Health Experts Are Worried About a Huge Rise in Smoking in Movies

Depictions of people using tobacco in top-grossing movies grew by 80% from 2015 to 2016, according to a new study.

The report, published by the Centers for Disease Control and Prevention, found tobacco use in movies jumped up a total of 72% from 2010 to 2016. Although the number of movies that showed “tobacco incidents” — defined by the CDC as the use or implied use of cigarettes, cigars, pipes, hookah, smokeless tobacco products and electronic cigarettes — declined from 2005 to 2010, that downward trend stopped in 2010.

The CDC analyzed data from Thumbs Up! Thumbs Down!, a project that analyzes tobacco content in movies under non-profit Breathe California. The data is posted to the website, which lists the number of tobacco incidents in each movie. For example, 2016’s 10 Cloverfield Lane, a PG-13 movie, had 8,333,295 tobacco impressions using cigarettes, according to the website. La La Land, also rated PG-13, had 34,936,834 tobacco impressions using cigarettes.

Overall, the number of tobacco incidents shown in R-rated movies grew by 90%, while PG-13 movies saw a significant increase of 43% from 2010 to 2016. In 2016, 67% of R-rated movies featured tobacco incidents, while 26% of “youth-rated movies” (G, PG or PG-13) showed the same.

The rise of smoking on screen has worried health professionals, who warned that the more frequency with which young people see tobacco use in movies will make them more likely to smoke. According to the CDC, youths who have a lot of exposure to smoking in movies are about 2 to 3 times more likely to start smoking than other young people who are less exposed.

In spite of the rise of tobacco incidents on screen, teen smoking has steadily declined since 2011. The number of teens who said they used tobacco dropped to 3.9 million in 2016 from 4.7 million the year before, according to the CDC.

The CDC recommends reducing tobacco incidents in movies meant for young people and giving films with tobacco use an R-rating. The Motion Picture Association of America does not currently give R-ratings to movies just because of tobacco incidents, although it does have a descriptor that indicates when some movies contain smoking.

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Coffee Drinkers Really Do Live Longer

By now, it’s clear: There’s a strong case for the health benefits of coffee. Studies have recently shown that regular java drinkers have a lower risk of diabetes, fewer strokes and heart problems and lower rates of certain cancers. All of that may help explain why coffee drinkers also tend to live longer than people who don’t drink the brew.

But much of this good news came from analyzing mostly white populations. Whether the benefits held for people of other racial and ethnic backgrounds remained uncertain. Now, scientists report that the longevity perks likely apply to African Americans, Latinos and some Asian Americans as well.

In two new studies published in the Annals of Internal Medicine, researchers delved into the coffee-drinking habits of more than 700,000 people in the U.S. and in 10 European countries. The scientists were particularly interested in looking at death rates among people of non-white populations. In both studies, people in these groups who drank more coffee tended to have a lower risk of dying during the study period than those who drank less coffee, or no coffee.

In the U.S. study, African Americans, Japanese Americans, Latinos and whites who drank more than four cups of coffee a day showed an 18% lower risk of dying prematurely in the 16 years of follow-up, compared to non drinkers. Even those who drank a single cup of coffee daily showed some benefit; their risk of dying early was 12% lower compared to non-drinkers. (In these studies, people self-reported their coffee consumption, and the researchers weren’t able to determine the strength of the brew.)

MORE: Can Coffee Make Your Workout Easier?

In the European study, researchers found similar benefits. Heavier coffee drinkers had a 7% to 12% lower risk of dying prematurely compared to non-drinkers. These scientists also found that java fans had lower rates of digestive diseases and heart-related conditions, such as stroke.

Best of all, the effect of coffee was similar for people who drank caffeinated or decaffeinated versions. This suggests that caffeine is not conferring the health benefits in coffee. Different studies have pointed to other components that might fight heart disease and cancer, such as antioxidants. Other compounds may also lower inflammation, which is a culprit in many chronic conditions, especially those linked to aging.

While the two studies involved a large number of people, the findings don’t imply that people who don’t drink coffee will necessarily die early, or that downing coffee throughout the day will help you live longer. And even though the findings favored heavy coffee drinkers, you may want to drink in moderation. Research suggests that up to four 8-ounce cups a day is safe. Coffee can have some downsides, including agitation, irregular heartbeat and digestion problems for some people.

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The Number of U.S. Adults Without Health Insurance Has Risen by Two Million This Year

(WASHINGTON) — The number of U.S. adults without health insurance has grown by some 2 million this year, according to a major new survey that finds recent coverage gains beginning to erode.

The new numbers highlight what’s at stake as Congress returns to an unresolved debate over Republican proposals to roll back much of former President Barack Obama’s health care law.

The Gallup-Sharecare Well-Being Index, published Monday, found that the uninsured rate among U.S. adults was 11.7% in the second three months of this year, compared with a record low of 10.9% at the end of last year. Though small, the change was statistically significant, survey analysts noted.

While “Obamacare” has remained politically divisive, it had helped drive the uninsured rate to historic lows as some 20 million people gained coverage.

Senate Majority Leader Mitch McConnell, R-Ky., plans to check vital signs on his GOP bill as senators trickle back to Washington from a July 4 break that many spent listening to constituents vent about health care.

McConnell is seen as a master legislative strategist, but there’s no sign he’s secured enough votes to pass a bill. He can only afford to lose two out of 52 Republican senators.

The Congressional Budget Office has estimated that at least 22 million more people would become uninsured under Republican legislation.

