Pills vs. Time: The Power of Patience
Another interesting article about slowing down our rush-to-treatment healthcare mentality (see Pills & Perils below) appeared in Tuesday’s ‘Personal Journal’ section of The Wall Street Journal. This one is a lot simpler: do nothing, just wait. WSJ‘s Melinda Beck is writing less about serious afflictions than about the minor problems that plague us all; still it points once again to our cultural tendency to Do Something, whatever it is.
What cures colds, flu, sore throats, sore muscles, headaches, stomach aches, diarrhea, menstrual cramps, hangovers, back pain, jaw pain, tennis elbow, blisters, acne and colic, costs nothing, has no weird side effects and doesn’t require a prescription?
Plain old-fashioned time. But it’s often the hardest medicine for patients to take.
“Most people’s bodies and immune systems are wonderful in terms of handling things—if people can be patient,” says Ted Epperly, a family physician in Boise, Idaho, and president of the American Academy of Family Physicians.
“I have a mantra: You can do more for yourself than I can do for you,” says Raymond Scalettar, a Washington, D.C., rheumatologist and former chairman of the American Medical Association. But, he says, “some patients are very medicine-oriented, and when you tell them they aren’t good candidates for a drug they’ve heard about on TV, they don’t come back. I have colleagues who say, ‘You can take this pill and get better in two days, or do nothing and get over it in 48 hours,’ ” says Dr. Scalettar.
Of course, we know this. Most of us have some genetic strain of either the leave-it-alone-it’ll-be-better-in-the-morning or the shut-up-and-tough-it-out approach to all aches and pains. But we also have those constant messages from the TV set, and increasingly from the computer screen, that say one little pill will make it all better, right this very minute. And we are a right-this-very-minute society.
Almost all viral infections resolve on their own, unless you have a compromised immune system. As a rule of thumb, Dr. Epperly says, infections in the nose, throat, stomach and upper respiratory tract tend to be viral. Infections elsewhere in the body are likely to be caused by bacteria, and those can get worse without antibiotics. About 80% of urinary-tract infections resolve on their own, for example, but about 20% develop into more serious kidney or blood infections. And even if they don’t, the symptoms can be very uncomfortable.
Some chronic maladies follow predictable courses, according to many medical experts ,whether or not they are treated.
Colic is almost always gone in four months. Some 70% of acne is gone three to four years after it first appears. “Frozen shoulder”—a painful restriction of the shoulder joint—is typically painful for three to six months and stiff for the next four to six months, and resolves completely after one to three more months. Temporomandibular joint (TMJ) pain tends to go away by itself in 18 months. Sciatica resolves on its own in three weeks in 75% of cases.
Not many of us do pain and misery very well. As a repeat TMJ sufferer, I can promise you if I tried to wait it out without pain killers for 18 days, let alone months, my entire neighborhood block would evacuate. Pain (see Caitlin Kelly’s Broadside post a few hours ago) is in a category all its own. Actually, though it is hell to pay, sometimes it can serve a purpose. My good husband wound up in the emergency room with a gall bladder infection that would’ve had anyone else, surely including myself, shrieking in agony; he does not feel pain. That is great when you’re young and macho, not so good when you get a few years on you and could use a signal that something’s wrong.
But for the minor issues, things wrong can often right themselves without outside interference. Now… if I could only start over again with everything I should or shouldn’t have taken…
When Doing Nothing Is the Best Medicine – WSJ.com.
Drugs, Perils and Trust
Oh great. Now I’ve got to worry about lung cancer.
Recently released findings on hormone replacement therapy now show it nearly doubles the risk of dying of lung cancer for those women who followed this regimen. Already we’ve learned that HRT is linked to increases in breast cancer, heart disease, stroke and who knows what else. It’s giving me a headache.
