TIME Infectious Disease

Ebola Outbreak Contained in Nigeria, Officials Say

After a total of 19 cases and seven deaths

The Ebola outbreak in Nigeria appears to be contained, health officials said Tuesday.

The U.S. Centers for Disease Control and Prevention (CDC) said that due to a very rapid local and international response, the country may have fully contained its Ebola outbreak. The 21-day incubation period for the disease has passed.

Nigeria saw its first confirmed case of Ebola on July 17 when a Liberian-American man collapsed at a Nigerian airport after traveling from Liberia. The man infected the health workers who treated him, and the country experienced a total of 19 cases and seven deaths. Unlike in other countries like Guinea, Sierra Leone and Liberia, where it took months for Ebola to be recognized, the Nigerian government quickly declared a public health emergency when it discovered the traveler may have come in contact with 72 people at the airport and hospital.

The Nigerian government coordinated the outbreak response with state and national networks and rolled out a massive public education initiative, with trained “social mobilizers” who were deployed to do house to house visits in areas where an Ebola contact resided. Nigeria also recently worked to eradicate polio, and the country tapped into those strategies as part of their response.

Still, if there’s a lesson to be learned from Ebola thus far, it’s not to overestimate containment. As TIME reported last week, there was a period in April when it appeared Guinea’s outbreak had subsided. In actuality, there were several unreported and hidden cases that re-ignited the outbreak with an even greater wave of infections.

TIME drinking

Science Explains Why Men Get Wasted Together

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Marcus Richardson—Getty Images/Flickr Select

A new study may shed light on why men seem to like getting drunk together more than women do

Male bonding over booze is a ritual as old as booze but modern science may have finally shed some light on why getting sloshed with your mates can seem like a particularly male pursuit.

Smiles are contagious in a group of men sitting around drinking alcohol, according to a study announced Tuesday in the journal Clinical Psychological Science. This suggests that booze serves as a social lubricant for men, making them more sensitive to social behaviors, like smiling, and freeing them to connect with one another in a way that a soda can’t.

Lest that strike you as laughably obvious, consider this: the effect does not hold if there are any women in the group, according to the study authors.

Researchers divided 720 “healthy social drinkers” — half men, half women, all ages 21 to 28 — into three groups. Each group received either an alcoholic drink (vodka cranberry, regrettably for any lab rats with refined taste, but so it goes), a placebo or a non-alcoholic drink. They found that, among men, smiles — and associated increases in positive mood and social bonding — tend to catch on, leaping from face to face, as it were, but only in exclusively male groups.

“Many men report that the majority of their social support and social bonding time occurs within the context of alcohol consumption,” said lead researcher Catharine Fairbairn. “We wanted to explore the possibility that social alcohol consumption was more rewarding to men than to women — the idea that alcohol might actually ‘lubricate’ social interaction to a greater extent among men.”

More importantly — get ready to never hear the end of this one, boyfriends and husbands of the world — researchers note that genuine smiles are perfectly contagious among sober women, just not sober men. A cold one merely evens the score for men, allowing them to catch smiles from each other, so long as there are no women present.

The authors don’t posit a guess as to why the presence of a woman keeps drunk men from catching smiles from one another, except to say that booze seems to disrupt “processes that would normally prevent them from responding to another person’s smile.”

Nice work, dudes. There’s nothing a girl likes more than an unsmiling humorless dolt.

TIME Heart Disease

People Without Friends Have Worse Outcomes After Heart Attack

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The importance of friends for heart health

Without the support of friends and family, you’re less likely to emerge from a heart attack healthy.

A study in the Journal of the American Heart Association analyzed the responses of 3,432 heart attack patients on their levels of social support one month and then a year after a heart attack. One-fifth of them had low social support—meaning they felt that they didn’t have friends or family they could confide in or lean on for emotional or financial support—and during their recovery this group showed lower mental functioning, worse quality of life and more depressive symptoms. The effect affected men and women equally.

MORE: A Happy, Optimistic Outlook May Protect Your Heart

Encouraging social support isn’t usually seen as a top priority for heart attack recovery, but this is just one more piece of evidence that it should be: one study showed that within six months of having a heart attack, depression increased the risk of death from 3% to 17%.

