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Modern medicine has its scientific roots in the Middle Ages − how the logic of vulture brain remedies and bloodletting lives on today

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Modern medicine has its scientific roots in the Middle Ages − how the logic of vulture brain remedies and bloodletting lives on today

This 15th-century medical manuscript shows different colors of urine alongside the ailments they signify.
Cambridge University Library, CC BY-NC

Meg Leja, Binghamton University, State University of New York

Nothing calls to mind nonsensical treatments and bizarre religious healing rituals as easily as the notion of Dark Age medicine. “The Saturday Night ” sketch Medieval Barber Theodoric of York says it all with its portrayal of a quack doctor who insists on extracting pints of his patients’ blood in a dirty little .

Though the skit relies on dubious stereotypes, it’s true that many cures from the Middle Ages sound utterly ridiculous – consider a list written around 800 C.E. of remedies derived from a decapitated vulture. Mixing its brain with oil and inserting that into the nose was thought to cure head pain, and wrapping its heart in wolf skin served as an amulet against demonic possession.

“Dark Age medicine” is a useful narrative when it comes to ingrained beliefs about medical progress. It is a period that stands as the abyss from which more enlightened thinkers freed themselves. But recent research pushes back against the depiction of the early Middle Ages as ignorant and superstitious, arguing that there is a consistency and rationality to healing practices at that time.

As a historian of the early Middle Ages, roughly 400 to 1000 C.E., I make sense of how the societies that produced vulture medicine envisioned it as one component of a much broader array of legitimate therapies. In order to recognize “progress” in Dark Age medicine, it is essential to see the broader patterns that led a medieval scribe to copy out a set of recipes using vulture organs.

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The major innovation of the age was the articulation of a medical philosophy that validated manipulating the physical world because it was a religious duty to rationally guard the body’s health.

Reason and religion

The names of classical medical innovators like Hippocrates and Galen were well known in the early Middle Ages, but few of their texts were in circulation prior to the 13th century. Most intellectual activities in northern Europe were taking place within monasteries, where the majority of surviving medical writings from that time were written, read, discussed and likely put into practice. Scholars have assumed that religious superstition overwhelmed scientific impulse and the church dictated what constituted legitimate healing – namely, prayer, anointing with holy oil, miracles of the saints and penance for sin.

However, “human medicine” – a term affirming human agency in discovering remedies from nature – emerged in the Dark Ages. It appears again and again in a text monks at the monastery of Lorsch, Germany, wrote around the year 800 to defend ancient Greek medical learning. It insists that Hippocratic medicine was mandated by God and that doctors act as divine agents in promoting health. I argue in my recent book, “Embodying the Soul: Medicine and Religion in Carolingian Europe,” that a major innovation of that time was the creative synthesis of Christian orthodoxy with a growing belief in the importance of preventing disease.

Medieval manuscript page with an illustration of a robed physician on the left column of the page and a cross on the right column.
This ninth-century manuscript juxtaposes a physician with Christ’s cross.
Bibliothèque nationale de France, CC BY-SA

Establishing an intellectual framework for medical study was an accomplishment of early medieval scholars. Doctors the risk of being lumped together with those who dealt in sorcery and pagan folklore, a real possibility given that the who composed the Greek medical canon were pagans themselves. The early medieval scribes responsible for producing the medical books of their age crafted powerful arguments about the respectability and piety of the doctor. Their arguments manifest in illustrations that sanctified the human doctor by setting him parallel to Christ.

This sanctification was a crucial step in medicine as its own advanced degree program at the first universities that were established around 1200 in Europe. Thus began the licensing of healers: the elite “phisici” – the root of the English word “physician” – trained at the university, along with empirical practitioners like surgeons, herbalists and female healers who claimed a unique authority to treat gynecological illnesses.

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Today, religious dogmatism is often equated with vaccine hesitancy and resistance to basic scientific truths like evolution. But deeply religious thinkers of the past often saw rational medicine as an expression of faith, not something endangering it. Herbal remedies were scribbled into the margins of early medieval works on theology, history, church sacraments and more. This suggests that book owners valued such knowledge, and people of all classes were actively exchanging recipes and cures by word of mouth before writing the most useful ones down.

The body in nature

Though the Dark Ages is a period from which no case histories survive, we can still form a picture of an average healing encounter. Texts from that period emphasize the need for the doctor to be highly learned, including being well read in philosophy, logic, arithmetic and astronomy. Such knowledge enabled healers to situate their observations of sick bodies within the rules that governed the constant transformations of nature.

