A patient typically leaves the hospital or clinic with a patient education package that has been vetted by department heads, checked and sanitized by the legal department, trimmed and restricted by finance, and augmented by sponsors. The patient has perhaps also spoken to physicians, radiologists, nurses, and administrative staff. Much of the information given to the patient is intended to educate the patient in self-care following the period of dependence upon hospital staff. How does this information help the patient at home when there is no medical staff on hand? Does it tell the patient how to remove the dressing, what to clean the wound with, or what to do if the drainage tubes seem to be clogged? There are questions the patient will simply not think to ask while still at the hospital.
If all patients were physicians or nurses who belonged to the medical community and all ascribed to common conventions and practices, there would be no difference essentially as to who was on which side of the stethoscope; the patient could reasonably be expected to understand exactly what was going on, and why. Each issue the nurse highlighted would fit neatly into demarcated categories and every significance placed on them would be understood and accepted by the patient. After returning home, there would be nothing that was unfamiliar to them about what to do and when to do it.
However, in reality, patients are bricklayers, plumbers, bankers, welders, accountants, teachers, lawyers, and philosophers. They cannot be expected to understand what it is you are doing or saying in the same way as your fellow physicians and nurses are likely to. These real-life patients may demarcate issues and assign significance differently from how the medical professionals do. The resonance will have been lost, and the information will stand alone without the rich context of mutuality that was shared in the previous scenario.
Just as facts are "theory-laden," so also information does not "speak for itself," it is interpreted and acted on through the spectacles and gloves of our beliefs and view of the world. The nurse needs to impinge on patients' world views, conveying the information to them by resignifying and demarcating it in such a way as to make it actionable by the patient.
As an example, one patient had the experience of being given practical instruction that included taking her physically through many sequences and procedures that would prove to be important to her. Her nurses didn't just tell her how to change a dressing or clean the surgical wound, they showed her, and critiqued her techniques. It was not just this practical, actionable knowledge that was imparted, but also the knowledge of where more knowledge resided. The nurse as an information-source stands out.
As it happened, the patient's nurse was changed and the new nurse did not become familiar with the patient's history and could not answer questions about what to do next when a particular test was returned negative. The flow of information had changed and the patient's experience was altered entirely.
Many people use the Internet to get information and make changes in their lifestyle. Unfortunately, information on the Internet is not always reliable. If you make changes in what you do based on unreliable information, you may waste your time and money because you won’t get the results you are aiming for; you may even damage your health.
Before making any changes, you need to determine that the website you consult is providing reliable information. Ask yourself the following questions:
You should be able to easily identify who is responsible for the site. Usually, this information is located in the “About Us” section, often at the top or bottom of the main page.
The reason you should know this information is because those who run the site will likely determine its content. For example, a site about depression that is run by a pharmaceutical company might present information in such a way as to encourage the use of their medications. It may leave out information about effective approaches for depression, such as therapy or regular physical activity. This can lead the reader to believe that medications are the only treatment for depression.
Be cautious of the information on websites where you cannot identify who is running the site and there is no way to contact them.
There are many different reasons to develop a website. If you are looking for reliable health information to guide changes in your behaviours, then use websites whose purpose is to help you identify and manage health problems or to Strengthen your health. This is usually the purpose of:
If the purpose of the website is to sell a product or a service, be skeptical about the information presented, as it will likely be chosen to encourage you to buy the product or service. Verify the information you receive from these sites with sources you believe are reliable.
Some websites are established by individuals or a group of people as a way to share their opinions or experiences. They may mean well, but the information they present will likely only support their opinions. These websites often rely on anecdotes or testimonials as the main source of information: This is not evidence.
It can be difficult to determine the purpose of a website that provides opinions; they may present content that leads the reader to believe their opinions are actually facts. The “About Us” section might be unclear or misleading. For example, the website thinktwice.com states that it “encourages an uncensored exchange of vaccine information, and supports every family’s right to accept or reject vaccines.” However, as you navigate through the site you will realize that the content strongly supports rejecting vaccines. You will need to consult other sources of vaccine information to get a balanced perspective.
The information on a site may be original (i.e. written by the people who run the site) or it may be collected from other sources. With original content you should be able to determine who wrote it. For content that is from other sources, the sources should be indicated and you should be able to verify the information from the original site.
The people who write original content should be qualified and credible sources, as these are generally more trustworthy. Their credentials should be indicated on the site. For example, TheBody.com, a website that provides information about HIV/AIDS and its treatments, has a biography about every health professional who contributes to the content.
