Health care reform: comatose but breathing

Virginia Governor McDonnell, who proclaimed in his rebuttal to President Obama’s State of the Union address that we have “the best medical system in the world” has my qualified agreement on one point. My personal medical system is the best in the world. As a member of Kaiser Permanente, I consider my physicians among the best in the world and my care right up there. I can e-mail any of my physicians with any question; most of them reply in 24 hours or less. I can schedule appointments with specialists with ease; usually I see anyone I want within a few weeks. Medicare helps me pay for all this.

Problem is, not everyone in America enjoys such care at such cost. Millions of my fellow Americans – who might not agree with Governor McDonnell – would be happy for any kind of medical care at any remotely affordable cost. Millions of Americans are suffering and dying for lack of care. Maybe, to correct this, I’ll have to settle for just moderately excellent care rather than the best. So be it. Maybe my costs would go up. So be it. It is morally wrong for people in this country to be without health care.

(In a recent comment on this page written very late at night I attributed Governor McDonnell’s interesting phrase to former Virginia Governor Tim Kaine. Even before my astute True/Slant editors had caught the gaffe an astute reader had brought my attention to it. After I thanked him, Astute Reader replied, “Virginia might be better off if you did give it back to Tim Kaine.” We’ll see.)

But back to health care. Although it has faded slightly into the background, word is that House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid are still hoping to salvage the sprawling bill. It could be done, if the Senate bill’s sprawl. As Noam Levey reported in Sunday’s Los Angeles Times,

(I)n the coming weeks, Pelosi and Reid hope to rally House Democrats behind the healthcare bill passed by the Senate while simultaneously trying persuade Senate Democrats to approve a series of changes to the legislation using budget procedures that bar filibusters.

At the same time, leading consumer groups, doctors and labor unions that have backed the healthcare legislative effort for more than a year are stepping up attempts to stiffen lawmakers’ resolve.

These included scaling back the Cadillac tax, boosting aid to help low- and moderate-income Americans buy insurance, closing the “doughnut hole” in the Medicare prescription drug plan, and giving all states the assistance that Nebraska secured to expand Medicaid.

But many House Democrats do not want to vote on the Senate bill until the Senate passes the fixes they want. And it is unclear whether the Senate could approve a package of changes to its bill before the House approves the underlying legislation, according to senior Democratic aides. Democratic leaders hope to agree on a procedural path forward by the end of this week.

Despite the hurdles, there is a growing consensus that a modified Senate bill may offer the best hope for enacting a healthcare overhaul.

“The more they think about it, the more they can appreciate that it may be a viable . . . vehicle for getting healthcare reform done,” said Rep. Gerald E. Connolly (D-Va.), president of the Democratic freshman class in the House.

Sen. Tom Harkin (D-Iowa), who chairs the Senate health committee, noted that even before the Massachusetts election, senior Democrats had substantially agreed on a series of compromises that addressed differences between the House and Senate healthcare bills.

This space still hopes that “the best medical system in the world” can be made available to a few of the millions in America who still so desperately need it.

A sucker born every minute: the link between casinos & the Supreme Court

Getting something for nothing is tough these days. But that, obviously, doesn’t stop millions of Americans from throwing money away trying, every day. And there’s a lot of money to be made off of those suckers. Witness the current hoopla between two bands of Pomo Indians, the Manchester-Point Arena Band v the Guidiville Band, over the latter’s push to develop a new “gaming” facility in the San Francisco Bay Area. Gaming is the new gambling, gambling having gotten a bad name for some reason, but certainly not the obvious reason that millions of people throw their money away on it and some of them suffer a lot thereafter.

If you don’t want to throw your money away on the slots, however, an anonymous gentleman (Joe Prosflow?) in Daly City, CA, invites you to toss it his way. (I Googled it, but you don’t want to go there; it’s pretty much defunct.) In a bright-yellow-background 2-column ad in today’s San Francisco Chronicle, a 76-year-old male who avows “I believe I have discovered a solution which has eliminated all of my symptoms” — i.e. waking up 3 or 4 times a night for bathroom calls — says he will send you “specific information” for $20 check or money order. Plus a self-addressed stamped envelope. Even though there are those near and dear to me who are known to arise multiple times during the night, I am resisting the temptation to respond to Mr. Prosflow.