McConnell has been considering easing some of the bill’s Medicaid cuts, beefing up health care tax credits to help people buy private insurance and adding billions of dollars to counter the opioid epidemic. That might comfort GOP moderates. To placate conservatives, McConnell is weighing demands to make it easier for insurers to offer skimpier policies.

He’s also admonished fellow Republicans that they may find themselves negotiating with Democratic leader Sen. Chuck Schumer of New York if they don’t close ranks. In that case, McConnell said he’d aim for a limited package propping up troubled insurance markets around the country.

The Gallup-Sharecare survey serves as a kind of early indicator, publishing several months before the nimblest government surveys. The most recent government report found that progress reducing the number of uninsured stalled in 2016, after five consecutive years of coverage gains under Obama.

Read More: President Trump’s Latest Health Care Push Could Repeal Obamacare and Do Nothing Else

Peering at this year, Gallup-Sharecare found an erosion of progress, with the number of uninsured edging up again. It estimated nearly 2 million dropped out of coverage.

The losses were concentrated among younger adults and people buying their own health insurance policies, the survey found.

That may be a reflection of rising premiums and dwindling choices in the insurance markets created under Obama.

Also, President Donald Trump has branded his predecessor’s leading domestic achievement a “disaster” while pursuing its repeal. Insurers say Trump administration actions are contributing to double-digit premium increases for next year.

Gallup-Sharecare found that the uninsured rate rose by 1.9 percentage points among adults aged 18-25 since the end of last year, and 1.5 points among those aged 26-34.

Participation by young adults is considered vital for keeping health insurance premiums in check. But young adults are also likely to enjoy good health and may not recognize value in having coverage.

The Gallup-Sharecare survey is an ongoing effort based on interviews with about 500 people a day. It was previously called the Gallup-Healthways Well-Being Index.

Results are based on telephone interviews conducted April 1-June 30, with a random sample of 45,087 adults, aged 18 and older, living in all 50 U.S. states and Washington, D.C. The margin of error is plus or minus 1 percentage point.

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Some Cases of Gonorrhea Are Now Untreatable Due to Drug Resistance

Some cases of the sexually transmitted infection gonorrhea are now untreatable due to resistance to antibiotics, according to the World Health Organization (WHO).

“Every time we use a new class of antibiotics to treat the infection, the bacteria evolve to resist them,” said WHO medical officer Dr. Teodora Wi in a statement.

About 78 million people get gonorrhea infections every year, according to the WHO, which also notes complications from the STI have a larger impact on women.

WHO Director of Antimicrobial Resistance Dr. Marc Sprenger said in a statement that corralling the infection requires new tools for better prevention, new antibiotics, and in the future, a vaccine against gonorrhea.

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Georgia’s Health Commissioner Becomes New CDC Director

(NEW YORK) — Georgia’s health commissioner was named Friday to lead the U.S. Centers for Disease Control and Prevention, the federal government’s top public health agency.

Dr. Brenda Fitzgerald is an OB-GYN and has been head of the Georgia Department of Public Health since 2011. She succeeds Dr. Tom Frieden, who resigned as CDC director in January at the end of the Obama administration.

Fitzgerald was appointed by Dr. Tom Price, who was a congressman from Georgia before he was named head of the U.S. Department of Health and Human Services by President Donald Trump.

“Having known Dr. Fitzgerald for many years, I know that she has a deep appreciation and understanding of medicine, public health, policy and leadership — all qualities that will prove vital as she leads the CDC in its work to protect America’s health 24/7,” Price said in a statement.

Fitzgerald, 70, has had strong ties to the Republican Party. She was a GOP candidate for Congress twice in the 1990s. She was also a health care policy adviser to Newt Gingrich, the former House Speaker, and the late Sen. Paul Coverdell.

Fitzgerald is respected in the public health community, and her choice drew praise from Dr. Georges Benjamin, executive director of the American Public Health Association.

“From her work as a practicing obstetrician-gynecologist to her recent service as the commissioner of the Georgia Department of Public Health, Dr. Fitzgerald is more than prepared to face the health challenges of our time, including climate change, Zika, Ebola, and our growing burden of chronic disease,” Benjamin said in a statement.

The CDC investigates disease outbreaks, researches the cause and frequency of health problems and promotes prevention efforts. It is the only federal agency headquartered outside of Washington, D.C. It has nearly 12,000 employees and 10,000 contractors worldwide.

Her first day at CDC was Friday. A CDC spokeswoman said Fitzgerald would not be available for interviews.

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The Opioid Opana ER Is Being Taken Off the Market

The opioid medication Opana ER is being voluntarily withdrawn from the market, its manufacturer Endo Pharmceuticals said in a statement Thursday. The decision comes less than a month after the U.S. Food and Drug Administration (FDA) requested that drug sales be halted, due to concerns over its potential for misuse and abuse.

On June 8, the FDA announced that an advisory committee had determined that Opana ER tablets—ER stands for extended-relief—had “dangerous unintended consequences” and that “the benefits of the drug may no longer outweigh the risks.” The FDA stated that if Endo did not voluntarily recall the drug, the agency would formally withdrawal approval. (Extended-relief opioids come with increased risks of addiction and overdose.)

At the time, Endo said it was reviewing the request and evaluating its options. Yesterday, the company released a statement saying that while it “continues to believe in the safety, efficacy, and favorable benefit-risk profile of Opana ER,” it has agreed to withdrawal the drug.

“Endo plans to work with FDA to coordinate the orderly removal of OPANA ER in a manner that looks to minimize treatment disruption for patients and allows patients sufficient time to seek guidance from their healthcare professionals,” the company’s statement reads. “Patients taking OPANA ER should discuss treatment options with their prescribing physician at their next visit.”