MORE: A Link Between Anxiety and Heart Attacks

“We shouldn’t just be concerning ourselves with pills and procedures,” said Harlan Krumholz, MD, the study’s senior author and director of the Center of Outcomes Research and Evaluation at Yale-New Haven Hospital, in a statement. “We have to pay attention to things like love and friendship and the context of people’s lives. It may be that these efforts to help people connect better with others, particularly after an illness, may have very powerful effects on their recovery and the quality of their lives afterwards.”

TIME neuroscience

How A Girl’s Brain Changes After a Traumatic Brain Injury

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Concussions may influence girls differently than boys

Girls who suffer traumatic brain injuries (TBIs) may be more susceptible to behavioral problems like psychological distress and smoking compared to boys, according to a new study.

Each year, TBIs cause 2.5 million emergency room visits, and so far research has consistently shown that they’re more common among boys than girls. Girls still get them, though, and often in sports like soccer, basketball and cheerleading. A new study published in the journal PLOS ONE that surveyed 9,288 Ontario students in grades 7 through 12 reports that girls who suffered brain injuries—in sports, most commonly—were more likely to report having contemplated suicide, experienced psychological distress, been the target of bullying and having smoked cigarettes.

Overall, the new study reports that one in five adolescents had sustained a TBI that resulted in their loss of consciousness for at least five minutes or hospitalization at some point in their lifetime. Boys experienced them 6% more than girls. These young people who had experienced a lifetime TBI also reported behaviors in the last year like daily smoking, binge drinking, using marijuana, cyberbullying and poor grades.

MORE: The Tragic Risks of American Football

Since the results were self-reported, the researchers could not determine causation, nor could they provide a definitive explanation for the gender differences. In the study, they speculate that it could have to do with a variety of factors that include hormonal differences, treatment differences, differences in cognitive abilities or some combination.

Dr. Geoffrey Manley, vice chairman of neurological surgery at the University of California, San Francisco, was not involved in the study but has another theory. According to his own research, women tend to be more forthcoming about their concussion symptoms than men. “Currently, we don’t have a clear idea of what exactly a concussion is,” he says. “We are really limited to self-reporting, and women are more honest about their symptoms than boys.”

Girls get TBIs most often playing soccer and basketball, but other sports—cheerleading, in particular—have very high risk for injuries. The American Academy of Pediatrics has called for more safety regulations for the cheerleading, even though it tends to not be included in national high school sports injury research.

There’s still a lot we don’t know about TBIs and concussions, including the best way to diagnose them. So far there is not a reliable imaging or biomarker test. But understanding who is at a risk, and for which reasons, helps bolster the collective knowledge of the issue. “No matter how you slice this, a subset of these folks are going to go on and have long-term disability,” says Manley. “We can try to predict who these people are going to be, and gender may be part of this.”

TIME Heart Disease

Olive Oil Repairs Failing Hearts, Study Finds

Olive oil.
Josa Manuel Ferra—Getty Images

Yup, the Mediterranean diet seriously starts today

For broken rat hearts, nothing beats a healthy glug of olive oil.

That’s what new research published in the journal Circulation found when it looked at beating rat hearts riddled with heart failure, a condition that manifests itself in humans over time when chronic high blood pressure makes it harder for the heart to pump blood, making the heart grow bigger, thicker, and less effective. The heart becomes unable to metabolize and store the fat it needs to keep pumping—like an engine out of fuel, the study author says—and the fat it does manage to metabolize breaks down into toxic by-products that exacerbate heart disease.

MORE: Ending the War on Fat

It’s a complicated problem without an obvious quick fix, which is why researchers were surprised by what came next. To see exactly how fat moves around in the cells of these impaired hearts, they removed hearts from rats, kept them beating normally and put them in a strong magnetic field through a process called nuclear magnetic resonance spectroscopy. They delivered two types of fat directly to the hearts—either oleate, the kind of fat found in olive oil and canola oil, or palmitate, which is in dairy products, palm oil and animal fat. When the scientists followed the fat around, they found drastic differences in how the hearts reacted to the two fats.

MORE: The Worst Times to Be Treated for a Heart Condition

“If we gave hearts that were failing palmitate, they basically looked like failing hearts,” says E. Douglas Lewandowski, study author and director of the University of Illinois at Chicago Center for Cardiovascular Research. Their fat metabolism and storage remained depressed and the hearts weren’t producing enzymes that would help metabolize fat. But when they gave the hearts oleate, they vastly improved. The presence of oleate completely restored the fat content in the cell back to normal, Lewandowski says, and the hearts contracted better and showed normalized genes that help in fat metabolism.

