The symptoms: The patient went to the emergency department after experiencing nausea and vomiting for about a month, along with decreased appetite. She told doctors that she'd also experienced a burning pain in her upper abdomen and right side of her torso, which wrapped around to her back. She'd tried treating these symptoms with two common over-the-counter medications for acid reflux, but the treatments didn't help.
In the year prior, the patient had started taking semaglutide, a type of drug known as a GLP-1 receptor agonist — the same class of drug as Ozempic. These injected drugs are used to treat type 2 diabetes and assist in chronic weight management; in this case, the woman had a history of type 2 diabetes and obesity. Since starting the medication, she'd lost about 40 pounds (18 kilograms), but notably, that weight loss had accelerated over the previous month, she noted.
What happened next: Doctors took a CT scan of the patient's abdomen and pelvis. This revealed that the bile ducts, which move bile from the liver to the gallbladder and small intestine, were slightly dilated. The woman also had "heavy stool burden" but no signs of obstructions in her bowels, and her stomach was slightly stretched out due to carrying "semisolid material."
To take a closer look, the medical team then used magnetic resonance cholangiopancreatography, a noninvasive scan that examines the bile ducts, gallbladder, pancreas and pancreatic ducts. The scan confirmed that the bile ducts were dilated and revealed a mass in the stomach that appeared to be trapped air. The doctors then examined the upper digestive tract, from the esophagus to the top of the small intestine, with an endoscope.
The diagnosis: The endoscopy revealed a large mass in the woman's stomach, known as a gastric bezoar. These masses are tightly packed blobs of partially digested or undigested materials.
The treatment: Semaglutide and other GLP-1 agonists typically cause delayed gastric emptying, which means they slow the rate at which the stomach empties its contents into the intestines. The woman was taken off that medication upon hospital admission.
The next step with a bezoar is to try and dissolve the mass while it's still in the stomach — and evidence suggests a good way to do this is to give the patient soda.
"Existing evidence, largely from case series and anecdotal experiences, supports the administration of 3 liters [0.8 gallons] of cola, either orally or through a nasogastric tube, within a 12-hour window," doctors noted in a report of the case. "It is not well understood whether acidity, carbonation, or another mechanism accounts for dissolution of the bezoar."
Due to the patient's history of diabetes, she was given diet cola. She also didn't enjoy carbonated beverages, so the typical prescription of 3 liters of soda was cut down to 1.5 liters (0.4 gallons). On the second day after starting this treatment, the patient noted a "tugging" sensation in her abdomen followed by relief of her nausea and abdominal discomfort. An endoscopic exam revealed that the bezoar was no longer stuck in her stomach.
The woman then transitioned to a typical diet in the hospital, and by the time she was discharged, she had no nausea, vomiting or abdominal pain. She did not restart semaglutide but was prescribed acid reflux medication to take daily. She reported that her appetite increased after hospital discharge and her weight rebounded a bit over the following months. Her abdominal symptoms had not returned within a few months of discharge.
What makes the case unique: Gastric bezoars are fairly rare, the report noted. They are found in less than 0.5% of endoscopies of the upper digestive tract. Common symptoms of the condition, such as pain, nausea, vomiting and abdominal discomfort, also appear in many more-common disorders, so they don't necessarily point to the presence of a bezoar in all cases.
The most common type of gastric bezoar is formed of plant fibers and called a "phytobezoar." Eating lots of certain foods, such as persimmons, pineapples, raisins or celery, can raise the risk of phytobezoars because the plants contain a high concentration of indigestible components, such as cellulose, lignins and certain tannins.
However, various medical conditions, procedures and drugs can also raise the risk of bezoars. These include anatomical changes related to bariatric or other gastric surgeries, autonomic nerve damage, and medications that cause delayed gastric emptying, such as GLP-1s. In the woman's case, semaglutide was likely to blame for her bezoar, and discontinuing the treatment helped resolve the problem.
The cola she consumed also helped. Although that course of treatment sounds strange on paper, it is the preferred first-line treatment over using a scope to physically break up the bezoar in the patient's stomach.
"Bezoars formed from food material may be initially managed with oral administration of cola in patients in a clinically stable condition," the report said. "This intervention is generally cost-effective and is associated with a lower risk of complications than invasive procedures."
The Stargazer figurine was carved from marble around 5,000 years ago. (Image credit: Cleveland Museum of Art / Leonard C. Hanna Jr. Fund; John L. Severance Fund 1993.165 (Public Domain))
QUICK FACTS
Name: The Stargazer
What it is: A marble figurine
Where it is from: Kırşehir, Turkey
When it was made: Circa 3000 B.C.
This small, abstract sculpture of a woman, carved from milky-white marble, is known as The Stargazer because her head is tilted back and her eyes appear to stare skyward. Only about 30 figurines of this type have ever been found; all of them date to about 3000 B.C. and were crafted by a culture that left no written records of the figurines' meaning, according to art historian Amanda Mikolic.
This particular stargazer figurine was once owned by philanthropist Nelson Rockefeller, a member of the wealthy industrial family and vice president of the United States under Gerald Ford. It is now in the collection of the Cleveland Museum of Art (CMA).
