United Health Care

Acne is a diabolically cruel thing: somehow it strikes your most visible feature just at the age when you become most vulnerable to a gaze. Not surprisingly, acne is often accompanied by serious depression among teenagers. In fact, a 1999 study found that kids with acne bad enough to prompt a trip to the dermatologist reported having emotional and social problems as severe as those reported by patients with disabling diabetes and epilepsy.

Other studies have shown similar, if less extreme, reactions to bad cases of acne. And so an international team of researchers — including scientists from Harvard Medical School in Boston and University Medical College in Tibet — decided the acne-depression question needed further investigation. The team's intriguing new paper, published this week in the open-access journal BMC Public Health, not only confirms that acne goes hand in hand with depression and anxiety but further suggests that teens' mental distress may in fact be worsening the condition of their skin.

Led by Jon Halvorsen, a dermatologist at the University of Oslo in Norway, the researchers launched their study in 2004, inviting every 18- and 19-year-old who was finishing high school in Oslo to answer some questions about zits and other things. Of the 3,659 students invited, 90% participated, along with 467 other 18- and 19-year-olds who were not graduating. The teenagers completed questionnaires about the severity of their acne as well as how much anxiety and depression they were experiencing, what they usually ate and whether they smoked and drank. Separately, the researchers collected socioeconomic data on the teens from the country's central information-gathering agency, Statistics Norway.

The results show that the level of mental distress kids reported was strongly associated with how much acne they said they had, independent of other factors like diet or lifestyle. Roughly 19% of all kids who reported symptoms of anxiety and depression said they had acne, compared to only 12% of those who reported no mental distress. Among boys, those with depression and anxiety were 68% more likely to report acne than their happier peers; among girls, those with mental distress were twice as likely as those without to report acne.

The study found, for the first time, a linear relationship between mood and pimples: the worse the mental-illness symptoms, the worse the acne. It's possible that the association simply means that kids who feel depressed are more likely to report they have bad acne, even if they don't — but previous studies have shown that dermatologists independently agree with teens' self-reports of acne severity about 75% of the time. Some of the depressed and anxious kids in the Norwegian study may have exaggerated their acne, but in a sample as large as this one, it's unlikely that most did.

So how could mental-health problems actually exacerbate acne? One theory is that people with mental distress eat more junk food. Dearly held teen lore says that overindulging in chocolate and potato chips — which can make greasy fingers and, consequently, greasy faces — spawns pimples. This is mostly myth, according to the study's findings, although they offered a bit of support for the notion that diet plays a role. Girls in the study who consumed few vegetables tended to have more zits than girls who ate lots of greens. But diet was entirely irrelevant for boys.

The authors also discount other lifestyle factors. The Norwegian adolescents who said they regularly use alcohol and cigarettes were no more likely to report acne than those who were abstemious. Only mental distress was strongly correlated with acne in both boys and girls.

But that still doesn't answer the question of what mechanism might be at work. The authors offer a few hypotheses. For instance, stress may somehow stimulate the growth of nerve fibers near sebaceous glands, which in turn contributes to the increased production of sebum — the fatty substance that combines with cell debris and dead skin cells to form those familiar blackheads and pustules. (All together now: Eww.) That theory is unproved, but previous research on the effects of depression and acne drugs suggests the authors may be onto something: we know, for example, that antidepressants can improve acne. We also know that a widely used drug that treats acne, Accutane (isotretinoin), has been associated with an increase in depression, although no causal link has been established.

The new study has some obvious shortcomings, particularly that it relies entirely on self-reports from a self-selected group of respondents. Much more rigorous research needs to be conducted to understand the relationship between mental illness and pimples — as well as the root cause of bad cases of acne. But in the meantime, drug companies might want to start working on a Clearasil-Prozac miracle cream.

If you are the type of person who keeps one eye open while washing your face (the better to catch ghostly reflections in the mirror, of course), here's another horrifying bathroom scenario you might not want to hear: every time you turn on your shower, you are sprayed with a heavy mist of millions of bacteria, which get inhaled deep into your lungs.

One such microbe called Mycobacterium avium is similar to the bug that causes tuberculosis (TB) and causes lung infection. It is also found commonly in showers in New York and Colorado, according to a new study led by University of Colorado microbiologist Norman Pace, who studies bacteria found in homes, schools, public buildings and other human environments.

In this latest study, published in the Proceedings of the National Academy of Sciences, Pace dispersed a team of undergraduate students into 45 bathrooms mostly in New York City and Denver to swab and test the inside of showerheads; bacteria tend to accumulate in dense communities there, forming thin, gooey "biofilms." When you run the shower, germs are ejected out of the showerhead in the spray. Inhale the fine water droplets and M. avium gets a direct passage to your lungs where it proceeds to wreak havoc if your immune system isn't strong enough.

