70 End-of-Life care eats up 12% of the health budget - yet we have no say in How to Die

(1) End-of-Life care eats up 12% of the health budget - yet we have no say in How to Die
(2) McDonald's, KFC and Pizza Hut agree to stop targeting kids
(3) America's Medicated Army
(4) Psychotropic drugs in the active-duty military
(5) Obama warns of Hazards of Mercury, but FDA approves Mercury Dental Fillings

(1) End-of-Life care eats up 12% of the health budget - yet we have no say in How to Die

From: Gary Kohls <gkohls@cpinternet.com> Date: 31.08.2009 07:10 PM

Harry and Louise must die

We could save billions in healthcare if we could accept death and say goodbye outside the hospital

ANNE MOORE, For Salon.com

Aug. 4, 2009

http://www.startribune.com/lifestyle/health/55788762.html?elr=KArksi8cyaiUeyD8_o8cyaiUiD3aPc:_Yyc:aUU

http://www.salon.com/mwt/feature/2009/08/04/dying/index.html

Next year we'll spend $17 billion in Medicare dollars on an oxymoron: preventing inevitable death.

At the end of our long and increasingly longer lives, when we are terminally ill and in the last months of life, we must accept our bodies' decline, face our own mortality, gather our families and say goodbye. Say no to feeding tubes, ventilators, resuscitators, the isolation of ICU.

End-of-life care eats up 12 percent of U.S. health care dollars; next year, we'll spend $135 billion on it. That's not money spent getting well and extending life, that's money spent preventing and easing death in terminally ill patients. Indeed, 40 percent of Medicare dollars are spent in the last 30 days of life.

Where does the money go? Hospitals. Half of us die in hospitals, 20 percent of us in their ICU beds, which cost 10 times as much, on a daily basis, as hospice care. ICU costs $1,500 daily; on average, $10,900 the first day. Don't blame hospitals or physicians. We check in, we ask to be saved. Doctors provide care; they're not supposed to cut off or limit care. Besides, they might get sued.

We are the problem. We are Harry and Louise, the fictional suburban couple who keep cropping up in TV ads, paid for by health industry groups. In 1994, they criticized government involvement in Clinton's health care plan, and now in 2009 they support government reform in Obama's plan. In each case, Harry and Louise embody and fan our fears about limiting care. They want it all, every choice, every procedure. They want doctors to "do everything possible." Harry and Louise must die.

How did we get into this mess? The 30 percent end-of-life spending rate hasn't changed since the 1970s, when Medicare began tracking it. We've been dying poorly -- at great expense -- for decades.

We did this to ourselves. We moved death out of homes and into hospitals, and once there, left poor or no instructions.

Besides, accept death? We're Americans! We're hard-wired to live fully and richly. We certainly will not go gently into that good night. Every day we cheat death. We buy automobiles with airbags on all sides, wear helmets when we bike and face infants backward in car seats. Many of us feel most alive flirting with death: We jump out of airplanes, surf with sharks and ski off-piste. We expect to be rescued from an avalanche and to have miracles happen in the ER. How do we know? We've seen it on TV.

That we fear death is understandable. Among human experiences, it's the sole unknown. No matter where or how we live -- in cities or countrysides, extreme skiing or sunning by the pool -- death is the only part of life we can't know.

But when it comes to dying, we act the same: We call 911 and leave decisions to medical professionals. We do everything medically possible to prevent death. We get hooked up. Do we fend off death? Nope.

In a study of terminally ill patients, one group received preventive care until death. The other group chose to be treated for pain with drugs, typically morphine, in a hospice setting. Which group lived longer? Patients treated only for pain lived 29 days more.

Hospice focuses on comforting the terminally ill patient and family, at a health facility or at home, the last six months of life. If a terminally ill person in hospice stops breathing, they die. If their heart stops, they die. If they stop eating, they'll die within weeks.

If a terminally ill person who's hospitalized stops breathing, they're intubated. If their heart stops, they're resuscitated. If they stop eating, a feeding tube is implanted. Death is prevented, life is extended -- but the person is still terminally ill with cancer, or kidney disease, or heart disease or diseases of the brain.

