The Washington Post - 03.03.2020

TUESDAy, MARCH 3 , 2020. THE WASHINGTON POST EZ EE e3

HealTH News

Exercise, like most things in
life, is good in moderation for
most people, but extremes can
hurt t he h eart, experts c aution in a
new scientific statement from the
American Heart A ssociation.
While promoting regular exer-
cise, the statement published in
Circulation warns against ex-
treme endurance sports and
against couch potatoes trying to
get fit too quickly.
“In many respects exercise is
like medicine,” said lead author
Barry A. Franklin, director of pre-
ventive cardiology and cardiac re-
habilitation at Beaumont Health
in Royal Oak, Mich. “Like medi-
cines, exercise comes with indica-
tions and contraindications. And
overdosing and under-dosing are
both possible.”
For most Americans, the issue
is under-dosing, Franklin s aid.
But there are also issues with
overdosing on exercise. Studies in
ultra-endurance athletes show ex-
treme exercise can result in scar-
ring of heart muscle, irregular
heart rhythms and buildup of cor-
onary c alcium, which can contrib-
ute to atherosclerosis, Franklin
said.
“More and more people are en-
gaging in extreme exercise be-
cause t hey think if some exercise i s
good, more is better,” he said.
“That is not necessarily t he c ase.”
But the biggest exercise risk,
Franklin said, “is with people who
have been inactive for years, such
as the p erson who may have been a
track athlete 40 years earlier and
wants to start up again, running
around the block,” Franklin said.
“A major take-home message is
that anybody middle a ged or older
should start with a walking pro-
gram and should not start with
running. But most can start a
walking program without a stress
test.”
Start slowly, in the range of two

to three miles per hour, Franklin

said. “Then y ou c an move u p to 3.5

to 4 mph and if you’re on a tread-

mill you can increase the grade,

provided you e xperience no symp-

toms,” h e said. “But, if you develop

pain or discomfort anywhere from

the belly on up, it could be (a sign

of angina) related to a blockage of

one o r more arteries.”

People starting to exercise

should consult their doctors if

th ey experience left arm, neck or

jaw pain, an unusual, extreme

shortness of breath, dizziness, or

heart palpitations. “These all sig-

nify that something is wrong,”

Franklin said, adding that most

people who suffer a heart attack or

cardiac arrest had symptoms in

the preceding weeks and ignored

them.

After reviewing more than 300

studies, Franklin’s team conclud-

ed that physically active people,

such as regular walkers, had a 5 0

percent lower risk of heart attack

and cardiac arrest. On the other

hand, they f ound, while the risk of

heart attack and cardiac arrest

was low overall among partici-

pants in marathons and triath-

lons, it rises o ver time.

The important message is that

regular exercise, that is, 30 min-

utes a day five days a week, is

beneficial, said Annapoorna Kini,

director o f the c ardiac c atheteriza-

tion lab at M ount S inai Hospital in

New York City, who wasn’t in-

volved i n the scientific statement.

Kini advises people who are

thinking about exercising to

choose something they’ll enjoy,

whether it’s biking, working out

on a treadmill, dancing or Zumba.

“It’s got to be something you look

forward to,” she said. “A nd you

have to put some effort into

weight training as you get older.

After age 40 you start losing mus-

cle m ass.”

— Reuters

Exercise is good for you, of course. But too

much may harm you, medical expert says

HealTH scaN

Drug overdoses were once spo-
ken about in whispers. Social s tig-
ma cast a dark shadow over them
because they were seen as the
natural, even deserved, conse-
quence of illicit drug u se.
So why are they spoken about
so openly today?
Science historian Nancy D.
Campbell has an answer: nalox-
one. The miraculous-seeming
drug, which reverses opioid over-
doses, was first approved in 1971.
In “OD: Naloxone and the Politics
of Overdose,” Campbell tracks
how it helped turn overdose from
an unmentionable affliction to an
experience that is now seen as
both common and p reventable.
In the days before overdose re-
versal, ODs were understudied
and barely reported. Drug users
faced harsh punishments. Heroin
and other opioid overdoses were
cast as a problem that mostly af-
fected people of color, even
though the majority of opioid us-
ers were white, Campbell says,
and “overdose deaths occurred at
or beyond the margins of respect-
ability.”
But armed with naloxone and a
vision of a world without overdos-
es, scientists, health-care workers
and community advocates began
to push for more data, treatment
and p revention.

