Category: Health

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Time flies when… or does it really?

by Fran Johns

In case you’re wondering what happened to 2009 — personally, I misplaced December, and have some real doubts about several weeks in March and August — maybe you were indeed having fun. Or having too much caffeine. According to an article seductively headlined “Where Did The Time Go? Do Not Ask The Brain” in the New York Times our perception of time can be linked to good times or bad, and the nature of events we peg time’s passage to affects whether it flew like the wind or dragged like a wet mattress. Science Times writer Benedict Carey assembles enough esoteric theories, along with the down-home speculations, to make a few moments vanish while reading.

That most alarming New Year’s morning question — “Uh-oh, what did I do last night?” — can seem benign compared with those that may come later, like “Uh, what exactly did I do with the last year?”

Or, “Hold on — did a decade just go by?”

It did. Somewhere between trigonometry and colonoscopy, someone must have hit the fast-forward button. Time may march, or ebb, or sift, or creep, but in early January it feels as if it has bolted like an angry dinner guest, leaving conversations unfinished, relationships still stuck, bad habits unbroken, goals unachieved.

I think for many people, we think about our goals, and if nothing much has happened with those then suddenly it seems like it was just yesterday that we set them,” said Gal Zauberman, an associate professor of marketing at the Wharton School of Business.

Studies of what makes time fly, or seem to, come up with opposite views: too many events that you’re pegging the past 30 days to might telescope them into 20 days. Or maybe your brain does have some control over your perception of time. You didn’t get that project finished on deadline? Well, the day just zoomed by.

In earlier work, researchers found a similar dynamic at work in people’s judgment of intervals that last only moments. Relatively infrequent stimuli, like flashes or tones, tend to increase the speed of the brain’s internal pacemaker.

On an obvious level, these kinds of findings offer an explanation for why other people’s children seem to grow up so much faster than one’s own. Involved parents are all too well aware of every hiccup, split lip and first step in their own children; whereas, seeing a cousin’s child once every few years, without intervening memories, telescopes the time.

On another level, the research suggests that the brain has more control over its own perception of passing time than people may know. For example, many people have the defeated sense that it was just yesterday that they made last year’s resolutions; the year snapped shut, and they didn’t start writing that novel or attend even one Pilates class. But it is precisely because they didn’t act on their plan that the time seemed to have flown away.

By contrast, the new research suggests, focusing instead on goals or challenges that were in fact engaged during the year — whether or not they were labeled as “resolutions” — gives the brain the opportunity to fill out the past year with memories, and perceived time.

My father, who spent his entire life in academia, used to speak of time as “the element that doesn’t exist.” Maybe he was right after all. Maybe that’s what happened to December.

Mind – Research on How the Brain Perceives Time – NYTimes.com.

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Skip the cold meds – hit the gym

by Fran Johns

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.

Health/Religion/seniors/USA
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Catholic bishops mandate treatment to keep comatose patients alive

by Fran Johns

Catholic hospitals across the country face a new mandate this year to provide life-sustaining treatment to comatose patients regardless of the wishes of those patients and/or their families, and even when there is no hope of recovery.

The U.S. Conference of Catholic Bishops issued the directive Nov. 17 to the more than 1,000 church-affiliated hospitals and nursing homes in the United States and to all Catholic doctors and nurses. Invoking a 2004 speech by Pope John Paul II, the bishops said Catholics must provide nutritional assistance to patients with “presumably irreversible conditions … who can reasonably be expected to live indefinitely if given such care.”

A previous directive let Catholic hospitals and doctors decide whether the burdens on the patient outweighed the benefits of prolonging life. The bishops said the new policy was guided by “Catholic teaching against euthanasia” and by John Paul’s observation that providing food and water “always represents a natural means of preserving life, not a medical act.”

The issue of whose wishes will be observed — the patient’s or the bishops’ — is certain to be raised. And in the case of a comatose patient, having someone else to advocate in one’s behalf will be critical.

Catholic hospital officials say the November decree isn’t rigid and leaves room for accommodating patients’ wishes. But the bishops’ language appears to conflict with a hospital’s legal duty to follow a patient’s instructions to withdraw life support, as expressed in an advance written directive or by a close relative or friend who knows the patient’s intentions.

Courts have ordered hospitals to disconnect feeding tubes when an unconscious patient’s wishes were clearly established. The best-known case involved Terri Schiavo, the Florida woman who died in 2005 after 15 years in a coma and unsuccessful attempts by her parents and Republicans in Congress to keep her alive.