But back to the slots. In a former life I had reason to attend occasional conventions in Las Vegas, which required walking through airports and hotel lobbies ad infinitum, all filled largely with little old ladies holding containers of coins and relentlessly feeding them into machines. Being now a little old lady myself, the remembrance of that sight makes me even sadder than ever. This is fun and games? I do not recall seeing anyone smiling. (Forgive me, Las Vegas, I’m sure you have good, smiling citizens there somewhere.)

But casinos cry at the top of their neon lungs about what a fun time you’ll have there! Glamour! Excitement! Not to mention all that money you’ll win! Just as lotteries tout the last gazillion dollar winner. Win big! Jackpot now over a gazillion! Hello? Have you met many gazillion dollar winners?

What brings this to mind, in addition to the interesting just-send-your-money ad, is the fact that casinos and lotteries and other nifty ways to abuse the poor — who are a large percentage of lottery ticket buyers if a smaller percentage of casino-goers — all get your votes. Because they advertise how their profits will make schools better (have you noticed schools getting better on casino taxes?) Or other wonderful benefits they will bring to the ‘hood. They somehow neglect to mention the increased costs they will bring in human miseries and public services required.

They get your votes, or your legislators’ votes, because they have a gazillion dollars to spend in order to get them.

Exactly as multinational corporations will now have a gazillion dollars to dominate every election in the country, large or small, thanks to the Supreme Court ruling that they can spend all the gazillions they want. Leaving us one-person-one-vote suckers still free to send our money to Daly City. But otherwise with not much of a voice.

When memory fades, is it all over?

Most of us know the feeling — a mom, a friend, a neighbor who’d seemed just a little spacey for the last few months has taken up residence in a “memory unit.” And some of us (OK, I’m older than you are, so you can relax now) stuff that sorrowful feeling down inside, right next to the fear that arose over where in the world I put the car keys.

Maybe we should all relax. Because anxieties can make you forget even more, and research shows that  “buying into the stereotype that memory function automatically dwindles with age could become a self-fulfilling prophecy,” according to reports just published on a new favorite health/science website of mine, RealAge.com.

At least that’s what happened in one study. When older adults (ages 60 to 70 years) were given cues that people their age tend to suffer from memory loss, they actually performed more poorly on memory tests than a control group not exposed to such cues. Likewise, older adults who felt looked down upon — or stigmatized — due to age also fared poorly on memory tests. Bottom line: Anxious thoughts about negative stereotypes may disrupt your working memory. So think positive!

The site is a new favorite partly because it has a “Find your real age” thing which determined that I am younger than 76.5 and why should one argue. RealAge does concede that positive thinking will not guarantee memory retention, but then plunges right ahead with other suggestions. Such as staying in touch with family and friends:

In a study of 16,638 older adults, people who were married, active in volunteer groups, and in regular contact with friends, family, and neighbors had slower declines in memory than their less social counterparts. In fact, declines in the most socially active types were about half of those in the least social group.

Or eating the right stuff: fish, nuts, real chocolate!; or walking a lot; or, and here’s the winner, taking power naps:

People who take daytime naps outperform non-nappers on memory exercises. And, surprisingly, a mere 6 minutes of shut-eye is enough to refresh the mind. How does a quick catnap power up your thinker? Seems the mere act of falling asleep triggers a brain-boosting neurobiological process that remains effective regardless of how long you snooze.

What’s not to love about a resource that advises hanging out with friends, eating almonds and chocolate and taking power naps? Now, if there were just something in there about where I put the keys…

Expect to Keep Your Memory – Health Tip – realage.com.

