2 popular diabetes drugs outperformed others in large clinical trial

 In a large clinical trial that directly compared four drugs commonly used to treat type 2 diabetes, researchers from the University of Minnesota Medical School aided in the discovery that insulin glargine and liraglutide performed best. The results were published in a pair of papers in The New England Journal of Medicine.

“The GRADE study is the first to compare the efficacy of four drugs commonly used to treat type 2 diabetes when added to metformin in people with short-duration diabetes. It found that liraglutide was superior to glimepiride and sitagliptin in controlling blood sugars,” said Elizabeth Seaquist, MD, Department of Medicine Chair at the U of M Medical School and endocrinologist with M Health Fairview. “This study provides evidence that clinicians can use in developing treatment plans with their patient.”

The study found that participants taking metformin plus liraglutide or insulin glargine achieved and maintained their target blood levels for the longest time compared to sitagliptin or glimepiride. This translated into approximately six months more time with blood glucose levels in the target range compared with sitagliptin, which was the least effective in maintaining target levels. Treatment effects did not differ based on age, sex, race or ethnicity. However, none of the combinations overwhelmingly outperformed the others.

Launched in 2013, the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness (GRADE) Study was conducted at centers across the country, including the University of Minnesota. It was designed to compare four major medications approved by the Food and Drug Administration (FDA) at the time GRADE started to treat diabetes in combination with metformin. While there is general agreement among health care professionals that metformin combined with diet and exercise is the best early approach in diabetes care, there is no consensus on what to do next to best keep high blood glucose in check.

The GRADE Study was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (U01DK098246). Additional support was provided by the National Heart, Lung, and Blood Institute; National Institute of General Medical Sciences; National Center for Advancing Translational Sciences; the Centers for Disease Control and Prevention; and the American Diabetes Association. The Department of Veterans Affairs provided resources and facilities. Material support in the form of donated medications and supplies has been provided by Becton, Dickinson and Company, Bristol-Myers Squibb, Merck & Co., Inc., Novo Nordisk, Roche Diagnostics, and Sanofi. ClinicalTrials.gov number: NCT01794143. 

JOURNAL

New England Journal of Medicine

DOI

10.1056/NEJMoa2200433 

METHOD OF RESEARCH

Randomized controlled/clinical trial

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Glycemia reduction in type 2 diabetes — glycemic outcomes

ARTICLE PUBLICATION DATE

22-Sep-2022

COI STATEMENT

N/A

https://www.eurekalert.org/news-releases/967244

nTIDE Sept 2022 Jobs Report: People with disabilities continue to enter labor force, foregoing Great Resignation

 Employment numbers were positive for people with disabilities, who continued to enter the labor force in September while labor force participation remained unchanged for people without disabilities, according to today’s National Trends in Disability Employment – Monthly Update (nTIDE), issued by Kessler Foundation and the University of New Hampshire’s Institute on Disability (UNH-IOD). nTIDE experts also noted that the employment-to-population ratio for people with disabilities continued to trend above previous historic highs.

Month-to-Month nTIDE Numbers (comparing August 2022 to September 2022)

In the U.S. Bureau of Labor Statistics (BLS) Jobs Report released today, the employment-to-population ratio for people with disabilities (ages 16-64) increased from 34.6 percent in August to 34.9 percent in September (up 0.9 percent or 0.3 percentage points). For people without disabilities (ages 16-64), the employment-to-population ratio was unchanged at 74.6 percent in September (0 percent or 0 percentage points). The employment-to-population ratio, a key indicator, reflects the percentage of people who are working relative to the total population (the number of people working divided by the number of people in the total population multiplied by 100).

“The trend in the employment-to-population ratio for people with disabilities continues for the thirteenth consecutive month at levels consistently above the historic highs seen in 2008,” said John O’Neill, PhD, director of the Center for Employment and Disability Research at Kessler Foundation. “This is encouraging for now considering that the Federal Reserve continues to raise interest rates to dampen economic growth, which will most likely curtail future hiring.”

