Tag: United States

California/Education/Environment/Health/Lifestyle/Medicine/seniors/USA/Women
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Your doctor's in shape… but may just be getting in shape to retire

by Fran Johns

U.S. doctors as a group are “leaner, fitter and live longer than average Americans… male physicians keep their cholesterol and blood pressure lower… women doctors are more likely to use hormone-replacement therapy than their patients,” according to several recent surveys.

That’s the good news.

The bad news is that they are taking all this health and fitness into early retirement. And thanks to the hordes of baby boomers hanging up their stethoscopes for good, finding enough doctors in any shape at all is going to be a challenge, particularly in light of the numbers of newly insured.

Nearly 40 percent of doctors are 55 or older, according to the Center for Workforce Studies of the Association of American Medical Colleges. Included in that group are doctors whose specialties will be the pillars of providing care in 2014, when the overhaul kicks in; family medicine and general practitioners (37 percent); general surgeons (42 percent); pediatrics (33 percent), and internal medicine and pediatrics (35 percent).

About a third of the much larger nursing workforce is 50 or older, and about 55 percent expressed an intention to retire in the next 10 years, according to a Nursing Management Aging Workforce Survey by the Bernard Hodes Group. New registered nurses are flowing from colleges, but not enough to replace the number planning to leave the profession.

“Moving into the future, we see a very large shortage of nurses, about 300,000,” said Peter Buerhaus, a nurse and health-care economist and a professor at Vanderbilt University. “That number does not account for the demand created by reform. That’s a knockout number. It knocks the system down. It stops it.”

According to the census, baby boomers include the 66 million Americans born between 1946 and 1964.

In an article for the Journal of the American Medical Association, Buerhaus and colleagues Douglas Staiger and David Auerbach predicted that there will be at least 100,000 fewer doctors in the workplace than the 1.1 million the federal government projects will be needed in 2020 under the health-care overhaul.

“There’s a much more rapid retirement of physicians,” Buerhaus said. “What does this retirement mean? This will mean at least 100,000 fewer doctors in the workplace in 2020.”He said the article does not estimate the change in demand or the level of recruitment by medical colleges, which is being beefed up significantly under the health-care law.

Although current studies involve more than a little conjecture — Will professions in the medical field continue to be as attractive as other areas? Will doctors and nurses work longer if truly needed? — there is no doubt about the coming shortage.

Lori Heim, president of the American Association of Family Practitioners, said someone might soon have to replace her. “My age group is looking at when we are going to retire,” said Heim, who is 54. “More physicians are changing their practice, doing things that have less calls. They want administrative roles.”

Heim said her statement is based on an impression. “I haven’t seen any numbers on this.” But, she said, her association is among the many that for years have pointed out the shortage of primary care doctors and nurses to the White House and Congress.

Staying healthy might be the best defense.

Retirements by baby-boomer doctors, nurses could strain overhaul.

California/Environment/Health/Lifestyle/Medicine/seniors/teens/USA/Women
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New 'morning after' pill meets opposition from abortion foes

by Fran Johns
MADRID, SPAIN - SEPTEMBER 27: In this photo i...
Image by Getty Images via @daylife

With global overpopulation among the most critical problems of the 21st century, news of a highly effective contraceptive becoming available in the U.S. would seem very good news indeed. But as health writer Rob Stein reports in the Washington Post, it may not happen:

A French drug company is seeking to offer American women something their European counterparts already have: a pill that works long after “the morning after.”

The drug, dubbed ella, would be sold as a contraceptive — one that could prevent pregnancy for as many as five days after unprotected sex. But the new drug is a close chemical relative of the abortion pill RU-486, raising the possibility that it could also induce abortion by making the womb inhospitable for an embryo.

Plan B (the last emergency contraceptive vetted by the FDA), which works for up to 72 hours after sex, was eventually approved for sale without a prescription, although a doctor’s order is required for girls younger than 17. The new drug promises to extend that period to at least 120 hours. Approved in Europe last year, ella is available as an emergency contraceptive in at least 22 countries.

“With ulipristal (ella), women will be enticed to buy a poorly tested abortion drug, unaware of its medical risks, under the guise that it’s a morning-after pill,” said Wendy Wright of Concerned Women for America, which led the battle against Plan B.

