Category: Locations

California/General interest/Health/Lifestyle/Money/Politics & Causes/Women
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Bone weary in America: contraceptives, celiac disease & other osteo-hazards

by Fran Johns

You might want to start paying attention to your bones.

Even if you’re not an over-50 hard-drinking guy, or a post-menopausal former-smoker gal — even  if you are, say, just a light-complexioned skinny person, your bones want you to understand they might not be able to keep you together forever.

My bones sent that message not long ago by summoning a few other medical markers. Anemia and exhaustion got my attention and lo! we discovered celiac disease. Who knew? Celiac sprue is a genetic condition half the country seems to have, now that it’s gotten half the country’s attention — and confirmed diagnoses are relatively easy to make. Because I am an asymptomatic celiac person, in my case it was just the ol’ bones sending a signal that they would like a little calcium, please.

Yesterday’s New York Times reported another new finding:

Almost half of all women who use a popular injected contraceptive lose a significant amount of bone mass within two years, and researchers now say the greatest risk is to smokers, women who don’t consume enough calcium and those who have never gone through a pregnancy.

A study that followed women who used the birth-control method — a shot of depot medroxyprogesterone acetate, better known as DMPA or Depo-Provera, every three months — found that 45 percent of the users experienced bone mineral density losses of 5 percent or more in the hip or lower spine, researchers said. The study appears in the January issue of Obstetrics & Gynecology.

More than two million American women use DMPA, including about 400,000 teenagers.

Researchers said the bone loss was of “significant concern” because recovering bone mass can take a long time, and the hip is the most common site for fractures in women later in life.

“We can now tell our patients, ‘Don’t smoke, and take your calcium every day’ — those are modifiable risk factors,” said the senior author, Dr. Abbey B. Berenson, director of the Center for Interdisciplinary Research in Women’s Health at the University of Texas Medical Branch at Galveston. “The flip side is that if I have a patient who smokes, I’m going to be more concerned about giving her Depo-Provera.”

Your bones could be aching for attention even if you’re still none of the above. The World Health Organization now has a nifty new bone-health tool called FRAX to help you figure if you’re at risk for fractures. You can visit their site, plug in country and ethnicity for your personal profile. You can also go to KnowMyBones.com (bones people are having a good time with titles and acronyms) and find out more about healthy bones and how to keep them thus.

Dem bones, as long as you help them, gonna walk around.

California/General interest/Lifestyle/Politics & Causes/USA/Women
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Sorry, no photos in Prop 8 courtroom

by Fran Johns

So much for what proponents of marriage equality thought would have been a good idea:

The Supreme Court has indefinitely blocked cameras from covering the high-profile federal court trial on the constitutionality of California’s ban on same-sex marriage.

The high court split 5-4 today, with the conservative justices in the majority.

Now in its third day, the trial in federal court in San Francisco is over the state’s voter-approved ban on gay marriage.

The presiding judge, Vaughn Walker, had proposed posting recordings of the trial on the court’s Web site after several hours of delay and allowing real-time streaming of the trial for viewing in other federal courthouses in California, New York, Oregon and Washington.

Gay rights advocates were calling Judge Walker’s earlier ruling a step towards openness and transparency. Proposition 8 supporters (who hope to uphold the voters’ ban on same-sex marriage in case you’ve been on another planet and missed the back story) were clearly — and probably rightly — afraid their supporters would fear being outed and skip testifying. A thoughtful person who lives in my house suggested it could be a bad precedent.

I personally was looking forward to looking in. But the Supreme Court didn’t consult with any of us. So now we’ll wait to see what they have to say when, as expected, this case gets to their chambers on appeal.

Supreme Court indefinitely blocks cameras from Prop. 8 trial – latimes.com.

California/General interest/Health/seniors/USA
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Nobody wants to talk about it

by Fran Johns

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.

California/General interest/Religion/USA
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Gay rights, hate crimes & social justice

by Fran Johns

Can hate crimes be erased from the U.S.? Probably not. Will same-sex marriage some day become the law of the land? Probably, eventually, so.

A few blocks around the corner from the federal courthouse in San Francisco where the latest battle for marriage equality is beginning an ambitious effort to combat hate crimes through community action was also getting underway on Monday morning.