Hormone replacement therapy was, some 30 or more years ago, generally accepted as being the be-all and end-all for postmenopausal women. No hot flashes! Limitless energy! Avoid cancer! Resist heart disease! Live long and prosper! That was more or less the message. My good physician, now long dead of drug-related causes himself but a wise and decent man he was, enlisted the aid of his nurse, who was also a friend of mine, to convince me to begin HRT. Addictable to anything that comes down the pike and resistant to drug-taking in general, I protested. But they and the general public belief that these drugs (estrogen and progestin) were the answer to every woman’s prayers, convinced me. I took them daily for years, then once weekly, when the formulae were perfected.
I quit in 2006 for the best of reasons: breast cancer.
I am absolutely certain my doctor wanted only the best for me. But I’m still somehow a little comforted now by the knowledge that Kaiser does not let drug company representatives meet with its physicians. Most of us trust our doctors. Some people whom they trusted convinced a lot of doctors, 30+ years ago, that HRT was a wonderfully promising regimen. Oh, doctors also read reports and journal articles, and listened to presentations, and early studies did indicate that HRT was a wonderful thing. I presume even the drug makers sincerely felt — hoped, at least — they were doing good. They had wives and mothers, after all. (Most people in those workplaces at the time were male, I suspect.) But maybe, just maybe, a few more studies would have been in order.
Now we’ve got studies. And a lot of interesting new information thanks to the Women’s Health Initiative. It was the first ever major effort to look at the most common causes of death, disability and poor quality of life in postmenopausal women. WHI was launched in 1991 and covered 161,808 generally healthy women; without yours truly they’d have only had 161,807. In the effort to help the WHI folks collect data on cardiovascular disease, cancer and osteoporosis, we made regular visits to designated clinics for 5 years, giving blood, getting weighed, filling out forms, answering questions. For another 10 years we filled out annual reports (and I think some participants did more; I was purely a control-group person because I didn’t want to alter my HRT regimen and knew I hadn’t enough will power to stick to some rigorous, data-producing diet.) A lot of us died along the way, thus the data. I remain a participant in a follow-up study that runs until 2010.
I await with interest the next release of findings. Some of the questions are along the lines of ‘On a scale of 1 to 10, how happy are you?’ so somebody’s watching for quality of life connections to things like exercise and marital status. And drugs. I know there are great things being done with drugs, but this profit margin business combined with what we keep finding out does give me pause. (I loved the survey question that asked whether, when I entered a room, I thought people were talking about me. There’s a story here.)
But whatever they’re finding out, it’s carefully done, covers a long period and a relatively huge bunch of women, and bless their hearts. Meanwhile, if you’re on HRT, you might want to talk to your doctor. What we didn’t know proved it could hurt us.
Some Women's Views of Health Reform
First Lady Michelle Obama is making the news in support of her husband’s health plan, hoping to tap into the energies of one group who voted for Obama in large numbers: women. Reform is everyone’s concern, but in many ways it occupies a specific gender niche. As reported by Voice of America’s Kent Klein,
Mrs. Obama says health care reform is a women’s issue. “Women play a unique and increasingly significant role in our families. We know the pain, because we are usually the ones dealing with it,” she said. The first lady spoke Friday to a gathering of women near the White House, and said the state of the U.S. health care system is unacceptable. “For two years on the campaign trail, this was what I heard from women: That they were being crushed, crushed by the current structure of our health care. Crushed,” she said.
A host of women’s groups, blogs, newsletters and web writers have also recently joined in. Posting in the National Women’s Law Center blog, Outreach Manager Thao Nguyen told the poignant story of hearing from a friend that she’d just married her long-time hesitant boyfriend. The marriage news was good news, but its terms took the joy out: having lost her job, it was the only way she could get health insurance.
Her point seemed so logical, but the entire idea was couched in such an insane reality I was simply speechless. Lucy is in her early 30s but she has a pre-existing condition so buying individual health insurance and the unfair, overpriced premiums that come with it was out of the question. Lucy has been living with Dan for 10 years, but unfortunately, he works for a company that doesn’t offer domestic partner benefits.
I couldn’t help but think: is this what our broken, unstable health care system means for millions of Americans around the country? As the economy continues to struggle, employers continue to shed jobs, and every day 14,000 more Americans wake up realizing that they are now uninsured and just one illness away from financial ruin. Are reluctant bachelors around the country going to put away their Megan Fox posters, cancel the “poker nights” (aka X-Box marathons we’re on to you), and start settling down?