Findings were similar for September’s labor force participation rate. For people with disabilities (ages 16-64), the labor force participation rate increased from 37.6 percent in August to 38.0 percent in September (up 1.1 percent or 0.4 percentage points). For people without disabilities (ages 16-64), the labor force participation rate decreased slightly from 77.5 percent in August to 77.1 percent in September (down 0.5 percent or 0.4 percentage points). The labor force participation rate is the percentage of the population that is working, not working, and on temporary layoff, or not working and actively looking for work.

“As a group, people with disabilities are not partaking in the Great Resignation,” remarked Andrew Houtenville, PhD, professor of economics and the research director of the UNH-IOD. “They are entering or reentering the labor force. While this could be seen as a positive sign of a more inclusive work force, it could be signaling the need to boost household income in the face of rising prices,” explained Dr. Houtenville.

Year-to-Year nTIDE Numbers (Comparing September 2021 to September 2022)

The employment-to-population ratio for working-age people with disabilities increased from 32.9 percent in September 2021 to 34.9 percent in September 2022 (up 6.1 percent or 2 percentage points). For working-age people without disabilities, the employment-to-population ratio also increased from 73.1 percent in September 2021 to 74.6 percent in September 2022 (up 2.1 percent or 1.5 percentage points).

Similarly, for people with disabilities (16-64), the labor force participation rate increased from 36.4 percent in September 2021 to 38.0 percent in September 2022 (up 4.4 percent or 1.6 percentage points). For people without disabilities (ages 16-64), the labor force participation rate also increased from 76.5 percent in September 2021 to 77.1 percent in September 2022 (up 0.8 percent or 0.6 percentage points).

In September, among workers ages 16-64, the 5,842,000 workers with disabilities represented 3.9 percent of the total 148,000,000 workers in the U.S.

NOTE: The statistics in the nTIDE are based on Bureau of Labor Statistics numbers but are not identical. They are customized by UNH to combine the statistics for men and women of working age (16 to 64). nTIDE is funded, in part, by grants from the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR) (90RT5037) and Kessler Foundation.

About the Institute on Disability at the University of New Hampshire

The Institute on Disability (IOD) at the University of New Hampshire (UNH) was established in 1987 to provide a university-based focus for the improvement of knowledge, policies, and practices related to the lives of persons with disabilities and their families. For information on the NIDILRR-funded Research and Training Center on Disability Statistics, visit ResearchOnDisability.org.

About Kessler Foundation

Kessler Foundation, a major nonprofit organization in the field of disability, is a global leader in rehabilitation research that seeks to improve cognition, mobility, and long-term outcomes – including employment – for people with neurological disabilities caused by diseases and injuries of the brain and spinal cord. Kessler Foundation leads the nation in funding innovative programs that expand opportunities for employment for people with disabilities. For more information, visit KesslerFoundation.org.

https://www.eurekalert.org/news-releases/967246

Other SARS-CoV-2 proteins are important for disease severity, aside from spike

 University of Maryland School of Medicine researchers have identified how multiple genes of SARS-CoV-2 affect disease severity, which could lead to new ways in how we develop future vaccines or develop newer treatments. The genes control the immune system of the host, contributing to how fiercely the body responds to a COVID-19 infection.

Although people typically think of the spike protein that forms the structural “crown” as the driving factor behind each new variant of COVID-19, research findings also show that mutations in these other “accessory” genes also play a role in how the disease progresses. Because of this, researchers believe these accessory proteins warrant further study as their mutations increasingly may become more significant as newer variants arise. 

Their findings were published on August 30, 2022, in PNAS.

The BA.4 variant of Omicron, which circulated earlier this year, was overtaken by the latest BA.5 variant of the virus circulating now. Both of these variants seem to evade the immune system due to mutations in the spike protein. Because of these spike mutations, the researchers say the previous vaccines are not as effective in preventing disease.

