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There Might Be Illegal Drugs in Your ‘Cognitive Enhancing’ Supplements

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As a general internist in Boston, Pieter Cohen never thought he would become a “supplement detective.”

But around 10 years ago, some of his patients began to get sick with mysterious symptoms. “Sometimes it’s just a racing heart,” said Cohen, who practices at Cambridge Alliance Health. “But other times it was chest pain that led to emergency room visits, or even kidneys shutting down and needing to go to the hospital.”

One 26-year-old single mom had unexplained chest pain, headaches, insomnia, nausea, and fatigue for two years. A 38-year-old man had been dealing with insomnia and heart palpitations, and then was suspended from his job as a truck driver when his urine drug test came back positive for amphetamine use.

Cohen learned that they, and other patients, were taking weight loss pills from Brazil. When he got his hands on the supplements, he found botanical ingredients on the labels, but when he analyzed them in the lab, found they contained multiple pharmaceutical drugs like fenproporex, an amphetamine derivative. Though fenproporex is prescribed in Brazil, it is not approved for use in the U.S. by the Food and Drug Administration (FDA).

Since then, Cohen has tackled head-on the larger problem of unregulated dietary supplements in the United States. He’s published numerous studies finding unapproved pharmaceutical drugs at erratic doses in pills that promise weight loss, fitness gains, or cognitive enhancement. He’s also been sued for $200 million for libel and defamation, but the threat of legal action hasn’t stopped him yet. “That’s not my favorite part of the work,” he acknowledged.

Last year, Cohen and his colleagues found that nootropics—supplements aimed at improving memory, intelligence, and focus—were openly advertising that they contained piracetam. This drug is prescribed in some European countries for cognitive impairment, dementia, and other neurological disorders, but is not approved in the U.S.

Recently, Cohen started to see that other nootropics were listing different versions of piracetam on their labels. In a new study, out today in Neurology, the medical journal of the American Academy of Neurology, Cohen and his colleagues looked specifically for these “analogs,” or compounds that have a similar chemical structure.

They found compounds similar to piracetam in 10 nootropic supplements. The unapproved drugs they discovered are used in countries like Russia and Japan for dementia, stroke, or traumatic brain injury. By taking these nootropics, a person could be exposed to unknown and high doses of these drugs, in combinations that have never been studied for safety in humans.

By continuing his work to expose illegal drugs in supplements, Cohen hopes to call on the FDA to take more action against companies that are blatantly skirting the rules, like those advertising illegal ingredients right on their labels.

“I’m not surprised,” said David Seres, the director of medical nutrition at Columbia University Irving Medical Center in New York City, who wasn’t involved in the new study. “Given both the long history of this happening in supplements and also because of the weakness in the regulation and the laws. What’s really offensive about the whole thing is that we’re dealing with substances that are supposed to be for people’s health.”

One of the supplements Cohen and his colleagues tested claimed it was a “brain enhancement formula,” while several others mentioned improvements in memory, mental clarity, or energy. One called itself a “workout explosive,” while another claimed taking it could help a person “outlast, endure, overcome.”


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Nootropics are able to make broad statements about their effects, as long as they avoid making specific claims. They can gesture at being “brain boosters,” for example, but cannot claim they can “cure ADHD.”

The supplement market overall is estimated to be worth $46 billion, and has gone from 4,000 products in 1994 to roughly 80,000. As of 2018, over half of adults in the US said they take dietary supplements, and cognitive enhancement drugs in particular are gaining popularity. In 2017, almost 30 percent of people said they had used supplements for “cognitive enhancement” in the past year, up 20 percent from 2015. Cognitive enhancing supplements were estimated by Grand View Research to be worth $10.7 billion annually by 2025.

Still, supplement companies are not allowed to use unapproved prescription drugs, despite them being consistently found. In 2016, Cohen and his colleagues found vinpocetine and picamilon in dietary supplements—those are drugs used in Germany, Russia, China, and other countries for acute stroke and cognitive impairment.

In 2018, a study in JAMA Network Open reported that 776 over-the-counter from 146 different dietary supplement companies contained unapproved ingredients. “The supplements in question include everything from sketchy sexual enhancement pills with donkeys and roosters printed on the packaging that you can find at bodegas, and more aesthetically pleasing pills that are now routinely hawked via Instagram marketing,” Hannah Smothers wrote in VICE.

In November of last year, Cohen and his colleagues found the unapproved drug piracetam in nootropics. Piracetam was discovered by a Romanian scientist Corneliu Giurgea in the early 1960s, who is also credited with coming up with the word “nootropic”—a combination of the Greek words for “mind” and “bending.” Evidence for piracetam’s effectiveness is rocky: a Cochrane Systematic Review didn’t find support that piracetam could meaningfully improve cognition in studies on more than 11,000 people.