Not In Our Town (NIOT) is a national movement planning a full-scale web organizing campaign  launch on April 6. Its focus is on mobilizing citizens in response to hate crimes, but its ultimate goal is to help build communities where such crimes won’t happen. Strategies were unveiled for a group of civic and religious leaders in San Francisco as part of the pre-launch efforts.

Not In Our Town began with a PBS documentary about Billings, Montana citizens joining together to respond to a series of hate crimes in their town. The story struck a chord with audiences, and created a model that inspired viewers around the country to hold their own campaigns against intolerance. Now in its second decade, the Not In Our Town movement continues to grow. Media company nonprofit The Working Group, which produced the PBS documentary, is the force behind NIOT’s emerging web-based organizational campaign

In the audience at Monday’s meeting, which was held at the San Francisco Public Library, were San Francisco Interfaith Council Executive Director Michael Pappas, Assistant District Attorney Victor Hwang (whose specific concentration is on prosecution of hate crimes), Director of the Mayor’s Office of Neighborhood Services Mike Farrah and representatives of a host of community action programs such as AfroSolo — a visual and performing arts nonprofit working, among other things, to combat black-on-black crime. Plus a wide assortment of individuals from religious and community groups. The audience mix was, NIOT representatives said, typical of groups around the country from which community efforts have grown.

NIOT grassroots efforts have taken place in communities from Patchogue, NY to Ft. Collins, CO to Richmond, CA and dozens in between. If the interest shown in the San Francisco Library — while most eyes were on the courthouse around the corner — was any indication, an enthusiastic San Francisco NIOT group will join others for the April 6 launce.

California/Lifestyle/Politics & Causes/USA
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Same-sex marriage trial underway in San Francisco — but no You Tube coverage for now

by Fran Johns

Shortly before the trial focusing on California’s Proposition 8 opened this morning, the Supreme Court blocked video of the proceedings on You Tube. Judging from the line-up of TV trucks and the impassioned testimony going on inside, it’s likely that a good sense of the action will be available.  But no on-site video.  Opponents of Prop. 8 had hailed an earlier order to allow posting of video on You Tube, but supporters of the anti-gay marriage initiative mounted a strong argument to get the U.S. Supreme Court to ban such action. An updated story link is included at the end of this earlier post.

California’s Proposition 8, the voter initiative that said marriage must be only for couples who can produce children, came up for discussion in a San Francisco courtroom beginning today.

The cameras-in-the-courtroom mini-drama, launched when maverick Chief U.S. District Judge Vaughn Walker ruled in favor of the YouTube postings, has become a significant sidelight to the main issue of the case.  Prop. 8 supporters fear their witnesses will be afraid to testify — public support of bigotry still being unpopular in California despite what the voters did when they passed the initiative; gay rights supporters are coming out, once more, for openness.

“What are they afraid of?” asked California State Senator Mark Leno Saturday. Leno was asked for his opinion while attending House Speaker Nancy Pelosi’s celebration with supporters in San Francisco. “As an advocate for open and transparent government,” he said, “what is there to fear? Taxpayers should be able to see the courts they pay for in action.” Leno, the first openly gay man elected to the California Senate and long a leader in gay rights and other progressive causes, called the State Supreme Court’s earlier ruling that upheld Prop. 8 last May “a rallying cry for all Californians who believe in equality and fairness… to stand up and fight the pervasive injustices LGBT people face in our community and our nation.”

The current primary issue, whether same-sex couples should have the right to marry, is being argued in San Francisco federal court beginning today. Judge Walker, an appointee of President George H.W. Bush, has made it clear he anticipates his ruling will be appealed.

For two couples and their allies who have filed a lawsuit seeking to overturn California’s Proposition 8, the November 2008 initiative was merely the latest example of historic discrimination against gays and lesbians.

Same-sex marriage poses no threat to opposite-sex couples, children or the public welfare, they argue, and a ballot measure that revoked the marital rights of one “disfavored group of citizens” was an unconstitutional appeal to fear and prejudice.

For Prop. 8’s sponsors, a religious coalition called Protect Marriage, anti-gay bias is no longer significant in California, where legislators have legalized domestic partnerships and twice voted to authorize same-sex marriage. Discrimination also had nothing to do with the ballot measure, which merely wrote the time-honored definition of marriage into the state Constitution, they argue.

Extending wedlock to gays and lesbians, they maintain, would radically redefine marriage, weaken biological parents’ connection with their children, tell men that “they have no significant place in family life” and force many religious Americans to “choose between being a believer and being a good citizen.”

