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The US healthcare system is at a dramatic fork in the road | Adam Gaffney

The Congressional Budget Office has given the revised American Health Care Act a dismal score. Will we let this terrible plan define our healthcare future?

The US healthcare system and with it the health and welfare of millions is poised on the edge of a knife. Though the fetid dysfunction and entanglements of the Trump presidency dominate the airwaves, this is an issue that will have life and death consequences for countless Americans.

The Congressional Budget Offices (CBO) dismal scoring of the revised American Health Care Act (AHCA) on Wednesday made clear just how dire Americas healthcare prospects are under Trumps administration. But while the healthcare debate is often framed as a choice between Obamacare and the new Republican plan, there are actually three healthcare visions in competition today. These can be labelled healthcare past, healthcare present, and healthcare future.

Let us begin with healthcare past, for the dark past is precisely where Republicans are striving to take us with the AHCA. The bill narrowly passed by the House on 4 May is less a piece of healthcare reform than a dump truck sent barreling at high speed into the foundation of the healthcare safety net.

Wednesdays CBO score reflects the modifications made to the AHCA to pacify the hard-right Freedom Caucus, changes that allowed states to obtain waivers that would relieve health insurers of the requirement that they cover the full spectrum of essential healthcare benefits, or permit them to charge higher premiums to those guilty of the misdemeanor of sickness, all purportedly for the goal of lowering premiums.

In fairness, the CBO report did find that these waivers would bring down premiums for non-group plans. This, however, was not the result of some mysterious market magic, but simply because, as the CBO noted, covered benefits would be skimpier, while sicker and older people would be pushed out of the market.

In some states that obtained waivers, over time, less healthy individuals would be unable to purchase comprehensive coverage with premiums close to those under current law and might not be able to purchase coverage at all. Moreover, out-of-pocket costs would rise for many, for instance whenever people needed to use services that were no longer covered say mental health or maternity care.

Much else, however, stayed the same from the previous reports. Like the last AHCA, this one would cut more than $800bn in Medicaid spending over a decade, dollars it would pass into the bank accounts of the rich in the form of tax cuts, booting about 14 million individuals out of the program in the process. And overall, the new AHCA would eventually strip insurance from 23 million people, as compared to the previous estimate of 24 million.

Its worth noting here that Trumps budget released Tuesday proposed additional Medicaid cuts in addition of those of the AHCA, which amounted to a gargantuan $1.3tn over a decade, according to the Center on Budget and Policy Priorities.

The tax plan and budget best characterized as a battle plan for no-holds-barred top-down class warfare drawn up by apparently innumerate xenophobes would in effect transform the healthcare and food aid of the poor into bricks for a US-Mexico border wall, guns for an already swollen military, and more than anything a big fat payout to Trumps bloated billionaire and millionaire cronies.

What becomes of this violent agenda now depends on Congress and on the grassroots pressure that can be brought to bear upon its members.

But assuming the AHCA dies a much-deserved death quite possible given the headwinds it faces in the Senate we will still have to contend with healthcare present.

Last week, the Centers for Disease Control released 2016 results from the National Health Interview Survey, giving us a fresh glimpse of where things stand today. And on the one hand, the news seemed good: the number of uninsured people fell from 48.6 to 28.6 million between 2010 and 2016.

On the other hand, it revealed utter stagnation: an identical number were uninsured in 2016 as compared with 2015, with about a quarter of those with low incomes uninsured last year (among non-elderly adults). It also suggested that the value of insurance is declining, with high-deductible health plans rapidly becoming the rule and not the exception: for the privately insured under age 65, 39.4% had a high-deductible in 2016, up from 25.3% in 2010.

Healthcare present, therefore, is an unstable status quo: an improvement from healthcare past, no doubt, but millions remain uninsured and out-of-pocket health costs continue to squeeze the insured.