“What is interesting is that both BA.4 and BA.5 variants have the same genetic sequence for the spike protein,” said Matthew Frieman, PhD, Alicia and Yaya Foundation Professor of Viral Pathogen Research in The Department of Microbiology & Immunology at UMSOM. “This means it’s the other genes, the non-spike protein genes, that seem to affect the way the virus copies itself and causes disease. So, mutations in these other accessory genes are what has allowed variants like BA.5 to outcompete the earlier versions of the virus.”

The SARS-CoV-2 virus has three kinds of genes — those involved in making more copies of the virus, those that make the virus structure, and accessory genes that have other functions. For this new study, the researchers wanted to find out the function of the accessory genes. To do this, they recreated viruses missing each of four accessory proteins and then infected mice with these new viruses or the original virus. Next, they observed how each virus affected the mice.

Dr. Frieman’s team of researchers found that virus missing the ORF3a/b gene led to more mild infections than the original SARS-CoV-2 virus. The mice with this virus strain lost less weight and had less virus in their lungs than mice infected with the original virus. These findings indicated that the ORF3a/b gene likely plays a role in either making more copies of the virus through viral replication or blocking the immune response to the infection. Other experiments suggested ORF3a/b has an extra job in the virus by seeming to activate the body’s innate immune system, the first line of defense launched by the immune system, signaling that a foreign invader needs to be vanquished.

In contrast, the researchers found that mice infected with virus missing the ORF8 gene were sicker than mice with the original strain of SARS-CoV-2. These mice had increased inflammation in their lungs when compared with the original SARS-CoV-2 virus. The researchers said that ORF8 seems to control the immune response in the lungs.

“By inhibiting the immune response, ORF8 helps the virus to replicate more in the lungs which worsens infection. When removed, it allowed the immune system to fight back harder,” said Dr. Frieman.

Next, the researchers looked at how important the spike protein was for disease severity in each of the different variants of SARS-CoV-2. They took the original virus and swapped out the spike gene with the spike gene of either the alpha, beta, gamma, or delta variant. Then they infected cells and mice and observed how each of these viruses replicated and entered healthy cells. The virus uses the spike protein to hitchhike on the host’s ACE2 receptors found on the outside of cells lining the lungs as a way to get inside and infect cells.

Dr. Frieman’s team found that the spike protein determines the severity of some of the variants, but not for others. The gamma variant was weaker than the other variants in its ability to replicate and infect. The researchers think that the mutations in genes outside of the ‘spike,’ particularly in the ORF8 gene, seem to play a role in making this version weaker than the others. Although the gamma variant circulated in Brazil, it did not spread further around the globe as it was overtaken by stronger variants.

“While the spike mutations are important for enhancing receptor binding and entry into cells, the researchers also found that the mutations in the accessory proteins can alter clinical disease presentation,” said Mark T. Gladwin, MD, Vice President for Medical Affairs at University of Maryland, Baltimore and the John Z. and Akiko K. Bowers Distinguished Professor and Dean, UMSOM. “We need to learn more about the role of accessory protein mutations in COVID-19 infection, especially as new variants and subvariants keep emerging where these other proteins may play more of a starring role.”

The researchers plan to focus on dissecting more of ORF8’s function in future studies.

Additional UMSOM authors include Graduate Student Marisa McGrath, Postdoc Carly Dillen, PhD, Research Technician Lauren Baracco, and Postdoc Louis Taylor, PhD;other study coauthors were from the J. Craig Venter Institute.

This work was supported by grants from The Bill and Melinda Gates Foundation, the National Institute of Allergy and Infectious Diseases (R01AI137365 and R03AI146632), and the J. Craig Venter Institute.

JOURNAL

Proceedings of the National Academy of Sciences

DOI

10.1073/pnas.2204717119 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Animals

ARTICLE TITLE

SARS-CoV-2 variant spike and accessory gene mutations alter pathogenesis

ARTICLE PUBLICATION DATE

30-Aug-2022

https://www.eurekalert.org/news-releases/967242

Previously deployed military personnel show retained dust in lungs

 Military personnel who were deployed in Afghanistan and Iraq may have been exposed to significant amounts of dust and other respiratory hazards, leading to persistent respiratory symptoms and diseases like asthma and bronchiolitis. Researchers from the U.S. Geological Survey (USGS) and National Jewish Health teamed up to investigate lung disease seen in previously deployed military personnel.