In that study, Cohen and his colleagues found that some supplements had 20 percent more piracetam than they claimed to on the label. In Europe, prescription piracetam is usually prescribed with 800 or 1200 mg tablets, and a daily dosage of 2400 to 4800 mg. The supplements could have more than 1500 mg per individual dose, meaning a person could take a whopping 11,000 mg if they followed the instructions on the label.

In the new work, Cohen and his colleagues looked for supplements that contained chemicals similar to piracetam. They searched for supplements that openly stated that they included the compounds omberacetam, aniracetam, phenylpiracetam, or oxiracetam—all drugs not approved in the U.S.

They bought 10 supplements online, and through lab testing, found omberacetam and aniracetam in all 10. Omberacetam is a medication available in Russia for treating conditions like traumatic brain injury and mood disorders. Aniracetam is used to treat dementia in Italy, Argentina, and China.

They didn’t find phenylpiracetam and oxiracetam, even in the supplements that claimed to contain them. But they did find three unapproved drugs in two of the supplements that were not listed on the labels: aniracetam, phenibut, and picamilon. Phenibut is used in Russia for anxiety, insomnia, or alcohol withdrawal, and picamilon is used in Russia to increase blood flow to the brain, for mood disorders, or alcohol withdrawal. Phenibut is an especially concerning addition, Cohen said, because it can be a drug of abuse, and people could overdose on it at high levels or have withdrawal symptoms if they stop taking it.

While it’s true that these drugs can be prescribed in other countries, that involves the guidance of a doctor. As the Renaissance alchemist Paracelsus said,”It’s the dose that makes the poison.” Even if a drug is not harmful at low doses, supplements with unknown amounts of compounds are dangerous.

“Every pharmaceutical medication will have a dose when it starts becoming problematic and not safe,” Cohen said. “That creates unpredictable risks.”

On the products that did include dosages on the labels, Cohen found that nine out of 12 of the supplements got it wrong. And if a person took the serving sizes recommended by the labels, they would be exposed to pharmaceutical-level dosages of drugs. Additionally, by mixing different compounds, you could be creating interactions that cause even worse side effects. Mixing prescription drugs is tricky, and best done under the watchful eye of a doctor, Cohen said.

“You would certainly want to know the dose of each of those drugs you’re putting in your body,” Cohen said. “In this case, what is particularly alarming is how many different combinations there were. There are no studies that combine a mixture of these drugs and ask, ‘What does that do in humans?’”

That so many of these supplements are on the market is a failure of the FDA’s ability to regulate them, according to Cohen. “There are regulations that are in place and rules about introducing new ingredients into supplements,” he said. “Those are being violated hundreds of times a day by companies that are selling new ingredients without going through the proper channels.”

The concept of a “dietary supplement” was created with the Dietary Supplement Health and Education Act of 1994, or DSHEA. DSHEA classified supplements as food, not medicine—meaning they are not subject to the same rigorous testing medications are, including clinical trials.

Still, new ingredients added to supplements are supposed to be vetted by the FDA, and FDA is supposed to be told about them 75 days in advance so they have time to make sure they are safe.  But while 75,000 new supplement products have entered the market since 1994, the FDA only has safety data for fewer than 250 new ingredients.

Cohen said that our laws don’t sufficiently protect the public from what’s really in our supplements. “Since it was written, the supplement industry has been reshaped by Internet sales and an increasingly complex global supply of new substances,” he wrote in a recent editorial in the New England Journal of Medicine. “What was a $4 billion market in 1994 with a few thousand products has grown into a more than $40 billion market with tens of thousands of dietary supplements.”

In the dietary supplements market, patients aren’t seen as patients, Seres said—they’re seen as customers. He’s disappointed there hasn’t been more interference, especially since studies continue to be published on the presence of unapproved drugs; it’s no secret that this is an issue.

“It speaks to the weakness of the laws, and the insufficient funding and support for consumer protection,” Seres said.

In a statement online, the FDA wrote that it had issued warning letters to five companies that had supplements claiming to contain picamilon.  It has similarly issued warning letters for phenibut, and warned that vinpocetine could be risky for women of childbearing age. But these warnings may not be enough.

The 2018 JAMA Network Open paper, with senior author Madhur Kumar, a research scientist at the Food and Drug Branch of the California Department of Public Health, concluded that active pharmaceuticals continue to be found in supplements “even after FDA warnings.” For the more than 140 companies involved in that study, the FDA only issued seven warning letters.

The warning letters, when they are sent, are less of a bite and more of a feeble bark, according to Cohen. If a supplement company got a warning letter from the FDA about its product, they could simply leave the ingredient off the label, Cohen said.