Walking while cellphoning can be hazardous to your health

Having raged and ranted about phoning/texting drivers and pedestrian-oblivious bikers, this space would now like to come to the defense of cellphoning walkers. Not, you understand, multi-tasking/app-studying cellphoning walkers, but talking walkers. Noting the attention that has recently focused on the hazards of distracted drivers, New York Times writer Matt Richtel reports on the new hazard:

But there is another growing problem caused by lower-stakes multitasking — distracted walking — which combines a pedestrian, an electronic device and an unseen crack in the sidewalk, the pole of a stop sign, a toy left on the living room floor or a parked (or sometimes moving) car.

The era of the mobile gadget is making mobility that much more perilous, particularly on crowded streets and in downtown areas where multiple multitaskers veer and swerve and walk to the beat of their own devices.

Most times, the mishaps for a distracted walker are minor, like the lightly dinged head and broken fingernail, a jammed digit or a sprained ankle, and, the befallen say, a nasty case of hurt pride. Of course, the injuries can sometimes be serious — and they are on the rise.

Slightly more than 1,000 pedestrians visited emergency rooms in 2008 because they got distracted and tripped, fell or ran into something while using a cellphone to talk or text. That was twice the number from 2007, which had nearly doubled from 2006, according to a study conducted by Ohio State University, which says it is the first to estimate such accidents.

“It’s the tip of the iceberg,” said Jack L. Nasar, a professor of city and regional planning at Ohio State, noting that the number of mishaps is probably much higher considering that most of the injuries are not severe enough to require a hospital visit. What is more, he said, texting is rising sharply and devices like the iPhone have thousands of new, engaging applications to preoccupy phone users.

There is the problem, it’s the apps. It is a solvable problem. Just as it is possible, without inviting death and destruction, to talk to a (non-distracting) passenger while driving a car, it is entirely possible to talk on a cellphone while walking. Many who have managed to do so without winding up in emergency rooms have the solution: don’t be accessing travel agencies and restaurant menus, just talk. Furthermore, do not give your cellphone number to anybody but your children and a few very good friends. They do not create angst while you are walking/talking, and will also understand that you turn the thing off when you get home. Anybody else can darn well call the land line and leave a message. The fact that addiction to electronic wizardry and perpetually multi-tasking with it is a fairly recent phenomenon probably explains another interesting discovery:

Mr. Nasar supervised the statistical analysis, which was done by Derek Troyer, one of his graduate students. He looked at records of emergency room visits compiled by the Consumer Product Safety Commission.

Examples of such (hospital) visits include a 16-year-old boy who walked into a telephone pole while texting and suffered a concussion; a 28-year-old man who tripped and fractured a finger on the hand gripping his cellphone; and a 68-year-old man who fell off the porch while talking on a cellphone, spraining a thumb and an ankle and causing dizziness.

Young people injured themselves more often. About half the visits Mr. Troyer studied were by people under 30, and a quarter were 16 to 20 years old. But more than a quarter of those injured were 41 to 60 years old.

Over 60? Except for the unfortunate gentleman strolling off his porch, we don’t event merit inclusion in the data. This may add up to one benefit of being too old to deal with the technological wonders of cellphone apps, and tending to use the cellphone as a phone. The Times article, highly recommended reading for all ages, is full of interesting factoids and neurological rationale. But much still boils down to the old can’t-walk-and-chew-gum adage.

“Walking and chewing are repetitive, well-practiced tasks that become automatic,” Dr. Gazzaley (Adam Gazzaley, a neurologist at the University of California, San Francisco) said. “They don’t compete for resources like texting and walking.”

Further, he said, the cellphone gives people a constant opportunity to pursue goals that feel more important than walking down the street.

“An animal would never walk into a pole,” he said, noting survival instincts would trump other priorities.

There could be a message here. Perhaps it is that the goal, or at least the top priority, of walking down the street should be to get to your destination in one piece. If you skip the apps and keep your eyes open for texting drivers at cross streets, it is entirely possible for someone of any age to accomplish this task — while talking on the cellphone.

Driven to Distraction – Pedestrians, Too, Are Distracted by Cellphones – Series – NYTimes.com.