The decree itself does not require life-sustaining care that would be “excessively burdensome for the patient” or would cause “significant physical discomfort.” If those exemptions don’t apply, a hospital will send a patient elsewhere rather than violate his or her expressed wishes, the (Catholic hospitals) organizations said.

The Catholic Health Association of the United States, which represents both hospitals and nursing homes, said a facility’s ethics committee would probably meet with the doctor and the patient’s representative to “explore the alternatives” whenever a patient’s decision to withdraw life support clashed with Catholic doctrine.”In some instances, this might include the transfer of the patient to another facility,” the association said.

Considering the number of Catholic hospitals, nursing homes, doctors and nurses under the bishops’ directive and the number of people who would not choose to spend their final weeks and months hooked up to tubes and wires, ethics committees are going to be very busy. It is hard to make sense of this across-the-board imposition of one religion’s views on countless patients whose own wishes may differ.

New Catholic mandate on comatose patients.

California/Health/seniors/USA/Women
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Montana court affirms aid in dying

by Fran Johns

Montana has become the third U.S. state to give terminally ill adults the right to choose aid in dying. The decision, which came from the State Supreme Court on New Year’s Eve, 2009, was handed down by the highest body for state issues and thus cannot be appealed. The other two states honoring a patient’s wish to choose aid in dying are Oregon, which has successfully maintained its Death with Dignity legislation for more than a decade, and Washington, which passed a similar law last year.

The Montana ruling came too late for one plaintiff.

Roberta King, of Missoula, the daughter of plaintiff Bob Baxter, said, “My father died without the peace and dignity he so dearly wanted for himself and others. He feared when he filed this lawsuit that he would not live long enough to benefit from it. I’m sure he would be deeply gratified that other terminally ill Montanans will have the choice and comfort that aid in dying affords them.”

The Montana case was backed by Compassion and Choices, with C&C Legal Director Kathryn Tucker serving as co-counsel to the plaintiffs/respondents. (Full disclosure: I serve on the board of Compassion and Choices’ Northern California chapter.) The decision gave Tucker a major boost for her New Year’s celebrations. She was quoted on New Year’s Day as saying,

Montanans trapped in an unbearable dying process deserve, and will now have, this end-of-life choice. This is the first state high court to find protection of this choice, and makes clear that in Montana, patients are able to make this choice and physicians can provide this care without risking sanction.”

Others, including medical professionals and critically ill patients who invested long hours in seeking the new ruling, were equally gratified.

Dr. Stephen Speckart, a Missoula cancer specialist and a plaintiff in the lawsuit, said, “This decision affirms that a terminal patient’s fundamental right to self-determination will guide end-of-life health decisions. I regularly treat patients dying from cancer, and many of these deaths are slow and painful. Terminal patients will no longer be forced to choose between unrelenting pain and an alert mental state as they approach the end of their lives from terminal diseases. The comfort this brings to their last days can have an immeasurable benefit.”

Missoula attorney Mark Connell, who argued the case to the Supreme Court on behalf of the plaintiff physicians and patients, described the decision as “a victory for individual rights over government control.” Connell added: “The Montana Supreme Court has now recognized that, where intensely personal and private choices regarding end-of-life care are involved, Montana law entrusts those decisions to the individuals whose lives are at stake, not the government. I know Bob Baxter would be very pleased that the court has now reaffirmed that these choices should be left to the terminally ill people in our state.”

Steve Johnson, 71, of Helena, who is terminally ill with brain cancer, hailed the decision and asked the Montana medical profession to provide patients like himself with aid in dying. “I approach the end of my life with a clear mind, and I would like to work with my doctor to minimize the pain and maximize the peacefulness in my dying. I would like my physician to be able to respect and honor my choice to die with dignity. Adults like myself should have the option, if terminally ill, to request physician aid in dying. It’s only compassionate to minimize unnecessary suffering at the end of life, and to let me make the choice about how much suffering to endure, based on my own values and beliefs,” said Johnson.

The movement had widespread support across the state.

Montana State Sen. Christine Kaufmann, Rep. Dick Barrett and twenty-nine other state legislators; the American Medical Women’s Association, the American Medical Students Association, and a coalition of Montana clinicians; the American College of Legal Medicine; the American Civil Liberties Union of Montana; the Montana Human Rights Network; the Northwest Women’s Law Center; terminal patients’ surviving family members; Montana religious leaders; and Montana’s leading constitutional law experts had urged the Court to find in favor of the terminal patient’s right to receive aid in dying from their physicians.