“In a setting in which the FDA is an authority respected by industry, a warning letter could be very powerful,” Cohen said. “It could suggest that if you don’t do this, then you’re going to suffer serious consequences. But in the case of the supplement industry, the FDA warning letters almost always are just a slap on the wrist.”

The FDA is also not recalling as many products as have been adulterated. Out of 746 supplement brands found to be adulterated in Kumar and his colleagues’ work, only 460 were recalled. Another study from 2013 found, similarly, that though the FDA had discovered 332 brands of supplements with pharmaceutical ingredients between 2004 and 2012, only 222 were recalled.

The negative effects of a lack of supplement regulation can be seen in emergency rooms around the country. Poison control centers got over 1,000 more reports of adverse events associated with dietary supplement use than the FDA did over a three-year period—proof of how the FDA isn’t keeping up. Another study from 2015 on 63 emergency departments from 2004 to 2013 found that 23,005 visits per year were related to dietary supplements. 2,154 of those people ended up hospitalized per year.

And a recent CDC report using regional poison center data suggests more people are being exposed to phenibut. From 2009 to 2019, there were calls for 1,320 phenibut exposures  in the US, and the number of cases has increased since 2015.  Most of the symptoms were drowsiness, agitation, irregular heartbeat, or confusion. But there were also 80 cases of coma, and three deaths.

“Whose job is it to get these products off store shelves? It’s the FDA’s,” Cohen said. “While they are aware of almost all of these drugs that we found in these supplements, their actions have been incredibly weak.”

In response to the 2018 JAMA Network Open study, an FDA spokeswoman Lindsay Haake told CNN that “the FDA recognizes the seriousness of this problem and continues to act within its resources and authorities to address this problem as best it can.”

There is no national tracking system for supplement brands; any supplement can be introduced into the U.S. market without informing the FDA. Cohen thinks that a crucial first step to reigning in the supplement market would be to create such a registration system that would give the FDA the right to decline to register a product if it listed a prohibited or pharmaceutical ingredient, and also give the FDA a way to quickly deregister a product if they needed to. Consumers could use a code printed onto a supplement to check with the registry what that supplement’s status is.

“The FDA should have authority, at a minimum, to require companies to list their ingredients in advance of marketing, with the ability to prevent plainly illegal products from reaching the market,” said Joshua M. Sharfstein, a professor at Johns Hopkins Bloomberg School of Public Health and former principal deputy commissioner of the FDA, who was not involved in Cohen’s new research.

The only thing resembling any kind of supplement registry is the National Institute of Health’s (NIH) Dietary Supplement Label Database. But rather than a site that’s geared towards consumers being informed whether their supplements are legitimate or not, this database just lists whatever the supplement prints on their label. This means that illegal and prohibited ingredients are openly listed on the NIH database. “Basically we’re just putting prohibited ingredients right onto the database and making it look like they’re totally legitimate,” Cohen said.

“It’s particularly unfortunate that the NIH database lists products that may not be sold legally,” agreed Sharfstein.

Outside of listing illegal ingredients, the NIH database may not always be accurate, since it just goes by the product’s labeling. In April of this year, Cohen and his colleagues looked up supplements that were listed as containing 5-alpha-hydroxy-laxogenin, a plant steroid that the FDA has said is not a legal supplement ingredient.

The actual chemical contents of the supplements listed on the NIH database did not match the ingredients listed on the website. They found that only a fraction of the ingredients listed on the labels were present in the supplements, and the doses were wrong too. “Quantities detected ranged from less than 5 percent to 109 percent  of what was listed on the label,” Cohen wrote. “Only one of the products actually contained 5-alpha-hydroxy-laxogenin, but some did contain phenibut.

Seres said that while creating a proper registry for supplements is important, it has to be paired with more investment in and power given to the FDA to enforce the laws. Otherwise, we’d end up with just another version of the NIH database.

“Without strengthening the FDA, it might not result in much difference,” Seres said. “These companies should be really seriously penalized for endangering the consumers.”

In an email, Nathan Arnold, a spokesperson from the FDA, said that “The FDA monitors the compliance of dietary supplements through a variety of surveillance activities and carefully reviews product complaints and adverse event reports.”

Arnold also said that the FDA has proposed legislation to require mandatory product listing, which “would require all products marketed as ‘dietary supplements’ to be listed with FDA and give the agency authority to act against non-compliant products and the manufacturers and/or distributors of such products.” This would help the FDA know what dietary supplements are on the market, when new products are introduced, or what they contain, Arnold said.