Facebook parenting — God help us

At the risk of sounding like a grandmother, which I quintupitally am, I have to say I’ve been spending a lot of time in the past several days being thankful I’m not raising any teenagers. This is thanks to the story of Tess of the d’Overmuch and her Facebook quest for relief from being grounded. If you’ve missed this exciting adventure, Susan Dominus summarizes it in today’s New York Times:

They feel her pain. At the Spence School and Greenwich High and Fullerton Union High and Nyack High and Narragansett High, teenagers and near-teenagers, hundreds of them, are waving a virtual flag for Tess Chapin, a 15-year-old from Sunnyside, Queens, who has been grounded for five weeks. A few days after founding the Facebook group — “1000 to get tess ungrounded” — Tess had nearly reached her stated goal, with 806 members by Friday morning; after this column about her quest was posted on nytimes.com, she surpassed it.

This is teenage rebellion, electronic style — peaceful, organized and, apparently, contagious.

So basically, Tess explains on her group page, she made an honest late-night mistake. Her parents flipped, and they grounded her for five weeks — “thats my childhood right there,” she wrote. “please join so I can convince them to unground me. please please please.”

Interesting she should mention childhood. Tess’ groundation, as she terms it, occurred after an honest late-night mistake involving drinking booze and missing a curfew, behaviors that are wisely left until childhood is past, which her parents, if not her friends, understand. To their everlasting credit — and bless their hearts for having to raise what must be a bright and feisty daughter in such a public arena — they seem thus far disinclined to let Facebook group rule.

If your parents didn’t care,” pointed out a sophomore at Ithaca College, “they would have just let you rot.” Someone agreed with Tess that “parents can be stupid.” A friend of a friend expressed hope that she and her parents would take something “grand” away from the experience. A close pal chimed in, “I love you, but your parents are not gonna unground you for convincing 1,000 people to join a group.”

It is to this last theory that Ms. Iselin Chapin (mom Jennifer Iselin Chapin, a fund-raiser for the Natural Resources Defense Council) subscribes.

“What’s your fallback strategy?” she asked her daughter Thursday night, sitting across from her in the living room of their two-bedroom apartment in Sunnyside.

“O.K., one: drive you so crazy that you’re going to unground me,” Tess replied.

Her mother shook her head. “That’s not going to do it, sweetheart.”

Times writer Dominus suggested early on that perhaps another group might be started in support of “Parents Who Believe in Consequences for Serious Lapses in Judgment and Care Enough About Their Kids to Enforce the Rules,” and reported that within an hour a Times Online reader had done just that. And bless that reader’s heart, too.

I think raising kids in the relative obscurity of pre-internet times was infinitely easier and surely effective, for proof of which I offer three excellent grown children, parents of three flawless teenagers and — in the case of son and daughter-in-law who deserve an extra blessing of hearts — two gorgeous girls who won’t be teenagers for another 6 or 8 years.

My eldest granddaughter came across the country to enter college last fall, offering joy and a learning experience to her creaky left coast grandparents. We are diligently learning about what 19-year-old college art students create, wear, enjoy and pierce. She is extraordinarily grounded and gifted and fast approaching the end of child/teenagehood — though she did exemplify the complexities of it all when assuring her mother she was not homesick while asking that she (the mom) please not talk about the dogs.

I have conceded that most of today’s teenagers will miss the pleasure of things like thank-you notes (they don’t write, they Facebook and they text,) and think it’s just as well my own college art major was in the dark ages. We did life drawing and paintings of little arrangements of bottles and fruits for starters. The college art life today is tough. My granddaughter took us on a walking tour of her dorm and its collection of depictions of violence and terrors, which prompted me to remark that there is so much angst in today’s art.

“Well, Gran,” she said with a note of weary indulgence, “we ARE teenagers.”

Big City – Teenager Taps Facebook to Protest a Punishment From Her Parents – NYTimes.com.

Nobody wants to talk about it

It’s the new Great American Conspiracy, the game of eternal youth. A little plastic surgery here, personal trainer there, here a test, there a scan, everywhere denial again. Death is optional, isn’t it?

Doctors are the happy co-conspirators in the game. They can always fix things up, can’t they?