The marble figurine is roughly 6.8 inches (17.2 centimeters) tall and weighs about 1 pound (454 grams). Clearly carved into human form but lacking a mouth, the statuette likely represents a woman, with the incised lines below the waist representing her pubic triangle. Her large, oval head is tilted back, and her tiny, dot-like eyes look upward.
Most stargazer figurines that have been discovered in western Anatolia (present-day Turkey) were broken at the neck before being buried in the ground millennia ago, making the CMA example one of the finest and most complete stargazer statuettes ever found.
But the meaning of the woman portrayed in The Stargazer figurine is unclear, since the culture that created it did not leave any written language explaining their art.
The figurine cannot stand on its own, suggesting that it was meant to be held or placed flat, according to Mikolic. "Deliberately rendered as female, she may be associated with fertility and abundance," she wrote. The statuette may be part of a trend of simplistic female figurines in the Mediterranean area linked to female fertility and the life cycle, such as the Cycladic figurines, according to The Getty, which has a stargazer figurine in its collection.
Regardless of the woman's specific meaning, "she must have been an important devotional object to some long-lost culture," Arielle Kozloff, former curator of ancient art at the CMA, wrote in the CMA Members Magazine.
Abstract female figurines like The Stargazer and other Neolithic examples are known to have inspired early-20th-century cubist masters, Kozloff wrote. This gives her "a sense of timelessness," according to Mikolic, "encouraging the viewer to think of humankind’s place and role in a larger cosmos."
For more stunning archaeological discoveries, check out our Astonishing Artifacts archives.
The space telescope detected a specific absorption line in the spectra of these worlds' atmospheres, revealing the characteristic trace of a unique and unknown molecule. It's unclear exactly what the molecule could be, and the mystery is made even more compelling by the fact that the environments of Pluto and Titan are very distinct.
China is no stranger to engineering projects designed to bring its environment to heel; we've recently covered the Asian powerhouse's attempts to tame nature through the creation of atmospheric rivers, the world's biggest dam and water transfers. But these are hardly China's only forays into sculpting its natural environment, with the country having planted more than 66 billion trees along its northern borders to halt the advance of the Gobi and Taklamakan deserts.
Now, new research has revealed a startling detail about the trees in this "Great Green Wall": they're growing significantly faster than natural forests. Exactly why remains a mystery, but, as Live Science contributor Brian Owens reveals, it could be due to a stronger response from the trees to rising atmospheric carbon dioxide.
Are you a robot? It used to be a question that only humans could answer — by clicking on traffic lights or strings of warped and grainy characters, or Completely Automated Public Turing tests to tell Computers and Humans Apart (CAPTCHAs). But what happens now that autonomous artificial intelligence (AI) agents can ace some of these trials without detection? Have they made CAPTCHAs obsolete?
The Medici family ruled Renaissance Tuscany with an iron fist, fulfilling their ruthless ambitions with methods so underhand that the name of their most famous advisor, Niccolò Machiavelli, became a synonym for skulduggery.
So, when two brothers from the infamous family died under mysterious circumstances, it was believed for 500 years that they were murdered, possibly by arsenic poisoning. Now, science has revealed the true culprit behind the medieval cold case, and it's not what we expected.
Antibiotic resistance is a growing threat in the U.S., with more than 2.8 million Americans developing antimicrobial-resistant infections each year. The solutions to this worrying trend can be very complex— such as moving agricultural systems away from their overreliance on antibiotics, or preventing the rapid spread of superbugs through international travel.
But stopping doctors from overprescribing antibiotics is one of the easiest strategies in the battle against this "silent pandemic." And it turns out that Japan has already fought it with some success, driving down antibiotic overuse with an innovative new policy. To investigate further and ask what notes the U.S. should be taking, Live Science's health editor Nicoletta Lanese visited Japan and reported back on their investigation.
Something for the weekend
If you're looking for things to keep you busy over the weekend, here are a smattering of our best expert opinion pieces, alongside a crossword, an interview and a quiz, that we published this week.
If you ask me, it looks more like a rusty anchor, or a blurry deep-sea fish. But whichever way you see it, the newly discovered "bow and arrow" galaxy — or, more formally, the RAD-Bow-And-Arrow Radio Galaxy (RAD-BAARG) — is an oddball unlike any other recorded.
The galaxy's unique structure is likely the result of gravity, which is warping RAD-BAARG into a funhouse mirror version of its former self as it falls into a nearby galaxy cluster. A shock front from this plunge surrounds the galaxy as it moves through hot gas.
While scanning one of Scotland's richest prehistoric landscapes, archaeologists uncovered evidence of what may be a newfound stone or timber circle buried beneath a peat moorland. The find may add another monument to a ceremonial structure that has fascinated researchers for more than a century.
The possible circle lies beneath the surface of Machrie Moor on Scotland's Isle of Arran, a landscape already famous for its towering standing stones, burial monuments and ceremonial sites dating to between roughly 3500 and 1500 B.C. Researchers from Historic Environment Scotland identified the possible circle using geophysical survey equipment, which is wheeled aboveground and detects subtle magnetic changes underground without disturbing any archaeological remains.
The discovery emerged from a survey designed to test how well modern archaeological instruments work in peat-covered landscapes, but instead the project revealed the unexpected subterranean circle.