Opana ER’s reported net sales for the first quarter of 2017 totaled $ 35.7 million, according to Endo’s statement, and the withdrawal will cost the company approximately $ 20 million. The statement also notes that “the Company has taken significant steps over the years to combat misuse and abuse,” and reiterates that its decision does not reflect any findings that the drug is not safe or effective when taken as prescribed.

Opioid addiction continues to be a serious problem across the U.S. A report released this week from the Centers for Disease Control and Prevention found that pain-relief prescriptions in the United States vary widely from county to county, with 6 times more opioids-per-resident in regions with the highest prescribing rate compared to the lowest. Counties in northern California, southern Nevada, and parts of Tennessee, Kentucky, and West Virginia had some of the highest per-capita rates.



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Eating Sugar During Pregnancy Is Linked to Kids’ Allergies

How much sugar a woman eats while she’s pregnant may affect her future children’s risk of developing allergies and allergic asthma, according to a study in the European Respiratory Journal. Although previous research has linked asthma and high-sugar intake in kids themselves, this is the first study to show that mothers’ diets may also play a role.

The new study analyzed data from nearly 9,000 women who were pregnant in the early 1990s, and from their children, who were tested for asthma and common allergies (like dust mites, cats and grass) at age 7. While pregnant, the women were asked about their weekly consumption of certain food groups and specific food items, including sugar, coffee and tea; their responses were used to calculate their intake of added sugar, not including natural sugars in fruits, vegetables or dairy products.

The researchers only saw weak evidence to suggest a link between women’s added sugar intake and their children’s chances of developing asthma overall. But when they looked specifically at allergic asthma—in which an asthma diagnosis is accompanied by a positive skin test for allergens—the link was much stronger. Children whose moms were in the top fifth for added sugar during pregnancy were twice as likely to have allergic asthma when compared to children whose moms were in the bottom fifth.

Kids of moms with high-sugar diets were also 38% more likely to test positive for an allergen—and 73% more likely to test positive for two or more—than those whose moms stayed away from added sugar. The researchers controlled for several factors that could have also influenced the findings, including social factors and other aspects of the mothers’ diets.

Not all allergic conditions were linked to maternal sugar consumption, however. No association was found for eczema or hay fever. And contrary to previous studies, no association was found between the children’s own sugar intake (at age 4) and any of their health outcomes at age 7.

MORE: How To Prevent Peanut Allergies

The study was not able to show a cause-and-effect relationship. But the authors speculate that high-sugar intake during pregnancy may increase inflammation in developing lung tissue, leaving children predisposed to allergies. “We know that the prenatal period may be crucial for determining risk of asthma and allergies in childhood, and recent trials have confirmed that maternal diet in pregnancy is important,” says first author Annabelle Bedard, a postdoctoral fellow in the Center for Primary Care and Public Health at Queen Mary University of London, via email.

Bedard believes that consumption of high-fructose corn syrup may be largely responsible. It increased from about 0% to nearly 30% of per capita consumption of refined sugars in the United States between 1970 and 2000. “The dramatic ‘epidemic’ of asthma and allergies in the West in the last 50 years is still largely unexplained,” she says. “One potential culprit is a change in diet.”

Given the extreme amounts of sugar consumed regularly in Western countries, the study authors say the need for further research is urgent. They hope to conduct clinical trials to see if reducing sugar intake during pregnancy will, in fact, affect children’s health several years later.

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No, Period Brain Is Not Actually a Thing

Have you ever thought to yourself—or had anyone else ever suggest to you—that you’re not at the top of your game, mentally, because you’re on your period? It’s a common belief, says Dr. Brigitte Leeners, professor of reproductive endocrinology at University Hospital Zurich. But according to her new study in Frontiers in Behavioral Neuroscience, it simply isn’t true.

As a gynecologist and psychotherapist, Leeners has seen many patients who believe that their menstrual cycle can or does influence their cognitive performance. “However,” she told Health via email, “I had the impression that in only very few women such limitations can indeed be attributed to hormones.”

Studies on this topic have been mixed, with several suggesting a connection between hormones and cognition. But because of limitations and biases in those study designs, it’s difficult to know how accurate their findings really are, says Leeners.

So she and her colleagues performed the largest and longest study on this topic to date, testing three aspects of cognitive functioning in 88 women at four different times throughout their menstrual cycle. Then they re-tested 68 of those women for a second consecutive month, which turned out to be key: While they found some data to suggest a link between mental performance and menstruation in some women during the first cycle, those findings weren’t replicated the second time around. 9 Best Workouts to Do When You Have Your Period

Overall, the researchers found no consistent relationship between any of the three hormone levels they tested for—estrogen, progesterone, or testosterone—and women’s working memory, ability to pay attention to two things at once, or complex cognitive functions. That was true both when they looked at the group results as a whole, as well as at individual women’s test results over the two months.

The research represents a meaningful step forward in the debate over how menstruation affects the brain, says Leeners. But more studies—with larger, more diverse groups of women and additional cognitive tests—could still help provide a more complete picture, she adds.

There may be individual exceptions to the group’s findings, she says; for example, some women may be more sensitive to hormonal changes than the women included in this study. She also points out that her team only looked for direct links between hormone levels and certain areas of cognition; the findings don’t account for how menstrual symptoms (like cramping and fatigue) may affect women’s mental state or distract from their normal thinking processes.

But in general, Leeners says, the study suggests that flaws in previous research may have skewed popular belief in this area—and that scientists should carefully evaluate future studies to avoid similar limitations.