Which takes us to the third vision, that of healthcare future. As it happens, another recent development provided a brief glimmer of hope for that vision. As the Hill reported, the Democratic congressman John Conyers held a press conference yesterday (Physicians for a National Health Program, in which I am active, participated) to announce that his universal healthcare bill the Expanded & Improved Medicare For All Act had achieved 111 co-sponsors, amounting to a majority of the House Democratic Caucus and the most in the bills history.

This bill like other single-payer proposals is the precise antithesis of Paul Ryans AHCA. Rather than extract coverage from millions to provide tax breaks for the rich, it would use progressive taxation to provide first-dollar health coverage to all.

Which of these three visions will win out is uncertain, but the outcome of the contest will have a lasting impact on the country. We can only hope that the thuggish, rapacious vision championed by Trump and his administration does not prevail.

Read more: https://www.theguardian.com/commentisfree/2017/may/25/us-healthcare-system-fork-road

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Popular social media sites ‘harm young people’s mental health’

Poll of 14- to 24-year-olds shows Instagram, Facebook, Snapchat and Twitter increased feelings of inadequacy and anxiety

Four of the five most popular forms of social media harm young peoples mental health, with Instagram the most damaging, according to research by two health organisations.

Instagram has the most negative impact on young peoples mental wellbeing, a survey of almost 1,500 14- to 24-year-olds found, and the health groups accused it of deepening young peoples feelings of inadequacy and anxiety.

The survey, published on Friday, concluded that Snapchat, Facebook and Twitter are also harmful. Among the five only YouTube was judged to have a positive impact.

The four platforms have a negative effect because they can exacerbate childrens and young peoples body image worries, and worsen bullying, sleep problems and feelings of anxiety, depression and loneliness, the participants said.

The findings follow growing concern among politicians, health bodies, doctors, charities and parents about young people suffering harm as a result of sexting, cyberbullying and social media reinforcing feelings of self-loathing and even the risk of them committing suicide.

Its interesting to see Instagram and Snapchat ranking as the worst for mental health and wellbeing. Both platforms are very image-focused and it appears that they may be driving feelings of inadequacy and anxiety in young people, said Shirley Cramer, chief executive of the Royal Society for Public Health, which undertook the survey with the Young Health Movement.

She demanded tough measures to make social media less of a wild west when it comes to young peoples mental health and wellbeing. Social media firms should bring in a pop-up image to warn young people that they have been using it a lot, while Instagram and similar platforms should alert users when photographs of people have been digitally manipulated, Cramer said.

The 1,479 young people surveyed were asked to rate the impact of the five forms of social media on 14 different criteria of health and wellbeing, including their effect on sleep, anxiety, depression, loneliness, self-identity, bullying, body image and the fear of missing out.

Instagram emerged with the most negative score. It rated badly for seven of the 14 measures, particularly its impact on sleep, body image and fear of missing out and also for bullying and feelings of anxiety, depression and loneliness. However, young people cited its upsides too, including self-expression, self-identity and emotional support.

YouTube scored very badly for its impact on sleep but positively in nine of the 14 categories, notably awareness and understanding of other peoples health experience, self-expression, loneliness, depression and emotional support.

However, the leader of the UKs psychiatrists said the findings were too simplistic and unfairly blamed social media for the complex reasons why the mental health of so many young people is suffering.

Prof Sir Simon Wessely, president of the Royal College of Psychiatrists, said: I am sure that social media plays a role in unhappiness, but it has as many benefits as it does negatives.. We need to teach children how to cope with all aspects of social media good and bad to prepare them for an increasingly digitised world. There is real danger in blaming the medium for the message.

Young Minds, the charity which Theresa May visited last week on a campaign stop, backed the call for Instagram and other platforms to take further steps to protect young users.

Tom Madders, its director of campaigns and communications, said: Prompting young people about heavy usage and signposting to support they may need, on a platform that they identify with, could help many young people.