Well, no. But a new study shows that doctors are just as happy to put off talking about end-of-life issues as their patients. This means that discussions get put off until they are beside the point because the patient died. Which saves all those uncomfortable moments… even if by the time he or she dies the patient has suffered distress that might easily have been avoided, the doctor has likely ordered expensive, agonizing, unnecessary tests and procedures (after all, isn’t the mandate always to treat, no matter what?) and friends and family are left emotional wrecks. All because it’s easier to be in denial than consider the possibility that we might actually — gasp — die.

It’s a conversation that most people dread, doctors and patients alike. The cancer is terminal, time is short, and tough decisions loom — about accepting treatment or rejecting it, and choosing where and how to die.

When is the right time — if there is one — to bring up these painful issues with someone who is terminally ill?

Guidelines for doctors say the discussion should begin when a patient has a year or less to live. That way, patients and their families can plan whether they want to do everything possible to stay alive, or to avoid respirators, resuscitation, additional chemotherapy and the web of tubes, needles, pumps and other machines that often accompany death in the hospital.

The right time to bring up these issues is today. When you’re 26. Or 52. Or 78 and feeling okay. Once someone is terminally ill it’s a whole new game, but to postpone talking about it, to behave as if never uttering the D-word means you’ll still live forever at that point is both foolish and costly. The reality is that we do postpone the conversation. But once a diagnosis suggests a foreseeable end to the living-forever fantasy the discussion should, for those very good reasons above, begin that day.

But many doctors, especially older ones and specialists, say they would postpone those conversations, according to a study published online Monday in the journal Cancer.

It’s not entirely clear whether these doctors are remiss for not speaking up — or whether the guidelines are unrealistic. Advice that sounds good on paper may be no match for the emotions on both sides when it comes to facing patients and their families and admitting that it will soon be over, that all medicine can offer is a bit of comfort while the patient waits to die.

Dr. Nancy L. Keating, the first author of the study and an associate professor of medicine and health care policy at Harvard, said not much was known about how, when or even if doctors were having these difficult talks with dying patients. But she said that her research team suspected that communication was falling short, because studies have shown that even though most people want to die at home, most wind up dying in the hospital.

The researchers surveyed 4,074 doctors who took care of cancer patients, instructing them to imagine one who had only four to six months left, but was still feeling well. Then the doctors were asked when they would discuss the prognosis, whether the patient wanted resuscitation or hospice care, and where he or she wanted to die.

The results came as a surprise: the doctors were even more reluctant to ask certain questions than the researchers had expected. Although 65 percent said they would talk about the prognosis “now,” far fewer would discuss the other issues at the same time: resuscitation, 44 percent; hospice, 26 percent; site of death, 21 percent. Instead, most of the doctors said they would rather wait until the patients felt worse or there were no more cancer treatments to offer.

How much worse are patients supposed to feel? How many treatments will be offered, for how long, at what expense in dollars and in human suffering?

If doctors were honest about the pain, distress and discomfort involved in end-of-life treatments, if patients could be informed and then clear about what they would choose, if friends and families could be open, the savings in dollars and in human suffering would be immense. Sarah Palin didn’t want you to talk about it. Is she still calling the shots?

Second Opinion – Doctors Often Delay Conversations About Death With Terminal Patients – NYTimes.com.

Adventure travel for the young — at heart

Not long ago I was fond of bragging, with more than a small amount of smug self- satisfaction, about completing Circus 101 class at the San Francisco Circus School shortly after I became eligible for Medicare. Although it was quickly evident that I can’t do upside down any more without tending to throw up, I was more flexible than the muscular hunks and quite good, if I do say so, on the top of the pyramids. I was always the top of the pyramid because nobody wanted to step on the little old lady. Moments of grandeur and glory, those were.

Well, tell that to Ilse Telesmanich, 90. She’ll be hiking in South Africa this summer. Or Tom Lackey, who is into wing-walking over the English Channel at 89. (“My family thinks I’m mad,” Mr. Lackey said in a telephone interview discussing the flight with New York Times writer Kirk Johnson — his 20th wing-walk. “I probably am.”)

