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

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

Eating cheese does not raise risk of heart attack or stroke, study finds

Consumption of even full-fat dairy products does not increase risk, international team of experts says

Consuming cheese, milk and yoghurt even full-fat versions does not increase the risk of a heart attack or stroke, according to research that challenges the widely held belief that dairy products can damage health.

The findings, from an international team of experts, contradict the view that dairy products can be harmful because of their high saturated fat content. The experts dismiss that fear as a misconception [and] mistaken belief.

The results come from a new meta-analysis of 29 previous studies of whether dairy products increase the risk of death from any cause and from either serious heart problems or cardiovascular disease. The study concluded that such foodstuffs did not raise the risk of any of those events and had a neutral impact on human health.

This meta-analysis showed there were no associations between total dairy, high- and low-fat dairy, milk and the health outcomes including all-cause mortality, coronary heart disease or cardiovascular disease, says the report, published in the European Journal of Epidemiology.

Ian Givens, a professor of food chain nutrition at Reading University, who was one of the researchers, said: Theres quite a widespread but mistaken belief among the public that dairy products in general can be bad for you, but thats a misconception. While it is a widely held belief, our research shows that thats wrong.

Theres been a lot of publicity over the last five to 10 years about how saturated fats increase the risk of cardiovascular disease and a belief has grown up that they must increase the risk, but they dont.

However, the governments health advisers urged consumers to continue to exercise caution about eating too many products high in saturated fat and to stick to low-fat versions instead.

Dairy products form an important part of a healthy balanced diet; however, many are high in saturated fat and salt. Were all consuming too much of both, increasing our risk of heart disease, said a spokesman for Public Health England. We recommend choosing lower-fat varieties of milk and dairy products or eating smaller amounts to reduce saturated fat and salt in the diet.

Givens and colleagues from Reading, Copenhagen University in Denmark and Wageningen University in the Netherlands analysed 29 studies involving 938,465 participants from around the world undertaken over the last 35 years, including five done in the UK.

No associations were found for total (high-fat/low-fat) dairy and milk with the health outcomes of mortality, CHD or CVD, they said. In fact, they added, fermented dairy products may potentially slightly lower the risk of having a heart attack or stroke.

Doctors, public health experts and official healthy eating guidelines have for many years identified saturated fats as potentially harmful for heart and cardiovascular health and advised consumers to minimise their intake.

That has led to consumers increasingly buying lower-fat versions of dairy products. For example, 85% of all milk sold in the UK is now semi-skimmed or skimmed.

Givens said consumers were shunning full-fat versions of cheese, milk or yoghurt in the mistaken view that they could harm their health. Young people, especially young women, were now often drinking too little milk as a result of that concern, which could damage the development of their bones and lead to conditions in later life including osteoporosis, or brittle bones, he said. Consuming too little milk can deprive young people of calcium.

Pregnant women who drank too little milk could be increasing the risk of their child having neuro-developmental difficulties, which could affect their cognitive abilities and stunt their growth, Givens added.

The most recent National Diet and Nutrition Survey, the governments occasional snapshot of eating habits, found that dairy products, including butter, accounted for the highest proportion of saturated fat consumption in British diets 27%, compared with meats 24%. But if butter was not counted then dairy products together were the second largest source of saturated fat, at 22%.

Saturated fat is a vital part of diet. The NDNS found that adults typically got 34.6% of their total energy from fats as a whole, just below the 35% the government recommends. However, while total fat consumption was just within target, saturated fats still made up an unhealthily large proportion of total food energy 12.6%, against the recommended maximum of 11%.

Givens said: Our meta-analysis included an unusually large number of participants. We are confident that our results are robust and accurate.

The research was part-funded by the three pro-dairy groups Global Dairy Platform, Dairy Research Institute and Dairy Australia but they had no influence over it, the paper said. Givens is an adviser to the Food Standards Agency.

Read more: https://www.theguardian.com/society/2017/may/08/consuming-dairy-does-not-raise-risk-of-heart-attack-or-stroke-study

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

What Im really thinking: the dental hygienist

The worst thing is the disrespect some people show by not cleaning their teeth or by eating just before seeing me

You may think youre coming in just for a clean but its my job to check your oral cavity for lesions, your teeth for caries and your gums for periodontal disease, and to provide advice to get you to full oral health. Many a joke is made about relaxing in the chair. I call it the comfy chair; it breaks the tension. I know its not the most pleasant experience, so I try to alleviate the worry by explaining the emotions people feel as they lie back. After all, I am exposing your vulnerable, soft places your belly and chest and instinct prompts the nervous patient to cross their arms. Then, as I start the treatment, I am right there in your personal space, wearing a mask and glasses another uncomfortable feeling for you.

I like my job and people mostly leave feeling better, wiser and yes cleaner. I dont mind how bad your teeth are, its bloody satisfying getting a load of tartar off, leaving smooth enamel to rub your tongue around instead of rough rock. But I have feelings too; I cant help looking at your blackheads and up your nose at your nasal hair (or worse). You cant blame me: I have excellent lighting.

I find it rather creepy when your tongue follows my instruments and irritating when it nudges them out of the way, and when you look me in the eye as I move into your vision. And why, all of a sudden, cant you swallow your own saliva? But the worst thing is the disrespect some people show by not cleaning their teeth or by eating just before seeing me. Id never say it, but I so want to ask: Would you leave another bodily cavity in the same condition if you were visiting your gynaecologist for a smear test or a urologist for a prostate exam? I dont think so.

Tell us what youre really thinking email mind@theguardian.com

Read more: https://www.theguardian.com/lifeandstyle/2016/sep/17/what-really-thinking-dental-hygienist

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