There was no way to perceive the internal of the body via technology – instead, healers had to be excellent listeners and observers. They sought to match the patient’s description of suffering with signs that manifested externally on the body. The inside of the flesh could not be seen, but the fluids the body excreted – sweat, urine, menstrual blood, mucus, vomit and feces – carried messages about that invisible realm to the outside. The doctor’s diagnosis and prognosis relied on reading these “excreta” in addition to sensing subtle changes in the pulse.

Medieval people were detailed investigators of the natural world and believed the same forces that shaped the landscape and the operated inside bodies formed from the same four elements of earth, , and fire. Thus, as the moon’s waxing and waning moved the ocean tides, so did it cause humors inside the body to grow and decrease.

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The way the seasons withered crops or provoked tree sap to flow might manifest in the body as yellow bile surging in the summer, and cold, wet phlegm dripping in the winter. Just as fruit and meats left untouched began to rot and putrefy, so did dregs and undigested material inside the body turn poisonous if not expelled. Standing water in ponds or lakes generated slime and smell, and so were liquids sitting stagnant in the body’s vessels seen as breeding grounds for corrupt vapors.

In this sense, the menstrual cycle was representative of all bodies, undergoing internal transformations according to seasonal cycles and periodically purged in order to release pent-up fluids.

Bloodletting is currently used as a treatment only for very specific blood disorders.

According to this logic, health depended above all on maintaining the body’s relationship to the physical and ensuring that substances were passing through their proper transformations, whether it was food turning into humors, blood disseminating throughout the body, or excess fluids and wastes leaving the body. Bloodletting was a rational therapy because it could help rebalance the fluids and remove toxins. It was visible and tangible to the patient, and, to the extent that we now better understand the placebo effect, it may well have offered some kind of relief.

Fasting, purging, tonics and, above all, monthly dietary regimens were also prominent tools healers used to prevent and relieve sickness. Several medical books, for instance, specified that consuming drinks with cinnamon in November and pennyroyal in August could recalibrate the body’s temperature in winter and summer because one drink was warming while the other was cooling.

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Some medieval remedies – such as one produced from wine, cow bile, garlic and onion to heal eye infections – were later proven to be likely effective in treating sickness. But whether these remedies worked isn’t the point. For medieval doctors, vulture brains and cow bile operated according to the same logic that continues to inform research today: Nature operates in mysterious ways, but rational deduction can unlock the hidden mechanisms of disease. The M.D. has direct roots in the Dark Age elevation of “human medicine.”

Before mocking medieval doctors, consider how popular juice cleanses and detox regimens are in the 21st century. Are we really so far from humoral medicine today?The Conversation

Meg Leja, Associate Professor of History, Binghamton University, State University of New York

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Invasive caterpillars can make aspen forests more toxic for native insects – a team of ecologists explains how

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theconversation.com – Richard L. Lindroth, Vilas Distinguished Achievement & Sorenson Professor Emeritus, of Wisconsin- – 2024-09-19 07:27:59

The aspen forest where our team conducted our recent study.
Mark R. Zierden

Richard L. Lindroth, University of Wisconsin-Madison and Patricia C. Fernandez, Universidad de Buenos Aires

When we walked with a colleague into an aspen forest near Madison, Wisconsin, in the early spring of 2021, we expected to finalize our plans for a research on several species of insects that and feed on the trees. Instead, we found a forest laden with fuzzy, brown egg masses.

These masses, belonging to an invasive species known as the spongy moth, brought our plans to a screeching stop. We knew that within weeks, hungry spongy moth caterpillars would strip the forest bare.

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A tree with two female spongy moths laying brown egg masses.
Female spongy moths lay individual egg masses, each of which contains 100 to 600 eggs.
Richard L. Lindroth

We are chemical ecologists interested in how plant chemistry influences the interactions between plants and plant-feeding insects. As seasoned scientists, we’ve seen that good science stories sometimes end up nowhere near where the researchers first anticipated. This is one of those stories. And like many good stories, it incorporates villains, beauty, poison and .

After an initial period of distressed hand-wringing about the fate of our aspen forest, we pivoted our research plans. We decided to address how defoliation – another word for leaf consumption – by an invasive species might alter the chemical composition of plants, to the detriment of native species.

All plants produce defense compounds to fend off herbivores, like insects, that try to eat them. These defenses include well-known chemicals like tannins, caffeine and cyanide. In turn, insects have evolved adaptations to these chemical defenses tailored to the particular species that they feed on.

The results from this study surprised even us and were published in September 2023 in the journal Ecology and Evolution.

The ecological players

Quaking aspen (Populus tremuloides) is the most widespread tree species in North America.