For websites where the content is obtained from other sources, the credentials and qualifications of those who review and present the information should be indicated.
Reliable information is supported by evidence, which comes from good-quality research. To help you assess the quality of the evidence, the site should provide some information as to when and how the research was conducted. The source of the research should be included so that you can find it and review it for yourself.
Even if you are not an expert in research methods there are some questions that can help you determine if the research was well conducted. Consult Chapter 3, “How to Interpret Medical Research”, in Women Wading Through the Web.
What we know about health expands every day. Websites with reliable information must review and update their content regularly. You can often find a statement at the bottom of a page as to when the content of a site was reviewed and updated.
Some websites ask you to register to use them. Before registering, find out how the information you provide will be used. The site should provide a “Terms of Use,” “Privacy Policy” or similar link where you can see how your information will be used. You might want to consider setting up a separate email account for registering for such sites.
The following websites provide reliable, evidence-based information.
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Teen looks on his phone.
Pexels/Michael Burrows
These days almost everyone goes online to look up health information. Googling medical questions and concerns has become a part of everyday life for many of us as the Internet has become an extremely easy way to search for a doctor of any specialty, book appointments and expand one’s knowledge.
Over the past several years, however, the online landscape has evolved quite dramatically with the advent of social media. In fact, much like Google, social media has also become an increasingly important source of mental health-related information, especially for teenagers and young adults.
We recently polled hundreds of teenagers who presented to the psychiatric emergency room at Northwell Health and found that nearly 65% of them listed TikTok as their primary source for mental health information, even more so than Google. While this can sound frightening, it can also represent an exciting opportunity for mental health clinicians and researchers, like me.
There are definitely pros and cons to obtaining mental health information from social media. On the one hand, it provides an excellent opportunity to meet other individuals with similar life experiences, obtain social and emotional support, and connect with experts nearly instantly who can provide access to high-quality information and resources. But on the other hand, it can be very challenging to know which sources can be trusted to provide the most accurate and helpful information, as there is a lot of incorrect and stigmatizing misinformation online.
Further, social media has introduced an entirely new dimension of challenges (and potential opportunities) stemming from their use of algorithms to identify interests and tailor digital content. Unlike Google, once you search for information on social media, these algorithms are designed to strategically select and promote images, videos, and posts that might align with one’s interests or online activity. Such content that has the potential to impact us in ways that we are only beginning to appreciate and understand.
We know that information gathered online can impact many aspects of care, including whether to seek care at all. In psychiatry, as in all other areas of medicine, the earlier the better, but many people (especially young people) wait months to years before finally getting the help that they need. Some never do. The decision to access care is not always easy. The Internet and social media can represent pivotal moments that can shape and influence one’s desire or readiness to access mental health help.
Social media-based algorithms may impact and influence help-seeking in ways that were previously impossible and unimaginable (both for the better and for the worse). As a mental health professional working with young people, who are nearly constantly connected to the Internet, my job is often to help them navigate the wealth of information available online to determine what’s good and what’s bad. A critical question for me and many others in this field is how might a person’s social media feed change or evolve as a result of their online activity and if that change can influence important decisions, like the decision to seek mental health care.
Nearly three decades since the first social media platforms were created, the White House has recently released its report on research priorities and has identified the need to better understand the impact (both good and bad) of social media use on adolescent development as a top research priority. At the same time, the U.S. Surgeon General recently released an advisory highlighting concerns associated with social media use on youth mental health.
Social media companies have received a lot of negative attention regarding the impact of their algorithms on mental health outcomes, especially for young people. While they certainly have the potential to deliver negative digital content, they could theoretically also be used for good, and we need to unpack the impact that the tailored flow of digital information can have on the person absorbing it. We need to move fast to get ahead of the curve if we are to understand how to enhance the benefits and minimize the risks associated with social media use. I believe that social media algorithms can be used to ensure that the information young people are receiving is accurate, helpful, and sound rather than misinformation that stigmatizes mental health and, in turn, steers them away from getting help.
Social media is expanding every day, and we have an opportunity to use it to its full potential and ensure that social media could one day truly live up to what it was meant to be – a place to share, learn and grow.
To find a therapist near you, visit the Psychology Today Therapy Directory.