So, does this mean you should turn off the shower and go back to old-fashioned baths? Not exactly. "If you are an otherwise healthy person, there is no cause for alarm," says Dr. Lynn Connolly, a practicing clinician and assistant professor at the University of California, San Francisco, who has treated patients with M. avium infection. Connolly is quick to add that if you have AIDS, chronic lung disease, cystic fibrosis or an immune system disorder, then there is some cause for concern. In such patients, the bacteria can cause lung diseases, and in some extreme cases infections in other parts of the body as well.

Overall, M. avium-related disease is rare. The illness causes occasional fevers, a persistent cough and a general feeling of exhaustion that can last for months. Researchers estimate that two in every 100,000 Americans become sick from M. avium. That's about as many people in the U.S. with TB, but unlike TB, M. avium-related disease doesn't spread from person to person.

It's a good thing the bug doesn't do much harm to the average human, since it's everywhere — in the air we breathe, the water we drink, even in soil outside our homes. If you receive municipal water, then you're getting about 10 million of these and other microbes per liter of tap water, says Pace. And while it's possible that some people's disease may be specifically related to the bacteria that comes from the shower, the only way to know for sure is to genetically match the pathogen in infected patients with the bugs in their showers. A few such studies have been done in the past, but each time with a tiny sample of one or two patients.

For now, to avoid a face full of bacteria each morning (Pace's team identified more than a dozen microbes other than M. avium in the showers they tested), let the shower run for a while before getting in. And remember to keep one eye open for zombies.

If, after watching months of hysterical TV coverage of H1N1, or swine flu, you think you already know everything you need to know, you are probably wrong. Pandemic influenza is notoriously complex — and it changes all the time. The best defense is wisdom. But because of the way our brains are wired, we tend to overestimate how well we understand the risks. Check your own IQ (influenza quotient) with our nifty Pandemic Pop Quiz.

Americans famously overspent during the 1990s and early '00s. It's a familiar story: we mortgaged oversized homes to buy colossal TVs. But you may have heard less about another commodity we binged on: justice. Americans indulged in an enormous criminal-justice spending spree during the past 25 years, locking up more and more offenders (particularly for drug-related crimes) for longer and longer sentences. Total spending on incarceration rose from $39 per U.S. resident in 1982 to $210 per resident in 2006, according to the most recent figures from the Justice Department. We now spend $62 billion a year on corrections, and about 500 of every 100,000 Americans are behind bars. As recently as the 1970s, the figure was only 100 in 100,000.

Owing to budget crises, many states are now having trouble affording to keep so many people locked up. Some states are cutting incarceration expenses by consolidating prisons; some are trying to slash prison-food and health-care costs. But real savings come only when you reduce prison populations, and so some states — including California, Colorado and Kentucky — have begun releasing inmates early. "The pressure in state legislatures all over the country is to bring down the populations, because we just can't afford the level of punishment that we've had the last 20 years," says Joan Petersilia, a criminologist at Stanford Law School. (Read "Experts: Street Crime Too Often Blamed on Gangs.")

Early-release programs can save states huge sums — $45 million a year in Colorado, for instance — but at what cost? One worry is that crime will rise if inmates are let go before completing their sentences. Republican Scott Suder, a Wisconsin assemblyman, crystallized a deeper concern, a moral one, when he told the Wisconsin State Journal in June that early release amounts to "rewarding bad behavior."

Criminologists say little research has been conducted to determine whether early-release initiatives lead to higher crime rates, although some prisoners who get out will undoubtedly commit crimes that they wouldn't have been able to commit if they were still behind bars. "There's no risk-free early-release program," says Jeremy Travis, president of John Jay College of Criminal Justice in New York City. But early release doesn't simply mean opening the gates and letting inmates run for it. No state is freeing sex offenders, murderers or habitually violent criminals. Most inmates who are eligible for early release are those who were caught with relatively small amounts of drugs. And generally, early-release guidelines require that inmates be within six months of their official exit date.

It's possible that in some cases, particularly with first-time, nonviolent offenders, early-release initiatives could actually help reduce crime. "There are two effects of incarceration," says criminologist Alfred Blumstein of Carnegie Mellon University in Pittsburgh, Pa. "One is specific deterrence — you go to prison, and you say, 'Holy s___, I don't want to go through that again.' That is the crime-reducing component of prison. But the other effect of incarceration is criminalization. You have connection with gangs. You have diminished opportunities after you get out — and therefore you have some higher chance of returning to crime. Lots of researchers have tried to sort out the strength of these two effects, without much success. With early release, then, the question becomes, Does it make them more criminal because they think, 'I got away with it,' or less criminal because they think, 'The system has been really nice to me'? No one knows the answer."

States can mitigate the risk of recidivism by providing inmates with job skills, drug treatment and other services they will need to reintegrate into the community. "Most recidivism occurs within the first three years," Blumstein says. "There need to be a lot of efforts targeted at people just coming out."