"We know that there is a lot of archaeology yet to uncover at Machrie Moor, but the discovery of a new circle completely surpassed our expectations," Nick Hannon, senior heritage recording manager at Historic Environment Scotland, said in a statement released June 30.
While Stonehenge is the world's most famous prehistoric circle, it is only one monument among hundreds built across Britain and mainland Europe during the Neolithic and Bronze ages. Machrie Moor is among the best-preserved examples of these ritual landscapes, with six ceremonial circles already identified since the 1980s.
In fact, the archaeologists found there was more to learn about some of the previously known circles. At Machrie Moor Circle 2, for instance, the team identified a ring of anomalies suggesting the circle may have had 14 stones instead of the seven or eight previously reconstructed.
An excavation of Circle 11 from the 1985 excavation. Circle 11 has been dated to the Bronze Age. (Image credit: Historic Environment Scotland)
The circles also share a striking orientation: They align with a notch at the head of nearby Machrie Glen where the midsummer sun would have risen, which suggesting astronomical observations may have played a role in ceremonies held there.
Archaeological anomalies
Unlike the circles that had already been discovered at the site, the newly detected monument has not been excavated yet. Instead, researchers identified a ring of magnetic anomalies — subtle disturbances in the soil that often indicate archaeological features such as pits or postholes.
According to the survey report, the feature consists of 12 circular, pit-like anomalies arranged in a circle approximately 92 feet (28 meters) across. The pits are spaced around 21 feet (6.5 m) apart, with two unusually wide gaps that the researchers say could represent the locations of two additional pits that are now decayed. If so, the monument may have originally contained 14 posts or standing stones.
"There is no indication that any of these anomalies contain a stone" at this time, the researchers noted in the report, so the circle could have been built from either timber posts or standing stones that were later removed.
An ancient circle believed to be from the Bronze Age at Machrie Moor in Scotland, looking northward. (Image credit: Historic Environment Scotland)
Previous excavations have already revealed that several of the other stone circles at Machrie Moor were originally built as timber circles before the wooden posts were replaced with stones around 2000 B.C. Human cremations and bodily burials were later placed within some of the circles, suggesting the monuments' functions changed over time.
"It is likely that the newly-discovered circle dates from a similar period as the other circles still standing," representatives of Historic Environment Scotland said in the statement.
See how much you know about Stonehenge with our Stonehenge quiz!
Life on Earth could continue for another 1.8 billion years, according to new research. This figure, which is based on complex climate models, is far longer than many previous studies indicated.
In the new study, published May 28 in the journal JGR Atmospheres, researchers suggest that plant life could continue about 1.8 billion years into the future. That nears the time when Earth would lose its oceans to space, either through radiation splitting water atoms or runaway evaporation, in about 2 billion years.
"We were trying to show that life on Earth — complex vegetation — could survive longer into the future than previous studies had shown," study co-author Jacob Haqq-Misra, an astrobiologist at space exploration charity Blue Marble Space, told Live Science.
The boundaries of life
Life on Earth relies on photosynthesis, the process used by plants, algae and some bacteria to turn sunlight into energy. The mechanism chemically converts carbon dioxide and water into sugars and oxygen. It requires both CO2 and sunlight.
But at certain temperatures, plants' photosynthetic machinery shuts down. Eventually, the sun will warm Earth to the point that plants are no longer able to photosynthesize, which would in turn cause entire food webs to collapse and all life to perish.
Another issue is that as the sun dies and it gets brighter, there will be less carbon dioxide in the atmosphere, effectively starving plants.
Plants turn sunlight into energy, but at certain temperatures this ability shuts down. (Image credit: lamyai via Getty Images)
"The Earth has stayed pretty hospitable in terms of surface temperature for most of the last 4 billion years because it has a built-in thermostat" by storing CO2 in rocks and releasing it during volcanic eruptions, Robert Graham, a planetary science researcher at the University of Chicago, who was not involved in the research, told Live science.
When it is hotter, the planet pulls more carbon dioxide out of the atmosphere and stores it in rocks underground, Graham said. This offsets the warming to keep the temperature stable but means that the carbon dioxide isn't accessible to plants.
Climate models and extreme plants
In the new study, Haqq-Misra and colleague Eric Wolf, a research scientist at Blue Marble Space, used 29 climate models to estimate what would happen to Earth's vegetative biosphere under different scenarios. They used the two extreme cases as limits — when Earth is too hot for life but the CO2 was stable; and when there is not enough CO2, but the temperature was stable. They then looked at the range of CO2 and sunlight conditions in between those extremes. This enabled them to include situations in which Earth was very efficient at pulling carbon from the atmosphere when temperatures started rising.
They also included information about a variety of plants. Some plants can survive on a much lower ratio of atmospheric CO2 than others. The study included plants that have a special photosynthetic process (known as crassulacean acid metabolism), such as succulents and orchids. These plants can sustain themselves on relatively tiny amounts of CO2. The same is true of some marine plants, which can dissolve and access carbon in the ocean system.
Other experts were impressed by the findings.