In April of 2019, the Deputy Commissioner for Food Policy and Response, Frank Yiannas, released a statement on these new efforts to strengthen the regulation of dietary supplements. They launched a tool called the Dietary Supplement Ingredient Advisory List, available on the FDA’s website, and the statement said that “consumers may wish to avoid buying and using dietary supplements containing ingredients on the List and industry may wish to avoid making or selling dietary supplements containing ingredients on the List.”

At the time of publication, there were just 10 ingredients on the advisory list.

Without strong government interference, it’s up to researchers like Cohen to regularly call out supplement companies. That comes with its own risks. When Cohen published in 2015 that an illegal compound called BMPEA, similar to  amphetamines, was found in a variety of supplements, he was sued for $200 million dollars by Jared Wheat, the owner and CEO of Hi-Tech Pharmaceuticals.

In 2017, STAT’s Rebecca Robbins reported that Wheat said his company makes more than $100 million a year in revenue. Wheat also told Robbins, regarding his spending of between $300,000 and $400,000 to sue Cohen, that he “spent a lot of money, but hopefully it will deter others from going out there and making baseless allegations.” Robbins noted Wheat’s advice to other academics was: “Think twice and do better research, knowing you can get sued if you do this.”

Even though Cohen won the defamation trial in federal court in Massachusetts in November, Cohen told Robbins how in the grueling months leading up the trial, he had to pause on his research, sit through hours-long depositions, and was lucky to have institutional support from Harvard University for his legal fees. Other researchers may not have that—and it could dissuade them from pursuing this line of research.

The supplements that Cohen had studied, like Black Widow, Yellow Scorpion and Fastin-XR, are still available to purchase online.

Why do people buy supplements, when they know they’re unregulated, and at risk for containing dangerous substances? Seres said that there needs to be consumer education, to create a more skeptical customer when it comes to products that make broad claims about bettering your health.

Part of the problem is that for nutrition especially, science can be unclear. It can be confusing to read back-and-forth news items about foods that are bad for you one day and good for you the next, like eggs or coffee or red wine. Nutrition science is an ever-developing and iterative field; supplements are able to take advantage of the dissatisfying nature of that slow progression of knowledge.

“It’s human nature to want to control your destiny,” Seres said. “And especially where health is concerned.”

For many people, taking a risk in exchange for that sense of control is worth it. When reporters at the New York Daily News asked men buying over-the-counter “natural” sex supplements at bodegas why they bought them, one man said: “You don’t know what you’re taking. But that was an afterthought. I thought, ‘OK well, it’s not going to kill me.'”

Follow Shayla Love on Twitter.

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World

All the products we found to be the best during our testing this year

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(CNN) —  

Throughout the year, CNN Underscored is constantly testing products — be it coffee makers or headphones — to find the absolute best in each respective category.

Our testing process is rigorous, consisting of hours of research (consulting experts, reading editorial reviews and perusing user ratings) to find the top products in each category. Once we settle on a testing pool, we spend weeks — if not months — testing and retesting each product multiple times in real-world settings. All this in an effort to settle on the absolute best products.

So, as we enter peak gifting season, if you’re on the hunt for the perfect gift, we know you’ll find something on this list that they (or you!) will absolutely love.

Coffee

Best burr coffee grinder: Baratza Virtuoso+ Conical Burr Grinder With Digital Timer Display ($249; amazon.com or walmart.com)

Baratza Virtuoso+ Conical Burr Grinder
Baratza Virtuoso+ Conical Burr Grinder

Beginner baristas and coffee connoisseurs alike will be pleased with the Baratza Virtuoso+, a conical burr grinder with 40 settings for grind size, from super fine (espresso) to super coarse (French press). The best coffee grinder we tested, this sleek look and simple, intuitive controls, including a digital timer, allow for a consistent grind every time — as well as optimal convenience.

Read more from our testing of coffee grinders here.

Best drip coffee maker: Braun KF6050WH BrewSense Drip Coffee Maker ($79.95; amazon.com)

Braun KF6050WH BrewSense Drip Coffee Maker
Braun KF6050WH BrewSense Drip Coffee Maker

During our testing of drip coffee makers, we found the Braun KF6050WH BrewSense Drip Coffee Maker made a consistently delicious, hot cup of coffee, brewed efficiently and cleanly, from sleek, relatively compact hardware that is turnkey to operate, and all for a reasonable price.

Read more from our testing of drip coffee makers here.

Best single-serve coffee maker: Breville-Nespresso VertuoPlus ($165; originally $179.95; amazon.com)

Breville-Nespresso VertuoPlus
Breville-Nespresso VertuoPlus

Among all single-serve coffee makers we tested, the Breville-Nespresso VertuoPlus, which uses pods that deliver both espresso and “regular” coffee, could simply not be beat for its convenience. Intuitive and a snap to use right out of the box, it looks sleek on the counter, contains a detached 60-ounce water reservoir so you don’t have to refill it with each use and delivers perfectly hot, delicious coffee with a simple tap of a lever and press of a button.