Campbell’s deeply researched

book is driven by her desire to

understand why it t ook s o long for

naloxone, and overdose preven-

tion, to hit the mainstream. She

discovered a group of varied pro-

tagonists — d rug users, advocates,

scientists and others — w hose sto-

ries illustrate how naloxone, sci-

entific progress and advocacy

slowly shifted social attitudes.

Over time, naloxone helped

change society’s focus from pre-

venting drug use t o helping people

reduce its negative consequences.

This harm-reduction model has

empowered the people most af-

fected by opioids, Campbell

writes.

“When people learn that they

might have saved someone’s life if

they’d had naloxone, many be-

come r eady to take harm reduction

into their own hands,” s he writes

For Campbell, ODs are an “un-

natural disaster” that can be tack-

led only in the open. Her book

offers a riveting and complex look

into the history of the phenome-

non — a nd a sense of what a future

without ODs could l ook l ike.

— E rin Blakemore

subsTaNce abuse TreaTmeNT

How an anti-overdose medication helped

revolutionize America’s view of addiction

oD: Naloxone and the Politics of

overdose

By Nancy D. campbell

B

etween 2006 and 2019,

romaine lettuce and

other leafy greens, such

as spinach and bags of

spring mix, were in-

volved in at least 46 multistate E.

coli outbreaks, according to the

Centers for Disease Control and

Prevention. Most recently, out-

breaks linked to romaine lettuce

in 2018 and 2019 have left many

consumers worried about the

greens in their salad bowl. In a

2019 nationally representative

Consumer Reports survey of

1,003 Americans, 25 percent of

those who were aware of the 2018

outbreaks said they eat lettuce

less often now than before.

But some experts point out

that the overall chances of get-

ting sick from vegetables like

leafy greens are still low. “There’s

generally a high level of safety

around these food items, so we

don’t want consumers to view

these outbreaks a s a reason not to

eat fresh fruits and vegetables,”

says Matthew Wise, deputy chief

of the CDC outbreak response

and prevention branch. So don’t

give up salad. Instead, try these

tips from CR’s experts to improve

the safety of the greens you eat.

Consider buying whole head

lettuce. Even though the data

show that whole heads of lettuce

not labeled “washed” d on’t n eces-

sarily have lower bacteria levels

than packaged greens, their in-

ner leaves aren’t exposed to as

many sources of contamination

and are not handled as much as

greens that are bagged, which

further reduces the opportuni-

ties for contamination.

Keep packaged lettuce cold

and eat it soon. “As you would

with meat and poultry, don’t let

bagged lettuce stay out of the

fridge for too long, because bac-

teria multiply at room tempera-

ture,” says James E. Rogers, CR’s

director of food safety research

and testing. In addition, the lon-

ger lettuce sits in bags or contain-

ers, the more opportunity bacte-

ria have to grow, so buy packages

with expiration dates as far in the

future as possible and don’t buy

more than you can eat in a few

days. If even a few leaves look

damaged, slimy or bruised, don’t

eat any of the greens in that

package.

Consider buying hydroponic

or greenhouse-grown greens.

These are less likely to be con-

taminated by bacteria from ani-

mal droppings in soil or water,

although they’re not risk-free.

Their cleanliness depends on the

source of the water used and

whether proper food safety prac-

tices are followed by people who

handle the greens, Rogers says.

Soak your greens in vinegar.

Microbiologist Carl Custer, who

spent his career at the Agricul-

ture Department’s Food Safety

and Inspection Service, says re-

search shows that soaking greens

in vinegar or a vinegar-water

solution will reduce bacteria lev-

els but won’t kill all bacteria.

Still, he advises dousing your

greens with white vinegar and

letting them sit for 10 minutes,

then rinsing. Your greens may be

a little vinegary-tasting, but most

salad dressings contain vinegar

anyway. Salad rinses are often

designed to clean greens of dirt

or chemicals, not bacteria, and

are unlikely to kill harmful b acte-

ria.

Cook your greens until wilt-

ed. This will kill harmful bacte-

ria, but it’s a solution only for

sturdier greens, such as spinach,

kale, collards, and Swiss chard.

It’s especially important for peo-

ple who are more likely to be

seriously affected by food poison-

ing: the elderly, young children,

pregnant women and those with

compromised immune systems.

“These people may want to con-

sider not eating raw leafy greens

at all,” Rogers says.

Stay informed. The Food and

Drug Administration and the Ag-

riculture Department (which reg-

ulates meat, poultry, eggs and

some seafood) post outbreak in-

formation on Twitter; you can

follow them at @FDAfood and

@USDAFoodSafety. On both

agency websites, you can also

sign up for email alerts.