Plan B prevents a pregnancy by administering high doses of a hormone that mimics progesterone. It works primarily by inhibiting the ovaries from producing eggs. Critics argue it can also prevent a fertilized egg from implanting in the womb, which some consider equivalent to an abortion.

Ella works as a contraceptive by blocking progesterone’s activity, which delays the ovaries from producing an egg. RU-486, too, blocks the action of progesterone, which is also needed to prepare the womb to accept a fertilized egg and to nurture a developing embryo. That’s how RU-486 can prevent a fertilized egg from implanting and dislodge growing embryos. Ella’s chemical similarity raises the possibility that it might do the same thing, perhaps if taken at elevated doses. But no one knows for sure because the drug has never been tested that way. Opponents of the drug are convinced it will. “It kills embryos, just like the abortion pill,” said Donna Harrison, president of the American Association of Pro-Life Obstetricians and Gynecologists.

A federal panel will convene this week to consider endorsing the drug. Those favoring approval are worried that the ambiguous sentiments, and the power of abortion foes who seem poised to weigh in against it, will influence the outcome.

“FDA should be a ‘Just the facts ma’am’ organization,” said Susan F. Wood, an associate professor at the George Washington University School of Public Health and Health Services who resigned from the FDA to protest delays in making Plan B more accessible. “I’m hoping the FDA will take that position.”

There is an great unmet need out there for emergency contraception that is effective as this for so long,” said Erin Gainer, chief executive of HRA Pharma of Paris. Studies involving more than 4,500 women in the United States and Europe show that ella is safe, producing minor side effects including headaches, nausea and fatigue, she said.

The company has no plans to test ella as an abortion drug, but it did not appear to cause any problems for the handful of women who have become pregnant after taking the drug, she said.

“The people who are opposing this are not just opposed to abortion,” said Amy Allina, program director at the National Women’s Health Network. “They also opposed contraception and they are trying to confuse the issue.”

Back to the issue: the planet has a finite amount of space for human beings. When one human being (and often two human beings acting as one) seeks not to add an unwanted human being, would it not make sense to furnish all available safe, legal tools to assist in that humanitarian effort?

Stay tuned for the answer from the FDA.

New ‘morning-after’ pill, ella, raises debate over similarity to abortion drug.

California/Health/Law/Lifestyle/Media/Politics & Causes/seniors/teens/Women
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Judge to rule on same-sex marriage

by Fran Johns

Can gay marriage be a fundamental right, when all legal protection has been denied until recently? In a state that treats domestic partners the same as spouses, “what purpose is served by differentiating – in name only – between same-sex and opposite-sex unions?”

These are two of the questions sent to opposing lawyers by U.S. District Judge Vaughn Walker, who will hear their closing arguments next Wednesday in the San Francisco case being watched for broader implications. Supporters of gay rights are seeking to overturn Proposition 8, California’s voter-approved ban on gay marriage.

The closing arguments won’t be watched by just anybody. Judge Walker ruled late this week that arguments may not be televised beyond the closed circuit of the courthouse. So you’ll have to be on site to follow the proceedings up close and personal. Media organizations had sought to have the session, which is expected to last all day, televised; proponents of Prop 8 argued against the idea.

The denial means “the public will again only hear about this case second-hand,” said Thomas Burke, the media groups’ lawyer.

Andrew Pugno, a lawyer for sponsors of the ballot measure that banned same-sex marriage, countered that “the purpose of the court is not to entertain or educate the public, but to protect the right to a fair and impartial trial.” The sponsors had opposed televising any trial proceedings.

Two same-sex couples and the city of San Francisco have sued to overturn Proposition 8, the November 2008 initiative that amended the California Constitution to define marriage as the union of a man and a woman.

Walker presided over the non-jury trial in January. He had proposed to televise the trial live to several federal courthouses around the nation and record the proceedings for a delayed Internet posting on YouTube.

The telecast, which would have been the first for a federal court in California, was blocked by the U.S. Supreme Court just before the trial started.

In a 5-4 ruling, the court said Walker hadn’t given the public enough time to comment on the proposed change in court rules. The court also cited claims by Prop. 8’s sponsors that showing the proceedings outside the courthouse might intimidate witnesses.

