TIME Exercise/Fitness

We Drink More Alcohol When We Exercise

gym treadmill
Getty Images

First we sweat, and then we swig: A new Northwestern Medicine study published in the journal Health Psychology finds that people tend to drink more alcohol on days they’ve exercised.

The study looked at 150 adults between the ages of 18-89 who used a smartphone app to record how much they exercised each day — and how much alcohol they drank for three weeks at different points of the year.

Previous studies have found that the more active among us are also the larger lushes. But this study didn’t exactly confirm that. Instead, the stronger link occurred between exercise days and the number of drained glasses, with beer being the most popular post-workout alcoholic beverage. Both physical activity and alcohol intake increased Thursdays through Sundays. Even after the researchers controlled for the fact that people have more alcohol-related social events on the weekend, that many prefer to drink primarily on weekends, and that drinking patterns often differ by season, the association still stuck.

The scientists aren’t sure why there’s such a close link, but they have some ideas. “It could be that people who are more physically active on a given day have to use all their willpower and cognitive resources to get themselves to be active, and they don’t have enough willpower left to resist the temptation of a drink at the end of the day,” says David E. Conroy, lead study author and professor of preventive medicine and deputy director of the Center for Behavior and Health at Northwestern University Feinberg School of Medicine. Other possible reasons: people proud of their workout might want to reward themselves for being good, socialize further over drinks, or even (mistakenly) view alcohol as a good way to replenish fluids, the study says. But other studies show that too much alcohol can negate some of the good that exercise does — in addition to adding calories after a hard-earned burnoff, alcohol might even impair muscle recovery.

If “dehydrate to rehydrate'” is your motivation to get to the gym, you’re not alone. But it might be time to choose a different mantra.

TIME Healthcare Policy

Getting Poor to Get Help: How a Tragic Accident Trapped My Family in Poverty

Trapped in America's Safety Net
Trapped in America's Safety Net Courtesy University of Chicago Press

Campbell is the author of the new book, Trapped in America’s Safety Net: One Family’s Struggle.

When Andrea Louise Campbell's sister-in-law was horribly injured, she and her family had to spend down their money and assets to get the medical care they needed

Nearly one-third of American households live in or near poverty. The causes are myriad – and much contested. Those on the political right tend to cite the personal shortcomings of poor individuals while those on the left blame systemic barriers to upward mobility. But as my family has painfully learned, there is another shocking cause: government policy.

In February 2012 my sister-in-law Marcella was in a car accident on her way to nursing school, where she was working towards a career which she hoped would catapult her and my brother Dave into middle-class security. Instead, the accident plunged them into the world of American poverty programs. Marcella is now a quadriplegic, paralyzed from the chest down. She needs round-the-clock personal care and assistance. The only source – public or private – for a lifetime of such coverage is Medicaid. But because Medicaid is the government health insurance for the poor, she and my brother must be poor in order to qualify. (Medicare does not cover long-term supports and services, and private long-term care insurance is time-limited and useless to a 32-year-old who needs decades of care). Thus, Marcella and Dave embarked on a hellish journey to lower their income and shed their modest assets to meet the state limits for Medicaid coverage.

To meet the income requirement, my brother reduced his work hours to make just 133 percent of the poverty level (around $2,000 per month for their family). Anything he earns above that amount simply goes to Medicaid as their “share of cost” – a 100 per cent tax.

Worse: the asset limit. In California, where they live, they can own only $3,150 in assets beyond their home and one vehicle. They’re “lucky,” a social worker tells Dave: if not for the baby (Marcella was pregnant at the time of the accident; the baby miraculously survived), the asset limit would be $3,000. As if you can raise a child on $150. This asset limit was last raised in 1989. It has fallen by half in real value since then.

Dave and Marcella began to liquidate. Under California rules, retirement plans are not exempt from the asset test. Marcella had to cash in a small 401(k) account from a previous job, paying the early withdrawal penalty to boot. Dave had to abandon his hobby, working on old cars, which violated the asset test. He sold them all, keeping a 1968 Datsun pickup because its tiny value didn’t impinge on the asset limit. The pickup is 45 years old, weighs less than a Miata, and has no modern safety features. The only able-bodied adult in the family has to drive to work in an unsafe vehicle. And they had to empty their bank account, watching their hard-earned security disappear.