According to Compassion and Choices president Barbara Coombs Lee, the battle for “the right to choose a humane and compassionate death will continue. (We) encourage terminally ill patients to call 800 247-7421 if they would like information about aid in dying, or suggestions on how to open a dialogue with their physician and loved ones.”

General interest/Health/Lifestyle/Money
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CIA casualties highlight endless wars

by Fran Johns

While we were watching bejeweled balls drop in Times Square, or fireworks over San Francisco Bay, pyrotechnics of a different sort were going on as usual around the globe, some of them more or less our fault — because people don’t like us or our government policies or our religious persuasions — some of them happening in our name. The news-making American casualties were not military personnel this time, but civilians in the employ of the Central Intelligence Agency.

The report of this attack sums up where we are, in the last few words of the first paragraph: America’s far-flung wars.

The deaths of seven Central Intelligence Agency operatives at a remote base in the mountains of Afghanistan are a pointed example of the civilian spy agency’s transformation in recent years into a paramilitary organization at the vanguard of America’s far-flung wars.

Is it possible we are fighting too many wars, too far-flung?

If you Google around a while, you can discover (for instance, on a college librarian’s eponymous and aptly named site, topsy.org) that many of the lists of exactly where and with whom we are fighting battles have been removed — but that there are a lot of them out there. We have “overseas operating sites,” which our thankfully now-former president sought to have “optimally positioned to respond to potential 21st century military threats” all over the globe.

PBS NewsHour on New Year’s Day featured one segment in which Georgetown University professor Christine Fair attempted to articulate the various factors involved in current impossible wars going on in the mountainous regions of Pakistan, Afghanistan etc. The Pakistan Taliban, she explained, are actually “a network of networks;” the insurgents include Afghan soldiers, or perhaps non-soldiers dressed in some of the uniforms acquired by stealing a truckload of them, which happened not long ago. PBS’ Ray Suarez then asked if there were any way of stopping this chaos. “I don’t think so,” was the answer.

Hello? Could we think about our foreign policy a while?

Even without easily accessible lists (it is somewhat comforting to know that amateurs can’t Google up strategic maps of these overseas operating sites,) everybody knows we have personnel, uniformed and otherwise scattered around from Germany to South Korea to Thailand to Honduras to wherever. We don’t know how many of them are fighting little wildfire battles, either in person or through U.S.-trained surrogates. In the recent C.I.A. tragedy, the survivors can be forgiven for anger and grief, but some of the response is still unsettling:

There was an air of defiance among intelligence officials on the day after the attack, and some spoke of their fallen comrades using military language.

“There is no pullout,” the American intelligence official said. “There is no withdrawal or anything like that planned.”

Is anybody, anywhere, considering the fact that we can’t keep fighting everybody everywhere, forever? The pundits (reinforced by Defense Department spokespeople) like to say that if we were to pull out — of Iraq, Afghanistan, Uganda, pick your piece of the globe where we’re actively or just-behind-the-lines at war — there would be chaos. But there’s already chaos.

What if we started taking a few of those trillions currently funding endless wars and diverting them into building schools, hospitals, community centers, friends? After the chaos, could we then emerge with more friends and fewer aspiring-martyr enemies?

Maybe not. But it would be nice, just once, in all the interminable debates about terrorists and security and rooting out the bad guys, to hear someone suggest changing course, waging peace. For now, we seem mired in countless un-winnable wars. It would be heartening to think we could get off the Through the Looking Glass course outlined by former Defense Secretary Donald Rumsfeld in 2002 and quoted by columnist David Sirota today:

As we know, there are known knowns. There are things we know we know. We also know there are known unknowns. That is to say, we know there’re some things we do not know. But there’re also unknowns unknowns; the ones we don’t know we don’t know.

We know how many wars we are fighting. We know we’re not winning many of them. We know that peace on earth isn’t getting any closer these days.

C.I.A. Takes On Bigger and Riskier Role on Front Lines – NYTimes.com.

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Goodbye to all that — & hello 2010

by Fran Johns

It’s hard to mourn the passage of 2009. Jobless friends struggled to survive while our own family income took a dive. Gay friends watched meanness triumph over decency in equality battles. Friends of many stripes lamented choices made by the president we elected with unrealistically high hopes. And my hometown paper this morning lists, among the top stories of the year, teenage gang rape, government insolvency and a bunch of senseless killings.