"Haqq-Misra and Wolf have used a sophisticated 3D climate model to show that Earth's climate may remain hospitable to plant life significantly longer into the future than predicted" by simpler models, said Graham, who authored one of those earlier studies. "It's an advance over previous work and suggests that complex biospheres like that of Earth are more resilient to environmental change from stellar brightening than previously suggested."
Looking to the future
Andrew Rushby, an astrobiologist at Birkbeck University of London who was not involved in the research, told Live Science that the paper updated the concept of the lifetime of the biosphere. However, he cautioned that the results remained "broad estimates."
"It is not possible for us to predict or know the possible evolutionary adaptations that the photosynthetic biosphere may undergo in response to increasing solar output and lower [atmospheric CO2], especially over billions of years," he said.
In their paper, the authors wrote that "limits posed by thermal stress or starvation may only reflect our observations of the biosphere today rather than hard limits on how the biosphere may evolve." There is also no way of knowing how life might adapt to new circumstances.
Haqq-Misra said that he found the results comforting. "Earth's system is resilient, and we are part of something that could have a much, much longer future," he said.
The results could also help scientists figure out what the thresholds could be on other planets. "Part of the challenge is starting with these Earth-based models, and then generalizing the physics as much as possible to be able to simulate a wider range of atmospheres," he said.
How much do you know about our blue planet? Test your terran knowledge with our Earth quiz!
'A silent pandemic': How Japan is curbing antibiotic resistance, $5 at a time
Antimicrobial resistance is a "silent pandemic," posing huge threats to public health while raising little attention. To curb resistance, doctors must use antibiotics sparingly and responsibly. This report is the first in a series comparing antibiotic use in Japan and the United States, with a focus on outpatient pediatrics. It was supported by a reporting fellowship from the Association of Health Care Journalists and The Commonwealth Fund.
About a decade ago, the Japanese government spotted a worrying pattern: Pediatricians were doling out a ton of antibiotics, well beyond what should be needed to treat the bacterial infections coming through their doors.
Antibiotics treat bacterial infections, not those caused by viruses, fungi or parasites. Yet doctors were often sending young patients home with antibiotics for illnesses unlikely to be bacterial. Treating nonbacterial infections with antibiotics can fuel antimicrobial resistance (AMR) and the rise of superbugs by unnecessarily exposing bacteria to the drugs, pressuring those bacteria to evolve strategies to survive. Resistant bacteria can then spread their adaptations to others, thereby compounding the problem.
In the long run, resistance could make common infections impossible to treat with existing drugs, raising the risk of serious illness and death across the population.
When pediatricians in Japan did treat bacterial infections, they were overusing the antibiotics that are likely to fuel resistance — "broad-spectrum" drugs that target many bacteria at once. When compared against 35 other high-income countries in 2015, Japan ranked dead last in the appropriateness of antibiotic choices for kids under 5.
One way to slow the development of AMR is to get antibiotic prescriptions under control. So Japan focused on one of its biggest sources of problematic antibiotic use: pediatric outpatient clinics.
"The clinics are a particular problem," said Dr. Yusuke Okubo, chief of clinical epidemiology and health services research at the National Center for Child Health and Development, a research center and hospital in Tokyo. Looking at Japan's overall antibiotic use, "90% of prescriptions are [from] outpatient clinics, not hospitals," Okubo told me. (Outpatient practices account for a similar proportion of antibiotic prescriptions in the U.S.)
A large proportion of problematic prescriptions were being written for children under 3 years old, especially those with upper respiratory tract infections, which nine times out of 10 are caused by viruses, Okubo said. The stomach bug gastroenteritis was another biggie for overprescription, despite most often being caused by a virus.
Government officials hatched an idea: What if each time a pediatrician chose not to prescribe an antibiotic in these cases, they earned a small financial reward — a tip for making a better choice? Each tip would be small, amounting to about $5 per claim at today's exchange rate, but could translate to thousands of extra dollars of annual income for individual clinics. That's no small matter for Japanese pediatricians, who Okubo estimates earn roughly $90,000 to $100,000 a year.
This incentive program, rolled out in 2018, has proved a success, so much so that it's since been expanded to cover more patients, more clinics and a wider variety of diseases. But what made the program work? I went to Japan to find out what systemic and cultural factors contributed to the program's success. Ultimately, I wanted to see whether other countries, like the U.S., could learn from this nationwide experiment.
Japanese pediatricians historically overused antibiotics, but an insurance policy is helping to change that. (Image credit: Susumu Yoshioka via Getty Images)
The quietly rising threat of resistance
With bacteria, as with animals, it's survival of the fittest. When exposed to antibiotics, a percentage of bacteria die, while others survive. That surviving population has traits that help them withstand the drug's effects, which are encoded in "resistance genes." Bacteria can transfer those genes to the next generation by multiplying, as well as physically pass those genes to nearby bacteria. Plus, they can pick up new resistance genes through random DNA mutations.
All antibiotics come with the risk of pressuring bacteria to evolve resistance — it's an inherent feature of the drugs. However, broad-spectrum drugs carry the greatest risk, because they place pressure on a wider variety of bacteria than narrow-spectrum drugs do. The 2015 cross-country comparison found that Japanese doctors prescribed antibiotics with the lowest risk of resistance only 35% of the time, meaning most antibiotic prescriptions were for broader-spectrum drugs.