Medical experts say feeding tubes extend life for those who, in the past, would die naturally, without medical intervention. When people near death, some can't swallow, some with dementia don't recognize food, others aren't interested in eating. In many nursing homes, when a patient doesn't eat, the choice is to accept end-of-life hospice care or be fitted with a feeding tube.

Loss of appetite is simply a stage in dying. Dying patients who stop eating drink water, sleep a lot and typically die within two weeks, of dehydration. It can be a gentle death.

Why should we care which path people take? Well, it comes out of our pockets. Medicare is funded by Social Security payroll taxes, and 75 percent of those who die each year are 65 or older, enrolled in Medicare. If we died more gently, we'd cut spending.

End of life choices

How? We ask terminally ill people how they want to die. Asking doesn't happen often enough, say medical experts who specialize in care for the dying. Terminally ill patients and their families need to make end-of-life choices, but they're often not asked to make them in a hospital setting. When no one asks, and no one answers, guess what? Hospitals provide aggressive, life-extending care.

That kind of care for the terminally ill hospital patient "is a preventable category of expenditure," says Julie Goldstein, M.D., section chief, Clinical Ethics and Palliative Medicine, at Advocate Illinois Masonic Medical Center. "It's a preventable tragedy to the patient, and to the system."

Goldstein says many patients, when asked by physicians whether they want to die in a hospital or at home with loved ones, "have of course chosen home." That's not always the case, she says. But what's important is that families be given the choice before being bound to a hospital in those final days.

Beyond the finances

Let's look beyond the financial cost: If you spend your last days in ICU, you're necessarily cut off from most people because of risk of infection. There's no sofa or extra bed for those who want to be with you as you die. You die alone.

If you spend your last days in hospice care, your family can come and go. They can sit beside your bed and read to you, or tell you a story, play music, watch TV, hold your hand. Is it messy to die at home? Yes. So is birth. We give birth at home; we YouTube births. We need to do the same for death. We need to welcome it again into our homes and our lives.

For 20 years, Loretta Downs, president of the Chicago End-of-Life Coalition, helped people die in a hospice setting. Downs envisioned a private place within the nursing home for residents in their last days of life, with enough space for family to gather, an extra bed for overnight visits, space for residents in wheelchairs to come by.

Nursing home directors agreed, and provided dedicated space: a double room outfitted with one hospital bed and cozy furnishings for visitors. Downs named it the Chrysalis Room, for the transformational place caterpillars create before turning into butterflies. Chrysalis Rooms have been replicated in a dozen nursing homes in the United States, says Downs, and more are in the works.

Downs used the room she helped create in 2006 when her mother was dying. "I moved in. It felt like home. I photographed my mother's last eight days, so I could share the experience later." Residents visited; so did nursing home staff, family and friends. "Visiting the dying helps others die," she says. "We've hidden death."

We can change. We can die with dignity and love, less expensively. We can put our fears to rest. Fill out a living will; say no to excessive care. Own the way you die. And die as you lived, surrounded by family and friends.

(2) McDonald's, KFC and Pizza Hut agree to stop targeting kids

Lara Sinclair | June 25, 2009

http://www.theaustralian.news.com.au/business/story/0,28124,25689435-36418,00.html

FAST food restaurants including McDonald's, KFC and Pizza Hut have signed up to new rules preventing them from advertising unhealthy food products to children aged under 14.

But the rules do not ban the use of premiums, or toys sold with food - a major complaint of parents' groups - as long as the food, not the toy, is the focus of the marketing.

Seven fast food chains _ also including Hungry Jack's, Oporto, Red Rooster and Chicken Treat _ have signed up to the rules, which state that any food or beverage advertising to children must be for healthy food, as determined by national nutritional guidelines, and must encourage a healthy lifestyle.

The fast food restaurants are nine months behind food companies, which last year announced a similar initiative.

The Australian Association of National Advertisers said the companies represented the majority of television fast food advertisers in Australia.

"It would be fair to say that between the Australian Food and Grocery Council initiative and this Quick Service Restaurants initiative we have a fairly comprehensive solution for the issues around responsible advertising of healthier food choices to children," AANA chief executive Scott McClennan said.

The move pre-empts a report from the federal government's Preventative Health Taskforce, due next week, that could go further and recommend bans on junk food advertising in popular children's and family television programs.

The taskforce was set up to find ways to reduce increasing child obesity rates and address associated lifetime health issues and treatment costs for obese or overweight adults.