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Aspen trees with no leaves.
Caterpillars completely defoliated our aspen forest in June 2021.
Richard L. Lindroth

As a keystone species, aspen provides food and shelter for many forest organisms. Without these trees, forests across much of North America would look very different. Aspen has been ecologically successful in part because of its unique chemistry. It produces a class of defense compounds called salicinoids. Under most conditions, these defenses keep herbivores from fully defoliating the trees.

Invasive spongy moths (Lymantria dispar) are the most destructive defoliators of broadleaf forests in North America. Aspen is a favored food plant of spongy moths, which feed on expanding leaves in early summer. At high population densities, spongy moths can defoliate extensive of forest.

This spongy moth-induced carnage does not bode well for other insects that depend on aspen for food, such as the native silk moth Anthereae polyphemus, which feeds on aspen from mid- to late summer.

A moth with big spots on its wings.
An adult polyphemus silk moth.
Richard L. Lindroth

A natural experiment

From May through June 2021, spongy moth caterpillars ate nearly every green leaf in our aspen forest.

By early July, however, the trees grew another full set of leaves. A second aspen forest of the same age, located 4 miles (6 kilometers) away, experienced no defoliation.

A large cluster of hairy spongy moth caterpillars on the trunk of an aspen tree.
A congregation of spongy moth caterpillars gathered on an aspen tree in June 2021.
Mark R. Zierden

This combination of damaged and undamaged forests provided the perfect conditions for what scientists call a natural experiment. The undamaged forests served as an experimental control that we could compare with the damaged forest to evaluate the consequences of spongy moth defoliation for insects that feed in late summer.

We collected leaves from both forests in late summer and analyzed them for levels of salicinoids.

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We also fed the native polyphemus caterpillars leaves from either the defoliated or control forest to see how the defense compounds might influence their ability to live and grow.

We found that after defoliation by spongy moths, aspen trees grew a second set of leaves with much higher levels of salicinoids – an average of 8.4 times higher. In contrast, the control forest had leaves with far lower salicinoid levels, typical of aspen in late summer.

The high levels of defense compounds in the defoliated forest caused serious to the native silk moth caterpillars. Few caterpillars survived when fed leaves from the previously defoliated forest. Those that did survive had stunted growth.

Two petri dishes with a leaf and a caterpillar in each. The leaf on the left has more pieces missing.
Polyphemus caterpillars fed previously undefoliated (control) leaves ate more and were healthier than caterpillars fed the defoliated (reflush) aspen leaves.
Richard L. Lindroth

Ecological implications

Our research showed for the first time how an invasive species can harm a native species by making their shared food resource far more toxic. And this type of ecological dynamic is likely not restricted to just aspen and silk moth caterpillars.

Over 100 different species of insects and mammals feed on aspen, and our earlier research has shown that high levels of salicinoids are harmful to many of them. Other tree species, like oaks, also produce more defense compounds after spongy moth defoliation, which could affect native herbivores.

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A caterpillar on a young tree.
A polyphemus caterpillar climbing on aspen.
Richard L. Lindroth

Insects are critically important for the functioning and flourishing of all terrestrial ecosystems. But scientists have seen their numbers and diversity decline worldwide, a phenomenon called the insect apocalypse.

The causes of these declines are many, varied and far from completely known. Research like this is helping to fill that gap. Plant toxin-mediated indirect effects of invasive species appear to be yet one more cut in the death by a thousand cuts experienced by insects worldwide.

Finally, our story is one of science in action. Scientists cannot fully anticipate how natural may disrupt the best-laid research plans, especially for field projects. Floods, droughts, tornadoes, lightning strikes, insect outbreaks – our research groups have experienced them all.

Occasionally, though, researchers can counter these challenges with creative ingenuity and scientific adaptability. And those can to surprising breakthroughs in our understanding of this extraordinary world.The Conversation

Richard L. LindrothUniversity of Wisconsin-Madison and Patricia C. Fernandez, Professor of Agronomy and CONICET Scientist, Universidad de Buenos Aires

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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TRUTH in Labeling Act would heighten the warning for shoppers looking to cut sugar, salt and saturated fat intake

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theconversation.com – Kimberly Baker, Food Systems and Safety Program Team Director, Clemson – 2024-09-19 07:26:40

Only about 40% of consumers frequently read the nutrition label.
demaerre/iStock via Getty Images Plus

Kimberly Baker, Clemson University

With rising rates of obesity in the U.S. and increasing attention being paid to the health harms of processed foods, it’s clear that far more could be done to consumers make healthy food choices.

A bill known as the TRUTH in Labeling Act has been sitting before since late 2023. If passed, it would require U.S. food manufacturers to add a second nutrition label to the front of product packages, in addition to the ones currently found on the back or side panel. It would also require the label to highlight any potentially unhealthy ingredients in the product, such as the amount of sugar, sodium and saturated fat it contains.