Read more from our testing of single-serve coffee makers here.

Best coffee subscription: Blue Bottle (starting at $11 per shipment; bluebottlecoffee.com)

Blue Bottle coffee subscription
Blue Bottle coffee subscription

Blue Bottle’s coffee subscription won us over with its balance of variety, customizability and, most importantly, taste. We sampled both the single-origin and blend assortments and loved the flavor of nearly every single cup we made. The flavors are complex and bold but unmistakably delicious. Beyond its coffee, Blue Bottle’s subscription is simple and easy to use, with tons of options to tailor to your caffeine needs.

Read more from our testing of coffee subscriptions here.

Best cold brewer coffee maker: Hario Mizudashi Cold Brew Coffeepot ($25; amazon.com)

Hario Mizudashi Cold Brew Coffeepot
Hario Mizudashi Cold Brew Coffeepot

This sleek, sophisticated and streamlined carafe produces 1 liter (about 4 1/4 cups) of rich, robust brew in just eight hours. It was among the simplest to assemble, it executed an exemplary brew in about the shortest time span, and it looked snazzy doing it. Plus, it rang up as the second-most affordable of our inventory.

Read more from our testing of cold brew makers here.

Kitchen essentials

Best nonstick pan: T-fal E76597 Ultimate Hard Anodized Nonstick Fry Pan With Lid ($39.97; amazon.com)

T-fal E76597 Ultimate Hard Anodized Nonstick Fry Pan With Lid
T-fal E76597 Ultimate Hard Anodized Nonstick Fry Pan With Lid

If you’re a minimalist and prefer to have just a single pan in your kitchen, you’d be set with the T-fal E76597. This pan’s depth gives it multipurpose functionality: It cooks standard frying-pan foods like eggs and meats, and its 2 1/2-inch sides are tall enough to prepare recipes you’d usually reserve for pots, like rices and stews. It’s a high-quality and affordable pan that outperformed some of the more expensive ones in our testing field.

Read more from our testing of nonstick pans here.

Best blender: Breville Super Q ($499.95; breville.com)

Breville Super Q
Breville Super Q

With 1,800 watts of motor power, the Breville Super Q features a slew of preset buttons, comes in multiple colors, includes key accessories and is touted for being quieter than other models. At $500, it does carry a steep price tag, but for those who can’t imagine a smoothie-less morning, what breaks down to about $1.30 a day over a year seems like a bargain.

Read more from our testing of blenders here.

Best knife set: Chicago Cutlery Fusion 17-Piece Knife Block Set ($119.74; amazon.com)

Chicago Cutlery Fusion 17-Piece Knife Block Set
Chicago Cutlery Fusion 17-Piece Knife Block Set

The Chicago Cutlery Fusion 17-Piece Knife Block Set sets you up to easily take on almost any cutting job and is a heck of a steal at just $119.97. Not only did the core knives included (chef’s, paring, utility and serrated) perform admirably, but the set included a bevy of extras, including a full set of steak knives. We were blown away by their solid construction and reliable execution for such an incredible value. The knives stayed sharp through our multitude of tests, and we were big fans of the cushion-grip handles that kept them from slipping, as well as the classic look of the chestnut-stained wood block. If you’re looking for a complete knife set you’ll be proud of at a price that won’t put a dent in your savings account, this is the clear winner.

Read more from our testing of knife sets here.

Audio

Best true wireless earbuds: AirPods Pro ($199, originally $249; amazon.com)

Apple AirPods Pro
Apple AirPods Pro

Apple’s AirPods Pro hit all the marks. They deliver a wide soundstage, thanks to on-the-fly equalizing tech that produces playback that seemingly brings you inside the studio with the artist. They have the best noise-canceling ability of all the earbuds we tested, which, aside from stiff-arming distractions, creates a truly immersive experience. To sum it up, you’re getting a comfortable design, a wide soundstage, easy connectivity and long battery life.

Read more from our testing of true wireless earbuds here.

Best noise-canceling headphones: Sony WH-1000XM4 ($278, originally $349.99; amazon.com)

Sony WH-1000XM4
Sony WH-1000XM4

Not only do the WH-1000XM4s boast class-leading sound, but phenomenal noise-canceling ability. So much so that they ousted our former top overall pick, the Beats Solo Pros, in terms of ANC quality, as the over-ear XM4s better seal the ear from outside noise. Whether it was a noise from a dryer, loud neighbors down the hall or high-pitched sirens, the XM4s proved impenetrable. This is a feat that other headphones, notably the Solo Pros, could not compete with — which is to be expected considering their $348 price tag.

