TIME Obamacare

How Obamacare Has Impacted The Uninsured Rate

Obamacare's 6-Million Target Hit As Exchange Sees Visits Surge
Bloomberg/Getty Images An Affordable Care Act application and enrollment help sign stands outside a Westside Family Healthcare center in Bear, Delaware.

An annual survey by the Centers for Disease Control and Prevention (CDC) recorded the sharpest drop in uninsured adults in 2014 since the survey began in 1997. The uninsured rate among adults under 65 dropped from 20.4 percent in 2013 to 16.3 percent in 2014. The uninsured rate among adults 19-25, especially, saw progress from 31.3 percent uninsured to 26.9 percent in 2014.

The growing prevalence of insurance reflects the start of Obamacare’s expanded coverage in January 2014. In states that accepted Medicaid expansion with Obamacare, the percentage of insured adults dropped from 18.4 to 13.3 percent — 2 percentage points more than the drop in states that refused the expansion.

But there’s still much more to do before all Americans have health insurance. The survey found that a total of 36 million people were uninsured at the time the survey was taken. Now, a Supreme Court decision is expected within the week on King v. Burwell, which will determine if the insurance subsidies given to 6.4 million Americans through the Affordable Care Act are constitutional. If not, then President Obama’s signature legislation could be crippled.

 

TIME mental health

Postpartum Depression Can Arise Months After Screenings

A new study shows that women who seem healthy after giving birth can develop symptoms of depression months later

Screening women for symptoms of postpartum depression shortly after they give birth may not be a sufficient, a new study found. Many women show signs of depression months after having a baby, and those who initially appeared the least likely to develop depression were later found to be at the highest risk, a study published in the Annals of Family Medicine found.

Researchers analyzed data from 1,432 women across the U.S., about a third of whom were first-time mothers. The women were asked to rate from 0 (none) to 3 (daily) their feelings of sadness, lack of appetite, thoughts of self-harm and other symptoms. Those with total scores of 10 or higher were identified as at-risk.

All of the women scored below 10 in their first screening, conducted four to 12 weeks after giving birth. Six months after giving birth, 10.9% of the women scored 10 or higher, and a year in, 16.9% of women did.

Though the American Academy of Pediatrics and American College of Nurse Midwives have advocated for regular screenings of postpartum depression during primary care visits, the U.S. Preventative Services Task Force has said they worry about the repercussions of possible misdiagnoses on women and children.

About 15% of American women experience postpartum depression within a year of giving birth, according to the Centers for Disease Control and Prevention. Obesity, domestic violence and several other factors contribute to the likelihood of experiencing depression symptoms. The researchers at the Olmstead Medical Center in Rochester did not have access to data about the women’s personal lives.

TIME health

One Factor That Kept the Women of 1960 Away From Birth Control Pills: Cost

Bottle of Enovid tabs 10mg, early 1960s. Front three quarter view. Graduated grey background.
David Exton—SSPL via Getty Images Bottle of Enovid tabs 10mg, early 1960s.

Fifty-five years ago, "the Pill" hit the market

The road to safe and effective birth control in the U.S. was long and winding — with more than a few bumps along the way. But 55 years ago today, June 23, 1960, marks the day when the birth control pill was first available for purchase in the U.S. for contraceptive purposes.

Previously, the Food and Drug Administration had approved hormone pills to treat menstrual disorders, such as irregular periods or PMS. But in May of 1960, the FDA had cleared Enovid, the trade name of an oral contraceptive by G.D. Searle and Company, and by June 23, “the Pill” — as oral contraceptives would soon be commonly known — was on the market.

And it was exactly what women had been waiting for. Because of the country’s squeamishness over birth control — anti-obscenity laws had prohibited even doctors from discussing contraceptives in the early 20th century — women had long been resorting to other, often unreliable and sometimes dangerous, methods to prevent pregnancy. Access to a dependable, safe form of birth control offered women a freedom that was previously unknown.

But there was initially one major downside to Enovid — the price. Taking stock of the Pill’s success, a little more than six months after it hit the market, TIME noted in February 1961 that:

Enovid proved to have remarkably few undesirable side effects: in her first month or two on the pills, a woman may be nauseated, and may gain weight. The main trouble with Enovid, as with all progestins, was cost. The pills were priced to retail at 50 cents or 55 cents each, and one a day for 20 days meant $10 or $11 a month. Last week Searle cut it price by 30%, which should bring the retail price down to $7 or $8… And Searle promptly cut this a further 50% by convincing the FDA that five milligrams will inhibit ovulation just as well as ten, making the net cost to the consumer $3.50 to $4 a month.