Other front pages aren’t much different: my second-favorite city winds up the year in the red and worried about the shadow of 9/11 (New York Times.) Murder and assault — specifically assault compounded by injustice — are among today’s concerns in Chicago. And a couple of other former hometown papers lead off the year’s last day with stories of car crashes, shootouts (Atlanta Journal Constitution) and a tragic, child-abandoning, now dead, alcoholic mom (Richmond Times-Dispatch). Plus another doozy about four or five hundred dead animals found in one house — and that happened in Philadelphia.

Optimism, these days, is a full-time job.

But hey. We’re inching toward health reform. Umar’s bomb didn’t go off.  Some of those bad guys (above) went to jail, and a few good guys who’d been jailed as bad guys for a very long time got out of jail thanks to the Innocence Project.  And even if the best we can do for employment optimism is note that the rate of jobs lost is getting smaller — can the country’s jobless find hope in that? — the jobless recovery seems to be happening. Surely jobs will follow.

Plus: even if we don’t like all of his choices and decisions, we have an articulate president who comes across, still, as thoughtful and decent — and doesn’t make you cringe when you see him on TV. There’s hope.

And True/Slant, which you’d never heard of this time last year, is closing in on a million readers.

Happy New Year from the Boomers and Beyond page.

California/Health/Lifestyle/seniors
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Your latte or your life

by Fran Johns

At last, an addiction I can be proud of. Having given up nicotine, alcohol and sin in general over the years, I was beginning to despair about the remaining unbreakable habits:  sugar, butterfat… and caffeine.  But now, suggests Wall Street Journal health writer Melinda Beck, caffeine might just be putting a little distance between Alzheimer’s and me. It might not be an anti-dementia guarantee, and it could have a few downer side effects, but still. A ray of sunshine on the addiction scene.

To judge by recent headlines, coffee could be the latest health-food craze, right up there with broccoli and whole-wheat bread.

But don’t think you’ll be healthier graduating from a tall to a venti just yet. While there has been a splash of positive news about coffee lately, there may still be grounds for concern.

  • Cancer: Earlier studies implicating coffee in causing cancer have been disproven; may instead lower the risk of colon, mouth, throat and other cancers.
  • Heart disease: Long-term coffee drinking does not appear to raise the risk and may provide some protection.
  • Hypertension: Caffeine raises blood pressure, so sufferers should be wary.
  • Cholesterol: Some coffee—especially decaf—raises LDL, the bad kind of cholesterol.
  • Alzheimer’s: Moderate coffee drinking appears to be protective.
  • Osteoporosis: Caffeine lowers bone density, but adding milk can balance out the risk.
  • Pregnancy: Caffeine intake may increase the risk of miscarriage and low birth-weight babies.
  • Sleep: Effects are highly variable, but avoiding coffee after 3 p.m. can avert insomnia.
  • Mood: Moderate caffeine boosts energy and cuts depression, but excess amounts can cause anxiety.

So let’s see. My bone reports have actually upscaled recently, so all that butterfat and a few bone meds are outpacing the latte. I can fall asleep midway through a cappuccino, and I don’t have time to be depressed. Unlikely to get pregnant. Addiction situation looks better and better. Further insight comes from Duke University Medical Center psychophysiologist Jim Lane, who’s been studying the effects of caffeine for more than 25 years, and from a distinguished addiction psychiatrist (I wonder if I should volunteer for a study) at Vanderbilt University.

“When I went to medical school, I was told that coffee was harmful. But in the ’90s and this decade, it’s become clear that if you do these studies correctly, coffee is protective in terms of public health,” says Peter R. Martin, a professor of psychiatry and pharmacology at Vanderbilt University and director of the school’s Institute for Coffee Studies, founded in 1999 with a grant from coffee-producing countries.Still, many researchers believe that the only way to draw firm conclusions about something like coffee is through experimental trials in which some subjects are exposed to measured doses and others get a placebo, with other variables tightly controlled. When that’s been done, says Duke’s Dr. Lane, “the experimental studies and the [observational] studies are in very sharp disagreement about whether caffeine is healthy or not.”

Harmful Effects

His own small, controlled studies have shown that caffeine—administered in precise doses in tablet form—raises blood pressure and blood-sugar levels after a meal in people who already have diabetes. Other studies have found that caffeine and stress combined can raise blood pressure even more significantly. “If you are a normally healthy person, that might not have any long-term effect,” says Dr. Lane. “But there are some groups of people who are predisposed to get high blood pressure and heart disease and for them, caffeine might be harmful over time.”

[HEALTHCOLfront]

Epidemiologists counter that such small studies don’t mirror real-world conditions, and they can’t examine the long-term risk of disease.