“We didn’t think it would have such profound effects,” Lewandowski says. “When we think about normalizing the metabolism, it’s so far upstream of so many disease processes that it’s very exciting.” In just half an hour, the fat induced all of these positive changes.

MORE: Can Olive Oil Help Prevent Stroke?

More research—especially on humans—is needed before imagining that oleate could help the failing hearts of people, but Lewandowski admits his study shows the potential for actual dietary therapeutic regimens. And the results might help partly explain why the Mediterranean diet is so heart-healthy. People who follow it have long shown lower rates of heart disease death and heart problems, and the good monounsaturated fats, like the kind in oleate, raises the good kind of cholesterol and lowers the less desirable kind. We’ll have to wait for the olive oil heart infusions, but in the meantime, here’s your latest excuse for heavy-handed drizzling.

TIME

7 Ways Being Single Affects Your Health

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The link between relationship status and well-being is a complicated one. Despite plenty of sensational headlines—”Get married and get fat!” “Stay single and die young!”—it’s hard to say definitively whether being a spouse or a singleton (or something in between, as many Americans are today) is healthier overall.

That’s because every relationship and every person is different, says Bella DePaulo, Ph.D., a visiting researcher at the University of California Santa Barbara and author of Singled Out: How Singles Are Stereotyped, Stigmatized, and Ignored, and Still Live Happily Ever After. And because scientists can’t randomly assign study participants to either get married or stay single, it’s impossible to rule out other factors that could be at play.

HEALTH.COM: 13 Reasons to Have More Sex

Still, trends do seem to exist among people in different types of relationships, with potential lessons that all adults—regardless of their marital status—can use to better their quality of life. Here are seven ways flying solo may affect your health, for better or worse.

You’re less likely to gain weight

A 2013 study in the journal Health Psychology shows that happily married couples tend to gain weight in the four years after getting hitched. Without the pressure to attract a new mate, the authors say, newlyweds can get complacent about their appearance.

A recent Australian study in the journal Body Image showed that women who feel pressured to slim down before their wedding gained more weight within the following 6 months. Married men were more likely to be overweight or obese compared to their peers who were single, in relationships, or engaged, according to a 2014 University of Minnesota study of young adults.

You’re more likely to exercise regularly

“Many single women and men care about their health and their well-being,” says DePaulo. “They exercise, eat right, and live overall healthy lifestyles.” In a 2004 study from the University of Maryland, for example, unmarried adults exercised more than married ones, including those without kids.

A British survey conducted in 2011 echoed these results, finding that 76% of married men and 63% of married women failed to meet the recommended 150 minutes of physical activity a week. Only 24 and 33% of single men and women, respectively, missed the mark.

HEALTH.COM: 20 Ways to Make Exercise a Habit

You may have more close friends

And you may be a better one, at that: A 2006 University of Massachusetts at Amherst study found that single people were better at maintaining relationships with friends, neighbors, and extended family than those who had tied the knot—both with and without kids.

Other studies have also found that single adults tend to do more volunteer work and keep in close contact with their siblings, says DePaulo. “Single people—especially single women—often have networks of people who are important to them,” she says. “They have ‘the ones’ rather than ‘the one.’”

You stress less about chores and money

One stereotype of single people is that they’re constantly worried about finding a mate—but that’s certainly not true for everyone. And in fact, there are plenty of areas where single people stress less than those in relationships. According to a 2005 University of Michigan study, for example, they do less housework than married people.

HEALTH.COM: 12 Signs You May Have an Anxiety Disorder

Money woes may weigh less on single people as well. In a 2014 survey of more than 2,000 adults in relationships, one in three admitted to “financial infidelity,” or lying to a partner about money issues. Married people are also more likely to have credit card debt—not exactly a health issue in itself, but something that has been shown to detract from both emotional and physical wellbeing.

You may be stigmatized—but maybe not for long

Single people are often viewed as lonely and unhappy, says DePaulo, which can in turn have a negative effect on their overall health. But that may be changing: the Bureau of Labor Statistics recently reported that, for the first time, the majority of adults in the United States are unmarried, with singles clocking in at 50.2%.