Radiological imaging is a major and increasing source of radiation exposure worldwide. Computed tomography (CT) is the largest contributor to medical radiation dose patients receive. Typically, CT scans impart doses to organs that are 100 times higher than doses imparted by other lower dose modalities such as chest X-rays. In general, CT examinations may involve doses (typically an average of 8 mSv) which may be equal to the dose received by several hundreds of chest X-rays (about 0.02 mSv/chest X-ray).
During an IAEA consultation on justification in 2007, it was estimated that up to 50% of examinations may not be necessary. It should be anticipated that part of the increase in global annual mean dose that has been observed recently is due to unjustified radiological procedures. Direct epidemiological data suggest that medical exposure to low doses of radiation even as low as 10-50 mSv might be associated with a small risk of cancer induction in the long term. The fact that a considerable percentage of people may undergo repeated high dose examinations , such as CT (sometimes exceeding 10 mSv per examination) dictates that caution should be used when referring a patient for radiological procedures. Health professionals need to make sure the patient benefits from the procedure and risk is kept minimal.
However, ensuring maximum benefit to risk ratio for the patient is not a trivial task. Referring medical practitioners, in a large part of the world, lack training in radiation protection and in risk estimation. 97% of practitioners who participated in a study underestimated the dose the patient would receive from diagnostic procedures. The average mean dose was about 6 times higher than the physicians had estimated. The fundamental principles of radiation protection in medicine are justification and optimization of radiological protection. Referring medical practitioners have a major role in justification. They are responsible in terms of weighing the benefit versus the risk of a given radiological procedure.
» What is justification and what is the framework?
Justification requires that the expected net benefit be positive. According to principles established by the International Commission on Radiological Protection (ICRP) and accepted by major international organizations, the principle of justification applies at three levels in the use of radiation in medicine.
» Is the referring medical practitioner responsible for justification of radiological procedures?
Yes, jointly with the radiological practitioner. As stated above, justification at the third level is the responsibility of the referring medical practitioner, as is the awareness about appropriateness criteria for justification at level 2. According to the BSS, the radiological exposure has to be justified through consultation between the radiological medical practitioner and the referring medical practitioner, as appropriate, or be part of an approved health screening programme.
Since referring medical practitioners usually have the most complete picture of the patient’s health, they should be responsible for the guidance of the patient in undergoing only necessary procedures and benefitting from them. Particularly, this responsibility weighs more on generalists such as primary care providers. In order to facilitate justification in the case of radiological procedures, it is desirable that referring medical practitioners are knowledgeable about radiation effects in regard to the various dose ranges. The referring medical practitioners are responsible for keeping their knowledge about radiation up to date. In support of this, they should be provided education in radiation protection during their medical studies.
» How should justification be practiced and what knowledge is required for proper justification of a radiological procedure?
According to the BSS, the justification of medical exposure for an individual patient shall be carried out through consultation between the radiological medical practitioner and the referring medical practitioner, as appropriate, with account taken, in particular for patients who are pregnant or breast-feeding or paediatric, of:
Justification should be patient specific. The referring medical practitioner should take into account all clinical aspects regarding the management of every patient separately. Other possible procedures with lower or no exposure, such as ultrasound or magnetic resonance imaging, should be considered, if and when appropriate, before proceeding to radiological procedures.
» Is the acquisition of patients’ consent important?
According to the BSS, in order for a symptomatic or asymptomatic patient to undergo a medical procedure that involves ionizing radiation, the patient or the patient’s legally authorized representative should be informed in a timely and clear fashion, of the expected diagnostic or therapeutic benefits of the radiological procedure as well as the radiation risks. Thus, the emphasis is on provision of information.
» When is an investigation useful and what are the reasons that cause unnecessary use of radiation?
According to the guidelines published by the Royal College of Radiologists (RCR), a useful investigation is one in which the result, either positive or negative, will alter a patient’s management or add confidence to the clinician’s diagnosis. According to the RCR guidelines, there are some reasons that lead to wasteful use of radiation. With emphasis on avoiding unjustified irradiation of patients, the RCR report has provided a check list for physicians referring patients for diagnostic radiological procedures:
» What are the reasons for over-investigating?
There are various reasons that may lead medical practitioners to refer patients for more procedures than needed. Practitioners should be aware of that and take action to avoid such situations. Some of the reasons that lead to over-investigation are the following:
» Is there any guidance available?
During the last 20 years international and national organizations published guidelines for proper justification of radiological procedures. The UK Royal College of Radiologists (RCR) publication "Making the best use of clinical radiology services " has been in print since 1989. The American College of Radiology (ACR) published its guidelines as Appropriateness Criteria. Similar efforts have been undertaken by the Department of Health of Western Australia in Diagnostic Imaging Pathways.