Report any suspected food

poisoning. If you think you got

sick from food, contact your local

health department and ask to

speak with the environmental

health specialist or sanitarian.

You can also contact the FDA or

USDA directly.

© copyright 2020, consumer Reports Inc.

From coNsumer rePorTs

Keeping salads free of E. coli, other ills

IStocK

You c an — and should — eat leafy greens, as long as you take a few precautions.

39,717

organ transplants

In what turned out to be a
record-setting year, 39, 717
organs — hearts and kidneys,
for instance — were
transplanted in 2019 in U.S.
residents. It was the seventh
consecutive year that the
number of organ transplants has increased, according to the United
Network for Organ Sharing (UNOS), the nonprofit organization that
has the federal contract to coordinate the country’s organ
procurement and transplant effort. Kidney transplants were the most
common, with 23,401 people getting a new kidney last year, followed
by transplants of the liver (8,896), heart (3,551) and lung (2,714). Most
donated organs came from 11,780 people who had died, a 38 percent
increase in deceased donors since 2014. Transplants from living
donors — 7,397 — also were at an all-time high. Still, not everyone who
needs a new organ gets one. UNOS reports that, on average, 17 people
die each day because the organ they need is unavailable. More than
112,000 people are on the waiting list for an organ transplant. For a
transplant to become reality, organ donors and transplant recipients
must be a close match, based on such factors as compatible blood and
tissue types. Depending on the specific organ, a similar body size
might be needed. The location of the donor and recipient, the severity
or medical urgency of the potential recipient, and the length of time
spent on the waiting list also may be considered. People who want to
be an organ donor can have that noted on their driver’s license, but
UNOS recommends that people also sign up on their state’s registry.
— Linda Searing

THe bIg Number

consumer Reports is an

independent, nonprofit organization

that works side by side with

consumers to create a fairer, safer,

and healthier world. cR does not

endorse products or services, and

does not accept advertising. cR has

no financial relationship with

advertisers in this publication. Read

more at ConsumerReports.org.

BY MICHAEL OLLOVE

The first years of life play an

outsize role in human health.

They are foundational to the de-

velopment of the brain and the

cardiovascular, immune and met-

abolic systems. Early childhood is

when medical interventions to

correct problems in any of those

areas a re most likely t o succeed.

So, f or many health e xperts, t he

most troubling aspect of a recent

increase in t he n umber of children

without health insurance is a

spike in the number of uninsured

kids under 6. That figure has

climbed above a million for the

first time s ince most of the Afford-

able Care A ct w as implemented in

2014, according to a recent analy-

sis of c ensus d ata by researchers at

Georgetown University’s Center

for C hildren and Families.

“Those years set up the trajecto-

ry for health into adulthood,” said

Olanrewaju Falusi, an assistant

director a t the C hildren’s N ational

Hospital in the District, and a

spokeswoman for the American

Academy of Pediatrics. “This is

very alarming to me, to say that

young children are becoming un-

insured at a higher rate.”

The academy r ecommends that

children visit the d octor at l east 14

times before they turn age 6. Dur-

ing those visits, they should re-

ceive speech, hearing and vision

tests, as well as screenings for

genetic disorders and the possible

effects of trauma or toxic expo-

sure.

The Centers f or Disease Control

and Prevention recommends that

children younger than 6 receive

numerous vaccinations, i ncluding

for hepatitis A and B, diphtheria,

whooping cough, polio, chicken-

pox, and measles, mumps, and

rubella.

Al Race, deputy director at the

Center on the Developing Child at

Harvard University, said a lack of

coverage often leads to a lack of

health care. Without it, health

problems that might have been

corrected can persist into adult-

hood.

“It’s never too late to address

problems,” R ace said, “but the ear-

lier you can catch them, the easier

it is and the better results you’ll

have to put t hings b ack o n track.”

The Georgetown researchers

found that the rate of children

younger than 6 without health

insurance climbed from 3.8 per-

cent in 2016 to 4.3 percent in 2 018.

Thirteen states had statistically

significant increases in either the

rate or number o f young kids with-

out insurance. Eleven states — Al-

abama, Florida, Georgia, Illinois,

Kentucky, M issouri, O hio, Te nnes-

see, Te xas, Washington and West

Virginia — had significant in-

creases i n both.