“I do think that as the number of single people continues to grow—to well over 100 million adults just in the U.S.—it will be increasingly difficult to maintain the stereotypes and caricatures of single people,” says DePaulo. “There are just too many single people who are happy and healthy and love their single lives, and too many people who know single people who are thriving, for the misperceptions to endure.”

In the meantime, DePaulo’s advice is simple. “Living your single life fully, joyfully, and unapologetically—even as other people are insisting, without any good scientific basis, that you must be less healthy than your married counterparts—is a good way to maintain your good health.”

HEALTH.COM: 12 Ways Your Relationship Can Hurt Your Health

Surgery may be more dangerous

Going under the knife carries risks no matter your relationship status, but a 2012 Emory University study found that single people were three times more likely to die in the three months following heart surgery (and 71% more likely to die over the next five years) than married study participants. Married people tended to be more optimistic about their recovery going into surgery, but they also had lower smoking rates than single people—an important factor in their higher five-year survival rates.

But even these findings aren’t definitive, says DePaulo. She points to a 2011 RAND Corporation survey on alumni of the Wounded Warrior Project, which found that veterans who had never been married reported higher levels of resiliency—the ability to bounce back after injury, illness, or hardships—than those who were married, divorced, or separated.

Your heart health may be at risk

Single adults are 5% more likely to develop heart disease than their married peers, according to a 2014 study of more than 3.5 million people presented at the American College of Cardiology’s 63rd Annual Scientific Session. (Divorced and widowed people in the study also had a higher risk.) “Not all marriages are created equal, but we would expect the size of this study population to account for variations in good and bad marriages,” said the study authors in a press release.

But other research hasn’t found that being married is any better for your heart. In a 2006 study from the University of Texas at Austin of more than 9,000 people there was no statistically significant difference in cardiovascular disease risk between those who were currently married or had never gotten hitched.

This article originally appeared on Health.com.

TIME Infectious Disease

5 Reasons We May Never Know Ebola’s True Impact

Ebola Liberia
A Medecins Sans Frontieres (MSF) worker is sprayed and disinfected as he leaves a high risk zone of MSF's Ebola isolation and treatment center in Monrovia, Liberia, Sept. 29, 2014. Jerome Delay—AP

In this unprecedented Ebola outbreak, measuring and predicting the virus' true impact is nearly impossible

The U.S. Centers for Disease Control and Prevention (CDC) published a report in mid-September estimating that if current trends in the Ebola outbreak continue without a ramped up effort, then Ebola cases in West Africa would double every 20 days. In that situation, Ebola cases could reach up 1.4 million by January.

It’s a worst-case scenario estimate, but that’s only one caveat behind the 1.4 million figure, which remains muddled by research limitations and assumptions. While health experts and a CDC official told TIME that it’s common in public health surveillance projects to report overestimates, the fact that this is the worst Ebola outbreak in history adds additional levels of uncertainty in forecasting an unprecedented epidemic.

Here are five reasons why we may never know Ebola’s true impact, despite health experts’ best efforts to fully understand the virus’ deadly potential:

1. Most Ebola cases aren’t reported

CDC researchers believe that for every 1 reported case of Ebola, there are 1.5 additional cases that go unreported. They estimated that without additional intervention, 550,000 Ebola cases will be reported by January, a lower bound that doesn’t account for the cases that go unreported. By correcting for underreporting, they arrived at the upper bound of 1.4 million.

“Underreporting is always an issue with communicable diseases,” says Thomas Gift, an economist at the CDC. “We believe the actual incidence of disease is higher than what shows up in case reports.”

In West Africa, a lack of on-the-ground healthcare resources has meant that many Ebola patients haven’t been treated by doctors, or, in some instances, they have been turned away by doctors, which has resulted in an incomplete headcount of afflicted people.

2. Adjusting the projected numbers accurately is extremely difficult.

“It’s always difficult with these models to try to capture what’s really going on on the ground,” says Dr. Eden Wells, an epidemiology professor at the University of Michigan. “Given the data they used, it’s the best projection they could get at the time.”

The projections were based on data from only one day in only one country—Liberia—Gift said. Researchers used a model to predict the number of beds in use in Liberia on Aug. 28, 2014—the occupied beds were a measure of reported cases. They then surveyed experts at Ebola treatment clinics in Liberia to estimate the actual number of beds in use, weighing that estimate by the proportion of those who stay at home (and are therefore “unreported” cases) who eventually arrive in hospitals: a measure of both reported and unreported cases.