However, he also urged caution in how content accessed by young people on social media is perceived. Its also important to recognise that simply protecting young people from particular content types can never be the whole solution. We need to support young people so they understand the risks of how they behave online, and are empowered to make sense of and know how to respond to harmful content that slips through filters.

Parents and mental health experts fear that platforms such as Instagram can make young users feel worried and inadequate by facilitating hostile comments about their appearance or reminding them that they have not been invited to, for example, a party many of their peers are attending.

May, who has made childrens mental health one of her priorities, highlighted social medias damaging effects in her shared society speech in January, saying: We know that the use of social media brings additional concerns and challenges. In 2014, just over one in 10 young people said that they had experienced cyberbullying by phone or over the internet.

In February, Jeremy Hunt, the health secretary, warned social media and technology firms that they could face sanctions, including through legislation, unless they did more to tackle sexting, cyberbullying and the trolling of young users.

Read more: https://www.theguardian.com/society/2017/may/19/popular-social-media-sites-harm-young-peoples-mental-health

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Postnatal depression I felt disembodied for so long but suddenly I was back in my own body

Jessica Friedmann talks to Viv Groskop about the terrifying years she experienced after the birth of her son

Jessica Friedmann thought she was managing well after the birth of her son. Then suddenly her thoughts took a dark turn. I had to come back into hospital two weeks later for a checkup and I realised that all I wanted to do was get out of the moving car. I was feeling as though I couldnt handle being alive any more and that it would be better for Owen if I wasnt.

Friedmann, 30, has written an extraordinary account of extreme postnatal depression as seen from the eye of the storm. She lives in Canberra, Australia, with her husband, Mike, 34, who is in the Australian air force. Their son, Owen, is four. The period of feeling foggy, as she calls it, dates it back to Owens early weeks. Friedmanns experience is at the sharp end of things. While the NHS suggests that the baby blues usually dont last more than two weeks after giving birth, Friedmann was ill for, she estimates, two and a half to three years.

She says cautiously that now she is fine. She had anticipated that she might feel fragile during her pregnancy. But when I was pregnant, I felt strong and vibrant, she says. I had experienced depression in the past and I was worried that I would feel resentful about sharing my body with another human being. You know, the idea of feeling colonised, of having another person growing inside me But it felt intuitively right and I felt safe.

Similarly she imagined she felt confident during and after the birth, despite some complications. I had to have a caesarean because he was breech I had a haemorrhage. But afterwards I thought I was OK. It turned out my uterus was inflamed and so I was on a course of antibiotics.

As her physical symptoms improved, her mental health deteriorated. A couple of weeks after he was born, I went from feeling euphoric to feeling good to feeling not good to feeling desperate quite quickly. Antidepressants helped, but did not fix everything. That got me up to half-speed. I thought that was as good as it was going to get. I felt so slow and tired.

Jessica was part of pilot programme in Australia where mothers can be monitored by a psychiatrist after birth. This helped to sort out her medication. Because she had had depression before, she was also seeing a therapist. But despite all this, she still felt at a loss as a new mother: You can read as much as you want, but you dont know what having a child is going to feel like. I didnt know it was ordinary to be in that much pain or to be so tired that I just couldnt function.

But while these things are normal and usually fairly transient for new parents, she realised that her symptoms were more serious. For me the key tell for depression is that I stop sleeping. Its a kind of interrupted sleep. In the early days, instead of getting sleep between Owens feeds, I would stay up all night and be awake. At the time I thought it made sense. That kind of sleeplessness is common if youre experiencing depression. Its a sleeplessness that is like agitation.

It got worse as she found herself heading into the world of what therapists call postpartum mood disorder. I started having intrusive thoughts. Although at the time I didnt have the language to express that. Its compulsive thinking about violence towards yourself or towards your child. You are thinking things that you dont want to think. But the majority of new parents dont have those thoughts. Or at least Ihope they dont.