It's sometimes necessary to use broad-spectrum drugs — such as when an infection is resistant to narrow-spectrum options — but using broad-spectrum antibiotics when they're not needed hastens the development of AMR. So does using antibiotics for nonbacterial infections. In both scenarios, you're introducing evolutionary pressure that could have otherwise been avoided.
Data showed that pediatricians in Japan often prescribed antibiotics for common childhood infections that were likely viral. Overprescription was a particularly big problem for children under 3. (Image credit: recep-bg via Getty Images)
Japan's youngest residents are also at risk, though, as resistant bacteria can sometimes pass from mothers to newborns at birth and can cause serious complications, like sepsis. Resistance has also been detected among respiratory bugs that frequently infect kids, such as Mycoplasma pneumoniae, said Dr. Takemi Murai, deputy head of the Infectious Diseases Division at Nagano Children's Hospital in Azumino. "There have been outbreaks of Mycoplasma that are resistant to antibiotics," he said.
Yet not long ago, the unrestrained use of antibiotics was a mainstay of Japanese medicine. (I'll dig into the myriad reasons why in later installments of this series.)
National insurance data sampled from 2005 showed that 60% of patients in Japan with nonbacterial upper respiratory tract infections were prescribed antibiotics, mostly broad-spectrum ones like third-generation cephalosporins, macrolides and quinolones. Most of those prescriptions came from clinics.
Something had to shift.
Tips for appropriate treatment
In 2016, Japan got serious about reducing its antibiotic misuse, releasing its first National Action Plan on Antimicrobial Resistance. It aligned with a global plan from the World Health Organization, which aimed to raise awareness of AMR and optimize the use of antimicrobials, including antibiotics, among its member states.
Two of Japan's big goals were to slash overall antibiotic use by 33% and broad-spectrum antibiotic use by 50% by 2020. The country came very close to hitting those ambitious targets by the deadline, and doing so was no small feat. The tipping program was just one of a slew of initiatives introduced to improve AMR awareness and antibiotic use.
The Japanese government created posters to raise awareness of AMR. This example features the popular anime character Amuro Ray, whose first name is similar to "AMR," so his inclusion in the campaign plays off of a pun. (Image credit: Courtesy of Dr. Yusuke Okubo)
Prior to the incentive's introduction, Japan's Ministry of Health, Labour and Welfare (MHLW) — whose role is somewhat analogous to the U.S. Department of Health and Human Services — rolled out educational campaigns for doctors and patients and wrote a manual for antibiotic use, with the first edition directed primarily at outpatient doctors. It emphasized that most acute respiratory tract infections and acute diarrheal diseases don't require antibiotics.
Among kids, children under 5 saw the highest antibiotic prescription rates, often receiving the drugs for respiratory infections. Data showed this overprescription problem was the worst in children under 3 being assessed for upper respiratory infections or acute gastroenteritis. The government's solution? Pay doctors extra to withhold antibiotics when faced with cases that don't warrant them.
"If the clinicians provide more appropriate medical services, we add additional payment," said Dr. Takuma Kato, a counselor at the Permanent Mission of Japan to the United Nations who previously worked on the incentive program for MHLW. In this case, they pay "a little bit more" when doctors don't give patients antibiotics for illnesses that are likely viral, he said.
A "little bit more" is accurate. Each tip is 800 yen, equivalent to about $7.20 when the program launched in April 2018 and about $5 at today's exchange rate.
Here's how it works: A caregiver brings in their sick infant or toddler for an initial visit, and the pediatrician determines the child likely has an acute upper respiratory tract infection or gastroenteritis. These illnesses are typically caused by viruses, so the doctor decides not to provide an antibiotic. The doctor explains this rationale to the caregiver and provides guidance for home care. If the appointment checks those boxes, the clinic can claim an extra 800 yen when they seek reimbursement.
Because mild viral infections typically resolve on their own in a few days, a strategy called "watchful waiting" can help clarify if a bacterium is actually at fault. So if a doctor does prescribe an antibiotic at the first visit, they'll often encourage the caregiver to bring the child back if their condition remains the same or worsens within a few days. The incentive and this "waiting" strategy go hand in hand.
There are a few technicalities. For example, the children being assessed must have no underlying conditions that might complicate their case, such as a weakened immune system. If children test positive on a formal diagnostic test for influenza or COVID-19, the incentive cannot be claimed. To qualify for the incentive, clinics must specialize in pediatrics and use a "comprehensive" payment system, meaning patients pay a standardized amount for the whole appointment rather than the itemized "fee for service" that is ubiquitous in the U.S.
Despite this fine print, the perk is pretty appealing for the clinics that claim it. "I think pediatric doctor associations are really happy," Okubo said.
Doctors say "small incentives add up"
The Japanese government generally incentivizes doctors to adjust their behaviors, rather than penalizing them for poor practices, Okubo said.
"It's a constructive message from the government: 'You changed your behavior, so we'll pay something,'" Okubo said. "This constructive approach motivates physicians, especially pediatricians, to apply their common sense to their actual practice."
This system is readily accepted by Japanese doctors, who have historically held a lot of political power, Kato noted. Just like in the U.S., their professional groups, such as the Japan Medical Association, lobby the government and typically push against policy proposals that they view as potential threats to their bottom line.