The competing legal theories that will come up in court are a bit simpler: whether Prop. 8 violates the constitutional guarantee of equal protection by discriminating on the basis of sexual orientation and gender, or whether it validly reserves marital status for those who can naturally conceive children.

The initiative overturned a May 2008 state Supreme Court ruling that allowed gays and lesbians to marry in California. The state high court upheld Prop. 8 in May 2009 in a challenge by gay rights advocates whose claims involved only state law and not the U.S. Constitution.

A few days before the state court ruling, two couples and a recently formed advocacy group, the American Foundation for Equal Rights, sued in federal court. Their lawyers are the unlikely duo of Theodore Olson and David Boies, who represented George W. Bush and Al Gore, respectively, in the Supreme Court case that decided the 2000 presidential election.

Established gay rights organizations had avoided federal court, fearing a possible adverse ruling by a conservative U.S. Supreme Court. But with the fate of same-sex marriage in California, and possibly elsewhere, at stake in the trial, the advocates are all on board and most have filed supportive briefs.

Prop. 8’s sponsors – vaulted into the case by state Attorney General Jerry Brown’s refusal to defend the measure – say its clear-cut goal was to reinforce traditional marriage, and any inquiry into the campaign’s allegedly hidden motives is both intrusive and pointless.

“The traditional definition of marriage does not reflect animus against gays and lesbians,” attorney Charles Cooper said in court papers. “It simply reflects the fact that the institution of marriage is, and has always been, uniquely concerned with promoting and regulating naturally procreative relationships between men and women to provide for the nurture and upbringing of the next generation,” Cooper wrote.

The trial will test such assertions, with competing experts arguing about the history and meaning of marriage, the adequacy of domestic partnership as a marital substitute, and the social and political status of gays and lesbians.

Walker has kept his views to himself, but his rulings so far have dismayed some of Prop. 8’s supporters, who appear to be bracing their followers for a short-term defeat.

“The consistency with which the judge has sided with our opponents is anything but comforting to supporters of traditional marriage,” Andrew Pugno, general counsel for Protect Marriage, said in a letter to backers of the measure last week.

Fortunately, Pugno said, the last word will come from “the nine justices on the highest court in the nation.”

Prop. 8 trial begins today.

http://www.sfgate.com/cgi-bin/article.cgi?f=/n/a/2010/01/11/state/n080724S48.DTL&tsp=1

California/Health/Lifestyle/Politics & Causes/Women
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Pelosi keeps public — and her own — options open in San Francisco talk

by Fran Johns

House Speaker Nancy Pelosi rallied the faithful in San Francisco Saturday afternoon, drawing the loudest applause (there had already been cheers for heavy-hitter Democrats, San Francisco liberal causes and hometown heroine Pelosi herself) with an assertion that passage of the health reform bill will happen soon. She said the House bill is the stronger,  and negotiations to reconcile House and Senate versions into a final bill “are intense.”

Whether that final bill will include the public option her audience of several hundred supporters clearly wanted remains in doubt – and Pelosi was keeping her own options open. “Any bill we approve will have to pass the Triple A test,” she said: “Affordability, specifically for the middle class, Accountability – insurance companies will have to be held accountable; and Accessibility.”

Accessibility, of course, brings the issue back to the public option, which the bill will have, Pelosi maintained, “…or what the public option was intended to do: keep the insurance companies honest.”

The invitation-only Saturday event was billed as a New Year Celebration, and held on the first anniversary of a similar gathering hailing her ascension to Speaker last year.  Both took place at Delancey Street, a residential self-help community founded in 1971 to help substance abusers, ex-felons and “people from America’s underclass” get back on their feet and into productive lives. A few of the 14,000+ who have graduated from Delancey Street programs mingled with the likes of former state senator and current California Democratic Party Chairman John Burton, prominent gay California State Senator Mark Leno, and San Francisco Mayor Gavin Newsom. Almost anyone who is, or aspires to be, anyone in local Democratic politics was working the room.

Pelosi worked it herself, smiling and greeting her way through the crowds for several hours. When she returns to Washington after this weekend at home, the greetings and workings are guaranteed to be a little more fractured.

California/General interest/Health/Lifestyle/seniors/Sports/USA/Women
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Adventure travel for the young — at heart

by Fran Johns

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.