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The proposed legislation would consumers with a standardized, easy-to-read and quick way to decide whether a product is a healthy choice. Should the bill, which is still in committee, become , the front-of-package label would be regulated by the U.S. Food and Drug Administration.

The current nutrition facts label, typically featuring more detailed nutritional information and found on a product’s side panel, would remain unchanged.

Consuming more vitamin D, calcium, iron and potassium can reduce the risks of osteoporosis, anemia and hypertension.

As a food safety extension specialist who works with farmers, entrepreneurs, manufacturers and the to help bring healthy food to shoppers, I believe that consistent front-of-package labeling would greatly benefit consumers by offering a straightforward way to compare multiple products, helping them make more informed choices.

Even if passed, it will take time for the FDA to interpret the law and standardize the design and format. And it might be years before all food manufacturers are required to use the new label. In the meantime, more than 175 million Americans are overweight or obese, and with each passing day, that number grows.

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Why the change?

The newly proposed legislation is the latest effort by lawmakers to educate the public about smart food choices. Congress began requiring standardized nutrition labels on food packages through the Nutrition Labeling and Education Act of 1990.

A black-and-white nutritional graphic that shows the sodium, saturated fat and added sugar content of a product is
The FDA has not made a final decision on the front-of-product label’s content and look, but it is testing a variety of designs, this one.
FDA

But in the 34 years since that first label appeared, the obesity rate has more than tripled; 40% of Americans are now obese. Another 31% are overweight, and diet-related chronic illnesses, including heart disease, stroke, cancer, hypertension and Type 2 diabetes are rampant. About 60% of U.S. adults – 130 million people – have at least one of these chronic illnesses.

All of these diseases are associated with consuming too much sugar, sodium or saturated fat – three key ingredients the front label will focus on.

Labels help shoppers make better choices

There’s another reason to require a second, easy-to-notice, easy-to-comprehend label. Only about 40% of Americans frequently read the existing nutrition facts label; some shoppers say they don’t understand it. A simpler label with a more direct message might help those consumers. In fact, some studies suggest front-of-package labels do assist shoppers in making smart choices.

Research shows that those who frequently read the current label tend to have healthier diets than those who don’t. For example, frequent readers are almost four times more likely than rare readers to meet the recommended daily fiber intake.

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Now the bad : Even the frequent readers met their fiber goals only about 13% of the time. That isn’t good, but it’s an improvement over the rare readers, who meet their goals a paltry 3.7% of the time.

For the record, the recommendation for fiber is 25 grams for women and 38 for men under 50; its slightly less for those over 50.

The existing nutrition facts label.
This is what the current nutrition facts label looks like. Note the serving size for this particular product is two-thirds of a cup. So if you have a 1-cup serving, you need to add 50% more to all the values listed below the serving size, including calories, fat and saturated fat.
FDA

Some foods still exempt

It’s possible you’ve already seen some front-of-package nutritional labels on food products. But these labels are not regulated by the government. Known as the “facts-up-front” labeling system, it’s strictly voluntary and a choice of the individual food manufacturer, with label designs and formats provided by the Consumer Brands Association, a trade association representing the food industry. Only a small number of manufacturers have chosen to put these labels on their products.

That said, more research is needed to know how long-term behavior may change due to front-of-package labeling. But at least one food safety advocacy organization, while supportive of front-of-package labels, says the trade association’s facts-up-front system is less than optimal.

Even if the TRUTH in Labeling Act passes as currently written, some foods could remain exempt from the nutritional label requirement, including fish, coffee, tea and spices.

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There is one caveat, however. If any product makes a nutritional or claim on its package – including those that are normally exempt – then a nutrition facts label must be on it.The Conversation

Kimberly Baker, Food Systems and Safety Program Team Director, Clemson University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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50 years after the first procedure, Tommy John surgery is more common than ever − especially for young athletes

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theconversation.com – Ted Spiker, Professor of Journalism, of Florida – 2024-09-19 07:25:43

Ted Spiker, University of Florida and Kevin W. Farmer, University of Florida

Tommy John pitched in the big leagues from 1963 to 1989 and won 288 . Only 25 MLB pitchers have won more.

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But check out his 27 years of statistics, and you’ll see one year is blank: 1975. That’s because in the fall of 1974, John underwent surgery for a ligament tear in his elbow, an injury once considered career-ending.

John was the first pitcher to return to action after suffering such an injury. In fact, John won more games after the surgery than before – and the procedure that repaired his arm is now named after him.