By contrast, an incentivizing approach is "very, very welcome, especially by the doctors' associations," said Dr. Norio Ohmagari, director of disease control and prevention at the National Center for Global Health and Medicine, part of the Japan Institute for Health Security (JIHS) in Tokyo. Ohmagari also leads the AMR Clinical Reference Center, which collaborates with the WHO on AMR countermeasures.
Dr. Yusuke Shibata has been treating patients at the Shibata Pediatric Clinic in Tokyo since the 1990s. He appreciates the incentive in that it both boosts his profits and aligns with his stance that the careless use of antibiotics should be avoided. (Image credit: Nicoletta Lanese)
Doctors I asked confirmed that they like the incentive, namely because it boosts their profits.
"I apply for the pediatric antibiotic appropriate use support premium each time" it's applicable, said Dr. Yusuke Shibata, who runs the Shibata Pediatric Clinic in Asakusa, a historic district in Tokyo's Taito ward. "I appreciate the premium, as pediatric clinics already have low profits" compared with clinics that care for adults, Shibata told me in an email after I visited his clinic.
For first visits with kids under 6, clinics are paid a base rate of 6,040 to 7,210 yen, or about $38 to $45 at current exchange rates. An extra 800 yen (about $5) increases that fee by more than 10% — "a huge amount," Okubo emphasized.
Shibata estimates that his clinic sees about 30 to 40 patients with an acute respiratory infection or diarrhea each week, depending on the season. He can potentially claim the incentive for the first visit with each of these patients, assuming they don't have any conditions that would disqualify the claim.
On the high end, Shibata estimates that he might claim the incentive 180 times in a single busy month, which would total 144,000 yen, or about $900.
Dr. Atsushi Miyahara of the Karugamo Clinic in Tokyo frequently claims the antibiotic incentive. He's long been careful about antibiotic use, and the incentive rewards him for those efforts. (Image credit: Nicoletta Lanese)
Dr. Atsushi Miyahara, who runs the Karugamo Clinic in the Setagaya ward in Tokyo, said he was already conservative about using antibiotics so the incentive rewards him for sticking with his status quo.
Fifteen years ago, when Miyahara opened his clinic, he noticed that other physicians prescribed a lot of antibiotics, and he questioned the practice due to the potential to fuel resistance. He provides his patients with informational flyers that explain the risks of resistance and how avoiding unnecessary prescriptions can reduce that risk. When antibiotics are needed, he predominantly uses narrow-spectrum drugs that pose a relatively low risk of resistance.
Miyahara said the local government and medical associations announced the antibiotic incentive when it was launched, and he felt its introduction has been very positive. It's increased his revenue and encouraged him to continue his stewardship practices. He estimates that for every 50 of his first visits with patients, he claims the incentive 10 to 15 times, so it applies to at least 20% of those visits.
An informational flyer Dr. Atsushi Miyahara provides to his clients. It states that the clinic takes measures against AMR, explaining that antibiotics are not used for viral illnesses, and for bacterial infections, the narrowest-spectrum options are prioritized. (Image credit: Nicoletta Lanese)
The incentive's impact
Because some pediatric clinics qualified and others didn't — due to fee-for-service clinics being excluded — Okubo and his colleagues could directly measure whether the policy worked.
To assess the incentive's effects in its first year, the researchers looked at insurance claims from over 10,000 medical facilities from just before and after the policy's introduction. About 3,000 of the facilities qualified and claimed the incentive 316,770 times, totaling 253 million yen ($2.29 million at the time). These eligible clinics saw a 17.8% reduction in their total antibiotic use over a year without any negative effects for patients, such as higher hospitalization rates.
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To see if those effects lasted, the team drew years of data from over 165,000 young children who went to either eligible or ineligible clinics. Within the first month of the policy's implementation, the former group of children saw a nearly 45% reduction in total antibiotic prescriptions, compared with the other kids. Cumulatively over the next four years, their overall antibiotic use and broad-spectrum-antibiotic use was 20% and 24% lower, respectively.
The decrease in antibiotic prescriptions did not come with an uptick in hospitalizations or healthcare costs, although there was a slight increase in the total number of doctor's visits. But that's what you'd expect as doctors track an infection over time, Okubo explained, meaning they likely employed the watchful-waiting strategy and had parents bring their kids back in if they didn't improve quickly.
Okubo's team has continued to track pediatricians' antibiotic use, and he noted that they're seeing "spillover effects" among age groups not covered by the incentive. In the under-20 age group, outpatient antibiotic prescriptions fell by 50% between 2011 and 2022. He thinks the incentive is a key driver of this trend, directly reducing prescriptions for the youngest kids while also triggering ripple effects in older groups. (This research will soon be published in a peer-reviewed journal.)
That said, there's room to improve doctors' selection of antibiotics when they are used, as the ratio of broad- to narrow-spectrum drugs is still too high. "Total antibiotic use was reduced, but its quality should be improved further," Okubo said.
Okubo conducts research at the National Center for Child Health and Development in Tokyo. As a research center and Japan's largest children's hospital, it aims to deepen the understanding of children's health and development while providing advanced medical care. (Image credit: Nicoletta Lanese)
The incentive's evolution
While the 800-yen tip has proved significant to clinicians, the incentive represents a very small slice of overall government healthcare spending, which totaled 468 billion yen ($3.1 billion) in 2022.