In spite of the initial cost of the Pill, 400,000 women saw their doctors about getting a prescription that first year — even though $10 in 1960 was the equivalent, with inflation, of nearly $80 today. By 1963, after the price had dropped, the number of women had risen to 2.3 million.

Just three years later, in 1966, TIME summed up just how quickly and thoroughly American women had taken to oral contraceptives, writing, “No previous medical phenomenon has ever quite matched the headlong U.S. rush to use the oral contraceptives now universally known as ‘the pills.’”

TIME Cancer

DDT, Lindane Can Cause Cancer, WHO Says

toxic pestisides lindane ddt
Arben Celi—Reuters An Albanian specialist removes toxic pesticides near the ruins of a former chemical plant in Porto Romano, a village 3 miles from the port city of Durres, May 5, 2006.

DDT was mostly banned in the U.S. in 1970, while lindane is still present in some products

Exposure to insecticides lindane and DDT can cause cancer, according to findings released by the World Health Organization (WHO) on Tuesday.

WHO’s International Agency for Research on Cancer (IARC) has now classified lindane, which has been used “extensively” for insect control, as carcinogenic to humans. DDT is now classified as probably carcinogenic to humans, based on evidence that DDT causes cancer in experimental animals and limited evidence that it does in humans.

The chemicals have been linked specifically to non-Hodgkin lymphoma, testicular cancer and liver cancer. Exposure to lindane can increase one’s risk of non-Hodgkin lymphoma by 60%, according to studies conducted in Canada and the U.S.

The chemical 2,4-D, a common weedkiller, was classified as possibly carcinogenic to humans based on “inadequate evidence” in humans and “limited evidence” in experimental animals. Exposure can occur through food, water, dust or residential application, the IARC said.

Agricultural workers have had the most direct exposure to such chemicals. DDT was introduced to control insect populations on farms during World War II and widely proliferated, but most applications of DDT were banned in the U.S. in 1970. According to the study, however, exposure to DDT through food still exists in some parts of the world.

Lindane-based shampoo is also used to kill lice, while lindane lotion is applied directly to the skin to treat scabies. Both these products have been available since the early 1950s and are still approved by the FDA. Dr. Kurt Straif, head of the IARC, told the BBC that there are no studies currently available that assess the risk of these types of exposure.

DDT can still be legally manufactured in the U.S., but only sold to foreign countries.

The full study can be found here.

TIME medicine

Here’s What Science Says About Medical Marijuana

It’s buyer-beware for medical marijuana users, since the data supporting the benefits of cannabinoids are still in flux, and most marijuana edibles aren’t well labeled

There’s a big difference between anecdotal evidence and scientific proof, and the field of medical marijuana research is filled with more of the former than the latter—in part because marijuana is notoriously difficult to study because it’s classified as a schedule-1 drug.

Scientists led by Penny Whiting from University Hospitals Bristol in the U.K. report in JAMA that there is only moderate-quality evidence supporting the benefits of medical marijuana, and only for certain conditions. The majority of studies involving medical marijuana are of lesser quality and therefore more likely to be biased and provide unreliable results.

MORE: Teens Don’t Smoke More Pot After Medical Marijuana Laws Passed, Study Finds

In all, Whiting and her colleagues analyzed 79 randomized trials, the gold standard in medical research in which volunteers are randomly assigned to take a cannabis-related product or a placebo. The studies evaluated marijuana’s ability to relieve a range of symptoms including nausea from chemotherapy, loss of appetite among HIV positive patients, multiple sclerosis spasms, depression, anxiety, sleep disorders, psychosis and Tourette syndrome. Most of the studies showed improvements among the participants taking the cannabinoid products over those using placebo, but in many, the scientists admitted that they could not be sure that the effect wasn’t simply due to chance since the association was not statistically significant.

MORE: The Great Pot Experiment

The strongest trials supported cannabinoids’ ability to relieve chronic pain, while the least reliable evidence involved things like nausea and vomiting from chemotherapy, sleep disturbances and Tourette syndrome. Cannabinoids were, however, connected to more adverse events such as nausea, vomiting, dizziness, disorientation and hallucinations than placebo.

Summing up the state of the evidence, Whiting and her colleagues write that “Further large, robust, randomized clinical trials are needed to confirm the effects of cannabinoids, particularly on weight gain in patients with HIV-AIDS, depression, sleep disorders, anxiety disorders, psychosis, glaucoma, and Tourette syndrome.”