Read more from our testing of noise-canceling headphones here.

Best on-ear headphones: Beats Solo 3 ($119.95, originally $199.95; amazon.com)

Beats Solo 3
Beats Solo 3

The Beats Solo 3s are a phenomenal pair of on-ear headphones. Their sound quality was among the top of those we tested, pumping out particularly clear vocals and instrumentals alike. We enjoyed the control scheme too, taking the form of buttons in a circular configuration that blend seamlessly into the left ear cup design. They are also light, comfortable and are no slouch in the looks department — more than you’d expect given their reasonable $199.95 price tag.

Read more from our testing of on-ear headphones here.

Beauty

Best matte lipstick: Stila Stay All Day Liquid Lipstick ($11, originally $22; amazon.com or $22; nordstrom.com and stilacosmetics.com)

Stila Stay All Day Liquid Lipstick
Stila Stay All Day Liquid Lipstick

The Stila Stay All Day Liquid Lipstick has thousands of 5-star ratings across the internet, and it’s easy to see why. True to its name, this product clings to your lips for hours upon hours, burritos and messy breakfast sandwiches be damned. It’s also surprisingly moisturizing for such a superior stay-put formula, a combo that’s rare to come by.

Read more from our testing of matte lipsticks here.

Best everyday liquid liner: Stila Stay All Day Waterproof Liquid Eyeliner ($22; stilacosmetics.com or macys.com)

Stila Stay All Day Waterproof Liquid Eyeliner
Stila Stay All Day Waterproof Liquid Eyeliner

The Stila Stay All Day Waterproof Liquid Eyeliner is a longtime customer favorite — hence its nearly 7,500 5-star reviews on Sephora — and for good reason. We found it requires little to no effort to create a precise wing, the liner has superior staying power and it didn’t irritate those of us with sensitive skin after full days of wear. As an added bonus, it’s available in a whopping 12 shades.

Read more from our testing of liquid eyeliners here.

Work-from-home essentials

Best office chair: Steelcase Series 1 (starting at $381.60; amazon.com or $415, wayfair.com)

Steelcase Series 1
Steelcase Series 1

The Steelcase Series 1 scored among the highest overall, standing out as one of the most customizable, high-quality, comfortable office chairs on the market. At $415, the Steelcase Series 1 beat out most of its pricier competitors across testing categories, scoring less than a single point lower than our highest-rated chair, the $1,036 Steelcase Leap, easily making it the best bang for the buck and a clear winner for our best office chair overall.

Read more from our testing of office chairs here.

Best ergonomic keyboard: Logitech Ergo K860 ($129.99; logitech.com)

Logitech Ergo K860
Logitech Ergo K860

We found the Logitech Ergo K860 to be a phenomenally comfortable keyboard. Its build, featuring a split keyboard (meaning there’s a triangular gap down the middle) coupled with a wave-like curvature across the body, allows both your shoulders and hands to rest in a more natural position that eases the tension that can often accompany hours spent in front of a regular keyboard. Add the cozy palm rest along the bottom edge and you’ll find yourself sitting pretty comfortably.

Read more from our testing of ergonomic keyboards here.

Best ergonomic mouse: Logitech MX Master 3 ($99.99; logitech.com)

Logitech MX Master 3
Logitech MX Master 3

The Logitech MX Master 3 is an unequivocally comfortable mouse. It’s shaped to perfection, with special attention to the fingers that do the clicking. Using it felt like our fingers were lounging — with a sculpted ergonomic groove for nearly every finger.

Read more from our testing of ergonomic mice here.

Best ring light: Emart 10-Inch Selfie Ring Light ($25.99; amazon.com)

Emart 10-Inch Selfie Ring Light
Emart 10-Inch Selfie Ring Light

The Emart 10-Inch Standing Ring Light comes with a tripod that’s fully adjustable — from 19 inches to 50 inches — making it a great option whether you’re setting it atop your desk for video calls or need some overhead lighting so no weird shadows creep into your photos. Its three light modes (warm, cool and a nice mix of the two), along with 11 brightness levels (among the most settings on any of the lights we tested), ensure you’re always framed in the right light. And at a relatively cheap $35.40, this light combines usability and affordability better than any of the other options we tested.

Read more from our testing of ring lights here.

Home

Best linen sheets: Parachute Linen Sheet Set (starting at $149; parachute.com)

Parachute Linen Sheets
Parachute Linen Sheets

Well made, luxurious to the touch and with the most versatile shopping options (six sizes, nine colors and the ability to order individual sheets), the linen sheets from Parachute were, by a narrow margin, our favorite set. From the satisfying unboxing to a sumptuous sleep, with a la carte availability, Parachute set the gold standard in linen luxury.