Heather Lowers, a research geologist at the USGS, will present findings looking at the characteristics of dust retained in the lungs of previously deployed military personnel Monday at the GSA Connects 2022 meeting in Denver.

“I never in my career thought I would be looking at human lung tissue,” said Lowers. “Through some previous work that we had done looking at first responders to the World Trade Center, we were connected with a team of pulmonologists and lung pathologists who were trying to better understand how inhaled particulate matter could cause lung injury. Several of my co-authors at National Jewish Health have a Department of Defense grant to look at what is causing some of the unexpected lung injury in people that were deployed to Iraq and Afghanistan.”

With funding support from the Department of Defense, National Jewish Health has built a clinic to evaluate previously deployed military personnel who were experiencing symptoms of lung injury. Lowers’ job as geologist on the project was to develop a method to extract and analyze particulate matter found in the lungs. Using techniques to produce high-resolution images of microscopic particles and characterize their elemental composition, Lowers evaluated the composition and size of inorganic particles found in the lungs.

Of the 250 deployers who came to the National Jewish Health clinic, 65 had a surgical lung biopsy as part of their clinical care, and 24 gave permission for their lung biopsy to be studied for this research. The lung biopsies of the 24 deployers were compared to 11 civilian control samples from donated lung specimens that matched the age and smoking history of the deployers.

“We found that generally speaking, the military deployers did have more retained dust in their lungs per cubic centimeter of tissue that we looked at compared to the controls. And the particles generally seemed to be a smaller size as well, compared to the dust that was retained in the control group,” said Lowers.

They also found that both deployers who reported low/no sandstorm exposure or medium-high sandstorm exposure had higher amounts of dust in their lungs than the control samples.

“In general, even when there are no dust storms, soldiers work in a pretty dusty environment. So we were looking at a culmination of all that would have been inhaled during their deployment,” said Lowers. “Even driving a truck across the desert floor, you’re going to kick up dust and breathe it in.”

While these analyses provide helpful insight into the lung injury seen in previously deployed military personnel, Lowers hopes that more samples can be studied to more fully evaluate the characteristics of retained dust in the lungs.

“One of the challenges I’ve learned working with human subjects is that it’s very difficult to get enough people enrolled in these studies. So, while we’re generally seeing differences between the controls and the deployers, the number of samples are limited,” said Lowers.

Based on the increased amount of dust that is found in the lungs of previously deployed military personnel, useful mitigation strategies will be needed to reduce deployers’ exposure to dust.

Paper 18-12: Analysis of retained dust characteristics in lung tissue from previously deployed military personnel
Contact: Heather Lowers, hlowers@usgs.gov
https://gsa.confex.com/gsa/2022AM/meetingapp.cgi/Paper/382104
Monday, 10 October 2022, 11:10–11:25 AM
Session: 81: T78. Environmental Geochemistry and Health I

https://www.eurekalert.org/news-releases/967267

Total Cost of Cancer Care Can Be Cut With Lower Cost Alternate Drugs Without Compromising Care Quality

 Substituting biosimilars, generics and clinically appropriate lower cost drugs for established, costlier drugs was shown to be an effective way to reduce the total cost of care, by 5% or so, while maintaining the quality of care for patients with cancer. Even small shifts towards lower cost drugs resulted in significant reductions in the total cost of care, according to a study to be presented as part of the 2022 ASCO Quality Care Symposium. 

Study at a Glance  

Focus	Reducing total cost of cancer care while maintaining quality of care.
Population	Patients with cancer receiving Medicare.
Findings	Substituting biosimilars, generics, and clinically appropriate lower cost drugs reduced the total cost of care by about 5% while maintaining the quality of that care for patients with cancer.
Significance	Cost of cancer care can be reduced while maintaining the quality of care.