Gift added that while on-the-ground conditions made it difficult to collect more frequent data, there was also an urgency in releasing information about the outbreak. “Why didn’t [researchers] do more to get a range of confidence? Partially because this was designed to provide a tool to be used by people to assess the potential impact of intervention while the outbreak is going on,” Gift says.

3. The projection, based on a slice of data from Liberia, was applied to all of West Africa.

Liberia has been the most hard-hit country in the Ebola outbreak, with more than 1,800 deaths and 3,400 confirmed cases, according to the CDC. Sierra Leone and Guinea have suffered significant death tolls as well, though far fewer than Liberia. “Notable regional differences in underreporting might mean that using one [assumption] across an entire country is inappropriate,” the report said. This could, in theory, result in an overestimate.

“The 2.5 correction factor”—meaning that for every one reported case, there are potentially 1.5 unreported cases, according to the CDC’s modeling—”seems to have been correct for that day,” Gift says. “But [that] might change over time.”

Still, the fact that an Ebola outbreak has never been this widespread—and thus never modeled so extensively—allows the study some liberty in deciding its parameters, the report said.

“The purpose is to show that this epidemic was not going to show signs of peaking on its own. In historic outbreaks, there were a few hundred cases, and the epidemic diminished. That didn’t happen this time,” Gift says.

4. Much of the data coming from West Africa is likely inaccurate or incomplete.

A recent World Health Organization report said that in Liberia, “data were being reported from 4 different and uncoordinated streams, resulting in several overlaps and duplicated numbers.” The report added that many deaths were not being properly documented.

Last week, the New York Times similarly reported a discrepancy between the number of reported deaths in Sierra Leone and the number of buried victims, a fact that further complicates researchers’ efforts to measure Ebola’s true impact.

5. Projecting all the way to January is difficult.

“It’s a bit like weather prediction,” says Marisa Eisenberg, an epidemiology professor at the University of Michigan. “There’s a lot more uncertainty if you’re going all the way out to January versus the end of October.”

The obvious difficulty is that the report is based on the assumption of no significant additional intervention, which, with each passing week, is changing. A shorter-term projection of Ebola cases was provided by the WHO in a report published last week in the New England Journal of Medicine. The projection’s limited time span indicates a more realistic prediction of Ebola cases, even though it also assumes “no change in the control measures for this epidemic.” If Ebola cases were to double every 20 days without additional measures, as the CDC reported, then the WHO’s estimate indicates that there will be about 150,000 cases by January, a markedly more conservative figure.

Still, experts believe there is value in examining the CDC’s “worst-case scenario” of 1.4 million cases. Overestimation offers a safety net in ensuring adequate assistance is provided. If anything, it also adds an urgency to prove wrong the study’s chilling caveat: that this is what could happen if no additional resources are used to battle the deadly disease.

“[The researchers] are trying to cover their bases, and make sure they don’t under-deploy resources,” Eisenberg says. “If you’re going to be wrong in one direction or the other, it’s better safe than sorry.”

TIME medicine

Soon You Can Send Your Expired Painkillers Through the Mail

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The DEA has a new way to get rid of extra meds

How to get rid of leftover medication is a tricky question—keep it around and it can get into the wrong hands, but dispose of it improperly and you risk contaminating the environment.

That’s why in the past, the U.S. Drug Enforcement Administration (DEA) has held National Prescription Drug Take-Back Day. Last April, the DEA reported that it collected 780,000 pounds of prescription drugs, and during the event on Sept. 27, a single county in Virginia dropped off 1,200 pounds of drugs. But even though half a ton of drugs for one county is certainly a coup, it was the last event of its kind—because soon, through an innovative new program, Americans will be able to safely abandon their unused pills at any time.

The DEA first recognized the leftover pill problem because the Controlled Substances Act had no outlined provisions for how people could get rid of their unused or expired prescription drugs. According to the DEA, people would keep them in their medicine cabinets (which made it possible for them them to be abused), toss them in the trash or flush them down the toilet. The latter method was discovered to contaminate water supplies.