And more importantly, she adds, the study delivers a strong message to the public, too. “We should stop blaming the period or the menstrual cycle for reduced cognitive performance,” she says.

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Teen Birth Rates in the U.S. Hit a Record Low

Last year there were fewer teenage births in the United States than ever before, according to a new government report.

The rate of births among 15-to-19 year olds declined by 9% in 2016 compared to 2015 — a record low for that age group, according to the report from the Centers for Disease Control. The birth rate was 20.3 births per 1,000 woman in 2016, compared to 22.3 births per 1,000 women in 2015.

The birth rate for women aged 20 to 24 also declined; in 2016, there were 4% fewer births among that age group, another record low.

The total number of births in the U.S. declined by 1% overall. In 2016, there were 3,941,109 births in total, but in 2015 there were 3,978,497. This is the second year that the number of births has declined following an increase in 2014, the government report explains.

The report did not discuss the reasons behind the teenage birth rate drop, but Elise Berlan, M.D., of the Nationwide Children’s Hospital, attributed the decline to better access to and use of contraceptives in an interview with the New York Daily News. “We know that the vast majority of teen births are unintended,” she added.

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Whole Foods Discovered Its Chicken Salad Actually Had Tuna

Willow Tree Poultry Farm had a 2003-era Jessica Simpson moment after shipping chicken salad that turned out to contain tuna instead to Whole Foods.

The farm is recalling about 440 pounds of buffalo chicken salad after Whole Foods employees discovered that it actually contained tuna — a known allergen, according to the U.S. Department of Agriculture.

The affected products, which are 12.5-ounce individual packets, were shipped to Whole Foods locations in Connecticut, New Jersey and New York. No illnesses have been reported yet.

Customers who purchased the mislabeled chicken salad are encouraged to throw them away or return them to Whole Foods.

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3 Things You Didn’t Know About Running

The following story is excerpted from TIME’s special edition, The Science of Exercise, which is available at Amazon.

There’s no denying that running is one of the most democratic ways to work out. You can do it anytime, anywhere, and all you need is a good pair of running shoes and some stamina. It’s no wonder, then, that more and more Americans are adopting the sport and doing it competitively; the number of people who finished organized races grew 300% in the U.S. from 1990 to 2013, and in 2015, there were slightly more than 17 million Americans who ran in races nationwide.

Still, estimates suggest that 79% of runners will get injured at some point, a statistic that’s remained relatively stable for more than 40 years. “Running is hard on the wheels, especially if you’re doing long-distance running,” says James O’Keefe, a cardiologist at St. Luke’s Mid America Heart Institute in Kansas City and a former runner. “A lot of people will break down orthopedically.”

Since more than 80 million Americans are living a sedentary lifestyle, there are certainly plenty of people who could benefit from running rather than doing nothing at all—and if you do run already, there is no reason to stop unless a doctor tells you to. The latest science on running and its effects on the body offers both encouraging and cautionary takeaways for people who enjoy the sport.

Running may prevent some injuries

Running has a reputation for causing wear and tear, but new research suggests that it may actually prevent injuries rather than increase the risk of them.

A small study published in December 2016 found that 30 minutes of running lowered inflammation in runners’ knee joints. In the report, researchers at Brigham Young University brought 15 healthy runners into a lab where samples of their blood and knee-joint fluid were taken before and after they ran for 30 minutes. The researchers then compared the samples with ones taken earlier when the men and women were sedentary.

The researchers expected to find an increase in molecules that spur inflammation, but they didn’t. Instead, they found that pro-inflammatory markers had decreased. “It was surprising,” says study author Matt Seeley, an associate professor of exercise science at BYU.

Seeley emphasizes that the report is a pilot and that his team plans to do the same study with more people in the near future. “I think, and hope, the data will show that running is good for your joints,” he adds. “Although the results are limited, they are also unexpected and could be important.”

Not everyone is convinced. “There is data on both sides of the fence,” says Brian Feeley, an orthopedic surgeon at the University of California, San Francisco, who wasn’t involved with the study. “We know there are some people who run all the time with no problems and others that have arthritis at a relatively young age.” For now, people of all abilities should allow themselves time to recover post-workout.

It may not be great for women’s bodies

Women make up about 57% of race finishers, and data suggests that the number of female runners is up worldwide. But men and women tend to run in different ways, and in some cases, that can mean more injuries for women.

Stephen Messier, director of the J.B. Snow Biomechanics Laboratory at Wake Forest University, is trying to understand why female runners get injured more often than men. So far he’s found that women tend to have higher arches and point their toes out more as they run. “We don’t know if those differences attribute to a greater risk for injury,” says Messier, but his team is trying to find out.

Prior research has found that female runners are more likely to be heel strikers, which some experts think increases risk of injury because of higher-impact landings. The way people’s hips and knees are naturally aligned may also increase their risk. Women also tend to have less strength in their core and hips, which could affect them.

That shouldn’t deter women from running, however. Women have more body fat, which is beneficial for energy storage and endurance, and they’re typically more flexible than men, which can benefit their muscles. Women also appear to be better at pacing themselves during races compared with men.

To prevent heel striking, experts suggest that people try landing closer to their midfoot or landing softer during each stride. Messier is also launching a trial that puts female runners through strength-training exercises to see if some bulking up can help them lower their injury risk overall.

You can run even in old age—to a point

As the popularity of competitive running increases, more people are doing it later in life, too. “Generations before us weren’t doing this,” says O’Keefe. “People weren’t running over 10 miles a day into their 60s.”