MORE: Even in Colorado Medical Marijuana Can Still Get You Fired

That puts patients who try medical marijuana products at a crossroads — in 23 states and Washington, DC, laws allow doctors to recommend cannabis products for their patients for medical reasons. But with little in the way of solid scientific evidence for which products works best, and in which doses, it’s up to the patients to adopt trial-and-error to figure out which, if any cannabinoids help to relieve their symptoms.

Adding to the confusion for patients, another study published in the same JAMA issue shows that medicinal marijuana food products, which include things such as candies, brownies and teas, aren’t often labeled correctly when it comes to their most active cannabis ingredient, and that the amounts are inconsistent. Ryan Vandrey, associate professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine and his colleagues evaluated the contents of 75 products from 47 different brands purchased at marijuana dispensaries in San Francisco, Los Angeles and Seattle, where medicinal marijuana use is legal. When they analyzed them for their content of THC and cannabinoids, the two most concentrated chemicals found in marijuana, they found wildly divergent amounts from what was noted on the products’ labels. Among them, only 17% were accurately labeled, with 23% of the products containing more of these compounds than listed, and 60% containing less than advertised. The labels noted that anywhere from 2 mg to 1000 mg of these agents were in the products, while the lab-based analysis revealed readings as low as 1mg to as high as 1237 mg. “When I have a health condition, and need to go buy my medicine, I want to make sure I know what I’m getting,” says Vandrey. “I want to make sure the dose I buy is the same today and the same the next time and the same the next time I buy it. I want reliability and accuracy so I don’t end up with problems.”

MORE: How Much Does Marijuana Impact Your Driving?

But medical marijuana products, he says, aren’t regulated by the same system that vets other pharmaceutical drugs. In fact, cannabinoids are not regulated at all, since the federal government still considers marijuana an illegal substance and therefore does not acknowledge that marijuana-based therapies exist at all. So far, 23 states have legislated such medicinal marijuana into legality, which means that legislation, and not scientific criteria, have “approved” these compounds for medical use. The results? “What we saw was that there cant’ be much if any consumer confidence within the cities we purchased and tested products,” says Vandrey.

For the larger medical marijuana distributors who see the emerging market as a profitable business, there’s the concern that profit motives may push them to under-deliver the amount of THC or cannabinoid they note on the label. And for the smaller outfits, it could be a matter of not knowing how to extract and measure the active ingredients from the cannabis plant and distribute it in a consistent way in a batch of tea or baked goods.

How can consumers know what they’re getting in a medical marijuana edible? They can do their homework and talk to other consumers and the dispensary about dosing of THC and cannabinoids, says Vandrey. Or they can try to test the products themselves, which some states offer in an effort to standardize and gain more control over these products. But ultimately, he says. “if states are going to supersede federal law and say we think there is medical benefit in marijuana, and we want it to be available to our residents, then it should also be the responsibility of the states to set up appropriate programs for regulating and overseeing the quality assurance and manufacturing standards for medications being sold.”

TIME Research

5 Fashion Choices That Are Bad for Your Health

170721658
Getty Images

It might be worth retiring a few of these trends

Fashion can be fun, but it can also take a toll. New research published Monday revealed that it’s possible for skinny jeans to cause nerve damage. Curious what other fashion dangers you’re wardrobe is causing?

Skinny jeans
As TIME reported Monday, a case report published in the Journal of Neurology, Neurosurgery and Psychiatry chronicles the woeful tale of a 35-year-old woman whose legs went numb while she was wearing skinny jeans. “Her legs and ankles had become so swollen that emergency room staff had to cut her jeans off. Her ankles and toes were weak, but the rest of her legs, including her knees and hips, were working normally,” Alice Park wrote. The perils of tight pants have been noted by health experts as far back as 1993, as the Wall Street Journal reports, internist Dr. Octavio Bessa coined the term “tight-pants syndromein a medical journal after reporting several men coming in with symptoms like abdominal discomfort. When Bessa compared the size of the pants to the abdominal girth, he found there was often a discrepancy. Men needed to loosen up. Tight pants are currently a trend among both men and women, and perhaps it’s not worth the fashion points.

High heels
Foot doctors say the higher the heel on the shoe the more weight is pushed forward onto the balls of the feet, which can cause pain. A 2014 review concluded that high heeled shoes alter that natural position of the foot and ankle and can cause a “chain reaction” of issues that can eventually bother the spine. As the New York Times recently pointed out, other research suggests wearing high heels less often could prevent ankle injury among women.