Read more from our testing of linen sheets here.

Best shower head: Kohler Forte Shower Head (starting at $74.44; amazon.com)

Kohler Forte Shower Head
Kohler Forte Shower Head

Hands down, the Kohler Forte Shower Head provides the best overall shower experience, offering three distinct settings. Backstory: Lots of shower heads out there feature myriad “settings” that, when tested, are pretty much indecipherable. The Forte’s three sprays, however, are each incredibly different and equally successful. There’s the drenching, full-coverage rain shower, the pulsating massage and the “silk spray” setting that is basically a super-dense mist. The Forte manages to achieve all of this while using only 1.75 gallons per minute (GPM), making it a great option for those looking to conserve water.

Read more from our testing of shower heads here.

Best humidifier: TaoTronics Cool Mist Humidifier (starting at $49.99; amazon.com)

TaoTronics Cool Mist Humidifier
TaoTronics Cool Mist Humidifier

The TaoTronics Cool Mist Humidifier ramped up the humidity in a room in about an hour, which was quicker than most of the options we tested. More importantly, though, it sustained those humidity levels over the longest period of time — 24 hours, to be exact. The levels were easy to check with the built-in reader (and we cross-checked that reading with an external reader to confirm accuracy). We also loved how easy this humidifier was to clean, and the nighttime mode for the LED reader eliminated any bright lights in the bedroom.

Read more from our testing of humidifiers here.

Video

Best TV: TCL 6-Series (starting at $579.99; bestbuy.com)

TCL 6-Series
TCL 6-Series

With models starting at $599.99 for a 55-inch, the TCL 6-Series might give you reverse sticker shock considering everything you get for that relatively small price tag. But can a 4K smart TV with so many specification standards really deliver a good picture for $500? The short answer: a resounding yes. The TCL 6-Series produces a vibrant picture with flexible customization options and handles both HDR and Dolby Vision, optimization standards that improve the content you’re watching by adding depth to details and expanding the color spectrum.

Read more from our testing of TVs here.

Best streaming device: Roku Ultra ($99.99; amazon.com)

Roku Ultra
Roku Ultra

Roku recently updated its Ultra streaming box and the 2020 version is faster, thanks to a new quad-core processor. The newest Ultra retains all of the features we loved and enjoyed about the 2019 model, like almost zero lag time between waking it up and streaming content, leading to a hiccup-free streaming experience. On top of that, the Roku Ultra can upscale content to deliver the best picture possible on your TV — even on older-model TVs that don’t offer the latest and greatest picture quality — and supports everything from HD to 4K.

Read more from our testing of streaming devices here.

Travel

Best carry-on luggage: Away Carry-On ($225; away.com)

Away Carry-On
Away Carry-On

The Away Carry-On scored high marks across all our tests and has the best combination of features for the average traveler. Compared with higher-end brands like Rimowa, which retail for hundreds more, you’re getting the same durable materials, an excellent internal compression system and eye-catching style. Add in smart charging capabilities and a lifetime warranty, and this was the bag to beat.

Read more from our testing of carry-on luggage here.

Best portable charger: Anker PowerCore 13000 (starting at $31.99; amazon.com)

Anker PowerCore 13000
Anker PowerCore 13000

The Anker PowerCore 13000 shone most was in terms of charging capacity. It boasts 13,000 mAh (maH is a measure of how much power a device puts out over time), which is enough to fully charge an iPhone 11 two and a half times. Plus, it has two fast-charging USB Type-A ports so you can juice a pair of devices simultaneously. While not at the peak in terms of charging capacity, at just $31.99, it’s a serious bargain for so many mAhs.

Read more from our testing of portable chargers here.

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World

Trump’s misleading tweet about changing your vote, briefly explained

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Searches for changing one’s vote did not trend following the recent presidential debate, and just a few states appear to have processes for changing an early vote. But that didn’t stop President Trump from wrongly saying otherwise on Tuesday.

In early morning posts, the president falsely claimed on Twitter and Facebook that many people had Googled “Can I change my vote?” after the second presidential debate and said those searching wanted to change their vote over to him. Trump also wrongly claimed that most states have a mechanism for changing one’s vote. Actually, just a few states appear to have the ability, and it’s rarely used.

Twitter did not attach a label to Trump’s recent tweet.
Twitter

Trump’s claim about what was trending on Google after the debate doesn’t hold up. Searches for changing one’s vote were not among Google’s top trending searches for the day of the debate (October 22) or the day after. Searches for “Can I change my vote?” did increase slightly around the time of the debate, but there is no way to know whether the bump was related to the debate or whether the people searching were doing so in support of Trump.

It was only after Trump’s posts that searches about changing your vote spiked significantly. It’s worth noting that people were also searching for “Can I change my vote?” during a similar period before the 2016 presidential election.