Today, people age 40 and up make up nearly 50% of marathon finishers in the U.S., whereas in 1980, they made up just 26%. O’Keefe says there is no definite age cutoff at which running is no longer good for you, but curbing it with age may be a good idea. “Many people find that their joints feel better if they do brisk walking rather than running after age 45 or 50,” he says. “I do advise people over age 45 to avoid chronic very-high-intensity long-distance running, as the body is not as resilient as we get older.”

One study looked at marathon runners and their non-runner spouses and found that the runners were thinner and had lower blood pressure and heart rate. But the findings also showed that the older racers had a lot of plaque in their arteries and scored higher on a measurement of heart-attack risk.

Other types of exercise, like high-intensity interval training and strength-based exercises, are good to mix in as you age. Pilates and yoga have also been shown to improve flexibility and balance, which are important for runners—and in aging. “If people tell me they are running 25 miles a week, I ask: Why are you doing it?” says O’Keefe. “If it’s to relax, be social or for long-term health, I tell them you’re better off running a mile and a half and then going to a yoga class. Concentrating on one thing can hurt in the long run.”

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Erika Eckley Helps People Die With Dignity. Here’s What She Fears About Health Care Reform

Kelly Wilkins was 39 years old when she learned she had breast cancer, and 44 years old when the doctors told her she would not get better. She was discharged from Broadlawns Medical Center in Des Moines, Iowa, and moved back home. Hospice nurses took care of her in those final days, thanks to her Medicaid insurance.

Wilkins’ sister, Erika Eckley, watched how those nurses softened the blows of dying. When Wilkins was too weak to climb the stairs to her bedroom, for example, the hospice nurses installed a medical bed in her living room so family could gather around her.

“There’s just a comfort level when you’re in your own home versus being in a clinical hospital,” Eckley says. Wilkins was able to reunite with her two cats, whom she’d painfully missed. She reread her favorite books. The hospice nurses talked to Wilkins’ mother, who didn’t move from her daughter’s bedside, about the grief of losing a child.

The hospice experience moved Eckley to join the field herself. Today she is the executive director of the Hospice and Palliative Care Association of Iowa. That makes her particularly well positioned to assess some of the personal and public health impact of the Senate’s proposed health care bill — which would slash federal Medicaid funding by $ 772 billion, according to the nonpartisan Congressional Budget Office.

Erika Eckley
courtesy of the subject Erika Eckley, executive director of the Hospice and Palliative Care Association of Iowa

Eckley fears that the measure will leave low-income people to die less gracefully, without the pain medicine, counseling and company that hospice care provides. Around 5% of hospice patients are covered directly by Medicaid, according to the National Hospice and Palliative Care Organization. But many patients also receive hospice care in nursing homes, which are reliant on Medicaid funding.

In her Des Moines office, Eckley spends her days preparing and sharing information about services like Medicaid to Iowa’s 105 hospice locations. Lately, she’s been looking at how the federal cuts to Medicaid could play out in her state.

“They could reduce the number of people who qualify for Medicaid by making eligibility more restrictive,” she says. “The state, in looking to reduce its costs, could eliminate the hospice benefit under Medicaid.”

Nursing Homes Strained

She adds a point she says is often overlooked: “About 50% of the hospice beneficiaries are in nursing homes. Nursing homes are paid through Medicaid funding,” she explains. “Nursing homes in Iowa might close if they have more losses coming through the Medicaid funding.”

And the death of those facilities could cause widespread damage, she says.

“If rural hospitals, nursing homes and hospices close, those communities are going to die as well, as those are the largest economic engines in a lot of those communities. Once those are gone, they don’t come back. So this isn’t just about whether or not someone can afford to be in a hospice. This is whether or not we can afford to let our communities languish, just because we don’t want to pay for a Medicaid benefit.”

‘The Hospice Individuals Loved Her’

Even though hospice care comes at the end of someone’s life, it can still have a tangible impact, Eckley says. One study found that people in hospice care live an average of 29 days longer than non-hospice patients.

One story stands out to Eckley, of a woman in southern Iowa who received hospice care through her Medicaid insurance.

“There was a younger woman who had been incarcerated and she had cancer. She was given the opportunity to be released from the prison for her final days, and to be taken care of in the hospice. Through her treatment, she had lost her hair. The hospice volunteers provided her with hats that people had knitted to keep her head warm. The hospice tried to help her get in touch with family that she’d lost contact with.

“Shortly before she passed, she told the hospice that she was grateful for the care they’d given her because nobody in her life had ever loved her the way the hospice individuals loved her at the end of her life.”

Around two weeks later, the woman died.

“This is changing lives,” Eckley says, adding that hospice services also provide support for the loved ones around the dying.

courtesy of Erika EckleyThe late Kelly Wilkins with her grandmother, who is now opting for hospice treatment.

At Death, a Lifeline for Survivors

Eckley remembers how the hospice nurses stayed with her sister until the very end. They helped Wilkins to call her family members who couldn’t be there, to say goodbye. They talked about the stages of grief to the family members who were there.

Even though the signs of the end were clear, Eckley says, it was still a shock when her sister stopped breathing: “It was hard to make decisions and to function.”

But the hospice nurses knew what to do. They made arrangements for her sister’s body to be collected. They called the funeral home.

“The family can focus on saying their goodbyes to the body without dealing with the administration,” Eckley says.

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You’re Treating Pink Eye the Wrong Way

Nearly six in 10 people diagnosed with pink eye in the United States are prescribed antibiotic eye drops, according to a recent study in Ophthalmology, even though the drugs are rarely needed to treat the common infection. In some cases, the authors say, this type of treatment could actually prolong symptoms and make them worse.