As Dave and Marcella spent down their assets, they had to keep track of every penny. They could only put the money into the exempt items, the house and the used wheelchair van they bought for Marcella. They could not use the money to pay credit card bills, household bills, or Marcella’s student loans from her undergraduate degree. And they are barred from doing any of the things the middle class is constantly advised to do: save for retirement. Create an emergency fund. Save for college with a tax-free 529 plan. Just $3,150 in assets – that’s it.

What happens in an emergency? One day the van’s wheelchair ramp stopped working. The repair cost $3,000—the sum of their meager assets. Fortunately their tax refund had just come in and went straight back out to pay for the repair. We don’t know what they’ll do next time.

What would help folks like Marcella and Dave?

True universal health insurance. A universal social insurance program for long-term care, not just Medicaid. And one modest change: no asset test. Policy is already trending in that direction. Under the Affordable Care Act, those newly eligible for Medicaid face no asset test. (Unfortunately those in the original eligibility categories, including the disabled like Marcella, are still under the old rule.) About half of the states have no asset test for any Medicaid recipient; perhaps someone realized that trying to ferret out the tiny amount of resources most Medicaid applicants have is inefficient. As for Dave and Marcella, I suppose they might move to a state with more generous rules. However, no state helps with wheelchair renovations. Lacking the assets to buy a new house elsewhere, they must remain in the home their friends renovated for them on an entirely volunteer basis.

It’s bad enough that America’s system of social supports is so limited. That the government also forces some of its citizens to get poor to get the help they need is an abomination.

 

Andrea Louise Campbell is professor of political science at the Massachusetts Institute of Technology. She is the author of Trapped in America’s Safety Net, out this month.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME ebola

CDC: Cases of Ebola Could Double Every 20 Days

Members of a burial team wearing protective suits bury an Ebola victim in Freetown, Sierra Leone.
Members of a burial team wearing protective suits bury an Ebola victim at King Tom Cemetery, which is bitterly resented by residents of the adjoining slum, called Kolleh Town, in Freetown, Sierra Leone, Sept. 21, 2014. Samuel Aranda—The New York Times/Redux

A new CDC report predicts the enormous cost of delayed response to Ebola

If Ebola conditions continue without a scaled-up effort, the CDC estimates that cases of Ebola in West Africa will double every 20 days — and in an absolute worst-case scenario without any intervention, numbers could reach 1.4 million by Jan. 20.

Using a new Ebola Response prediction tool, the CDC has published results that show that if current trends continue unimpeded, Liberia and Sierra Leone will have approximately 8,000 total Ebola cases, or 21,000 if the tool accounts for underreporting, by Sept. 20. Liberia will account for about 6,000 of those cases.

The numbers are frighteningly high, but it should be noted that it’s a prediction of a hypothetical situation in which absolutely no intervention were to happen. That won’t be the case if many countries and the UN keep their promises. The model also shows that a big response could turn the outbreak around. In another hypothetical situation, the outbreak could ease up and eventually end if 70% of people with Ebola are placed in medical care facilities, Ebola treatment units, or somewhere where transmission could be contained.

“The model shows that a surge now can break the back of the epidemic,” said Dr. Tom Frieden, director of the CDC, in a press conference. “The importance of implementing effective programs rapidly cant be over-emphasized. The cautionary finding of the modeling is the enormous cost of delay.”

During the press conference, Dr. Frieden said the outbreak is very fluid and changing, but that he does not think West Africa will meet their worst case scenario predictions. “If you get enough people effectively isolated, the epidemic can be stopped…Even in dire scenarios, if we move fast enough we can turn it around. I do not think the most dire circumstances will come to pass,” he said.

The CDC report comes out on the same day the World Health Organization released their reports on the outbreaks at six months in all affected countries, and it appears that cases in Nigeria and Senegal have stabilized “for the moment.” Last week, President Obama announced a deployment of 3,000 U.S. military personnel and over $500 million in defense spending to go to West Africa, and the UN announced a new task force called the U.N. Mission for Ebola Emergency Response. The hope is that an exponentially increased response will prevent these possible scenarios.

TIME medicine

When Doctors Ignore Their Own Advice

doctor with donut
Getty Images

What to do about docs who smoke, drink, and tan

I live near a health clinic, and on more than one occasion, have walked by men and women in scrubs smoking cigarettes. No human being is immune to nicotine’s addictiveness, but since health care professionals are supposed to advise patients against such behaviors, it’s extremely hard to justify the habit.

Earlier this month, a report published in The BMJ showed that one in 10 doctors admit to using tanning beds. The survey sample was small at only 163 U.K. doctors, but considering skin cancer is the most common cancer in the U.S., the fact that any physician would choose to partake in an activity that puts them at a direct risk for cancer is pretty mindboggling.