Media organizations asked Walker last month to approve televising the closing arguments. They said that airing a hearing that included only lawyers and the judge couldn’t affect witnesses or the fairness of the trial.

Prop 8 supporters argued, though, that cameras in the courtroom could prompt “grandstanding and avoidance of unpopular decisions or positions.” Whatever the judge’s decision, it is guaranteed to be widely unpopular.

No TV for closing arguments in Prop. 8 trial.

California/Education/Health/Lifestyle/Money/seniors/USA/Women
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Aging brains can still follow the $$

by Fran Johns
day in the life: lunch money
Image by emdot via Flickr

Balancing the checkbook isn’t as easy as it used to be? You can’t remember where you put the keys? OhmyGOODness, you say, I must be getting old.

The bad news is, age happens. The good news is, it does not necessarily bring a concurrent loss in cognitive ability. Get a new calculator, maybe one with a bigger keypad. Accept the fact that you’ve been misplacing the keys, occasionally, since you started driving.  And take heart in a new study from Duke University indicating that, all things considered, age is not a determining feature in the ability to make sound economic decisions.

Just because your mother has turned 85, you shouldn’t assume you’ll have to take over her financial matters. She may be just as good or better than you at making quick, sound, money-making decisions, according to researchers at Duke University.

“It’s not age, it’s cognition that makes the difference in decision-making,” said Scott Huettel, PhD, associate professor of psychology and neuroscience and director of the Duke Center for Neuroeconomic Studies. He recently led a laboratory study in which participants could gain or lose money based on their decisions.

“Once we accounted for cognitive abilities like memory and processing speed, age had nothing to do with predicting whether an individual would make the best economic decisions on the tasks we assigned,” Huettel said.

The study was published in the Psychology and Aging journal, published by the American Psychological Association.

Working with 54 older adults between 66 and 76 years old, and 58 younger adults between 18 and 35, the Duke researchers assigned a variety of economic tasks that required different types of risky decisions, so that participants could gain or lose real money.

On a bell curve of performance, there was overlap between the younger and older groups. Many of the older subjects (aged 66 to 76) made similar decisions to many of the younger subjects (aged 18 to 35). “The stereotype of all older adults becoming more risk-averse is simply wrong,” Huettel said.

Getting to the heart — and brain — of the issue, PositScience blogger Ted Baxa says “this finding will come as no surprise to many.  Legendary investor Warren Buffett, 79, continues to outperform fund managers half his age.  The message to take from this article is that age by itself, as the saying goes, is just a number.”

When you finish with the checkbook, in other words, you might want to get busy on your brain exercises.

Cognitive Ability, Not Age, Predicts Risky Decisions – DukeHealth.org.

California/Health/Lifestyle/seniors/USA/Women
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Baby boomers & long-term care: innovation is the key

by Fran Johns

Baby boomers well into their final careers are increasingly discovering a new one: caregiver to elderly parents. And if current studies are to be believed, boomers themselves are more than likely to need long-term care. A new report out of Canada suggests that “baby boomers will have to develop non-traditional caregiver networks, or pay for long-term care facility care” in our neighbor to the north.

Today, up to 70% of the care provided to the elderly comes from an informal network of spouses, children and close family. But the baby-boom generation is unlike previous generations in that they have relatively few children, and stable couples are a rarity, according to researchers at the Université de Montréal. Baby boomers “risk finding themselves in difficult circumstances and might have to turn to the public system or pay their way,” says professor Jacques Légaré, who authored the study of aging boomers.

Friends, siblings or cousins could make up a new, non-traditional model of caregiving for seniors who can’t afford assisted living or skilled nursing care, Légaré suggests. The paper was presented this week at the 2010 Congress of the Humanities and Social Sciences at Concordia University in Montreal.

In the U.S., most surveys put the figure of “informal caregivers” — family members or friends — closer to 80%, and estimates of the number of boomers likely to need long-term care themselves go up with virtually every new study.

Choices in long-term care also are going up, though. The National Clearinghouse for Long-Term Care Information is a government-run (Department of Health and Human Services) site that offers information and resources for long-term care planning — along with some eye-opening information about costs and coverage.