For references of publications from national societies in Europe, Oceania, and other regions please see publication from Remedios. These publications constitute guidelines and aim to guide referring medical practitioners in the selection of the optimum procedure for a certain clinical problem. In case there are alternative procedures that do not utilize radiation but yield results of similar clinical value, these guidelines encourage the avoidance of radiological procedures.
The cited publications provide very specific guidance to help practitioners perform justification properly.
» What is the role of radiation protection experts?
A medical physicist with experience and expertise in radiation protection will be able to provide information and guidance on radiation doses and risks in radiological procedures. In case you do not have an access to the help of radiation protection experts, referring medical practitioners may address their questions to their colleagues who work in radiology departments. However, staff specialized in radiation protection is more likely to provide complete, responsible and up-to-date information for the specific clinical problem. Radiation protection experts are comfortable with dose measurements and quantities which come from the domain of natural sciences and are usually hard to conceive for people outside the field.
» Which procedures are responsible for the highest doses to the patient?
The referring medical practitioner should be aware about procedures which impart high radiation dose to patients in order to be more cautious in such cases. This does not mean that other procedures should be written without proper justification. A quantitative knowledge of doses of various procedures is useful for the referring medical practitioner. Data given below will help the practitioner in that direction. In diagnostic radiological procedures, dose depends on the modality used. Computed tomography (CT) exposes patients to relatively high doses in comparison to other diagnostic imaging modalities.
Interventional diagnostic and therapeutic procedures that utilize fluoroscopy may also be a source of high radiation doses. Such procedures carry the risk of causing erythema to patients that receive high dose in single or repeated procedures. Some nuclear medicine procedures are also responsible for high radiation doses to patients.
» What if the patient whom I refer for a radiological procedure is pregnant?
The responsibility to identify patients that might be pregnant and are unaware of it is shared by the patient, referring medical practitioner and the imaging service providers. Safeguards to avoid inadvertent exposures of the foetus should be observed at all times.
The “ten day rule” was postulated by ICRP for women of reproductive age. The more latest “28-day rule” allows radiological procedures throughout the complete menstrual cycle unless there is a missed period. When a woman has a missed period, she is considered pregnant unless proven otherwise.
Even if safeguards are observed, sometimes a pregnant patient may be exposed to radiation. Depending on the radiation dose and the gestation age of the foetus, radiation effects may differ. Radiation risks are most significant during organogenesis in the early foetal period, somewhat less in the second trimester, and least in the third trimester.
As a rule of thumb one can assume that properly carried out diagnostic radiological procedures to any part of the body other than the pelvic region or when the primary X-ray beam is not passing through the foetus can be performed throughout pregnancy without significant foetal risk, if clinically necessary and justified. For radiological procedures where the primary beam intercepts the foetus, advice from the medical physicist should be obtained, who will calculate radiation dose to the foetus and, based on that, the practitioner and patient should make a decision. However, doses associated with radiotherapy procedures and interventional procedures are high and they require the attention of experts (including medical or health physicists, practitioners, and sometimes engineers and epidemiologists). In the case when a practitioner is responsible for a patient who has undergone a radiological procedure inadvertently and has subsequently been found to be pregnant, advice from the individuals listed above is needed. For more information, please click here where comprehensive information is provided not only for diagnostic radiology but also for nuclear medicine and radiotherapy.
» Should pregnant patients undergo radiological procedures?
Sometimes it is imperative that pregnant women should undergo radiological procedures. The referring medical practitioner and the imaging provider have to be mindful of risk and benefit and decide whether a radiological procedure should be asked for or if the medical problem may be solved by other non-radiological procedures. Generally, it is preferable that non-radiological procedures, or at least those that do not provide exposure to ionizing radiation, are used whenever possible. However, the use of radiological procedures is not prohibited and, when properly justified, they may be optimized so that these procedures may help to achieve the desired result for the patient while keeping dose to the foetus at low levels. The patient should be made aware about the possible impact of radiation exposure to the foetus. The need for consent must be determined based on individual practice standards, guided by more global professional or regulatory/legislative requirements.
» Can radiological procedures cause acute radiation injury?