But indoor tanning isn’t the only doctor vice. Smoking, poor eating habits, being sedentary, and heavy drinking–while still not the norm–are behaviors not completely eradicated from the medical community.

An unforgiving culture

“It’s unrealistic to expect that knowledge should prompt physicians to avoid unhealthy behaviors,” says Anthony Montgomery, an associate professor of work and organizational psychology at the University of Macedonia in Greece. “Just like everybody else, they have a low risk perception with regard to their health.”

Montgomery says a big part of the problem is how physicians cope when they encounter health problems. In a 2011 study, Montgomery and his colleagues conducted an analysis published in Occupational Medicine that looked at 27 studies on doctors self-medicating. They wanted to examine the implications of a persisting culture within medicine where doctors do not expect themselves or their colleagues to be sick.

“We found that there was considerable evidence that physicians and medical students engage in high levels of inappropriate self treatment for reasons that include avoiding the patient role and occupational norms–keeping things inside the profession,” he says.

The study concluded that these behaviors could be occupational hazards for doctors, and that these problems are not benign for patients. Congruent research finds that doctors with bad health habits are less likely to counsel their patients on the same issues.

“Fifty years ago smoking was very common among physicians and nurses, though fortunately we’ve reduced that significantly,” says Shiv Gaglani, co-founder of a pledge for medical students called The Patient Promise. “Now however, physicians and nurses have the same level of obesity as the general population. Our caregivers are human too and can succumb to same behaviors that everyone else can.”

Montgomery, who typically studies doctor burnout, is working on a report that collected data from health care professionals in Croatia, Portugal, Macedonia, Greece, Turkey, Romania and Bulgaria and found that the effects of burnout were significant predictors of fast food consumption, infrequent exercise, drinking alcohol and using painkillers.

“Certainly most physicians I’ve met understand the paradox between what they preach and what they practice,” says Gaglani. “Seeking help is often complicated by the fact that you don’t want word to spread about your issues because it would spread within the community you practice. In some cases it could even mean the end of your career.”

Solutions

Gaglani created The Patient Promise in 2008 with his roommate at Johns Hopkins Medical School after they attended a course on obesity and motivational interviewing of patients.

“We realized that many of the harmful lifestyle behaviors we were learning to counsel against as future physicians were actually becoming part of our daily lives,” says Gaglani.

The pressure and stress of medical school was causing Gaglani and his peers to eat less nutritious food, exercise fewer times each week, and get significantly less sleep. “We asked the simple question: How can we counsel patients on important lifestyle behaviors if we couldn’t practice them ourselves?” says Gaglani.

And so the Patient Promise was created, and still serves as a pledge for health care workers to live the lifestyles they are recommending for their patients. The movement calling for doctors to be healthy has spread to many health care facilities.

Some hospitals have even incentivized healthy behaviors, like the Cleveland Clinic, which took staff health to task in 2014 and asked all of its employees to wear an activity tracker called Pebble. Target goals were set across the board, and participating in the program allows employees to get lower health insurance premium rates. So far out of the 26,790 employees and spouses participating, 18,302 have already met their target goal for the year: 100,000 steps a month or 600 activity minutes a month for six months.

The Patient Promise is available for all health care workers to sign as a pledge to patients and themselves. “We believe in the power of partnership and shared accountability between clinicians and their patients to lead healthier lives,” says Gaglani.

TIME Food & Drink

Poultry Giant Ditches Antibiotics for Probiotics

Chicken houses could offer stability for Southside farmers
In this Aug. 21, 2014 photo Robert Mills holds a four-day old chicken in Pittsylvania County, Va. Stephanie Klein-Davis—AP

Your chicken will be antibiotic-free, but rich in bacteria — and that's a good thing, Perdue Farms says

To keep its chickens disease-free, Perdue Farms is giving the livestock fewer antibiotics — but more probiotics, NPR reports.

The poultry giant believes probiotics, or “good bacteria,” will fend off the harmful kind that might otherwise take up residence in its birds, according to NPR.

Poultry companies have long raised their chicken on antibiotics to increase weight and prevent infections — a practice that public-health officials say runs the risk of spurring the development of so-called “superbugs” that are resistant to antibiotics and harmful to humans.

In response to a recent Reuters investigation into the widespread use of so-called “farmacueticals” in six chicken plants, including Perdue, U.S. lawmakers are eyeing new legislation to compel companies to release more information about their use of antibiotics.