My own run-in with healthcare weirdness is minor in comparison to most, but I still remember the shock. Making a routine call to renew the prescription for a bone-building drug I had taken for years to stave off osteoporosis, the message center person said she probably should warn me that rather than the $24 co-pay I’d been having per quarter my cost would now be $230. I do need these bones, but couldn’t see them worth $920 a year. I hung up and started drinking more milk. Had to get breast cancer, for which I now take a covered post- cancer drug which my oncologist prescribes… mainly to keep my bones healthy. Something is bizarre here.
Or maybe we women might bend the old macho adage a little: It’s broke, fix it.
Watching Idols and Icons Die
An article in yesterday’s New York Times chronicled the recent “funereal season” that has seen the passage of such players on the national stage as Walter Cronkite, Les Paul, Farrah Fawcett, Michael Jackson, Ted Kennedy and Patrick Swayze. Add to that the death this week of singer Mary (“Peter, Paul and Mary”) Travers. Although Times writer Sarah Kershaw noted that no more celebrities died this summer than in summers past, a couple of other elements are in play: the particular folks who departed the stage in recent months did so just as Baby Boomers are hitting retirement age, and they were the people who “defined (the Boomers) as a tribe, bequeathing through music, culture, news and politics as a kind of generational badge that has begun to fray.”
Generational badge-fraying is not necessarily a bad thing. As long as one wears the badge lightly on the pocket and occasionally notices which threads are coming loose, in fact, I maintain it is downright healthy. Contemplation of our terminal condition could do most of us a lot of good.
(Specifically, a few of those Boomers who have been putting off getting their advance directives done (OK, I see your eyes glazing over, but stick with me here) will start thinking about doing so. Or at the very least, have a little talk with their significant others about how long they’d like to be kept on life support if they have a stroke tomorrow. Getting this done today leaves tomorrow for enjoying everything else. Plus, it encourages calm; see below.)
Walter Cronkite wound up a long and happy life at 93. But Ted Kennedy was 77, one year older than yours truly. Farrah Fawcett was 62. Patrick Swayze, 57; Michael Jackson, 50. DJ AM Adam Goldstein was 36. The reality is that we’re all terminal; most of us terminate before we’re quite ready but it does happen. Acknowledging that fact can be ridiculously freeing.
The Boomers are reportedly worried not only about the finiteness of their lives, but also about their legacy. The Times article quoted a survey of 1,000 Americans age 44 to 79 conducted by AARP, which found that 55 percent believed they would leave the world worse off than they found it. That prospect can turn you gray in a hurry. But these near-retirees are not planning just to sit around getting gray.
Loss of their legends, according to Marc Freedman, author of “Prime Time: How Baby Boomers Will Revolutionize Retirement and Transform America, has created in this generation a sense of both the “expansion and compression of time,” and they are looking toward second careers doing good. “I think this is the first time so many have simultaneously had an awareness of death and the prospect of a whole new act,” Mr. Freedman says. Many of those new acts may turn the above expectation around, so the world might be left a little better off than they found it.
To which the post-Boomers say, Go Boomers.
Pelosi's Plea for Calm
However you feel about Nancy Pelosi’s performance as Speaker of the House so far, or however much you agree or disagree with her views, yesterday’s comment (as reported by San Francisco Chronicle Washington staffer Carolyn Lochhead) is worth both consideration and support.
For the first time anyone can remember, House Speaker Nancy Pelosi teared up at a news conference Thursday morning in response to a question about the current state of political discourse.
Visibly struggling to retain her composure, Pelosi recalled a time in San Francisco when emotions ran out of control, referring to the 1978 assassination of Mayor George Moscone and Supervisor Harvey Milk by former Supervisor Dan White.
“We are a free country, and this balance between freedom and safety is one that we have to carefully balance,” Pelosi began. She then became emotional as she recalled the events, startling the reporters gathered for the weekly news conference.