The report notes that children

are more likely to be uninsured in

states that did not expand Medic-

aid under Obamacare, which

would have extended eligibility to

all adults earning less than 138

percent of t he federal poverty l ine.

Studies show t hat parents in Med-

icaid are more l ikely t o enroll their

children in Medicaid or the Chil-

dren’s Health Insurance Program,

public health plans for families

with lower incomes.

Only Minnesota had a statisti-

cally significant decrease in the

number of uninsured young chil-

dren, the report said. Minnesota

expanded Medicaid in 2014, as

soon as t he ACA allowed.

The results dovetail w ith the ongo-

ing trend of children younger than 19

losing their health insurance. The

overall rate of children without cov-

erage increased from 4.7 percent in

2016 to 5.2 p ercent i n 2018.

A big factor in that rising rate

was a drop-off in children younger

than 19 enrolled in Medicaid and

CHIP. According to another

Georgetown analysis, in a 20-

month period from December

2017 to August 2019, the number

of children younger than 19 in

those two programs declined by

2.9 percent.

Children younger than 6 had a

higher uninsured rate in 2018

than children 6 to 18 in seven

states: Kentucky, N ebraska, N orth

Dakota, Ohio, Pennsylvania,

Rhode Island and Wyoming.

The steepest increases in the

rate of young children without

health insurance between 2 016

and 2 018 occurred in M issouri ( up

1.7 percentage points), West Vir-

ginia (1.5), Ohio and Tennessee

(1.4), and Kentucky (1.3).

West Virginia had the largest

percentage increase in the num-

ber of young children without

health insurance (70 percent), fol-

lowed by Alabama and Kentucky

(51 percent) and Te nnessee and

Missouri (46 percent). Of those,

Kentucky and West Virginia ex-

panded Medicaid.

Te xas, another non-expansion

state, had by far the highest num-

ber o f uninsured children younger

than 6, about 198,000, and the

second-highest rate of uninsured

kids of that age (8.3 percent), be-

hind Alaska (9.2 p ercent).

Adriana Kohler, policy director

of the advocacy group Te xans Care

for Children, laid much of the

blame in Te xas on unreasonable

paperwork and deadlines for par-

ents to provide income verifica-

tion to keep their children en-

rolled in public health p lans. “It’s a

very messy, chaotic system in

Medicaid,” s he said.

Kohler blamed the Trump ad-

ministration’s a ttacks o n Obamac-

are, such as spending less money

to help educate consumers and

enroll them in health insurance,

for a decline in coverage among

both children and adults.

She also s aid that an i ncreasing-

ly anti-immigrant climate has

made many immigrants afraid to

sign up their children for public

programs such as Medicaid and

CHIP, and that Te xas has cut pro-

grams intended to help people

enroll in h ealth insurance.

The Te xas Health and Human

Services Commission, which runs

Medicaid and CHIP in the state,

did not respond to specific ques-

tions from Stateline about the un-

insurance rate among young chil-

dren. It emailed a statement say-

ing, “HHS team members work

hard every day to enroll and pro-

vide quality health care benefits

for Texas children who qualify for

the programs we administer in

Medicaid and the Children’s

Health Insurance Program.”

Kohler said, however, that the

Te xas lieutenant governor and

speaker of the House this fall di-

rected state lawmakers to exam-

ine ways to increase the overall

health insurance rate in the Lone

Star State.

Jessica Ice, executive director o f

West Virginians for Affordable

Health Care, said that in her state,

drug addiction i s a major factor i n

the h igher rate of children w ithout

insurance.

Households where family

members are struggling with ad-

diction o ften are i n turmoil, and in

some cases children must be

placed in foster care. In such cha-

os, Ice said, parents may not take

the necessary steps to get their

kids covered.

Maureen Corcoran, director of

Ohio’s M edicaid program, said her

state was particularly concerned

about being one of the few Medic-

aid expansion states where the

uninsured rate among younger

children was higher than among

older k ids.

Corcoran said Ohio is studying

why children lose Medicaid and

CHIP coverage, and trying to im-

prove how county offices enroll

and r e-enroll families.

“We know many of those chil-

dren are eligible,” she said, “so we

want to find out and work with

counties to do whatever addition-

al outreach or system changes”

can get more kids covered.

— Stateline

Stateline is an initiative of the Pew

charitable tr usts.

Health coverage vanishing for youngest children

IStocK

“This is very alarming

to me, to say that

young children are

becoming uninsured at

a higher rate.”

olanrewaju Falusi of children’s

National Hospital

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