John went under the knife 50 years ago. Since then, Tommy John elbow reconstruction surgery has changed the and the people who play it, from Little Leaguers to the pros.

A man in a white cutoff T-shirt chills his elbow in a container of ice water.
Tommy John ices his elbow in 1974.
Bettmann via Getty Images

How elbow ligaments tear

The ulnar collateral ligament, or UCL, is a band of fibrous tissue connecting two bones – the humerus in the upper arm and the ulna in the forearm on the inside of the elbow. If you didn’t have that ligament, there would be a gap between the two bones.

This ligament plays a critical role for athletes who throw, such as football quarterbacks and pitchers, because it serves as an anatomical bridge. The UCL transmits the force of the throw from the shoulder to the hand as the ball is released.

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But here’s the problem: The force on the elbow generated by pitching a baseball, especially from today’s high-velocity pitchers, exceeds the strength of the ligament.

Poor mechanics and other factors stress the ligament to the point where it can tear, thus causing the need for repair. To replace the torn tissue, the surgeon typically takes a relatively unused tendon from the pitcher’s forearm or hamstring.

Arms brought back to life

Before this surgery, a tear of the UCL ended many major league pitching careers.

Case in point: Sandy Koufax, the Los Angeles Dodgers pitcher and Hall of Famer, retired in 1966 because of severe elbow pain. Koufax was only 30 years old and at the zenith of his career. Frank Jobe, the doctor who performed the first Tommy John surgery and the Dodgers’ team physician at the time, said the procedure could have been called Sandy Koufax surgery had he developed the idea earlier.

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Returning to play after Tommy John surgery is not without difficulties, and recovery takes a long time; John took close to two years before he could pitch again. Although ‘s surgery is much less invasive, recovery takes about a year.

About 80% of pitchers successfully return to playing after the surgery. But sometimes the repair doesn’t last forever, and about 30% of pitchers with repaired elbows undergo a second surgery.

A surge in surgeries

Since Tommy John, it’s estimated that nearly 2,500 professional baseball players have undergone the surgery, and the number of overall procedures increases about 9% a year.

One-third of current Major League Baseball pitchers had Tommy John surgery at some point. Shohei Ohtani, the Dodgers’ two-way superstar, had the procedure in 2023. While Ohtani returned to batting in 2024, he’s not expected to pitch until 2025.

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There are several reasons why the number of surgeries have increased. First is the addition of a pitch clock in 2023, which works like a shot clock in basketball – pitchers must throw their next pitch within a certain time frame.

Pitchers also throw harder today than they did a half-century ago; the average velocity of pitches has increased about 4 miles per hour in the past 20 years. But pitchers who throw at higher velocities – particularly at speeds exceeding 100 miles per hour – are more likely to suffer this injury.

The rise of the sweeper pitch has also made an impact. This high-velocity breaking ball has been blamed for stressing the UCL.

One physical therapist says he sees up to five young athletes with throwing pain every week.

Young arms carry heavier loads

Today, more than half of Tommy John surgeries are performed on kids ages 15 to 19 – essentially, teenagers who are high school or college athletes.

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This is because youth have changed dramatically over the decades. It is now a US$15 billion business. Between school leagues, travel ball, all-star teams and showcases, young athletes play more often; in warmer parts of the country, they go year-round. Because many of them play for different teams and different coaches, nobody is monitoring overall pitch counts.

That, along with the relentless focus on one sport at an early age, means excessive stress on the elbow. Studies show athletes who play more than one sport actually have reduced injury rates.

The Pitch Smart program, sponsored by Major League Baseball and USA Baseball, offers resources to coaches and to young athletes reduce the risk of injury. But adherence to the program is strictly voluntary. A 2021 study shows 90% of surveyed teams are not complying with Pitch Smart guidelines. Many youngsters are throwing too many pitches per day and not getting enough rest between games. Either parents and coaches are not aware of the Pitch Smart recommendations or they are simply ignoring them.

Indeed, there are parents who want their to have the surgery prior to a possible injury because they believe that using the procedure as a preventive measure will make the elbow stronger and resistant to future tears. This, however, is a myth.

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Tommy John, now 81, laments that the surgery that saved his career has become a routine procedure for children whose bodies are still developing. With teenagers now the clientele for the majority of these surgeries, John has called for a return to the youth sports of the past, a time when kids played not so much for the promise of fame, riches or scholarships but simply for the fun of it.

Admittedly, there’s little profit in that. But as more and more kids go under the knife, maybe parents and coaches will finally start to listen.The Conversation

Ted Spiker, Professor of Journalism, University of Florida and Kevin W. Farmer, Professor of Orthopaedics and Sports Medicine, University of Florida

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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