“I saw this, myself, in the late ’70s in San Francisco,” she said. “This kind of rhetoric was very frightening and it created a climate in which violence took place.”
I was not it San Francisco at the time, but those who were affirm that the intensity of anger, fear and hostility abroad in the community at large offered the ground out of which such an appalling act could grow. Many say the movie Milk accurately caught that mood, and watching the movie made my heart rate accelerate. I don’t think we need any more heart rate acceleration in the U.S. right now.
Regaining control, (Pelosi) expressed a wish that “we would all, again, curb our enthusiasm in some of the statements that are made” and “take responsibility” for what is said.
Those of us who have lived through other periods of polarization in this country — the McCarthy witch hunts, the Vietnam war, the battles for civil rights — retain vivid memories of too many brutalities, assassinations and cruelties. Pelosi is right about the need to retain a balance between freedom and safety. Unless we return to some semblance of civility in the public discourse we stand the chance of losing either, or both.
via Emotional Pelosi urges civility in discourse.
Couldn't Healthcare & Morality Be Age-Neutral?
Maybe the moral-issue debate (see below) lands squarely within the geriatric gap. If so, this makes me sad. And raises the question of whether those of us so well cared for by Medicare can find a way to wish the same for others. Not easy, when opponents of health reform are doing everything possible to ramp up the fear factor. If you’re old, and fearful, it’s hard to get beyond fear and into morality. An article by Adam Nagourney in Sunday’s New York Times asserts that Medicare recipients and about-to-be Medicare recipients are being pitted against the rest of the country in efforts to divide and defeat reform.
Certainly, the friction is driving the strategies of both sides in the health care battle. The Republican National Committee has financed a television and Internet advertising campaign directed at older Americans in places like Florida, asserting that what the Democrats propose is a threat to Medicare, would ration health care services and would involve the government in end-of-life decisions (the infamous but nonexistent “death panels”).
Democrats have responded by attacking Republicans for past efforts to cut Medicare. Mr. Obama devoted a long section in his speech to Congress on Wednesday night reassuring older voters about his plan. The retirees’ lobby AARP, which is working with the White House, last week sent letters to nine million members making the case for health care reform, officials there said.
David Axelrod, a senior adviser to Mr. Obama, said, “We’re certainly not going to let anyone pose as Little Red Riding Hood in reverse — let Republicans pose as friends of Medicare when they are not.” Still, Mr. Axelrod acknowledged the hurdle Mr. Obama faces as Republicans argue that his proposal to cut Medicare spending to help expand overall health coverage would result in cutting services to Medicare recipients.
“Older Americans all have coverage,” he said. “I’m not saying they don’t care about anybody else. But it’s a natural impulse to want to keep that. It doesn’t take great strategic insight to say, ‘Let’s go rattle older voters and make them oppose this.’ ”
It’s this rattling that seems not just distasteful but dishonest. As in the “death panels,” or the “they’re going to cut the heart out of Medicare.” But Nagourney goes on to concede that the geriatric generation is not, indeed, one amorphous voting bloc, and that concession is reinforced by a woman who knows a lot about us elders.
Meredith Minkler, a professor of health and social behavior at the University of California at Berkeley, contends that the whole notion of generational warfare has been exaggerated anyway: polling suggests that on issues other than health care reform, older Americans are no different from the rest of the country in how they divide on issues.
“This whole business of intergenerational conflict has been blown out of proportion,” Professor Minkler said.
I am with Meredith Minkler, who happens to be a friend of mine. But I hope that Boomers and seniors who have not been swayed by the frantic fear tactics will continue supporting health reform. Some may even see it as a moral issue. It is surely a political issue.
Democrats and Republicans have been focusing on elderly voters going back at least 50 years; this is a large and growing group that is clearly up for grabs. Indeed, it is something of a role reversal now for Republicans to be attacking Democrats on Medicare.
“The Democrats must be very concerned about this,” said Robert B. Hudson, the chairman of the Boston University School of Social Work. “What is just amazing is that Republicans, or a subset of Republicans, after 20 years of intergenerational warfare, can suddenly turn on a dime and present themselves as defenders of Medicare.”