Corsets
The Kardashian clan are “obsessed” with using corsets to “train” their waists. (Basically using a corset to squeeze your weight into submission). There’s essentially no evidence the process works, but efficacy aside, wearing corsets can be painful, make it hard to breathe, and could possibly result in rib damage according to some experts.

Neck ties
A small amount of evidence suggests wearing a neck tie that’s too tight could elevate intracranial pressure (though the study found that the raised levels were still within normal range), and possibly increase blood pressure in the eyes to unsafe levels. A couple studies by no means make neck ties a risk factor for serious health problems, but those who choose to don them may want to give themselves some breathing room.

Body piercings
A 2012 Northwestern University study reported that bacterial infections affect about 20% of body piercings. Other issues that can arise, the authors report, include things like medical procedure interference and allergies. Using proper utensils when undergoing a piercing and knowing how to keep piercings clean can prevent problems.

TIME Healthcare

The Number of Uninsured Americans Continues to Drop

36 million people were uninsured last year

New federal data released Tuesday reveal that 36 million people in the United States were uninsured in 2014. That number marks a significant drop from the 48.6 million Americans without insurance in 2010, the year the Affordable Care Act was signed into law.

The new data from the CDC’s National Center for Health Statistics (NCHS) are based on interviews with 111,682 people. The findings show that the number of uninsured Americans of all ages dropped to 36 million in 2014 from 44.8 million in 2013. “That’s pretty sharp,” says study author Robin A. Cohen, a statistician at the NCHS.

“This is another set of data tracking what I think has become a pretty broad consensus that the Affordable Care Act is having a significant impact on reducing uninsurance,” says Sabrina Corlette, a senior research fellow and project director at the Center for Health Insurance Reforms at Georgetown University (who was not involved with the research.)

The findings estimate that 170.4 million Americans under age 65 were covered by private health insurance plans in 2014. Overall, 2.2% of Americans were covered via plans that were purchased through the Health Insurance Marketplace or state exchanges. Hawaii had the lowest percentage of uninsured individuals under age 65 in 2014, and Texas and Oklahoma had the highest rates of uninsured Americans in that year.

“If you look at the states with the greatest decrease in uninsurance rates, they are all Medicaid expansion states, and the states that continue to have pretty high rates of uninsurance have declined to expand Medicaid,” Corlette says.

Though the numbers show a significant decline in the number of Americans without health insurance, there’s still a lot of room for improvement, Corlette says. “[36 million people] is still a pretty hefty portion of the population,” she says. “It’s understandable that there is always going to be a certain segment of the population that doesn’t have insurance at a given point in time, but 36 million people is not where we need to be.”

TIME public health

Bottled Water Company Issues Recall Over Possible E. Coli Contamination

The bottled water potentially at risk was produced between June 10 and June 18

A bottled water company has issued a voluntary recall over fears of E. coli contamination.

After traces of E. coli bacteria were found at one of the spring sources for Niagara Bottling LLC, the company has issued a voluntary recall for all 14 of its spring water products that are bottled at two plants in Pennsylvania.

The bottled water potentially at risk for contamination was produced between June 10 and June 18; customers are being urged not to consume those bottles. If consumers must drink the water, it should be boiled first.

E. coli bacteria are typically found in animal and human waste and can cause diarrhea, cramps and nausea. E. coli can be particularly dangerous for the very young, very old, and those with weak immune systems.

According to Niagara, the potentially affected products would have reference codes starting with either “F” or “A” and would have a date between June 10 and 18.

The products under voluntary recall are listed below:

  • Acadia
  • Acme
  • Big Y
  • Best Yet
  • 7-11
  • Niagara
  • Nature’s Place
  • Pricerite
  • Superchill
  • Morning Fresh
  • Shaws
  • Shoprite
  • Western Beef Blue
  • Wegman’s
TIME Drugs

How Much Does Marijuana Impact Your Driving?

A new federal study has answers

A rigorous federal research study by the National Institute on Drug Abuse offers new data on the effects of marijuana on driving performance.

The exact impact of marijuana on driving ability is a controversial subject—and it’s become more important states continue to loosen their drug laws. And, while drunk driving is on the decline in the U.S., driving after having smoked or otherwise consumer marijuana has become more common. According to the most recent national roadside survey from the National Highway Traffic Safety Administration of weekend nighttime drivers, 8.3 percent had some alcohol in their system and 12.6 percent tested positive for THC—up from 8.6 percent in 2007.

It is illegal in all states to drive under the influence of anything, but years of work went in to establishing the .08 breathe alcohol limit that exists in most states. The question is whether we can establish a similar threshold for pot.