Baby boomers can take heart in the fact that innovative models are being developed in many states, and possibilities are being pursued in both public and private sectors.  Non-traditional networks may be the new best thing for this looming fact of boomer futures.

Baby boomers may need to find new, innovative care networks, report finds – McKnight’s Long Term Care News.

California/crime/Health/Law/Lifestyle/Politics & Causes/Religion/seniors/teens/USA/Women
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Abortion foes are winning, folks

by Fran Johns
WASHINGTON - JANUARY 22: A pro-choice advocat...
Image by Getty Images via @daylife

Will women in the U.S. soon be unable to have a safe, legal abortion? That scary possibility becomes more likely every day. Does anyone really understand the pre-Roe v Wade horrors which abortion foes want to see returned? Not really. That’s because huge numbers of women who could have told the horror stories died at the hands of back-alley abortionists, and those of us who did survive are dying off fast, unheard.

This space welcomes writer John Leland’s front page article in today’s New York Times to the voices crying in the wilderness — just in case someone other than Nancy Keenan might care to listen.

At least 11 states have passed laws this year regulating or restricting abortion, giving opponents of abortion what partisans on both sides of the issue say is an unusually high number of victories. In four additional states, bills have passed at least one house of the legislature.

In a flurry of activity last week, Gov. Haley Barbour of Mississippi signed a bill barring insurers from covering abortion in the new insurance exchanges called for under the federal health care overhaul, and the Oklahoma Legislature overrode a veto by Gov. Brad Henry of a bill requiring doctors who perform abortions to answer 38 questions about each procedure, including the women’s reasons for ending their pregnancies.

It was the third abortion measure this session on which the Legislature overrode a veto by Mr. Henry.

At least 13 other states have introduced or passed similar legislation this year. The new laws range from an Arizona ban on coverage of abortion in the state employees’ health plan to a ban in Nebraska on all abortions after 20 weeks, on the grounds that the fetus at that stage can feel pain.

Fetal pain is a subject of debate in the medical community, and the United States Supreme Court has recognized the government’s right to ban abortions only after a fetus becomes viable, which is more than a month later.

“Fetal pain” is just one ploy; its determination can easily go from 20 weeks backward to ban the morning-after pill. Other ploys? Forcing a pregnant woman to look at ultrasound pictures, prohibiting a physician from discussing fetal abnormalities with his/her patient, and “in Utah, after a pregnant 17-year-old paid a man $150 to beat her in an effort to induce a miscarriage, legislators passed a law that would allow a woman in such circumstances to be charged with homicide.”

Unwanted pregnancies happen. When they do, the man involved can simply walk away, as countless millions have done and will continue to do. Why, then, should so many men purporting to have such omnipotent wisdom be empowered to eliminate a woman’s right to choose what happens to her body?

It’s going to get worse. Unless people — and that includes males of the species who still have brains and some concern for the future of womankind — start paying attention, and standing up to the fundamentalists of all stripes, the U.S. Conference of Catholic Bishops and the religious factions who claim authority over all women, it’s going to get worse than many people in today’s society can even begin to imagine.

Opponents of Abortion Advance Cause at State Level – NYTimes.com.

General interest
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One more (anti)-gun law progresses

by Fran Johns
Glock 19 Pistol,
Image via Wikipedia

Yesterday the California state Assembly approved a bill 45-25 that would ban “Open Carry” — the carrying of unloaded handgun in public. The bill now goes to the Senate.

The measure by Assemblywoman Lori Saldaña, D-San Diego, came in response to advocates who have been toting unloaded pistols in public in an attempt to expand Second Amendment gun rights.

She and other Democrats behind the measure, AB1934, called it a public safety issue and said law enforcement groups support the bill. Republicans said the measure targets law-abiding citizens.

Visitors to this space reading earlier posts about the Open Carry debate were essentially unanimous in saying I have no constitutional right to feel safe in public; 45 state Assembly members apparently see banning Open Carry as a way for people to be safe in public. Or more so, to some extent. The debate continues.

Assembly bans openly carrying guns in public.