In 2010, the Drug Disposal Act gave the DEA the authority to create a framework for how the general public and facilities could dispose of prescription pills properly and safely. On Sept. 9 the regulations were approved, and the DEA says it will start implementing the plan in early October. The new regulations allow Americans to get rid of their excess drugs at pharmacies or police departments with drop-off receptacles. Patients will also be able to grab envelopes from places like hospitals that they can use to mail their pills to authorized collectors, who will make sure the pills are properly incinerated. “It will be more convenient because once these rules are implemented, then people can do it all the time,” a DEA spokesperson told TIME.

The number of Americans abusing prescription drugs has dropped in the last couple years, but the DEA says the 6.5 million people who reportedly abused prescription drugs in 2013 is double the number of people who use hard drugs like cocaine, heroin, LSD and Ecstasy combined.

TIME medicine

For Back Pain or Headache, Painkillers Do More Harm than Good

Blue pills
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For the first time, a major medical organization takes a stand on rampant overuse of opioids for treating back pain, headaches and migraines

Powerful painkillers do little to improve patients’ daily functioning, finds the American Academy of Neurology in a new position statement on opioid painkillers for chronic pain not related to cancer. Written by Dr. Gary Franklin, research professor in the departments of occupational and environmental health sciences and neurology, the paper outlines the growing epidemic of overdose deaths—most of them unintentional—linked to opioid use. It concludes that in the majority of these cases, pain killers may ease some pain but fall short of truly improving patients’ health. Coupled with the potential hazards of addiction and overdose, the Academy says that doctors should be looking for other ways to help these patients manage their pain.

“This is the first position paper by a major American specialty society saying that there is a real problem here, and the risk might not be worth the benefit for certain conditions,” says Franklin.

MORE: Stopping America’s Hidden Overdose Crisis

The statement traces the rise of the opioid prescribing epidemic to loosening of previously strict regulations put in place in the 1940s, when opioid-based opium and heroin gained popularity as narcotic drugs of abuse. Recognizing the potential for addiction and overdose, states implemented rigorous controls over who could prescribe opioids and how much of the medications were dispensed; violating the rules meant doctors could lose their medical licenses or face criminal prosecution. Therefore, most physicians shied away from the drugs, leading to under-treatment of chronic pain, particularly among the growing number of cancer patients.

To address that trend, advocacy groups and pharmaceutical makers of opioids lobbied to change state laws to remove sanctions against doctors prescribing them—and ended up making them too lenient, says Franklin. “The language in Washington state, for example, said that no doctor shall be sanctioned for any amount of opioids written. So even if a doctor is handing out bags of opioids, it made it hard for the medical board or disciplinary board of the state to do anything about that doctor.”

MORE: FDA Approves New Pain Pill Designed To Be Hard to Abuse

That push to begin treating pain more aggressively began with cancer patients and those who were terminally ill, but drug makers saw another opportunity in people with chronic pain. The problem, say experts, is that for most such chronic pain, including low back pain, headaches and fibromyalgia, there is little evidence to support the idea that opiates are effective, and even less data suggesting that escalating doses and keeping patients on opioids for months or even years to treat persistent pain would benefit them. Most studies only followed patients for about a month on average.

Some in the pain community called out a red flag when they saw that a growing proportion of pain patients were still taking opioids but not reporting any improvements. In 2003, Dr. Jane Ballantyne and Dr. Jianren Mao, then at Massachusetts General Hospital and Harvard Medical School, published a review of the existing data on opioid use for chronic pain in the New England Journal of Medicine. It was among the first studies to highlight the fact that the skyrocketing number of prescriptions was doing little to actually reduce reports of chronic pain. “The real problem is physicians who are practicing with the best intentions and not understanding what the limited role of opiates is,” says Ballantyne, now a professor of anesthesiology and pain medicine at the University of Washington. “For 20 years they have been taught that everybody deserves an opiate, because they really don’t know what else to do. It’s a cultural thing and it’s hard to reverse that.”

The result, Franklin notes, is that since the 1990s, more than 100,000 people have died from opioid overdoses – more than the total number of American soldiers who lost their lives in the Vietnam War. In addition, studies have linked opioid use to serious health problems, from changes in hormone levels that can contribute to infertility, abnormal immune function, heart problems, and even worsening of pain symptoms.

MORE: Viewpoint: FDA Approval of Overdose Antidote Leaves Lives on the Table

Ballantyne says that the opioids can backfire in excessive doses; in the same way that neurons become over-sensitized to pain and hyper-reactive, high doses of opioids could prime some nerves to respond more intensely to pain signals, rather than helping them to modulate their reaction. “The idea is that we have the answer to all chronic pain, and that is to give opiates. That’s simply not true,” she says. “A lot of chronic pain isn’t appropriate for opiates.”