The restaurants have banned the use of popular personalities and licensed characters to market unhealthy foods, but companies may still use characters they own to promote their brands.

The new rules appear to ban product advertising in schools, but they leave open the possibility when a school administration agrees or the marketing is associated with healthy lifestyle activities.

(3) America's Medicated Army

From: "Gary Kohls" <gkohls@cpinternet.com Date: Fri, 6 Jun 2008 21:30:59 -0500

America's Medicated Army

Thursday, Jun. 05, 2008 By MARK THOMPSON

http://www.time.com/time/nation/article/0,8599,1811858,00.html

Seven months after Sergeant Christopher LeJeune started scouting Baghdad's dangerous roads ˜ acting as bait to lure insurgents into the open so his Army unit could kill them ˜ he found himself growing increasingly despondent. "We'd been doing some heavy missions, and things were starting to bother me," LeJeune says. His unit had been protecting Iraqi police stations targeted by rocket-propelled grenades, hunting down mortars hidden in dark Baghdad basements and cleaning up its own messes. He recalls the order his unit got after a nighttime firefight to roll back out and collect the enemy dead. When LeJeune and his buddies arrived, they discovered that some of the bodies were still alive. "You don't always know who the bad guys are," he says. "When you search someone's house, you have it built up in your mind that these guys are terrorists, but when you go in, there's little bitty tiny shoes and toys on the floor ˜ things like that started affecting me a lot more than I thought they would."

So LeJeune visited a military doctor in Iraq, who, after a quick session, diagnosed depression. The doctor sent him back to war armed with the antidepressant Zoloft and the anti-anxiety drug clonazepam. "It's not easy for soldiers to admit the problems that they're having over there for a variety of reasons," LeJeune says. "If they do admit it, then the only solution given is pills."

While the headline-grabbing weapons in this war have been high-tech wonders, like unmanned drones that drop Hellfire missiles on the enemy below, troops like LeJeune are going into battle with a different kind of weapon, one so stealthy that few Americans even know of its deployment. For the first time in history, a sizable and growing number of U.S. combat troops are taking daily doses of antidepressants to calm nerves strained by repeated and lengthy tours in Iraq and Afghanistan. The medicines are intended not only to help troops keep their cool but also to enable the already strapped Army to preserve its most precious resource: soldiers on the front lines. Data contained in the Army's fifth Mental Health Advisory Team report indicate that, according to an anonymous survey of U.S. troops taken last fall, about 12% of combat troops in Iraq and 17% of those in Afghanistan are taking prescription antidepressants or sleeping pills to help them cope. Escalating violence in Afghanistan and the more isolated mission have driven troops to rely more on medication there than in Iraq, military officials say.

At a Pentagon that keeps statistics on just about everything, there is no central clearinghouse for this kind of data, and the Army hasn't consistently asked about prescription-drug use, which makes it difficult to track. Given the traditional stigma associated with soldiers seeking mental help, the survey, released in March, probably underestimates antidepressant use. But if the Army numbers reflect those of other services ˜ the Army has by far the most troops deployed to the war zones ˜ about 20,000 troops in Afghanistan and Iraq were on such medications last fall. The Army estimates that authorized drug use splits roughly fifty-fifty between troops taking antidepressants ˜ largely the class of drugs that includes Prozac and Zoloft ˜ and those taking prescription sleeping pills like Ambien.

In some ways, the prescriptions may seem unremarkable. Generals, history shows, have plied their troops with medicinal palliatives at least since George Washington ordered rum rations at Valley Forge. During World War II, the Nazis fueled their blitzkrieg into France and Poland with the help of an amphetamine known as Pervitin. The U.S. Army also used amphetamines during the Vietnam War.

The military's rising use of antidepressants also reflects their prevalence in the civilian population. In 2004, the last year for which complete data for the U.S. are available, doctors wrote 147 million prescriptions for antidepressants, according to IMS Health, a pharmaceutical-market-research firm. This number reflects in part the common practice of cycling through different medications to find the most effective drug. A 2006 federally funded study found that 70% of those taking antidepressants along with therapy experience some improvement in mood.

When it comes to fighting wars, though, troops have historically been barred from using such drugs in combat. And soldiers ˜ who are younger and healthier on average than the general population ˜ have been prescreened for mental illnesses before enlisting.