Senator Robert Menendez of New Jersey, the head of the Democratic Senatorial Campaign Committee, said he did not believe that by next year Republicans would be able to make the attacks. “The very people who fought Medicare don’t have the credibility to demagogue on this issue,” he said.
Perhaps. But it will be a while until this generation gap can be measured. A year from now, the health care battle may be forgotten. The problem for the White House is that even if the geriatric gap turns out to be little more than a political blip, it is at this moment very powerful indeed — influencing greatly how Democrats who face re-election in tough districts approach what could be a very difficult vote next year.
Will consumerism rise again?
For some reason, maybe it’s the stock market, maybe it’s just wishful thinking-of-anything-but-wars-&-health-reform, consumerism is all over the news of late. Summer tourists didn’t tour as much or buy enough, clunkers were eagerly turned in for cars, caution abounds in the land. People are even beginning to save for the rainy days that have not yet cloudburst upon them.
A closer look at all this was taken through a couple of recent studies reported on by the San Francisco Chronicle’s Tom Abate this morning. Abate focuses on California, but the trends are all over.
California will trail the nation in emerging from the Great Recession, as consumers save more and spend less in a behavior shift that will slow growth and job creation in the short term but eventually lead to a stronger economy.
That message emerged from two separate reports released Tuesday by the UCLA Anderson Forecast and Beacon Economics, a consulting practice with offices in San Rafael.
Both forecasts characterized California as the epicenter of back-to-back consumption binges fueled by the dot-com boom and the housing bubble, and argued that now the state faces big adjustments as it recovers from ills that have long plagued the U.S. economy.
“Consumers have been on a spending binge ever since 1995,” said Jon Haveman with Beacon Economics, as soaring 401(k)s and, later, inflated home prices made Americans feel so wealthy they stopped saving money.
California, of course, rather outdid itself in the business of spending too much, buying too much and borrowing to do more of the same, but none of this was peculiar to the left coast.
It did not go unremarked, however, by one of the current candidates for Mayor of New York, Rev. Billy. You don’t know Rev. Billy of the Church of Stop Shopping? You’ve been missing something. The Rev, probably going on the ballot as Bill Talen, does not get the coverage that other candidates do, but he is dead serious about his mission and pretty raucous about delivering the message. He is seriously running for Mayor. He doesn’t like consumerism, or the corporate takeover of America, or war. At times his church becomes the Church of Stop the Bombing. In any event, if we’d been listening to Rev. Billy all these years we might have missed getting in quite so deep a mess — but we’d also have missed a lot of Starbucks lattes.
Now comes word that senior shopping at Walgreen, Rite-Aid and Family Dollar stores is going to be made more comfortable, just in time for Boomers to start turning 65 in 2011. According to a recent Wall Street Journal story by Ellen Byron, in one exercise designed to help participants in a Kimberly-Clark program understand the difficulties confronting senior shoppers, Kimberly-Clark executive Don Quigley tried going through the aisles with dark-tinted glasses, un-popped popcorn in his shoes and his thumbs taped to his palms. This rather hurts my senior-shopper feelings if it is how Rite-Aid sees me, but I will try to appreciate the effort.
It appears that we current savers/cautious spenders are not expected to change back to rampant consumerism overnight, which is good news to the senior seniors of us, brought up so rigorously in the save-first-spend-later mode that we feel better within it anyway.
Ed Leamer, director of the UCLA Anderson Forecast, said consumers usually roar back from recessions with spending that lifts production and fuels hiring, but he thinks that is unlikely during this recovery because Americans have been living beyond their means for too long – borrowing too much and importing more than the country sells abroad.”We need to turn our shopping malls into factories,” Leamer said “Our economy over the next decade is going to have to build more of the stuff we buy.”
Haveman said the painful adjustments now under way should eventually benefit California and the Bay Area, which lead in technology, biotechnology, clean energy and other cutting-edge industries.
“The light at the end of the tunnel is visible, but it’s still a long way off,” he said.
That business about turning shopping malls into factories and living within means — that’s going to please Rev. Billy.