The study examined data from more than 340,000 people diagnosed with acute conjunctivitis, known as pink eye, between 2005 and 2014. Of that group, 58% filled a prescription for antibiotic eye drops. Even more concerning to the researchers was that 20% of those prescriptions were for antibiotic-corticosteroid drops, a combination that’s not typically recommended for pink eye because it can worsen underlying infections. If taken for long periods, these drops may increase the risk of cataracts and glaucoma.

The findings are consistent with a nationwide trend of overprescribing antibiotics for common bacterial infections (and viral ones, against which they don’t even work). But it was still surprising for the study authors to see how widespread an issue it’s become for pink eye, a condition that affects 6 million Americans every year.

“The proportion of patients who filled prescriptions for antibiotics was indeed much higher than we had expected,” said co-author Dr. Joshua Stein, director of the Center for Eye Protection and Innovation at the University of Michigan, in an email. That may be because many patients with pink eye are diagnosed and treated by a primary care physician, pediatrician or urgent-care provider, and never see an ophthalmologist or optometrist.

That was the case with 83% of people in the study. Those who hadn’t seen an eye specialist were two to three times more likely to fill prescriptions for antibiotics.

The odds of filling an antibiotic prescription also depended on people’s socioeconomic status. Those who were white, younger, affluent and better educated were more likely to get unnecessary meds. The odds did not, however, depend on factors that could actually increase a person’s risk of serious infection: whether patients had diabetes or HIV or wore contact lenses, for example.

MORE: Contact Lenses Fill Your Eyes With Bacteria

Pink eye is usually caused by a virus, says Stein, and tends to clear up in a week or two without treatment. Antibiotics won’t speed healing—or prevent the infection from spreading—except in rare cases in which pink eye is caused by bacteria.

“For most cases of pink eye, we simply recommend cool compresses and artificial tears to help alleviate some of the symptoms,” he says, “and lots of hand washing and not sharing towels or linens with others to reduce the risk of spread to close contacts.”

Doctors who are unsure of an infection’s cause may prescribe antibiotics “just in case,” the authors wrote in their paper, or patients might ask for them in hopes of a quicker recovery. Some schools also don’t allow children into classrooms without proof that they’ve been treated, a policy that an accompanying editorial called “highly inconvenient for patients and parents” and “devoid of evidence.”

Most patients won’t experience negative effects from a short course of unnecessary antibiotics, Stein says, but there are risks. The drugs can cause cells on the surface of the cornea to slough off, leading to irritation, blurry vision and an increased risk of infection. They can also cause allergic reactions, kill off good bacteria on the surface of the eye and contribute to antibiotic resistance. Plus, he adds, they can be expensive—more than $ 200 per bottle, in some cases.

Stein says patients who are prescribed antibiotics for pink eye should feel comfortable asking their doctor how confident he or she is that the infection is caused by bacteria and not by a virus. (If pus is present, he says, a bacterial infection is more likely; if discharge is watery, it’s probably a virus or allergy.)

There is a test to identify the most common virus responsible for pink eye, but Stein says he doesn’t usually use it unless a patient’s symptoms last more than two weeks. But if people want to be more certain as to whether antibiotics will help them, he says, “they can inquire with their doctor whether such a test can be performed.”

Health – TIME

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Trump Tweeted a Misleading Medicaid Chart. Here’s What’s Right

President Donald Trump’s tweets typically don’t get into wonky policy, but he broke from that tradition on Wednesday in support of the Senate’s health care bill, tweeting out a chart showing how Medicaid spending would rise over the years.

The Better Care Reconciliation Act, as the Senate’s bill is called, contains an estimated $ 772 billion in Medicaid cuts through 2026, as well as a change in the funding formula that will sharply decrease spending beyond that point. Critics fear these deep cuts will jeopardize care for the roughly 73 million Americans on Medicaid, which include low-income workers, adults with disabilities, special needs children, and elderly people who have exhausted their assets and need long-term care.

Medicaid spending will indeed increase over time under the Better Care Reconciliation Act, but that’s because more people will be on the program — for starters, Medicaid funds certain long-term care, and the number of elderly Americans is projected to more than double by 2060, to more than 98 million — and also because the cost of health care continues to mount. It’s not because the legislation increases Medicaid funding; it does just the opposite. Spending would rise at a higher rate under current law, as Vox illustrated.


Health – TIME

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Beyond Repeal and Replace

Ashley Hurteau knows she’s not your typical public-health advocate.

In and out of jail, a recovering heroin addict equipped with few credentials beyond her personal story, the 32-year-old New Hampshire resident says it took waking up to find her husband dead from an overdose to put her on the path toward recovery. That and health care. Which is why, at a public forum on June 23, Hurteau stepped up to the microphone and pleaded with her state’s two U.S. Senators to fight with everything they had to block Republican plans to gut health care programs like the one she credits with saving her life.

“I got back custody of my son two weeks ago, and I’ve been sober 17 months,” Hurteau said as more than 200 people watched that afternoon in a law-school classroom in Concord, N.H. “Medicaid expansion is really about opportunity, the opportunity to get sober, to move on and to live a clean life.” She was there as a success story–and a warning about what could go wrong if someone like her didn’t have access to care during a time of need.

But scaling back Medicaid–the 52-year-old federal health care program for the needy–is exactly what Senate Republicans are vowing to do when they return from the July 4 holiday. It is a huge risk for the GOP and helps explain why Mitch McConnell postponed a vote on his party’s latest plan in the final week of June. The public defections betrayed deeper problems for the bill, which will be weaponized against its supporters in coming elections.