The increase in the use of medication among U.S. troops suggests the heavy mental and psychological price being paid by soldiers fighting in Iraq and Afghanistan. Pentagon surveys show that while all soldiers deployed to a war zone will feel stressed, 70% will manage to bounce back to normalcy. But about 20% will suffer from what the military calls "temporary stress injuries," and 10% will be afflicted with "stress illnesses." Such ailments, according to briefings commanders get before deploying, begin with mild anxiety and irritability, difficulty sleeping, and growing feelings of apathy and pessimism. As the condition worsens, the feelings last longer and can come to include panic, rage, uncontrolled shaking and temporary paralysis. The symptoms often continue back home, playing a key role in broken marriages, suicides and psychiatric breakdowns. The mental trauma has become so common that the Pentagon may expand the list of "qualifying wounds" for a Purple Heart ˜ historically limited to those physically injured on the battlefield ˜ to include posttraumatic stress disorder (PTSD). Defense Secretary Robert Gates said on May 2 that it's "clearly something" that needs to be considered, and the Pentagon is weighing the change.

Using drugs to cope with battlefield traumas is not discussed much outside the Army, but inside the service it has been the subject of debate for years. "No magic pill can erase the image of a best friend's shattered body or assuage the guilt from having traded duty with him that day," says Combat Stress Injury, a 2006 medical book edited by Charles Figley and William Nash that details how troops can be helped by such drugs. "Medication can, however, alleviate some debilitating and nearly intolerable symptoms of combat and operational stress injuries" and "help restore personnel to full functioning capacity."

Which means that any drug that keeps a soldier deployed and fighting also saves money on training and deploying replacements. But there is a downside: the number of soldiers requiring long-term mental-health services soars with repeated deployments and lengthy combat tours. If troops do not get sufficient time away from combat ˜ both while in theater and during the "dwell time" at home before they go back to war ˜ it's possible that antidepressants and sleeping aids will be used to stretch an already taut force even tighter. "This is what happens when you try to fight a long war with an army that wasn't designed for a long war," says Lawrence Korb, Pentagon personnel chief during the Reagan Administration.

Military families wonder about the change, according to Joyce Raezer of the private National Military Family Association. "Boy, it's really nice to have these drugs," she recalls a military doctor saying, "so we can keep people deployed." And professionals have their doubts. "Are we trying to bandage up what is essentially an insufficient fighting force?" asks Dr. Frank Ochberg, a veteran psychiatrist and founding board member of the International Society for Traumatic Stress Studies.

Such questions have assumed greater urgency as more is revealed about the side effects of some mental-health medications. Last year the U.S. Food and Drug Administration (FDA) urged the makers of antidepressants to expand a 2004 "black box" warning that the drugs may increase the risk of suicide in children and adolescents. The agency asked for ˜ and got ˜ an expanded warning that included young adults ages 18 to 24, the age group at the heart of the Army. The question now is whether there is a link between the increased use of the drugs in the Iraqi and Afghan theaters and the rising suicide rate in those places. There have been 164 Army suicides in Afghanistan and Iraq from the wars' start through 2007, and the annual rate there is now double the service's 2001 rate.

At least 115 soldiers killed themselves last year, including 36 in Iraq and Afghanistan, the Army said on May 29. That's the highest toll since it started keeping such records in 1980. Nearly 40% of Army suicide victims in 2006 and 2007 took psychotropic drugs ˜ overwhelmingly, selective serotonin reuptake inhibitors (SSRIs) like Prozac and Zoloft. While the Army cites failed relationships as the primary cause, some outside experts sense a link between suicides and prescription-drug use ˜ though there is also no way of knowing how many suicide attempts the antidepressants may have prevented by improving a soldier's spirits. "The high percentage of U.S. soldiers attempting suicide after taking SSRIs should raise serious concerns," says Dr. Joseph Glenmullen, who teaches psychiatry at Harvard Medical School. "And there's no question they're using them to prop people up in difficult circumstances."

