the war in Ukraine and the threats it poses to the Zaporizhzhia nuclear power plant (ZNPP), and the risks it sees for the people who live in the area.

In April 2024, more than two years since taking control of the ZNPP, IAEA director-general Rafael Grossi said his agency had been able to confirm three attacks against the Zaporizhzhia nuclear power plant since the start of the month.

"These reckless attacks must cease immediately," Grossi told the United Nations Security Council. "Though, fortunately, they have not led to a radiological incident this time, they significantly increase the risk where nuclear safety is already compromised."

Earlier risks to Zaporizhzhia safety

The ZNPP is located in the southeast of the country on the banks of the Dnipro River.

When the Kakhovka dam was blown up in June 2023, the IAEA said the severe damage had led to "a significant reduction in the level of the reservoir used to supply cooling water to the ZNPP."

Water is essential for cooling residual heat from the ZNPP reactors and its spent fuel ponds and for cooling emergency diesel power generators at the site.

The explosion at the Kakhovka dam came after missile strikes in March 2023 had caused outages and left the plant running on those emergency diesel generators.

That backup power supply is itself vital for cooling reactor fuel at the plant and preventing a nuclear meltdown, which would release dangerous thermal energy and radiation into the atmosphere.

Russian forces reportedly evacuated more than 1,500 people in the area by force in May 2023.

Nuclear poses two threats in the Russia-Ukraine war

When people think about nuclear threats and the war in Ukraine, most consider two possibilities: What would happen if an accident occurred at a Ukrainian nuclear plant? And what would happen if a nuclear weapon were deployed?

For this article, which was originally published in 2022 and has been updated regularly to reflect developments in the war, we talked to experts about the health impact the Fukushima and Chernobyl disasters had on surrounding populations and asked them to explain the degree to which those disasters might provide a framework for our current understanding of risk at Zaporizhzhia.

In a second article, we explained the health effects linked to the detonation of nuclear weapons at Hiroshima and Nagasaki and also look at what could happen if nuclear weapons were detonated in today's world.

Zaporizhzhia under occupation

Ukraine's Zaporizhzhia power plant is located close to the country's southern border. Zaporizhzhia is Europe's largest nuclear power plant, with six reactors on site. In 2022, it became the first active nuclear plant in history to continue operations in the midst of a war.

When occupying forces seized the plant in March 2022, experts tried to weigh up how a potential accident there would compare with the 1986 Chernobyl disaster — an event that for decades marked the worst nuclear power accident in history. The Chernobyl meltdown released radiation across Europe, affecting the lives of humans, plants and animals throughout the region.

Over 30 plant workers died in the three months following the disaster at the Soviet power station Chernobyl as a direct result of the meltdown.

A report published by the Chernobyl Forum, a group of UN agencies formed in 2003 to assess the health and environmental consequences of the accident, suggested in 2006 that it will cause at least 4,000 cancer deaths in the long term, although that estimate is contested.

Did Soviet officials try to downplay the aftermath of Chernobyl?

Some experts, including Massachusetts Institute of Technology (MIT) professor Kate Brown, say Soviet officials concealed the impact of the disaster in an attempt to downplay its severity.

Brown has conducted extensive research on the impact radiation has had on people's health in Ukraine and surrounding countries since the 1986 accident.

In a Greenpeace report published in 2006, researchers estimated the predicted death toll at around 90,000 — nearly 23 times the number suggested by the Chernobyl Forum report.

Edwin Lyman, a physicist and director of Nuclear Power Safety with the US-based Union of Concerned Scientists, said he, "doesn't consider the Chernobyl Forum report to be authoritative."

Lyman said the Forum's report based its cancer death predictions only on cases within the former Soviet Union, ignoring exposure to populations in other parts of Europe and the northern hemisphere. The original Chernobyl health impact report conducted by UN agencies and published in 1988 did address the global exposure to radiation in response to the accident and estimated it would ultimately correspond to 30,000 or more cancer deaths, Lyman said.

"The fundamental issue is whether one believes that low-level exposures will cause cancer or not — and the worldwide expert consensus is that they do. The Chernobyl Forum essentially assumed otherwise," he said, calling the study a "highly political document with conclusions that were carefully massaged to minimize the impacts of the accident."

Studies following the survivors of the Chernobyl disaster have shown an increase in cases of thyroid cancer. In the decades following the accident, researchers detected rates of that particular condition in young people in the former Soviet Union that were around three times higher than expected. Studies reported that this increase is partly attributed to the consumption of tainted milk.

However, according to Lyman, the large studies outlining overall cancer risk were published in the early 2000s, at a time when many cancers that could have been triggered by the Chernobyl disaster may not yet have started showing up. And nearly 20 years later, there hasn't been any comprehensive follow-up to these reports.

Reports on the disaster's health impact also note high rates of depression and anxiety in the surrounding population.

Fukushima — a better comparison

Lyman said any fallout from an accident at the Zaporizhzhia power plant would have more in common with the fallout from the 2011 Fukushima nuclear disaster in Japan.

"The consequences that led to such a large and wide dispersal of radioactive activity [at Chernobyl] are probably less likely to occur at the reactors at Zaporizhzhia, which are light water reactors more similar to the reactors in Germany or elsewhere in the West," he said.

The nuclear accident in Fukushima marks the only other disaster at a plant that has been rated a "seven" on the IAEA's International Nuclear Event Scale.

It was generated by a powerful tsunami and earthquake that caused the plant to lose power, prompting three nuclear meltdowns, hydrogen explosions and extensive radiation releases from the facility.

Official reports have concluded that although many people died in the tsunami and earthquake, none died in direct response to the nuclear incident. Aside from radiation sickness experienced by people in the direct vicinity, they say, the biggest health impact has been the psychological stress people nearby experienced when they were evacuated.

Today, researchers say the Fukushima incident has left only a negligible mark on the surrounding environment because much of the radiation was released into the nearby sea.

"Zaporizhzhia is landlocked, so that wouldn't be the case. But still, you would expect probably less radioactive material released and dispersed less widely," Lyman said.

Lyman added that the level of radiation a potential accident at Zaporizhzhia could release would depend on whether the accident was technical, such as a response to the facility losing power for multiple days, or otherwise related to combat, in which case the radiation would be released more quickly. In a situation like that, the severity of any consequences would probably fall somewhere in between that of what happened at Chernobyl and what happened at Fukushima, he said.

"I think the likelihood of another Chernobyl-like event affecting Germany is lower," he said. "There would probably be measurable impacts, but not as great as what was experienced in 1986."

Ukraine's other reactors also present a risk

Zaporizhzhia drew a lot of attention when it came under direct Russian control.

But Lyman said he was also concerned about the other plants in Ukraine, including the inactive one at Chernobyl and three other active sites, which are older than Zaporizhzhia. That makes them even more susceptible to catastrophic failure in the event of an accident.

"There are three other nuclear plants in Ukraine that are closer to the western border. So, they're away from the front, but they're still within range of Russian rocket fire or drones," said Lyman.

He said that although none of those reactors was the same model as those at Chernobyl, some are older Soviet light-water reactors that wouldn't be as resistant to an attack as the plant at Zaporizhzhia.

"If things unravel and it becomes more affordable to attack, that could be a greater concern to Western Europe," he said.

Edited by: Derrick Williams and Carla Bleiker

This article was originally published on November 8, 2022. It was last updated April 16, 2024, to reflect developments in the Russia-Ukraine war and renewed concern over the stability of the Zaporizhzhia nuclear power plant. It is the first of two articles on the threats posed by nuclear technology and weapons in the war.