Jessica
Jessica Friedmann. Photograph: Heather Lighton/Scribe

Her mother took over the care of her son for a while. At one time Friedmann had the urge to walk out of the window. Recovery was slow: Depression is very isolating, so I felt so grateful that I had so many people around me who Icould ask for help.

Friedmann realised she was getting better when she felt more in control of her mind. It was almost like a light came on. I had felt disembodied for so long and suddenly it was like I was back in my own body. I felt as though I were present in all my senses in a way that I hadnt felt for years. It was like falling in love or wearing glasses for the first time.

She now has a close, easy relationship with her son, but still worries about the impact on him. I think hes a very resilient child. From the beginning when I was in such a bad way, I just followed him and his needs. Ididnt try to put him in a routine. We had a period of separation at one point. But theres a lot of love and trust between us.

She says cautiously that anyone who is depressed should also get help for whoever is looking after them: Mike didnt talk for years about whathe was going through. Because hewas so worried about me. But if youare the caretaker for someone witha psychiatric illness, looking after yourself is not selfish.

Her advice to her earlier self would be to be more realistic about the caesarean. I wish I had known more about the effect it has on your body. The whole too posh to push thing makes it seem like its supposed to be awalk in the park compared with avaginal birth. I didnt really realise that its a major abdominal surgery thattakes six weeks to recover from. Ithurt a lot. It was scary.

Most of all, though, she says she wishes she had been kinder to herself. Although when you are in the grip of a psychological crisis, the idea of having a self is nebulous. And the idea of kindness to that self even more so. I look back at those months now and its all just a fog. I wish I had known how to simultaneously be experiencing a psychological crisis and be an advocate for myself. But that is almost impossible. I think mental illness is such a bear trap because in any other crisis you can articulate what is going on. But I couldnt. She sighs, realising the impossibility of what she is wishing for. Then she jokes: Maybe a series of flashcards would have helped?

She hopes her book about this experience will help others feel able to say Im sick when things become too difficult to manage. Her story, she says, is partly one about severe postnatal depression but its also about the complicated business of starting out in family life while feeling overwhelmed something which happens to everyone who has a baby.

Theres nothing straightforward about parenting, she says. Its grief, sorrow, exultation.

Things That Helped by Jessica Friedmann (Scribe, 12.99). To order a copy for 11.04,go tobookshop.theguardian.comorcall the Guardian Bookshop on0330 333 6846. Free UK p&p over 10, online orders only. Phone orders min. p&p of 1.99.

Read more: https://www.theguardian.com/lifeandstyle/2017/may/13/postnatal-depression-i-felt-disembodied-for-so-long-but-suddenly-i-was-back-in-my-own-body

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Health report links antibiotics to risk of miscarriage

Canadian study finds taking the drugs raises chances of having a miscarriage by between 60% and 100%

Many common antibiotics may double the risk of miscarriage in early pregnancy, research has shown.

A Canadian study has found that taking the drugs raised the chances of having a miscarriage by between 60% and 100%.

The link was seen with several classes of antibiotic including macrolides, quinolones, tetracyclines, sulphonamides and metronidazole. However, nitrofurantoin, often used to treat urinary tract infections in pregnant women, had no effect on miscarriage risk. Nor did the widely used antibiotic erythromycin.

The researchers looked at data from almost 9,000 cases of miscarriage at an average time of 14 weeks into pregnancy, involving girls and women aged between 15 and 45.

The study leader, Dr Anick Brard, from the University of Montreal in Quebec, said: Infections are prevalent during pregnancy. Although antibiotic use to treat infections has been linked to a decreased risk of prematurity and low birth weight in other studies, our investigation shows that certain types of antibiotics are increasing the risk of spontaneous abortion, with a 60% to two-fold increased risk.

Women who miscarried were more likely to be older, living alone, and to have multiple health issues and infections. But all these factors were accounted for in the analysis, whose findings are published in the Canadian Medical Association Journal.

Dr Brard added: The increased risk was not seen for all antibiotics, which is reassuring for users, prescribers and policymakers.