Acute injuries such as skin erythema, blistering and hair loss have been recognized as a rare side effect of procedures guided by fluoroscopy. Similar injuries have been long recognized in radiation oncology, which uses much higher doses of radiation than diagnostic imaging. While radiation therapy is administered in fractions and the radiation-inflicted cells may recover in between sessions, fluoroscopy usually imparts a high dose to the skin in a short amount of time and with no dose fractionation. Referring medical practitioners could miss recognizing acute radiation injury resulting from interventional procedures. Such injuries may appear weeks after the interventional procedure and patients may not think of the procedure as being the cause unless they have been instructed accordingly by the interventional facility. Practitioners have often tended to attribute injury to many other causes, including insect bite and allergic reactions, but not to radiation exposure. Awareness about radiation through fluoroscopy being a possible cause can avoid mis-diagnosis and patient suffering.
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In our ever-changing world, children are not shielded from the realities of racial injustice and discrimination. As a health professional and a mother, I have encountered numerous instances where the impact of racism on children’s health and well-being could not be ignored.
As my coauthors and I shared in an American Academy of Pediatrics policy statement:
The impact of racism has been linked to birth disparities and mental health problems in children and adolescents. The biological mechanism that emerges from chronic stress leads to increased and prolonged levels of exposure to stress hormones and oxidative stress at the cellular level. Prolonged exposure to stress hormones, such as cortisol, leads to inflammatory reactions that predispose individuals to chronic disease.
In short, research has found that racism harms children’s physical health, as well as their mental health. As health providers, we cannot avoid discussions of race and racism. When we identify a risk factor for a disease, our job as health providers is to educate our patients about how to prevent or decrease their exposure to the risk, like talking to new parents about sleep-related infant deaths.
Race and racism is another risk factor that we should discuss with our patients in our role to Strengthen their health and well-being. These discussions play a crucial part in combating the harmful effects of racism and providing families with the support that they need.
Children learn about race and racial bias early. As early as six months of age, children notice differences in skin color. As children get older, they learn about race based on what they see and hear from their loved ones and the world they live in. They see that people are treated differently based on characteristics such as skin color, hair texture, hair color, language, gender, and ability. They often have questions about why they look different from other friends or why their friends look different. Children can develop biases based on these experiences.
Children can also experience the effects of racism individually and through the places they learn, live, play, and grow. Children experience the effects of racism through individual acts of discrimination or bias; as bystanders watching others experience racism; and additionally through unequal access and distribution of resources, limited economic opportunity, and unequal enforcement of rights.
Trusted adults in children’s lives, such as parents, caregivers, educators, and health providers, can help children understand their racial and ethnic identity and learn about others. Starting conversations early about race is essential to help children understand differences, get answers to their questions, deal with racial bias, and stand up to racial bias and discrimination. It also normalizes these conversations.
It is important to include white families and their children in conversations about race, too. Unfortunately, white children are frequently excluded from discussion about race. White children, like children of color, are part of the racial and ethnic diversity spectrum and experience the impacts of racial bias and discrimination.
Having conversations about race and racism can be uncomfortable. The strategies below provide ways that health providers can begin to engage with families about the courses of race and racism. By fostering open dialogue, we can empower families to address these sensitive courses and work toward building a more just and equitable society for all children.
Create a culturally safe, supportive, and welcoming environment for patients and their families. This is essential when addressing the Topic of race and racism with families. Here are some ways to do this from our American Academy of Pediatrics policy statement:
Listen and validate experiences. Racism affects individuals differently, and children may have encountered instances of mistreatment or witnessed racism firsthand. Ask families if they want to engage in conversations about race and racism; if a family declines, let them know that you respect their decision and that you are available for future conversations.
For families who want to engage in conversations, encourage them to share their experiences, actively listen, and validate their feelings. By doing so, health professionals demonstrate empathy and provide a platform for families to express themselves. This validation also helps families recognize that their experiences are real and important. I experienced this firsthand when a parent asked for recommendations for mental health providers that reflected their family’s racial background. The family appreciated being heard and receiving information that was best for them.
Educate yourself about race and racism, and share resources. To effectively address race-related issues, health professionals must continually educate themselves about racial disparities, historical contexts, and the impact of racism on health. See the sidebar for examples of educational resources for providers and families, including books, websites, and articles, that provide additional information about the courses of race and racism.