Intensely active older men and women who have the means and see the twilight years as just another stage of exploration are pushing further and harder, tossing aside presumed limitations. And the global travel and leisure industry, long focused on youth, is racing to keep up.

“This is an emerging market phenomenon based on tens of millions of longer-lived men and women with more youth vitality than ever imagined,” said Ken Dychtwald, a psychologist and author who has written widely about aging and economics.

And the so-called experiential marketplace — sensation, education, adventure and culture, estimated at $56 billion and growing, according to a new study from George Washington University — is where much of that new old-money is headed.

At the Grand Circle Corporation, for example, a Boston-based company that specializes in older travelers, adventure tours have gone from 16 percent of passenger volume in 2001 to 50 percent for advance bookings this year, even as the average traveler’s age has risen to 68 from 62.

At Exploritas, a nonprofit educational travel group previously known as Elderhostel, the proportion of people over 75 choosing adventure-tour options is up 27 percent since 2004. The sharpest growth has been in the over-85 crowd, more than 70 percent.

At VBT, a bike touring company in Vermont that does rides in countries around the world, the number of bikers over 70 has doubled in the last 10 years.

“Unusual is way more popular now,” said Alan E. Lewis, chairman of Grand Circle, “and with this audience, that’s a major shift.”

It’s not all fun and high adventure — medical insurance with companies such as  InsureMyTrip.com is likely to quadruple, transporting medications can be problematical, and ordinary risk factors (though wiser elders often fare better than macho youngers) remain.

But it’s enough to make me renew my Exploritas membership, hit the par course more often and shut up about circus school.

Seeing Old Age as a Never-Ending Adventure – NYTimes.com.

Skip the cold meds – hit the gym

Just in case the cold weather and a few sniffles are luring you toward the couch in front of the TV, you may want to stop and read Wall Street Journal health writer Laura Landro’s article in today’s “Personal Journal” section first.

Regular workouts may help fight off colds and flu, reduce the risk of certain cancers and chronic diseases and slow the process of aging.

Who knew? Well, most of us knew, we just haven’t been convinced. But Landro’s piece is stuffed — no offense to couches or potatoes — with evidence from new research, including data on fitness v the common cold. The fit, it turns out, have fewer and less severe colds, of shorter duration than the afflictions of their less-fit fellow creatures.

No pill or nutritional supplement has the power of near-daily moderate activity in lowering the number of sick days people take,” says David Nieman, director of Appalachian State University’s Human Performance Lab in Kannapolis, N.C. Dr. Nieman has conducted several randomized controlled studies showing that people who walked briskly for 45 minutes, five days a week over 12 to 15 weeks had fewer and less severe upper respiratory tract infections, such as colds and flu. These subjects reduced their number of sick days 25% to 50% compared with sedentary control subjects, he says.

Medical experts say inactivity poses as great a health risk as smoking, contributing to heart disease, diabetes, hypertension, cancer, depression, arthritis and osteoporosis. The Centers for Disease Control and Prevention says 36% of U.S. adults didn’t engage in any leisure-time physical activity in 2008.

Even lean men and women who are inactive are at higher risk of death and disease. So while reducing obesity is an important goal, “the better message would be to get everyone to walk 30 minutes a day” says Robert Sallis, co-director of sports medicine at Fontana Medical Center, a Southern California facility owned by managed-care giant Kaiser Permanente. “We need to refocus the national message on physical activity, which can have a bigger impact on health than losing weight.”

[INFORMED]

Researchers are also investigating whether exercise can influence aging in the body. In particular, they are looking at whether exercise lengthens telomeres, the strands of DNA at the tips of chromosomes. When telomeres get too short, cells no longer can divide and they become inactive, a process associated with aging, cancer and a higher risk of death.

A companion article goes further, suggesting that “spurring more exercise out of the half of Americans who are already active is just as important as coaxing the sedentary off the sofa.” The jury on this, however, is still out. For the time being, you could focus on warding off the January chest cold and stretching out the telomeres.

The Hidden Benefits of Exercise – WSJ.com.

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