Some states, like Colorado, are launching new efforts to help the recently released find housing and secure other social services. California has allocated some $42 million for an entire re-entry facility — a former prison for women — where inmates within a year of release will get training and, if needed, substance-abuse counseling. But other states may be flirting with disaster by cutting re-entry programs even as they let some inmates go early. The state of Washington was having trouble releasing some of its inmates early because they had no place to live. Now the state is helping roughly 700 offenders pay up to $500 per month in rent. At the same time, however, the state has cut funding for more substantive transitional services. (Read "A Brief History of Prison Riots.")

The politics of early release are delicate. The prison boom of the past 25 years benefited a great many politicians who could claim to be tough on crime. One can easily imagine the political ads that will air in the next cycle in attempts to defeat elected officials who vote not only to set prisoners free but also to spend more on social services for them.

That's why some states are opting not to open the cells of current inmates. Instead, they're making it harder for those who are already out on parole to return to prison. Parolees who commit minor infractions — missing a meeting with a parole officer, for instance — account for an astonishing proportion of incarceration costs. "Every year," Stanford's Petersilia told the Los Angeles Times recently, "[the state of California] sends some 70,000 parolees back to prison, about 30,000 from L.A. County alone. Most serve two to three months. Everybody knows this revolving door does not protect the public ... These are the lower-level people who may have been in drug treatment [on the outside], may have found a job. When you send them back to prison, you break those connections."

In short, sometimes being tougher on crime requires a softer approach like early release. But try explaining that in a 30-sec. ad in the next election cycle.

Environmentalists were ecstatic when the House of Representatives passed the carbon cap-and-trade bill, led by Democratic Representatives Henry Waxman and Edward Markey, in June. Certainly, the legislation to limit national greenhouse-gas emissions could have been stronger, but the very possibility that the House would pass any such bill would have been unimaginable a year ago. And the timing was perfect. With do-or-die climate negotiations set for the U.N.'s global-warming summit in Copenhagen at the end of the year, the U.S. needed to show the world that it was ready to act on carbon emissions. All that was left was passage by the Senate. (See pictures of the effects of global warming.)

But that's the problem. Despite hopes — and promises by the Democratic leadership — that the Senate would tackle cap-and-trade legislation this fall, it's looking increasingly as if the U.S. will go to Copenhagen with no national carbon caps in place. Senate majority leader Harry Reid told reporters on Sept. 15 that the Senate might have to wait to act on cap and trade until after tackling health care and banking reform. "We still have next year to complete things if we have to," he said.

Reid's spokesperson backed off those comments the next day, indicating that the schedule hadn't yet been set, but with the health-care debate threatening to stretch from now until the end of the world, it's becoming increasingly difficult to see how cap and trade could be finalized before the Copenhagen summit begins in December. And given how controversial cap and trade remains even among many Democrats in the Senate — Republicans remain almost unanimously opposed — action in the election year of 2010 might be even tougher. (Watch a TIME Climate Central video.)

The more immediate concern will be the negotiations in Copenhagen. Since Reid's comments, environmental groups have been getting calls from foreign embassies suddenly unsure of where the U.S. stands on a global deal. What they want to avoid is a replay of the negotiations over the Kyoto Protocol back in 1997 — the U.S., led by then Vice President Al Gore, agreed to long-term carbon-emission reductions, only to be repudiated later 95-0 by the U.S. Senate.

Even though President Barack Obama has taken almost a 180° turn from former President George W. Bush on climate change, Obama's negotiators will be hamstrung if Congress can't deliver emissions cuts in time. The White House can point to unilateral steps it has taken — like the Sept. 15 move to place the first-ever national limits on greenhouse-gas emissions from automobiles — but that might not be enough. "U.S. negotiators have made it pretty clear they won't get ahead of the stated will of Congress," says Jonathan Lash, the president of the World Resources Institute. "Without action from the U.S., it's hard to imagine a comprehensive agreement in Copenhagen."

As it stands, the chances of a new global deal being achieved in Copenhagen — one that would succeed the expiring Kyoto Protocol and include both the U.S. and major developing nations like China — are already looking dim. There are still major differences between the developed and developing nations over how the responsibility for cutting carbon should be divided — and how much the rich world should devote to poor countries that will need to adapt to climate change. "It's going to be a very difficult situation at Copenhagen," says Annie Petsonk, the international counsel for the Environmental Defense Fund.

U.N. Secretary-General Ban Ki-moon will try to get the negotiation process jump-started next week in New York City, when he hosts a daylong session dedicated to climate change with heads of state. But Washington — and, ultimately, President Obama — still holds the key. As he told delegates at a California climate summit last November, when he was still President-elect: "Now is the time to confront this challenge once and for all. Delay is no longer an option. Denial is no longer an acceptable response. The stakes are too high."

See the top 10 green ideas of 2008.

See pictures of the world's most polluted places.

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