For me, one discussion about race occurred during a well visit with a family of color. After discussing sun safety, the mom asked me if I could recommend a sunscreen that wouldn’t leave a white cast on darker skin. This encounter made me examine how I talked to families and provided guidance on sun safety. During and after this encounter, I researched sunscreen brands for darker skin tones and developed a resource list that I could share with families and colleagues. This discussion matters because skin cancer is preventable and research finds that patients of color are less likely to be counseled about sunscreen use and doctors are less likely to discuss skin type in making recommendations.
Support families in talking to their children about race and racism. Encourage families to engage in critical thinking and reflection by discussing racial stereotypes, biases, and the importance of challenging them. Help them explore ways to foster empathy and understanding toward individuals from diverse racial and ethnic backgrounds. Encourage families to actively seek out opportunities for their children to learn about different cultures, traditions, and histories, such as taking a trip to a cultural museum.
To help with this, you can share resources with families to empower them with knowledge and equip them to have informed conversations with their children. Books, articles, documentaries, and websites can serve as valuable tools in initiating discussions and promoting racial literacy.
Engaging in conversations about race helps children develop empathy, challenge stereotypes, and embrace diversity.
Empower families to take action. Guide families in identifying ways they can actively contribute to dismantling racism and promoting racial equity. Encourage them to engage in advocacy, both at the individual and community levels. Families can participate in community events, join organizations working toward racial justice, and support policies that promote equality.
Emphasize the importance of modeling anti-racist behavior within the family and creating a nurturing environment that fosters inclusivity and respect. In addition, as health professionals, we can help empower families through our own engagement in advocacy for more equitable and just policies and practices that will lead to better health for our families.
Addressing the Topic of race and racism with families is vital for promoting children’s health and well-being. The strategies provided are meant to help health professionals so that they can offer families the tools and knowledge to engage in meaningful conversations about race. As health professionals, we have a unique opportunity to make a positive impact by fostering open dialogue, fostering racial understanding, and working toward a more equitable future for all children.
This essay was adapted from Reflections on Children’s Racial Learning 2023, published by EmbraceRace, an organization that aims to help parents and educators raise a generation that is thoughtful, brave, and informed about race.
While getting your protein from food sources may be preferable for experts, I will admit that I don’t like a lot of the typical protein sources, such as eggs. I also don’t eat red meat and can’t digest nuts or legumes well, which makes a good protein supplement a regular part of my diet.
I was excited to receive my shipment of Ritual’s Essential Protein Daily Shake 18+. I’m always looking for high-quality protein supplements, as I’m very active.
It took about a week for my first order to arrive. When I opened the box, I enjoyed the bright yellow packaging and inscription “Build a habit—Turn it into a Ritual.” The protein itself comes in a BPA-free resealable pouch, though once opened , I could never get the resealable zipper to work again, so I clipped it shut.
I’ve used a lot of protein powders and found Ritual’s to have a lightweight consistency and no odor. The directions suggested that, for best results, users shake or blend the powder rather than stir. For my first try, I decided to pop it in my blender with only water to taste the flavor on its own. I didn’t find the powder to have any particular taste, which I found to be a bit boring. However, for some, a lack of flavor might be a positive and welcomed benefit.
Next, I mixed the powder with frozen strawberries and bananas. Adding the fruit helped add more flavor, but the taste was still not sweet. Then again, Ritual’s protein powders are sugar-free, meaning you’ll need to add sweetener yourself. In my case, I chose to add honey, which helped.
I liked that the protein powder had a smooth texture when mixed, and left no residue in the bottom of my glass. Since the powder didn’t settle at the bottom, I didn’t have to worry about drinking my shake quickly to make sure I got all the protein. Instead, it stayed blended to the last drop.
I checked the Informed Sport web page against my product, and my batch number was recorded. It actually felt reaffirming to see my number listed along with the 11 other batches of the product that showed up. It feels like that level of transparency is rare with anything these days.
There are only 15 servings in a 1-lb. bag of Ritual’s Essential Protein Daily Shake 18+. For a product that’s marketed as a “daily shake,” I found this serving size to be inadequate. For example, this means a person with a monthly subscription can only have one shake every other day before they run out, if they’re looking to make their product last one month.
It would therefore seem that a “monthly subscription” should be a 2-lb. bag with enough servings for one scoop of powder for every day in a typical month of 30 days. However, that would obviously drive the price up ($80-$88 a month is a hefty amount and would probably not be competitive). The $40-$44 a bag already felt like a good chunk of change when looking at other similar protein supplements on the market (that comes to about $2.70 a serving, which seems comparatively expensive).
Basically, you’re paying extra for quality and transparency.