“Our study shows that smarter spending can be achieved while also boosting quality of cancer care. The big challenge for providers and pharmacists is balancing preferred options from a variety of insurers as well as the storage, prior authorization, and billing specificity that accompany having to use different biosimilars or drugs for patients with differing insurance plans. These are complex circumstances that we hope our study will help sort out and result in lowering costs for everyone,” said co-author Erica Feinberg, PharmD, BCPS, Senior Clinical Data Analyst, The U.S. Oncology Network, The Woodlands, Texas.

About the Study
An Affordable Care Act initiative called the Oncology Care Model was developed by the Centers for Medicare & Medicaid Services (CMS) in 2016 to encourage better oncology care1. The model included 24-hour access to doctors for people undergoing cancer treatment and emphasized coordinated, personalized care aimed at rewarding the value of care rather than volume. Participating practices received monthly care management payments for each Medicare beneficiary to support the transformation of how cancer care was provided.

In the model, enrolled patients were evaluated every six months. The clinical appropriateness of choosing one drug over the other was based on the treating provider’s medical judgement of whether the patient could tolerate the medication as well as whether the drug had any potential interactions with other treatments. The use of lower cost medication alternatives was offered to bend the cost curve. Eight less expensive drugs or supportive care treatments became available during, or just prior to, the implementation of the Oncology Care Model.

Medicare Part B (primarily physician services) & D (drug costs) claims for 14 practices in the United States (U.S.) Oncology Network participating in the OCM were used to evaluate the impact of the eight medication substitutions during the final 18 months of the five-year OCM program. The substitutions included changing therapy from reference products to biosimilars (bevacizumab, trastuzumab, rituximab, pegfilgrastim, and filgrastim), from brand to generics (abiraterone, imatinib, fosaprepitant) and from high cost to lower cost (aprepitant to fosaprepitant and denosumab to zoledronic acid) when clinically appropriate.

Key Findings
The cumulative savings were $26.0 million, $32.3 million, and $32.9 million per consecutive six-month interval between July 2019 and December 2020. Switching to biosimilars contributed $6.6 million in savings in the first six months of 2020 and $12.2 million in the last six months of 2020. Overall, the switches reduced the total cost of oncology drug care by 2.78%, 4.13%, and 5.25% in six-month intervals of the Oncology Care Model between July 2019 and December 2020, consecutively.

The researchers note that there is room for this benefit to continue as long as price differences exist between two interchangeable products.

Next steps
The investigators are continuing to track the benefits of biosimilar and generic interchanges in the Oncology Care Model. CMS recently announced a new five-year pilot program – The Enhancing Oncology Model – that the researchers hope to study at some point. They also continue to track the pipeline of generic drugs and biosimilars to optimize the value of any similar opportunities with other drug classes (both therapeutic and supportive care).

Funding
This study received no external funding.

View the abstract

https://www.asco.org/about-asco/press-center/news-releases/total-cost-cancer-care-can-be-reduced-lower-cost-alternate

8 physician specialties that are desperately needed in rural America

 Everyone knows there’s a physician shortage. But one thing that isn’t talked about as much is the fact that high-demand physician specialties are becoming increasingly concentrated in urban areas. This may make medical care more efficient, because specialists can see as many patients as possible, but it also means that many rural patients are left behind. Here are the eight physician specialties rural healthcare facilities are most desperately in need of.

Psychiatry

One-fifth of people living in rural areas have some type of mental illness (NCBI). This is proportional to more urban areas, but the number of physicians in these areas is not proportional. In fact, NCBI also found that up to 65% of rural counties do not have a psychiatrist practicing in that county. This makes access to mental health that much more difficult; patients who need to regularly see a psychiatrist will likely need to travel long distances.

Because psychiatry is among the high-demand physician specialties, locum tenens psychiatry jobs can be particularly rewarding. Dr. Heather Cumbo is a psychiatrist who works locum tenens. She has worked in rural areas that have waiting lists with 250 patients because of the lack of psychiatrists in the area.