To find out, the study recruited 18 occasional cannabis smokers, 13 of them men, between the ages 21 and 37. The participants took six 45-minute drives in a driving simulator—a 1996 Malibu sedan mounted in a 7.3 diameter dome—at the University of Iowa. Each drive tested a different combination of high or low concentration THC, alcohol, and placebos (to create a placebo, participants were given fruit juice with alcohol swabbed in the rim, topped of with 1ml alcohol, to mimic alcohol’s smell and taste).

The researchers looked at 250 parameters of driving ability, but this paper focused on three in particular: weaving within the lane, the number of times the car left the lane, and the speed of the weaving. While alcohol had an effect on the number of times the car left the lane and the speed of the weaving, marijuana did not. Marijuana did show an increase in weaving. Drivers with blood concentrations of 13.1 ug/L THC, the psychoactive ingredient in cannabis, showed increase weaving that was similar to those with a .08 breath alcohol concentration, the legal limit in most states. For reference, 13.1 ug/L THC is more than twice the 5 ug/L numeric limit in Washington and Colorado.

Dr. Marilyn Huestis, the principal investigator in the study, says it is important to note that the study looked at the concentration of THC in the driver’s system while they were driving. This is quite different from the concentration typically measured in a drugged driver out on the road, whose blood may not be checked until several hours after an arrest, allowing the THC level to drop considerably from the time they were driving.

Huestis says the researchers are looking at how to estimate how long it takes for THC concentrations in the blood to drop. Huestis believes that the 5 ug/L limit is not strict enough, particularly when you take into account those with low tolerance.

The study also found that pot and alcohol have more of an impact on driving when used together. Drivers who used both weaved within lanes, even if their blood THC and alcohol concentrations were below the threshold for impairment taken on their own. “We know cannabis is primarily found with a low dose of alcohol,” Huestis says. “Many young people have a couple beers and then cannabis.”

Smoking pot while drinking a little alcohol also increased THC’s absorption, making the high more intense. Similarly, THC delayed the peak of alcohol impairment, meaning that it tended to take longer for someone using both to feel drunk. Such data is important to educate the public about pot’s effects before they get on the road.

“I think this has added really good knowledge from a well-designed study to add to the current debate,” on marijuana’s effects on road safety, says Dr. Marilyn Huestis, the principal investigator in the study, which was conducted by researchers at the National Institute on Drug Abuse.

Read next: Here’s Why Marijuana Prices Appear to Be Dropping in Colorado

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TIME public health

Climate Change Could Erase 50 Years of Health Advances, Report Says

Smoke stacks climate change
Getty Images

'We are facing a predicament that strikes at the heart of humanity'

Climate change may have a bigger impact on our health than we think. According to new research by an international team of researchers published in the journal The Lancet, climate change poses a potentially “catastrophic risk” to public health due to increased risk of the spread of disease, food insecurity and air pollution, among many other things.

“When climate change is framed as a health issue, rather than purely as an environmental, economic, or technological challenge, it becomes clear that we are facing a predicament that strikes at the heart of humanity,” wrote Lancet editor Richard Horton and Lancet Asia editor Helena Hui Wang in a comment also published with the study. “Health puts a human face on what can sometimes seem to be a distant threat.”

Some of the health risks posed by climate change are more obvious, according to the report; extreme weather events like hurricanes, blizzards and tornadoes kill and injure people, and they’re expected to get more frequent. A greater number of people will also be exposed to more frequently occurring heat waves, the report notes.
But there are many secondary consequences to climate change that affect human health in unexpected ways, the study says. Air pollution can cause allergies and asthma, drought could lead to a decline in agriculture and subsequent food shortages and a loss of ecosystems could push pests into contact with humans and increase the number of vector-borne diseases, the authors write.

Despite the potential for devastating health consequences, the researchers also argue that climate change presents the opportunity to structure what they call “more resilient health systems.” The need to stem global warming may inspire a switch to clean energy, and the benefits of clean energy—including a reduction of air pollution—will extend beyond stemming global warming, they write. Switching to clean energy, investing in medical research and changing cities to support healthy lifestyles are among the key recommendations in the report; after all, riding a bike not only saves gas, but also improves your health.

“We can save countless lives, reduce the spread of disease and ensure a secure food supply even as we continue expanding clean energy,” said Kim Knowlton, senior scientist at the Natural Resources Defense Council, in a press release. (Knowlton is not affiliated with the report.) “Our children and future generations are counting on us.”

 

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