The debate goes on. Do people remember how many cups they drink? How big is your mug? How random is your study? Did your ancestors have a history of — uh, oh, my parents met and married in Brazil where I was born. Maybe that’s where it all started.

I will welcome your comments on caffeine addictions; they will be compiled over a take-out tall extra-foamy latte.

Seeking Coffee’s Benefits to Health – WSJ.com.


California/Health/seniors/USA
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End-of-year look at end-of-life issues

by Fran Johns

Two end-of-year stories offer stark insights into end-of-life issues in the U.S., one from a purely financial perspective, the other purely about compassion. Between the two, the conflicted American way of dying comes into focus.

First the finance. The Wall Street Journal of December 30 features a front page story by Laura Saunders about wealthy families coming to grips with the disappearance, thanks to a quirk of Congress, of the estate tax beginning January 1, 2010. It will only disappear for a year, and in 2011 it will return at a higher rate with lower exemption. For those approximately 5,500 super-rich taxpayers to whom this tax applies, a lot of money is at stake. Presumably if a member of one of these families is now near death every possible measure will be taken to keep him or her alive into the new year and presumably that will be done for the best of reasons. But imagine the struggles involved if someone is near death this time next year, and his or her heirs stand to benefit in the millions if that death happens before January 1st rather than soon after. An altogether new meaning will have to be added to “letting go.” Not something one really wants to think through.

But the last two sentences of the WSJ article demonstrate how extensively the scenario is indeed being thought through, not from the heir’s point of view but from the soon-to-be-departed:

The situation is causing at least one person to add the prospect of euthanasia to his estate-planning mix, according to Mr. (Andrew) Katzenstein (a lawyer with) Proskauer Rose (LLP in Los Angeles.) An elderly, infirm client of his recently asked whether undergoing euthanasia next year in Holland, where it’s legal, might allow his estate to dodge the tax.

His answer: Yes.

However hard we might try to eliminate costs (and cost/benefit ratios) from considerations of end-of-life care and decision-making, they are here to stay and sure to remain complex. Another complexity — and this one should not be as difficult as it continues to be — surrounds the subject of palliative care. Palliative care is simply comfort care. It means, do everything possible to insure that a dying person might go about his or her dying with as little pain and anguish as humanly, medically possible.  A long, careful look into the issue is in the New York Times most recent “Months to Live” series article, “Hard Choice for a Comfortable Death” by health writer Anemona Hartocollis.

In almost every room people were sleeping, but not like babies. This was not the carefree sleep that would restore them to rise and shine for another day. It was the sleep before — and sometimes until — death.

In some of the rooms in the hospice unit at Franklin Hospital, in Valley Stream on Long Island, the patients were sleeping because their organs were shutting down, the natural process of death by disease. But at least one patient had been rendered unconscious by strong drugs.

The patient, Leo Oltzik, an 88-year-old man with dementia, congestive heart failure and kidney problems, was brought from home by his wife and son, who were distressed to see him agitated, jumping out of bed and ripping off his clothes. Now he was sleeping soundly with his mouth wide open.

“Obviously, he’s much different than he was when he came in,” Dr. Edward Halbridge, the hospice medical director, told Mr. Oltzik’s wife. “He’s calm, he’s quiet.”

Mr. Oltzik’s life would end not with a bang, but with the drip, drip, drip of an IV drug that put him into a slumber from which he would never awaken. That drug, lorazepam, is a strong sedative. Mr. Oltzik was also receiving morphine, to kill pain. This combination can slow breathing and heart rate, and may make it impossible for the patient to eat or drink. In so doing, it can hasten death.

Mr. Oltzik received what some doctors call palliative sedation and others less euphemistically call terminal sedation. While the national health coverage debate has been roiled by questions of whether the government should be paying for end-of-life counseling, physicians like Dr. Halbridge, in consultations with patients or their families, are routinely making tough decisions about the best way to die.

Writer Hartocollis covers in thoughtful detail the long, sometimes conflicted process through which the medical team and the patient’s family arrived at his eventual, peaceful death. The article looks at the multiplicity of issues that cry out for reasoned public dialogue — palliative care, physician aid in dying, end-of-life choice, family decision-making — that have been raised on this page in recent months and will be back again. It’s a story worth reading in full.

And meanwhile, the beginning of the year is a fine time to get your advance directives and other documents completed and to have those conversations with friends and loved ones that keep you from becoming another Terri Schiavo. Getting this done is one great way to put dying behind you and go about the business of living for a happy new year.

Months to Live – Hard Choice for a Comfortable Death – Sedation – Series – NYTimes.com.

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