When it comes to changing Medicaid, the Republican plan has two main parts. First, it would roll back programs that allow states to enroll residents who earn wages slightly above the poverty line in state-run Medicaid programs. That alone has boosted the rolls of people with health coverage by more than 14 million, allowing, for instance, families of three who earn $ 27,000 to qualify for free or low-cost coverage.

The second part would cap federal funding that states use to underwrite their Medicaid programs, which roughly 76 million Americans rely on for health care. While each state’s program goes by a different name–like MaineCare, Healthy Louisiana and New Jersey FamilyCare–their collective reach is epic. Nearly half of all babies born in America are covered by Medicaid, as are close to 40% of all children and two-thirds of all nursing-home residents. Roughly 9 million more Americans who are blind or disabled, including those born with Down syndrome or cerebral palsy, also rely on Medicaid for coverage. Most children’s vaccines are covered, and adults in many places get their flu shots at the corner drugstore for free as well.

Normally, making entitlement cuts of this size is political suicide, but these are not normal times. The House has already passed a version of these cuts. McConnell postponed a Senate vote when conservatives and moderates rebelled at the pace and terms, including the lack of funding for opioid addicts and the long-term cuts to Medicaid. “Legislation of this complexity almost always takes longer than anyone else would hope,” McConnell told reporters off the Senate floor as he pressed pause on legislation he would rather have kicked down on his to-do list in favor of other heavy lifts like tax reform or a big-ticket infrastructure package. “We’re still working toward getting at least 50 people in a comfortable place.”

That’s partly because voters are not sold on the idea. Clear majorities oppose the GOP plan in polls; one survey of the Senate proposal found that just 1 in 5 Americans supported the idea.

President Lyndon Johnson signs legislation creating Medicare and Medicaid in 1965.
APPresident Lyndon Johnson signs legislation creating Medicare and Medicaid in 1965.

Medicaid traces its origins to 1965, when it was birthed as one of the pieces of Lyndon Johnson’s Great Society. Conservatives–who at the time were not exclusively Republicans–found the laws too ambitious and onerous for states, and too costly for federal taxpayers. In the intervening decades, conservative antipathy toward the program deepened as its costs rose, leading to higher taxes and larger deficits.

For a while, it sounded like President Trump would break with his party and emerge a Medicaid defender. “I’m not going to cut Medicare and Medicaid,” Trump promised in 2015, a vow he repeated in the months that followed. Since then he has sent mixed messages. After the House passed a measure dramatically scaling back Medicaid in May, he summoned allies and the press to a victory rally in the Rose Garden to praise lawmakers for taking action in the name of scrapping Obamacare. Later, he said the bill was “mean” and urged the Senate to come back with something “with heart.”

At the core of both the House and Senate bills is a reversal of the basic premise of Obamacare, which used new taxes on high-income workers and their investments to pay for more coverage and treatment for those in the lower-middle class. The Republican plans cut $ 701 billion in taxes over a decade on the wealthy while cutting health care for the poor and working poor. The nonpartisan Congressional Budget Office says 22 million would lose their health coverage under the Senate bill, with 15 million being shed from Medicaid.

The measure starts to firm up the nation’s financial footing, but at the cost of its most vulnerable citizens. Seniors are among the most reliable voters, and threatening their final years’ care is seldom good politics.

President Trump celebrates after House Republicans passed a bill to repeal Obamacare in 2017.
Evan Vucci—APPresident Trump celebrates after House Republicans passed a bill to repeal Obamacare in 2017.

The White House insists that the changes in spending shouldn’t be called a cut, since they are merely decreases from what everyone thought they’d spend in the coming years. “If you spent $ 100 last year on something, and we spend $ 100 on it this year–on that same thing–in Washington, people call that a cut,” White House Budget Director Mick Mulvaney said in May. As White House counselor Kellyanne Conway put it on June 25, “This slows the rate for the future.”

That leaves those steeped in the budget bemused, since no one expects health care to stop becoming more expensive. “If the federal government says, ‘Well, we’re only paying a certain amount going forward,’ then one of two things happen: either services are going to be cut or 25% of people who are currently covered are going to be cut,” says Andy Slavitt, a former administrator for the Centers for Medicare and Medicaid Services. “There’s no way around it–there’s not that much slack in state budgets.”

Here’s the rub: the states that have benefited the most from federal subsidies for state-run health care programs like Medicaid are often Republican. The non-college-educated, lower-income residents who helped fuel Trump’s rise to the White House often rely disproportionately on government-subsidized health care. Republican governors in several states, including Ohio, Arizona and Nevada, are panicked about the current plans, which reduce the number of insured and delay hard choices about which poor residents will be denied coverage starting next year. “They think that’s great? That’s good public policy?” an incredulous Ohio Governor John Kasich asked during a June 27 news conference in Washington. He had traveled to the capital to rally against his own party’s bid to overhaul one-sixth of the American economy. “Are you kidding me?”

Study after study shows the risks of skimping on relatively cheap procedures and the high return on investment for them, but that’s on the table too. Medical associations, whose members stand to lose patients, predict that higher long-term costs will result. “If women are not going to get mammograms and not going to get Pap smears, we’ll see an increase in breast cancer, in cervical cancer and in vulvar cancer,” says Dr. Hal Lawrence, executive vice president and CEO of the American Congress of Obstetricians and Gynecologists. “There will be a cascade turning back the health of the nation.”