"This program is not large compared to the whole budget," Dr. Kosuke Sasaki, who works in the MHLW's health insurance bureau, told me. The program's budget has no upper limit, so if the number of claims from clinics increased, there isn't a cap on how many could be paid out. "The number of doctors using this program has increased while the number of antibiotic prescriptions has decreased since the start," Sasaki's colleague Dr. Tomonori Aoki added, noting that the government isn't concerned about how to pay that rising bill.
The program's measurable impact and low price tag may explain its growth over the years.
Every two years, Japan's Ministry of Finance hands the MHLW its slice of the government budget, and MHLW then revises the pricing for drugs, medical devices and healthcare services. The antibiotic incentive falls under this revision process and has been expanded several times.
The Ministry of Health, Labour and Welfare is housed in an unremarkable building in Central Tokyo. It sets the prices for pharmaceuticals, medical devices and healthcare services nationwide. (Image credit: Nicoletta Lanese)
During its first revision in 2020, the incentive was extended to children under 6. In 2022, ear, nose and throat specialists (ENTs) newly qualified for the incentive; like pediatricians, they treat many acute infections in kids and tend to overuse antibiotics, insurance data suggested. That same year, doctors could start claiming the fee for ear infections and sinus infections.
"I see a tendency for pediatric clinics to avoid prescribing antibiotics, but I do see some ENT clinics prescribing antibiotics carelessly," Shibata, the clinic owner in Asakusa, Tokyo, told me. So ENTs seem to be a logical next target.
In 2024, a separate, facility-level incentive was introduced as a complement to the 800-yen incentive. It encourages clinics to submit data to a government database that tracks antibiotic use. If first-line, narrow-spectrum antibiotics make up a certain percentage of the clinic's overall prescriptions, that clinic earns extra money, Okubo explained.
Ultimately, the 800-yen incentive helped put AMR on the radar of doctors who didn't take it as seriously as experts like Kato, who told me "AMR is kind of my life's work." Kato and researchers like Okubo see the program as a success, although they pointed to room for improvement in antibiotic selection. Ministry officials like Sasaki and Aoki said the program is easy to implement and makes a difference. Clinic doctors like Shibata and Miyahara appreciate the incentive and use it consistently. All in all, at just $5 a claim, the incentive has been remarkably effective.
In speaking with experts in Japan and the U.S., I've learned that U.S. doctors have historically faced the same pressures and showed similar lapses in antibiotic use that Japanese doctors have. However, the U.S. does not have an incentive program like Japan's. Should it launch one?
In the next installment of this series, I'll explore a central feature of this problem: the motivations behind pediatricians' antibiotic misuse. What are they, and do those motivations differ between doctors in the U.S. and Japan? Answers to those questions will help determine whether a similar incentive might have the same impact in both places.
Homer's "Iliad" and "Odyssey" have inspired countless books, movies and works of art in the nearly three millennia since the epic tales were first written. This small, bronze sculpture, once attached to an ancient box, shows how the Greek epics influenced the aesthetics of the enigmatic Etruscans.
The Sleep and Death cista handle, which is in the collection of the Cleveland Museum of Art, features a set of bronze figurines welded to form a decorative handle for a cista — a small, cylindrical, lidded box used for a variety of purposes in ancient Egypt, Greece, Rome and Etruria, an ancient region in central Italy.
The handle is roughly 7.3 inches long and 7.2 inches tall (18.5 by 18.3 centimeters). The figurines represent Hypnos (the Greek god of sleep) and Thanatos (the Greek god of nonviolent death) bending to lift the body of Sarpedon, one of Zeus' sons who fought in the legendary Trojan War.
Sarpedon fought on the side of Troy, leading his men into battle against the formidable Greeks, according to Book XVI of the "Iliad." The Greek hero Patroclus entered the fray wearing Achilles' armor to trick the Trojans into thinking the greatest Greek warrior had joined the fight and scare off the Trojans. Sarpedon met Patroclus on the battlefield, and even though Zeus wanted to save his son, Sarpedon was mortally wounded. The Greeks stripped Sarpedon's body of his armor, but Zeus commanded Apollo to retrieve the corpse and deliver it to twin brothers Hypnos and Thanatos, "who bear men swiftly away" (translation by A. S. Kline).
The ancient sculptor of this piece "succeeded brilliantly in capturing the pathos and emotion in a scene from Homer's 'Iliad,'" Michael Bennett, former curator of Greek and Roman art at the Cleveland Museum of Art, said in a video. And on a technical level, the piece is much more detailed than a typical Etruscan handle; this one appears to be almost ergonomically designed, as Sarpedon's limply falling hair can be used as a finger grip, according to Bennett.
But the reason the Etruscans adapted the visual aesthetic of Homeric epic to many of their artworks, such as sculptures and wall paintings, is still unclear.