California/General interest/Lifestyle/Money/USA
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New killer: high tech in the front seat

by Fran Johns

How many people will this latest gadget kill?

Some cool dude can decide between the Boeuf Bourguignonne or the Coq au Vin en route to the restaurant – what difference should running over a pedestrian or two make? Or rear-ending a smaller car with a new baby in the back seat? Maybe he’ll smack into another cool dude flipping through music albums and they can take each other off the map. But it seldom works that way; usually the dead include innocent people who were doing nothing stupid at all.

That, clearly, should be where the line is drawn: when our obsession with high tech and cool toys means we will be killing other folks. But high tech cool toys make a lot of money.

To the dismay of safety advocates already worried about driver distraction, automakers and high-tech companies have found a new place to put sophisticated Internet-connected computers: the front seat.

Technology giants like Intel and Google are turning their attention from the desktop to the dashboard, hoping to bring the power of the PC to the car. They see vast opportunity for profit in working with automakers to create the next generation of irresistible devices.

This week at the Consumer Electronics Show, the neon-drenched annual trade show here (New York City), these companies are demonstrating the breadth of their ambitions, like 10-inch screens above the gearshift showing high-definition videos, 3-D maps and Web pages.

The first wave of these “infotainment systems,” as the tech and car industries call them, will hit the market this year. While built-in navigation features were once costly options, the new systems are likely to be standard equipment in a wide range of cars before long. They prevent drivers from watching video and using some other functions while the car is moving, but they can still pull up content as varied as restaurant reviews and the covers of music albums with the tap of a finger.

It really is beside the point to blame Intel and Google. Drunk drivers kill people and nobody blames Old Crow. Or, as the NRA folks like to say, “Guns don’t kill, people do.” People, lacking the common sense to admit that hurtling around in a few tons of steel requires paying attention while you hurtle, are going to kill people with these new toys.

Safety advocates say the companies behind these technologies are tone-deaf to mounting research showing the risks of distracted driving — and to a growing national debate about the use of mobile devices in cars and how to avoid the thousands of wrecks and injuries this distraction causes each year.

“This is irresponsible at best and pernicious at worst,” Nicholas A. Ashford, a professor of technology and policy at the Massachusetts Institute of Technology, said of the new efforts to marry cars and computers. “Unfortunately and sadly, it is a continuation of the pursuit of profit over safety — for both drivers and pedestrians.”

One system on the way this fall from Audi lets drivers pull up information as they drive. Heading to Madison Square Garden for a basketball game? Pop down the touch pad, finger-scribble the word “Knicks” and get a Wikipedia entry on the arena, photos and reviews of nearby restaurants, and animations of the ways to get there.

A notice that pops up when the Audi system is turned on reads: “Please only use the online services when traffic conditions allow you to do so safely.”

Oh, sure. As if someone with the arrogance to believe he or she can drive a car while drinking a latte, negotiating a business deal and reserving tickets to the ballgame is going to notice a little thing like a kid on a wobbly bike just ahead.

The technology and car companies say that safety remains a priority. They note that they are building in or working on technology like voice commands and screens that can simultaneously show a map to the driver and a movie to a front-seat passenger, as in the new Jaguar XJ.

“We are trying to make that driving experience one that is very engaging,” said Jim Buczkowski, the director of global electrical and electronics systems engineering at Ford. “We also want to make sure it is safer and safer. It is part of what our DNA will be going forward.”

Ford’s new MyFord system lets the driver adjust temperature settings or call a friend while the car is in motion, while its built-in Web browser works only when the car is parked. Audi says it will similarly restrict access to complex and potentially distracting functions. But in general, drivers will bear much of the responsibility for limiting their use of these devices.

Drivers are proving every day that they would rather multi-task than pay attention to their driving. Lives are lost every hour to distracted drivers. More lives will be lost to people engaging in Mr. Buczkowski’s driving experience because driving without paying attention is not part of our DNA.

There is a family joke around our house about my husband, who doesn’t eat, drink or talk on cell phones while riding and has certainly never drunk anything or phoned anybody himself while driving, suggesting that “a car is something intended to get you from point A to point B.”

Maybe we should quit laughing.

Driven to Distraction – Despite Risks, Carmakers Integrate the Web With the Dash – Series – NYTimes.com.

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