In fact, almost every major health care group, including the American Medical Association and hospital associations, oppose the Republicans’ proposals. “Most states are in a budget crisis, and if there is a federal reduction in Medicaid, then most states will not be able to make up the difference with state dollars,” says Kirsten Sloan, vice president for policy at the American Cancer Society Cancer Action Network. “So we will mostly see states cut back. Cancer care is very expensive, and our fear is that one of the ways states will cut back is by cutting the most expensive care.”

When the Senate version landed on the desk of New Hampshire’s Republican Governor Chris Sununu, he initially wasn’t sure what to make of it. Fellow Republicans were gutting Medicaid programs in his state while offering up a relative pittance to fight opioids. Sununu asked his aides if there were loopholes or carve-outs that he was missing, if there were a way he could back the broader goal of repealing Obamacare. No, they told him. If the bill passes, it will result in $ 1.4 billion less in federal funding for his state in the next decade. About 186,000 residents receive some form of Medicaid in New Hampshire, and through the Medicaid expansion, more than 23,000 have received substance-abuse services. Medicaid provides $ 29 million to cover the costs of resources for school nurses and students with disabilities, along with 27% of births. As it does elsewhere in the nation, it also covers two-thirds of seniors in New Hampshire nursing homes. Sununu, a conservative Republican, decided to come out against the Senate Republican’s plan. “We simply do not see the resources necessary for us to craft a successful system that meets the needs of Granite Staters,” Sununu wrote to the Senate on June 27.

The next day, Sununu told TIME he felt boxed in. The proposals coming from Washington, where his father served as a White House chief of staff to George H.W. Bush and a brother was a Senator, are forcing governors to make impossible choices, he explained. “There’s only one way to account for that. You’re increasing taxes or cutting services or cutting constituents. All of those are really bad. We’re not talking just minor cuts. These are very serious and very deep cuts,” he said. Fellow Republicans, he said, had strayed from their electoral mandate: “The country is looking for reform on Obamacare. That’s where the sole focus needs to be. This goes beyond that.”

Back in the Senate, McConnell has talked about creating carve-outs to address some individual Senators’ concerns, including a pot of money to specifically target the opioid epidemic. Conservative activists, in turn, have attacked the Republican governors for betraying their ideological roots. And suspicion of widespread abuse, or opportunism, in the current Medicaid system is not limited to Washington. Susan Lees of Danbury, Conn., is a 50-year-old nanny and dog walker who is covered by Medicaid, which she pays some money toward. “A lot of them do need to go out and get a job. I’m not going to lie,” she says. “There are people out there who are soaking the system. I see it.”

Lees would be hard-pressed to convince the likes of Democratic Senator Maggie Hassan from New Hampshire, who met with TIME on a recent morning between meetings in her third-floor Senate office. As the phones rang incessantly with constituents calling in to voice their concerns about the bill, Hassan leaned back in her chair. For her, the Medicaid issue is personal. Her 28-year-old son Ben has severe cerebral palsy, cannot walk and gets most of his nutrition through a feeding tube. Like roughly 9 million other disabled people, he and his family benefit from Medicaid support.

“There’s a whole bunch of stuff that even the best private insurance doesn’t cover,” Hassan tells TIME. “Medicaid recognizes that there are some vagaries in life that hit some people harder than others. We never know when one of our children is going to be born with a particular condition that requires this kind of intensive care, not only to keep them alive but to keep them out of the hospital, out of intensive nursing homes, and be members of the community.”

If McConnell can find 50 Republican votes for the plan–and it is a big if, given Democrats’ unified resistance to this version of reform–the immediate effects will hit the District of Columbia and the 31 states that opted to expand Medicaid programs under Obamacare. In the next few years, they would face the task of deciding whether to cut health care spending or tell constituents like Josey Redder that services are no longer available. The 22-year-old Ridgefield, Conn., woman works as a waitress, earning $ 6 an hour, plus tips. “We work the jobs that we’re able to get, and those jobs don’t pay enough,” she said. So she turns to Connecticut’s Medicaid system for her doctor visits, birth control and therapy.

If leaders want to fill in the missing pieces, there are two answers: cut programs like schools or roads, or raise taxes. Almost every state is required to balance its budget, and they simply don’t have rainy-day funds large enough to cover an $ 834 billion shortfall from federal cuts over the next 10 years.

Health care spending thus could force lawmakers to ditch highway-exit ramps, welcome centers or college dormitories. Or, the state could direct patients to less-expensive (and often less-effective) treatments. The urgent would overtake the preventive, and mental health advocates worry that visible ailments would take priority over less obvious ones. “Mental illness, behavioral issues and addictions are chronic conditions,” says Arthur Evans, CEO of the American Psychological Association and one of the many critics of this plan. “They require sustained support over a period of time–sometimes years. When you truncate that and only give people help during crises, that sets them up for failure. It’s just expensive, and you don’t get the outcomes you want.”

Consider Hurteau. Her husband died from an overdose on June 11, 2015. She was in and out of jail for 10 years before his death, entering for the last time on Dec. 27 of that year. She had lost custody of her son and was addicted to heroin, and had no plan to remedy either situation. New Hampshire officials helped her enroll in a Medicaid program that provided counseling and treatment. Today she works to help others fight their addictions. “There’s a lot of potential behind the [prison] wall,” she says. “There’s a lot of opportunities for people with insurance, but without insurance, there’s no treatment.” For millions of Americans, that’s a prospect that should worry them.


This appears in the July 10, 2017 issue of TIME.
Health – TIME

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