Heading off such legislation, Perdue said in a statement earlier this month that it would stop using antibiotics in 95% of its chickens — that is, just to treat ill livestock. Turning to probiotics is among the firm’s alternative strategies for keeping its chickens disease-free, NPR says.

[NPR]

TIME ebola

There Could Be 20,000 Ebola Cases by November if More Isn’t Done Now

Ebola Lessons
Nurses train to use Ebola protective gear with World Health Organization, WHO, workers, in Freetown, Sierra Leone on Sept. 18, 2014. Michael Duff—AP

Public-health experts warn that the epidemic could turn from “a disaster into a catastrophe”

A new study by the World Health Organization released on Tuesday warned of 20,000 Ebola cases worldwide in just over a month’s time if authorities failed to ramp up efforts to combat the growing epidemic.

“We estimate that, at the current rate of increase, assuming no changes in control efforts, the cumulative number of confirmed and probable cases by November 2 will be 5,740 in Guinea, 9,890 in Liberia, and 5,000 in Sierra Leone, exceeding 20,000 cases in total,” read the report published in the New England Journal of Medicine this week.

The Ebola virus is spread primarily through exposure to body fluids of symptomatic patients. Transmission of the virus is prevented through early diagnosis, contact tracing, patient isolation and infection control along with the safe burial of those killed by Ebola.

However, the virus has primarily hit impoverished West African communities, where many of these protocols are difficult or impossible to enforce.

“If we don’t stop the epidemic very soon, this is going to turn from a disaster into a catastrophe,” Christopher Dye, a co-author of the study and director of strategy at the WHO, told reporters in Geneva. “The fear is that Ebola will become more or less a permanent feature of the human population.”

The publication of the new report comes as Sierra Leone concluded an ambitious lockdown of the country for three days by effectively asking its 6 million residents to stay at home while approximately 30,000 volunteers and health officials canvassed the country to distribute soap and instructions on how to prevent contraction of the virus.

There are currently 5,833 recorded cases of Ebola across six African nations. The disease has killed at least 2,833 people.

TIME Infectious Disease

More Than 700 Babies Exposed to Tuberculosis at Texas Hospital

The Texas Department of State Health Services said it's "one of the largest TB exposure investigations we've ever been involved in"

More than 700 babies and 40 health workers have been exposed to tuberculosis in an El Paso, Texas, hospital, the city’s Department of Public Health announced.

At some point between September 2013 and August 2014, a Providence Memorial Hospital employee with TB, as the disease is commonly known, entered the hospital and worked in close proximity with infants, CNN reported Monday.

It is unknown whether any of those exposed have subsequently tested positive for tuberculosis, which can be fatal. The hospital and the health department promised free care for anyone infected and said they have alerted each person at risk by phone call and letter.

“This is one of the largest TB exposure investigations we’ve ever been involved in, and it involves infants, so it is particularly sensitive,” Carrie Williams, the director of media relations for the Texas Department of State Health Services, told CNN. “Babies are more likely than older children and adults to develop life-threatening forms of TB.”

The department investigated last week and reported that the hospital’s infection-management standards were lacking. The Centers for Medicare & Medicaid Services gave the hospital an Oct. 11 deadline to identify changes in protocol to prevent similar exposures in the future — otherwise it will cut off Medicare and Medicaid funding.

Active cases of TB can spread through the air when an infected person coughs and sneezes. Typically treatment requires months of antibiotics, although an infection can stay dormant in patients and not show symptoms, which include breathing difficulties and chest pains.

The employee who was initially infected is no longer working at the hospital but is reportedly receiving treatment.

[CNN]

TIME medicine

Generic Drug Discount Programs Work — for Everyone

Americans are increasingly participating in programs that fill cheaper versions of prescription drugs

More and more Americans are buying the cheaper generic versions of prescription drugs, new research published in JAMA Internal Medicine shows.

In 2006, Walmart introduced what would become one of many generic drug discount programs that allowed people to pay just $4 to fill prescriptions of generic drugs. The program was meant to help people meet difficult medical costs–especially more vulnerable groups like the elderly and low-income populations.

At first, the program didn’t appear to gain a lot of traction. In 2007, only 3.6% of patients receiving prescription drugs were partaking in a program. But similar programs popped up at other pharmaceutical retailers like Rite Aid, CVS and Walgreens and has since gotten much more popular.