The researchers identified a total of 182,369 pregnancies from the Quebec pregnancy cohort, a large population group from the province providing data for ongoing studies. Of these, 8,702 (4.7%) ended with an early miscarriage.

Writing in the journal, the team concluded that there was a link between some antibiotics and an increased risk of miscarriage, but added: However, residual confounding by severity of infection cannot be ruled out.

Read more: https://www.theguardian.com/society/2017/may/02/health-report-links-antibiotics-to-risk-of-miscarriage

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Plain cigarette packaging could drive 300,000 Britons to quit smoking

Review by research organisation Cochrane suggests impact of UKs ban on branded packs could echo results seen in Australia

Plain cigarette cartons featuring large, graphic health warnings could persuade 300,000 people in the UK to quit smoking if the measure has the effect it had in Australia, scientists say.

Standardised cigarette packaging will be compulsory in the UK from 20 May. A new review from the independent health research organisation Cochrane on the impact of plain packaging around the world has found that it does affect the behaviour of smokers.

In the UK, the tobacco industry has become increasingly innovative in the design of cigarette packets as other controls on sales and advertising have taken hold, according to Ann McNeill, professor of tobacco addiction at Kings College London. The tobacco industry has been focusing its efforts on the tobacco packs, she said.

Among those that will be banned are vibrant pink packets, targeted at young women, and gimmicky cartons that slide rather than flip open. The rules that come into force next month require all packs to look alike, with graphic health warnings across 65% of their surface.

The Cochrane reviewers found 51 studies that looked at standardised packaging and its impact on smokers, but only one country had implemented the rule fully at the time. Australia brought in plain packs in 2012.

Analysing the evidence from Australia, the team found a reduction in smoking of 0.5% up to one year after the policy was introduced. According to the Australian government, that translates to 100,000 people no longer smoking. The decline was attributable specifically to plain packaging, after taking into account the continuing drop in the numbers of smokers caused by other tobacco control measures.

Dr Jamie Hartmann-Boyce of the Cochrane tobacco addiction group at Oxford Universitys Nuffield Department of Primary Care Health Sciences said: We are not able to say for sure what the impact would be in the UK, but if the same magnitude of decrease was seen in the UK as was observed in Australia, this would translate to roughly 300,000 fewer smokers following the implementation of standardised packaging.

The review found signs that more people were trying to quit smoking as a result of plain cartons, rising from 20.2% before to 26.6% after introduction. There was also evidence that standardised packs were less attractive to those who did not smoke, making it less likely that they would start.

However, the researchers say variations in the way countries are introducing standardised packs may affect the outcomes. Some allow different colours, slightly different carton shapes and the use of descriptive words such as gold or smooth.

Cancer Research UK backs plain packaging. Smoking kills 100,000 people in the UK every year, so we support any effective measure which can help reduce this devastating impact. The evidence shows that standardised packaging works and helps to reduce smoking rates, said George Butterworth, the charitys tobacco policy manager.

Its too soon to see the impact in the UK, as the new legislation will only be fully implemented in May, but we hope to see similar positive results as the UK strives towards a day when no child smokes tobacco. Cancer Research UK is continuing to evaluate the impact of standardised packaging in the UK and will share the lessons with other countries who are considering introducing them.

Simon Clark, director of the smokers group Forest, said the idea that plain packaging would have an impact on the number of smokers in the UK was based on hope and anecdotal evidence.

Since plain packaging was introduced in Australia, smoking rates have fallen, but only in line with historical trends, he said. Its grasping at straws to credit plain packaging with the continued reduction in smoking rates, because the most significant anti-smoking measure in recent years in Australia has been a massive increase in tobacco taxation. Like graphic health warnings, the novelty of plain packaging quickly wears off.

Read more: https://www.theguardian.com/business/2017/apr/27/plain-cigarette-packaging-could-drive-300000-britons-to-quit-smoking