To stop the epidemic of deaths by opioids, Franklin says, states have to reinstate stricter oversight over doctors who prescribe these medications and implement guidelines that call for clear limits to opioid use that both doctor and patient agree upon, particularly for chronic conditions outside of cancer or terminal care. A handful of states and the Centers for Disease Control, for example, have already instituted so-called yellow-flag warning doses that require providers to get additional opinions if a patient reaches daily opioid doses of 80 mg to 120 mg and continues to complain of pain.

MORE: FDA Expands Access to Overdose Antidote to Stem Opiate Addiction Epidemic

But perhaps the best way to move the needle in the epidemic is to reset expectations that doctors and the public have about pain treatment. “In this country we expect everything to be fixed, and that doctors have the answer and can take pain away,” says Ballantyne. Yet many of the first strategies for alleviating pain might start with patients and their lifestyles rather than a prescription. Exercise and a healthy weight can ease much of the chronic pain associated with the back and joints, for instance. “We shouldn’t be resorting to pills as a first resort; they should very much be a last resort,” she says.

Alternative approaches to managing pain, including cognitive behavioral therapy, should also be given strong consideration. The Academy is urging insurers to step in and cover more such pain management approaches so that drug therapy doesn’t continue to be the default. “The important message is that we should not use opioids chronically for most people because they don’t work,” he says. “But at the same time we ought to be paying for things that do work.”

TIME Obesity

Antibiotics Before Age 2 Increase Risk of Childhood Obesity

A potential unintended consequence of the broad-spectrum drugs

Antibiotics, the most commonly prescribed medications in the first two years of life, might come with the unintended consequence of childhood obesity.

By age 2, an astonishing 1 in 10 kids are obese, weighing about 36 pounds. Childhood obesity isn’t a problem with a single cause, but according to a new study published in JAMA Pediatrics, some of it could start at the doctor’s office. Researchers looked at the health records of more than 64,000 children from 2001-2013 and found that using antibiotics before age 2 was associated with an increased risk of obesity by age 5. Almost 70% of the children in the study had taken antibiotics before age 2, with an average of 2.3 courses of the drugs per child. The link was especially strong in children who took four or more courses.

MORE: This Is How Much Childhood Obesity Costs Over a Lifetime

Not all antibiotics had the same effect, however. The association was only significant with broad-spectrum antibiotics—those that wipe out different kinds of bacteria all over the body—but not narrow-spectrum antibiotics, which target only certain families of bacteria. Of the kids in the sample, 41% took broad-spectrum antibiotics at some point.

Doctors prescribe antibiotics for a host of common infections ranging from the mild, like sinus and ear infections, to the more severe, like pneumonia. Broad-spectrum antibiotics are generally recommended only when the narrow-spectrum kind won’t work, like if an infection won’t respond or if the patient has an allergy. But in practice, broad-spectrum antibiotics are being prescribed for a lot of typical childhood infections that might not even need an antibiotic at all, says study author Charles Bailey, MD, PhD of the Children’s Hospital of Philadelphia.

MORE: Antibiotics Overload Is Endangering Our Children

When parents visit the pediatrician with a sick child, they often request antibiotics to help the child feel better faster, Bailey says. “There are these non-medical pressures to use some of the broader-spectrum drugs,” he says. “But if we use broad-spectrum antibiotics a lot of the time, are we creating unintended effects down the road that we didn’t appreciate when we were sitting in the office?”

MORE: Gut Bugs—A Hidden Trigger of Obesity

One of those unintended consequences might be killing off certain kinds of beneficial bacteria in the guts of young kids at an age when their collection of bacteria—or microbiome—is thought to be especially sensitive. Studies have shown that feeding antibiotics to mice around birth alters the kind of microbes that colonize their guts, which in turn changes how they digest food, how many calories they get from their diet and how they extract energy, Bailey says. “Our worry is that we may be seeing some of the same things going on with people.”

Though obesity in early life puts a child at greater risk for obesity in adulthood, it’s still early enough to intervene, Bailey says. “Our hope is that we can find out what the risk factors are in early childhood and do a better job not just at preventing this, but of identifying the kids…who then can change their path by changing their lifestyle and changing the healthcare they get.”

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