(4) Psychotropic drugs in the active-duty military

From: Gary Kohls <gkohls@cpinternet.com Date: 14.05.2009 02:41 PM

Must view video about psychotropic drugs in the active-duty military (50% of suicides among active duty soldiers occur AFTER "treatment" [ie drugs] has been started

Sent: Wednesday, May 13, 2009 1:25 PM

Subject: Must view video about psychotropic drugs in the active-duty military (50% of suicides among active duty soldiers occur AFTER "treatment" [ie drugs] has been started

One has to wonder what (if any) mind-altering, neurotoxic and psychotoxic psych drug(s) the latest stressed-out killer was taking - or withdrawing from? See attachments for the background for asking that question. GGK

 http://abcnews.go.com/International/WoodruffReports/Story?id=6095812&page=1

(5) Obama warns of Hazards of Mercury, but FDA approves Mercury Dental Fillings

From: Ellen H Brown <ellenbrownjd@gmail.com>  Date: 30.08.2009 12:01 PM

The Mercury Mischief: As Obama Warns of Hazards, The FDA Approves Mercury Dental Fillings

http://www.huffingtonpost.com/ellen-brown/the-mercury-mischief-as-o_b_271520.html

 Posted: August 28, 2009 07:02 PM

The government seems to be speaking out of both sides of its mouth, as the President preaches one thing and the FDA does another. If we are going to have "smarter medicine that really works," we need to get politics, lobbies and cronyism out of science.

President Obama has proposed covering the costs of his new medical plan with "smarter" medicine, meaning the adoption of procedures that eliminate inefficiencies and stress prevention. At a town hall meeting in New Hampshire on August 11, 2009, he gave the example of a diabetic needing to have a foot amputated, at a cost of $30,000 to $50,000. It would have been smarter to counsel the patient on diet and weight loss and monitor his medications before amputation was required. The insurance company would have saved money and the patient would have saved a foot.

The 2008 Obama/Biden Plan for a Healthy America also stressed preventive approaches to disease, including the reduction of toxins to which the body is exposed; and chief among these toxins was mercury. The Plan stated as a fundamental goal:

    Reduce Risks of Mercury Pollution. More than five million women of childbearing age have high levels of toxic mercury in their blood, and approximately 630,000 newborns are born at risk every year. The EPA estimates that every year, more than one in six children could be at risk for developmental disorders because of mercury exposure in the mother's womb.

As a Senator, Obama was responsible for extensive legislation reducing environmental exposure to mercury, including a ban on the export of elemental mercury, and legislation to phase out the use of mercury in the manufacture of chlorine.

Mercury can get into the blood by various routes, and one that has been lately in the news is the mercury found in the thimerosol in vaccines. Another source that made the news in July is the mercury released from dental fillings by chewing. The World Health Organization has stated that between 3-17 micrograms of mercury are released into the body each day by chewing, compared to only 2-5 micrograms from fish and all other environmental sources combined. In 1990, the New England Journal of Medicine published an editorial calling mercury amalgam fillings "possibly the chief source of exposure [to mercury] of a large segment of the U.S. population".

Surprise FDA Ruling

When mercury amalgam made the news on July 29, 2009, however, it was not to warn of its hazards. Rather, it was to report the FDA's surprise ruling that mercury fillings are safe. The ruling came after years of foot dragging by the FDA and a wave of consumer lawsuits. A growing consumer movement had amassed so much evidence for the dangers posed by mercury dental fillings that when a court finally ordered the FDA to come out with a ruling, the plaintiffs announced, "We won!" But instead of the declaration they expected, the FDA imposed no restrictions on the use of mercury amalgam. Dentists were not even required to inform their patients that "silver" fillings are composed mostly of mercury. The FDA conceded that it did not know if amalgam was harmful to children under six, pregnant women, or nursing mothers, but it took no steps to protect them. It even pulled from its website an existing neurological risk advisory that said, "Dental amalgams contain mercury, which may have neurotoxic effects on the nervous systems of developing children and fetuses."

Consumer advocates were stunned, as the FDA had earlier agreed to strengthen its warnings against mercury amalgam fillings. The evidence against mercury amalgam dental fillings was considered so compelling that Sweden, Norway, and other countries had already banned their use entirely. Degussa, Germany's largest producer of amalgam and the world's largest producer of metals for dentistry, completely shut down its amalgam production after a federal court ruled that dentists who used it faced legal liability. The FDA was expected to follow suit.