California/crime/Environment/General interest/Health/Law/Lifestyle/Politics & Causes/seniors/teens/USA/Women
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Guns, drugs & sit/lie laws: who's got the real rights?

by Fran Johns

Discussions stirred up by the comments in this space a few days ago (see below) concerning gun rights v public safety rights ranged from the specifically pro-gun and pro-open carry (“citizens use firearms for self-defense between 150,000 and 3,052,717 times a year. The lowest estimate comes to about 410 times a day, and the highest estimate is 8,363 times a day,” says willbill; “How many times has an open carry proponent shot someone? If you use statistics rather than “from the hip” anti gun rhetoric, you will find legal gun owners are not the problem. Illegal gun owners are the problem,” says airtechjr) to the pointedly anti-gun (“Besides looking really stupid, having a gun visible – even if unloaded – is scary! Do you know how fast you can jam a clip into a Glock Automatic? 3 seconds,” says Tom Medlicott.) Emeryville, CA Police Chief Ken James says it’s 1.3 seconds.

In the long run, though, the argument is not about gun rights v public safety rights, says carlfromchicago, because I have no constitutional right to feel safe in public. And this all started because I admittedly did not feel safe while attending a panel discussion on the proposed California Open Carry ban (AB #1934 now in the state legislature) and learning that I was the only unarmed citizen within three solid rows of citizens carrying (presumably legal) concealed weapons. According to Carl,

Whether people are comfortable around guns is a very interesting and relevant social discussion. But this is not a question of two rights pitted against one another. As much as we all want to feel safe, it’s simply a frame of mind. The right you have is to think what you wish, and feel what you wish … but that compels no one, or the government, to ensure what you think or what you wish becomes reality for everyone.

This brings us to San Francisco’s currently proposed sit/lie ordinance. It says (more or less) you may not sit or lie on the sidewalk. It means, please get the drug pushers and increasingly obnoxious defecators-on-front-steppers out of the ‘hood. It arose out of frustrations in San Francisco’s famously tolerant Haight Ashbury (remember the 60s?) neighborhood where things recently have gotten somewhat out of hand.

This space is a strong supporter of humane treatment and expanded rights for homeless. Countless local and national programs, some good, some better, are in place and worth everyone’s attention; I try to make regular, teeny contributions of time and resources. But should I have the right to walk along Haight Street in broad daylight without tripping on a soiled, zoned-out kid whose dog is only loosely tied next to him? That’s the question. And should we now have a law enabling law enforcement officials to wake him up (if possible), move him along or toss him in the paddy wagon to be deposited in a jail cell? That may not be the answer. Either way, it is generating great heat and not a lot of light in my beloved hometown.

San Francisco is not alone in this dilemma. City Watchdog blogger Melissa Griffin, on her Sweet Melissa blog, reports having dug up a report (“Big pdf here,” she warns) on “Homes Not Handcuffs: The Criminalization of Homelessness in U.S. Cities.”

The report surveyed laws in 235 cities (including San Francisco) and made some interesting findings:

  • 30 percent prohibit sitting or lying in certain public places.
  • 47 percent prohibit loitering in certain public places and 19 percent prohibit it citywide.
  • 47 percent prohibit begging in certain public places; 49 percent prohibit aggressive panhandling; and 23 percent have citywide prohibitions on begging.

At almost 200 pages, the report provides an exhaustive discussion of the legal landscape in 90 cities. Some have definitely used creative methods:

  • In Billings, Mont., it’s illegal to “aggressively solicit” and/or lie about being “from out of town, a veteran, disabled or homeless” while asking for money.
  • In Boerne, Texas, all panhandlers have to buy a license to solicit (like other solicitors and vendors) at a cost of $115. Durham, N.C., charges $20 for a panhandling permit.
  • Las Vegas, briefly had a law that prohibited sleeping “within 500 feet of a deposit of urine or feces.”

I am getting right back on the fence. Public safety does seem to me both an appropriate issue for discussion and an individual right. How far it can be legislated (there are over 20,000 gun laws already on the books across the country, uncertain wrote in) is debatable. I still wish guns would just go away. I don’t know what to do about obnoxious sitters/liers upon the sidewalks. Both seem obstacles to the peaceful communities some of us have in our memories and all of us have in our imaginations.

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