Because the Etruscan language is only partly understood, most information about this civilization, which arose around 900 B.C., comes from outside sources, such as the Greek historian Herodotus, who was writing several centuries later. Herodotus believed the Etruscans came from Lydia in Asia Minor, not too far south of Troy. Coupled with the later legend that Aeneas, a Trojan hero, wandered to Italy after the war and helped found Rome, some experts, such as linguist Robert Beekes, believe the Etruscans may derive from the Trojans or groups that fought on the Trojan side. However, a 2021 genetic study found the Etruscans may have been local.
The Etruscans may have used scenes from the Trojan War to decorate their vases and bronze boxes because they felt kinship with the antagonists in the "Iliad." But they also might have adopted the aesthetics because the Trojan War was a popular theme in Greek art at the time, and vases and other works decorated in this style reached the Etruscans through extensive trade networks. The Etruscans then put their own spin on the stories of the Trojan War, focusing in particular on scenes of death and brutality, classical archaeologist Larissa Bonfante argued in "Etruscan Myths" (2006, British Museum Press).
For more stunning archaeological discoveries, check out our Astonishing Artifacts archives.
During several recent conversations, people have told me that they've stopped checking their phones in the morning. Not because nothing was happening, but because everything was. They described the feeling as standing under a waterfall of perpetual bad news.
Globally, 40% report they at least sometimes or often do the same, the highest figure ever recorded. People shared consistent reasons for this: the news put them in a bad mood, they felt overwhelmed and powerless to act.
As a researcher in developmental psychology, focusing on social development and psychological well-being, I argue that news fatigue is not laziness, weakness or a generational decline in civic interest. It's the predictable response of a human brain meeting an environment it was never designed to navigate.
Wired for bad news
Long before smartphones or even the printing press, our cognitive architecture was shaped by a single problem: stay alive long enough to reproduce. Our ancestors whose attention drifted past the rustle in the grass left fewer descendants than those who froze, looked and listened.
The brain that paid attention to threats was the brain that survived.
This is the foundation of what psychologists call the negativity bias, one of the most replicated findings in cognitive science. Across decades of research, the human mind has been shown to weigh negative information more heavily than positive, attend to it faster and remember it longer.
A predator nearby mattered more than a beautiful sunset. The cost of missing a real threat was death, while the cost of overreacting was a few minutes of wasted vigilance. The asymmetry made this bias adaptive.
Here is the problem: the human brain has not changed since then. We are the same species as we were thousands of years ago. What's changed is the size of the world it's asked to scan for threats.
News fatigue is not laziness, weakness or a generational decline in civic interest. It is the predictable response of a human brain meeting an environment it was never designed to navigate. (Image credit: pzAxe via Getty Images)
Scanning the whole world
For most of human history, the threats our nervous system processed were local. A neighbouring tribe. A drought. The illness of a child we personally knew. Information about distant places would barely arrive, and if it did, it was mainly irrelevant.
In 2026, the same neurological system is being asked to absorb a war in one region, a financial shock in another, a climate disaster in a third and a violent crime in a fourth, all before lunchtime.
A study published in the scientific journal Nature Human Behaviour examined more than 105,000 real news headlines viewed nearly six million times. Each additional negative word increased click-through rates, while positive words had the opposite effect.
It's crucial to recognize the tactics meant to exploit our negative biases and create cognitive distance (Image credit: cbies/Shutterstock.com)
Recent studies suggest people around the world demonstrate measurably stronger physiological responses to negative news than to positive news. The body is reacting before the mind has decided whether the threat is relevant.
Some researchers have introduced a clinical framework for what happens in this instance called Problematic News Consumption (PNC) — a pattern of news engagement that results in preoccupation, dysregulation and disruption to daily functioning. In their 2022 study, the researchers found that 17% of American adults qualified as having severe levels of PNC. Among that group, 61% reported feeling unwell quite a bit or very much, compared with 6% of those who didn't.
For minority populations, news fatigue may be even more consequential.
Repeatedly witnessing harm directed at our own groups, even when we're not the immediate target, can have a significant psychological impact on people from the same group affiliation. For racialized communities, such as immigrants, the cognitive load could be even heavier, and the option to simply stop watching is much harder to exercise when the news is about their country of origin.
Looking away is not the fix
What's the solution to news fatigue? Well, it's not avoidance. A democracy depends on informed citizens.
Many adults already cite the spread of misleading information as a major source of stress. Withdrawing from accurate, trustworthy information only deepens the problem. We're wired to pay more attention to bad news, and that kind of content will find its way to us one way or another.
The fix is to manage the consumption and the sources.
Several approaches can help manage news fatigue and protect mental health. Containing news consumption to defined windows of time reduces the sense of being overwhelmed. Choosing depth over volume also matters: one carefully reported long-form article will inform you better than bursts of random, unreliable and emotionally loaded posts on Instagram.
There is also value in distinguishing between information and action — research on perceived control and stress consistently shows that the gap between awareness and agency is one of the strongest predictors of psychological distress. Identifying what you can actually do about what you read in the news, however small, regulates that response.
Finally, be wary of "rage bait" — intentionally provocative messages or content designed to boost engagement on social media platforms by eliciting negative reactions. Recognizing that certain content creators want to provoke rather than reflect reality creates useful cognitive distance.
The news will not become less "heavy." But our relationship with it can become more deliberate. Our brains were not built for this scale of input. They were, however, built to learn to adapt.
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