Why its unexpected about-face? Charles Brown, of the National Counsel for consumers for Dental Choice, suggests it had to do with a change in personnel. In May 2009, Dr. Margaret Hamburg succeeded to the post of FDA Commissioner. The Wall Street Journal noted that for five years before that, she served on the board of Henry Schein Inc., a $4 billion firm that distributes medical and dental supplies, including vaccines. Brown wrote skeptically:

    Washington is famous for the revolving door -- those in the party out of power take highly paid corporate positions, then return to government to bail out their benefactors. The new FDA Commissioner, Margaret Hamburg, worked in the Clinton Administration, then went out and became a director at the dental products colossus Henry Schein, earning a quarter million dollars a year for the handful of hours it takes to be a director. Corporations do this because they know the other party will return to power, at which time the corporations will call in their chits.

Science or Politics? The Liability Question

Beyond that potential conflict of interest, there was likely to have been heavy pressure from the American Dental Association, the professional union of dentists. If mercury amalgam were officially declared to be toxic, an estimated two billion mercury amalgam fillings might have to be replaced at practitioners' or insurers' expense, not to mention the flood of lawsuits for medical injuries that would follow.

Dentists could hardly defend by pleading ignorance of mercury's harmful effects, since its health risks have long been known. Lewis Carroll alluded to the toxic effects of mercury in his nineteenth century character the Mad Hatter. Felt hat workers exposed to mercuric nitrate were observed to exhibit emotional symptoms including sudden anger, depression, loss of memory, timidity, insomnia, irritability, hallucinations, delusions and mania, a condition referred to as "mad hatter syndrome." The manufacturer of the product Dispersalloy, consisting of capsules of metal powder mixed with liquid mercury and placed in the patient's mouth, has a warning on its website stating:

    Inhalation of mercury vapor over a long period may cause mercurialism which is characterized by fine tremors and erethism... Erethism may be manifested by abnormal shyness, blushing, self-consciousness, depression or despondency, resentment of criticism, irritability or excitability, headache, fatigue and insomnia. In severe cases, hallucinations, loss of memory and mental deterioration may occur.

Among other disturbing studies prompting consumer concerns was one reported in August 1990 by Drs. Lorscheider and Vimy of the University of Calgary in Alberta, in which twelve radioactive mercury amalgam fillings (a typical number for a human adult) were placed in the mouths of sheep. A control group received fillings made of an inert material. Within thirty days, the sheep that got the amalgam had lost half their kidney function. The study showed that mercury in amalgam fillings is not locked in the teeth but spreads through the body to the organs. Similar data have been reported for monkeys. The isotope labeled mercury showed poisoning of the internal organs and the brain of both sheep and monkeys.

Studies in humans include one conducted at the University of Kentucky, showing significant elevations of mercury in the brains of 180 Kentucky residents who were autopsied after dying of Alzheimer's disease. When the concentrations of trace elements were analyzed, the most important imbalance found was an elevation of mercury. In studies of the cadavers of accident victims, those with a mere five amalgams had three times the amount of mercury in their brain tissues as cadavers without amalgams.

Other studies have linked mercury fillings to multiple sclerosis. In one reported by Colorado State University researcher Robert Siblerud, MS patients having amalgams were compared to MS patients whose amalgams had been removed. The former group was found to have significantly lower levels of red blood cells, hemoglobin, hematocrit, T-Lymphocytes and T-8 suppressor cells (indicating lowered immunity). They also had 33 percent more flare-ups of their symptoms during the previous year. In another study, mercury levels in the cerebrospinal fluid of MS patients were shown to be eight times higher than in controls. Siblerud observed that MS was first described by a French doctor in the mid-1830s, less than a decade after silver/mercury fillings were first promoted in Paris.

All of which suggests that the FDA's July 31 ruling was based more on politics than science. The effects of mercury amalgam fillings on the patients themselves apparently carried less weight than its effects on the balance sheets of medical professionals and insurance companies.

If we are going to have "smarter medicine" that really keeps people well, we need to get politics out of medicine. We need a government agency that explores and funds solid research into what keeps people healthy and what makes them sick, an agency that makes its determinations independently of lobbies, drug detail men, funding from industries standing to benefit from the results, or revolving doors into and out of those industries.

Written in consultation with Richard Hansen, D.M.D., co-author of The Key to Ultimate Health: Non-Toxic Dentistry.