Google declined to comment on the accuracy of Trump’s post.

Trump also claimed that these results indicate that most of the people who were searching for how to change their vote support him. But the Google Trends tool for the searches he mentioned does not provide that specific information.

Perhaps the most egregiously false claim in Trump’s recent posts is about “most states” having processes for changing your early vote. In fact, only a few states have such processes, and they can come with certain conditions. For instance, in Michigan, voters who vote absentee can ask for a new ballot by mail or in person until the day before the election.

The Center for Election Innovation’s David Becker told the Associated Press that changing one’s vote is “extremely rare.” Becker explained, “It’s hard enough to get people to vote once — it’s highly unlikely anybody will go through this process twice.”

Trump’s post on Facebook was accompanied by a link to Facebook’s Voting Information Center.
Facebook

At the time of publication, Trump’s false claims had drawn about 84,000 and 187,000 “Likes” on Twitter and Facebook, respectively. Trump’s posts accelerated searches about changing your vote in places like the swing state of Florida, where changing one’s vote after casting it is not possible. Those numbers are a reminder of the president’s capacity to spread misinformation quickly.

On Facebook, the president’s post came with a label directing people to Facebook’s Voting Information Center, but no fact-checking label. Twitter had no annotation on the president’s post. Neither company responded to a request for comment.

That Trump is willing to spread misinformation to benefit himself and his campaign isn’t a surprise. He does that a lot. Still, just days before a presidential election in which millions have already voted, this latest episode demonstrates that the president has no qualms about using false claims about voting to cause confusion and sow doubt in the electoral process.

Open Sourced is made possible by Omidyar Network. All Open Sourced content is editorially independent and produced by our journalists.


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Nearly 6,000 civilian casualties in Afghanistan so far this year

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From January to September, 5,939 civilians – 2,117 people killed and 3,822 wounded – were casualties of the fighting, the UN says.

Nearly 6,000 Afghan civilians were killed or wounded in the first nine months of the year as heavy fighting between government forces and Taliban fighters rages on despite efforts to find peace, the United Nations has said.

From January to September, there were 5,939 civilian casualties in the fighting – 2,117 people killed and 3,822 wounded, the UN Assistance Mission in Afghanistan (UNAMA) said in a quarterly report on Tuesday.

“High levels of violence continue with a devastating impact on civilians, with Afghanistan remaining among the deadliest places in the world to be a civilian,” the report said.

Civilian casualties were 30 percent lower than in the same period last year but UNAMA said violence has failed to slow since the beginning of talks between government negotiators and the Taliban that began in Qatar’s capital, Doha, last month.

An injured girl receives treatment at a hospital after an attack in Khost province [Anwarullah/Reuters]

The Taliban was responsible for 45 percent of civilian casualties while government troops caused 23 percent, it said. United States-led international forces were responsible for two percent.

Most of the remainder occurred in crossfire, or were caused by ISIL (ISIS) or “undetermined” anti-government or pro-government elements, according to the report.

Ground fighting caused the most casualties followed by suicide and roadside bomb attacks, targeted killings by the Taliban and air raids by Afghan troops, the UN mission said.

Fighting has sharply increased in several parts of the country in recent weeks as government negotiators and the Taliban have failed to make progress in the peace talks.

At least 24 people , mostly teens, were killed in a suicide bomb attack at an education centre in Kabul [Mohammad Ismail/Reuters]

The Taliban has been fighting the Afghan government since it was toppled from power in a US-led invasion in 2001.

Washington blamed the then-Taliban rulers for harbouring al-Qaeda leaders, including Osama bin Laden. Al-Qaeda was accused of plotting the 9/11 attacks.

Calls for urgent reduction of violence

Meanwhile, the US envoy for Afghanistan, Zalmay Khalilzad, said on Tuesday that the level of violence in the country was still too high and the Kabul government and Taliban fighters must work harder towards forging a ceasefire at the Doha talks.

Khalilzad made the comments before heading to the Qatari capital to hold meetings with the two sides.

“I return to the region disappointed that despite commitments to lower violence, it has not happened. The window to achieve a political settlement will not stay open forever,” he said in a tweet.

There needs to be “an agreement on a reduction of violence leading to a permanent and comprehensive ceasefire”, added Khalilzad.

A deal in February between the US and the Taliban paved the way for foreign forces to leave Afghanistan by May 2021 in exchange for counterterrorism guarantees from the Taliban, which agreed to sit with the Afghan government to negotiate a permanent ceasefire and a power-sharing formula.

But progress at the intra-Afghan talks has been slow since their start in mid-September and diplomats and officials have warned that rising violence back home is sapping trust.

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