“I’m also taking care of people that otherwise would not have any mental healthcare at all,” said Dr. Cumbo. “So, it’s very gratifying to feel as though I’m actually giving back to my community.”

OB/GYN

According to AAMC, half of the counties in the United States don’t have an OB/GYN physician. There are two main issues causing this. First, there’s a shortage of OB/GYNs across the country in general, so their care is concentrated in larger cities. Second, OB/GYNs face burnout because of this shortage, where pressure is high. The AAMC found that many OB/GYN patients have to travel more than half an hour to see their physicians. In an emergency, this travel time can be perilous.

Anesthesiology

Anesthesiology is a critical part of hospitals, yet rural hospitals continue to shut down. According to the University of Toronto, there are few rural anesthesiologists because rural areas “do not provide the volume or complexity” necessary to attract and fund anesthesiologists. However, the patients who do need anesthesiology suffer because of this. For routine non-emergent surgeries, patients are able to travel, but for emergency surgeries such as cesarean delivery, anesthesiology is crucial but missing. The University of Toronto mentioned that the availability of anesthesiology can avert 37% of disability-adjusted life years lost during surgeries.

Cardiology/Cardiovascular Surgery

When it comes to cardiovascular care, rural Americans are facing a slew of barriers. First, obesity is much more prevalent in rural areas than in urban areas; 34.2% of adults in rural areas are obese compared to 28.7% in urban areas, according to the CDC. Second, rural patients are less likely to have healthcare and more likely to have lower quality care. Third, they’re older than their urban counterparts, so their care tends to be more serious. So given all this, why is cardiology still a high-demand physician specialty in rural areas? There’s a shortage of cardiologists across the country; there may be a shortage of 7,080 cardiologists by 2025.

Orthopedic Surgery

Orthopedic surgery faces a shortage across the nation, and the shortage is particularly felt in rural areas. Currently, 60 million people living in rural areas have limited access to orthopedic surgeons, according to NCBI. Rural communities are generally too small to support a full-time orthopedic surgeon when their average salary is currently more than half a million dollars per year.

Dr. Sonya Sloan is an orthopedic surgeon who works locum tenens jobs in rural New Mexico. She visits for one week each month, so her patients and staff know who she is.

“I’ve been there long enough to see patients that have brought their moms and their dads and their children. I’ve treated three generations now in some families,” said Dr. Sloan. “The word gets out if there’s a good doctor there who they know that is going to take care of them.”

General Surgery

In the last 20 years, general surgery physicians have decreased across the country, but at a much faster rate in rural areas. Overall, general surgeons have decreased by 18%. But in rural areas, they’ve decreased by nearly 30%. In addition, nearly 60% of rural general surgeons are at least 50 years old, so the availability of general surgeons is likely to continue to decrease. The decrease of general surgeons is particularly difficult when you consider the fact that general surgeons cover the surgeries that, in urban areas, might be covered by other surgeons.

Neurology

A study of Medicare data found that some rural areas had as few as 10 neurologists for every 100,000 people. Like many of these physician specialties, the shortage of neurologists comes from the fact that many rural communities can’t support a full-time neurologist. That same study found that 2.1 million people saw a neurologist for conditions ranging from dementia, strokes, back pain, and brain injuries. Patients in rural areas, however, are less likely to access a neurologist. For example, only 38% of dementia patients saw a neurologist, compared to 47% of urban dementia patients. Further, only 21% of rural stroke patients saw a neurologist, compared to 31% of urban patients.

Urology

According to the American Urology Association, 89.5% of urologists live in metropolitan areas with more than 50,000 people. This leaves just 10.5%, or 1,408, urologists working in rural areas. In an interview with AAMC, Christopher Gonzalez, MD, public policy council chair at the AUA, explained that urologists make up less than 1% of all doctors in the United States, but that three of the most common cancers in men (bladder, kidney, and prostate) are all treated by urologists. Of the urologists in rural areas, many are older. So this shortage, once again, will continue to worsen.