The researchers looked at a 2010 national household survey of health care usage among patients over age 18 who had at least one prescription during that year. They found that among the 13,486 adults identified in the survey as having at least one drug prescription, 3,208 were users of generic drug discount programs, and overall program use was at about 23%–much higher than the 3.6% participation rate three years earlier.

Researchers also found that people who were elderly, sick, uninsured and living in rural areas were more likely to participate in the programs, but interestingly, there were no significant differences across education levels or race/ethnicity groups. “Generic drug discount programs were not considered inferior despite the common perception that generic drugs are of poor quality,” the study authors write. “In fact, generic drug discount programs offer convenience by not requiring insurance claims to be filed.”

The researchers think the mere fact that more pharmaceutical retailers have offered similar programs is one of the reasons there’s greater uptake across the board, and while participation could still be higher, plenty of people of different backgrounds are taking part in the cost savings programs.

TIME Heart Disease

Healthy Behaviors Can Prevent 4 Out of 5 Heart Attacks

A study of Swedish men shows just how beneficial healthy living is for the heart

We all know the basic tenets of a healthy lifestyle–maintaining a good diet and waist size, exercising, not smoking and drinking alcohol in moderation. But how healthy will they get you, exactly? A new study published Monday in the Journal of the American College of Cardiology quantifies the effects of a healthy lifestyle and finds that practicing these behaviors can prevent four out of five coronary events in men.

Researchers looked at a study population of 20,721 healthy Swedish men between the ages of 45 to 79 and followed them for more than a decade, asking them about their lifestyle choices and behaviors from levels of physical activity to their smoking status.

Men didn’t have to stick to every healthy behavior to see results: Every good habit was associated with a reduced risk for heart attack. Eating a low-risk diet plus drinking alcohol in moderation was associated with a 35% reduced risk of heart attack compared to those in the high-risk group. When men combined even more behaviors, the protective effects soared. Men who don’t smoke and walked or cycled at least 40 minutes a day, exercised at least one hour a week, had a waist circumference under 37.4 inches, drank moderately, and ate a diet of fruits, veggies, legumes, nuts, reduced-fat dairy products, fish and whole grains had an 86% lower risk of heart attack than those with high-risk behaviors.

It’s not all good news, of course. Only 1% of men in the study–and about the same amount of the U.S. population–keeps this kind of heart-healthy regime.

TIME Infectious Disease

Pregnant Women and the Flu: Why Influenza Is More Dangerous for Expectant Moms

Immune responses are enhanced during pregnancy, study finds

Only 50% of pregnant women get the flu vaccine, but they’re among the most vulnerable to influenza. When mothers-to-be catch the virus, they tend to get much sicker than other healthy adults, and it increases their risk for delivering prematurely.

A new Stanford University study published in the Proceedings of the National Academy of Sciences looked at why pregnant women are so susceptible to the flu, and they found the culprit may be over-zealous cells that are key to fighting off infection.

Researchers collected immune cells from about 50 women, half of whom were pregnant and half who weren’t. They then infected the cell samples with influenza virus in a lab. In the samples from the pregnant women, two types of white blood cells, called natural killer and T cells, had enhanced immune responses, causing them to attract even more immune cells to help fight the virus.

While it might seem that such a strong response to the flu is exactly what expectant mothers would want, it can be too much of a good thing, says Dr. Catherine Blish, assistant professor of infectious diseases at Stanford School of Medicine and the study’s senior author. “Having too many immune cells in the lung can cause inflammation that makes it hard to breathe,” she says, which might help explain why pregnant women who get the flu are at greater risk for pneumonia and death. “If these findings are confirmed in bigger studies and then natural infection, they could explain why pregnant women do so poorly.”

“We normally think that these particular cells are suppressed by pregnancy to protect the fetus—it’s what we all learned in medical school,” Blish says. “And we found when we used a generalized stimulation that that was the case. But there’s something specific about flu that leads to this enhanced response.”

Getting the flu vaccine helps protect pregnant women, Blish says, and she and her team “really strongly recommend” that all women who are pregnant or considering getting pregnant get vaccinated.

Blish and her colleagues plan to study whether other viruses have the same effect and whether it’s possible to treat severe influenza by turning down this immune response. But even if these findings eventually lead to new therapies, she says, “the most important thing to remember is that influenza vaccine is really the best tool to prevent infection in the first place.”

Your browser, Internet Explorer 8 or below, is out of date. It has known security flaws and may not display all features of this and other websites.

Learn how to update your browser