Interested in learning more about physician opportunities in rural communities? Give us a call at 800.453.3030 or view today’s job opportunities in your specialty.

https://comphealth.com/resources/top-specialties-rural-health/

6 strategies to help you make (and keep) friends as an adult

 Writing for the New York Times, Catherine Pearson explains what is driving the "loneliness crisis" in the United States and offers six expert suggestions to help adults make—and keep—friends.

'People are actually really open to friendship'

When Marisa Franco, a psychologist who studies friendship, was conducting research for her new book, "Platonic: How the Science of Attachment Can Help You Make — and Keep — Friends," she learned several strategies on how to successfully make and keep friends as an adult.

During a solo vacation in July, Marisa Franco was able to use those strategies to form a new group of friends in just 10 days.

According to Pearson, Franco assumed that the people she met would like her. "And she reminded herself that people in transition — like those who've recently moved, gone through a breakup or who are traveling — tend to be more open to making new friends," Pearson writes.

At a café, Franco invited a fellow English-speaking traveler to an event for people who want to practice speaking Spanish. "At the language event, I met someone else, made the same assumptions, and we exchanged numbers," she recalled. "I invited them to a lucha libre wrestling match, and they came. This is to say: People are actually really open to friendship."

How to make (and keep) friends as an adult

Franco acknowledges that making friends as an adult is not always "simple or easy," which may be one reason friendship is declining.

While just 3% of Americans said they had no close friends in 1990, almost 12% said they had no close friends in 2021. "The United States is in the grips of a loneliness crisis that predates the Covid pandemic," Pearson writes.

According to Franco, there are some simple strategies to help people make friends in adulthood.

Remember that platonic love is just as important and meaningful as romantic love

"We have this idea that people who have friendship at the center of their relationships are unhappy or unfulfilled," Franco said. "It's something I used to believe myself: I thought romantic love was the only love that would make me whole."

Don't fall for the misconception that friendship happens organically

According to Franco, research suggests that people who believe that friendship happens by chance are lonelier than those who make an effort to put themselves out there.

Assume people want to be your friend

When people follow the "risk regulation theory," they decide how much effort to invest in a relationship based on how likely they think they are to get rejected. "So one of the big tips I share is that if you try to connect with someone, you are much less likely to be rejected than you think," Franco said.

"And, yes, you should assume people like you. That is based on research into the 'liking gap' — the idea that when strangers interact, they're more liked by the other person than they assume."

Take advantage of the 'mere exposure effect'

While it can be nerve-racking to put yourself out there, Franco suggests looking for clubs and activities that require regular participation. "That capitalizes on something called the 'mere exposure effect,' or our tendency to like people more when they are familiar to us."

In addition, the "mere exposure effect" means that people "should expect that it is going to feel uncomfortable when you first interact with people," Franco noted. "You are going to feel weary. That doesn't mean you should duck out; it means you are right where you need to be. Stay at it for a little while longer, and things will change."

Make sure your friends know how much you like them

According to Franco, people typically like us more when they believe we like them.

"The more you can show people that you like and value them, the better. Research shows that just texting a friend can be more meaningful than people tend to think," Franco said.

Don't put too much pressure on yourself

"I want people to understand that they are much more typical if they don't have friendship all figured out," Franco said. "The data shows that so many people are lacking for community, and that is nothing to be ashamed about."

For example, social media can be a good way to connect with others, but it is often used to "lurk," which can increase feelings of loneliness and disconnection. "That's not necessarily our fault, though," Franco noted. "Social media is designed in a way so that we don't use it consciously; we tend to just stay on it mindlessly."

Ultimately, "[t]here are just a lot of societal reasons people feel lonely," Franco added.

Reach out to your existing connections

For people who are trying to form a new friendship or strengthen existing relationships today, Franco suggests taking one easy step. "I'd say to swipe through your contacts, or look at who you were texting this time last year, and reach out," she said. "You can say something simple, like: 'Hey, we haven't chatted in a while. I was just thinking about you. How are you?'" 

https://www.advisory.com/daily-briefing/2022/10/05/friendship-strategies