Easy. Quick. Convenient. Cheap. These are great characteristics of products and services Americans desire. But when it comes to health care,  we need to add two other attributes: common sense and moderation. Just consider what we’re learning about excess reliance on two disparate items: over-the-counter heartburn medications and a ubiquitous health measure known as the Body Mass Index or BMI.

Proton pump inhibitors

For those who suffer heartburn, proton pump inhibitors (PPIs)─more commonly known by their brands, including Nexium, Prevacid, and Prilosec─have become some of the most taken drugs in the United States. But as the New York Times reports, experts are growing more wary of them  because:

[S]cores of studies have reported associations between prescription P.P.I. use and an array of health problems, including bone fractures, low magnesium levels, kidney injuries and possibly cardiovascular drug interactions. They are also linked to infections, like the stubborn Clostridium difficile and pneumonia. Reducing the acidity of the stomach, researchers believe, allows bacteria to thrive and then spread to other organs like the lungs and intestines.

A new study raises concerns with the drugs and chronic kidney disease. Although the many commercials for PPI provide a fast, terse, required warning that the drugs are not recommended for use longer than 14 days at a stretch, experts say too many Americans gulp them down more often and for months or years instead of a few weeks. The studies warning about PPIs, so far, show correlations and associations but not direct harms from the drug. Still, the kidney disease research on PPIs found that: “The risk of chronic kidney disease rose 15 percent among those taking the drug once a day, but 46 percent in those taking it twice daily, compared with nonusers,” leading researchers to term this a likely “causal” link, the Times said.

As we age, a muscle that prevents acid from rising from the stomach to irritate the esophagus weakens; the incidence of acid reflux rises sharply, leading millions to seek relief. PPIs are prescribed and taken over the counter extensively by older Americans─even though the American Geriatrics Society put them on a major list of potentially inappropriate drugs for seniors. And while some patients have taken the meds under doctors’ order and supervision for long periods and they have done fine, the meds’ increasing use─and potential for increasing patients’ risk─only grows.

This situation also should serve as a reminder: don’t pop over-the-counter drugs casually. Just because you can get them without prescription doesn’t mean they can’t harm you and that they’re not powerful. They’re not candy and some can pack a wallop and be dangerous.

Misguided about a health measure?

Whip out a tape measure, hop on a scale, and presto: Americans have been led to believe they can do simple math (or tap into an online calculator) and get a great sense of their health through a now ubiquitous measure known as the Body Mass Index, or BMI. The BMI has provided a solid way for caregivers to talk to us all about obesity, exercise, nutrition, and diet. In some gyms and health clubs, trainers and members toss the figure around more freely than horoscope signs. The metric has become so accepted that the federal Equal Employment Opportunity Commission has proposed rules allowing employers to penalize employees up to 30 percent of health insurance costs if they fail to meet two dozen “health” criteria such as reaching a specified BMI.

Whoa,  some UCLA researchers say. They report in a published study that BMI may mislabel as many as 54 million Americans as obese or overweight. As the Los Angeles Times reported:

[Researchers] analyzed data from 40,420 individuals who participated in the 2005-2012 National Health and Nutrition Examination Survey. They looked at individuals’ blood pressure, triglycerides, cholesterol, glucose, insulin resistance and C-reactive protein data — markers that are linked to heart disease and inflammation, among other issues. …nearly half (47.4 percent) of overweight people and 29 percent of obese people were, from a metabolic standpoint, quite healthy. On the flip side, more than 30 percent of individuals with “normal” weights were metabolically unhealthy.

The speed and convenience of the BMI measurements, the researchers say, should not make it such a determining factor in important decisions about health, especially since other relatively easy indicators, such as blood pressure, can give equally valuable and valid decision-making insights. Your health is a complex concern. You wouldn’t total your car if a red light went on the dash.  Weight gain and obesity are significant issues for us all and we should use BMI as it was meant to be─one of many gauges of how we can be healthier.

After four years of undergraduate education, four years of medical school, and then internships and residencies for several years after, doctors should be a well-informed lot, right? But they can get themselves into some downright dumb stuff. This includes their wrong thinking about the prevalence of medical malpractice litigation, and their head-scratching revisiting of a less stressful way to train tomorrow’s practitioners.

Contrary to conventional wisdom, new research has found that a relatively few number of physicians account for almost a third of medical malpractice claims paid. The researchers, examining more than 66,000 malpractice claims paid against 54,000 MDs nationwide between 2005 and 2014, said that just 6 percent of doctors had paid claims in the decade. Just 1 percent of physicians paid nearly a third of all claims. The researchers focused on paid claims as a marker of substandard care.

The MDs who had to pay out generally were older, internists, OB-gyns, general practitioners, or family medicine practitioners. As one news report on the study noted: “Each time a doctor got sued, the likelihood that he or she would be sued again went up.” Neurosurgeons, orthopedists, general surgeons, plastic surgeons and OB/GYNs were roughly twice as likely to have repeat settlements, as compared with internists, even after the researchers controlled for the inherent risk of practices like surgery, another news report on the study said.

The researchers said their work could help hospitals, medical groups, insurers, regulators, and patients start to better identify and deal with repeat offenders─doctors who are not taking on the most sick or highest risk patients but those with real problems and clearly in need of training, discipline, or more.  States and advocacy groups are creating publicly accessible databases to let patients research their doctors’ histories with malpractice claims.

Unfortunately, as I have experienced, physicians, medical boards, and professional groups are all too willing to look the other way and to shuck their responsibility to patients to deal with bad practitioners and bad practices. This often leaves the injured and aggrieved few options except the civil justice system. I recently pointed out colleagues’ work that shows that a mossy mythology has grown up around medical malpractice. This lets MDs, in particular, cling to their costly, inefficient use of defensive medicine. They say they so fear malpractice suits that they order up too many needless, costly, and harmful diagnostic tests and procedures; they move too slowly on innovation to improve care. This has got to stop.

Long hours for MDs in training

Some other recent research does little but ring alarm bells for me:  This effort purported to answer whether there are harms for surgeons in training if they work longer hours. After years of controversy, regulators stepped in and sought to cap the ridiculous hours that residents, surgical and otherwise, were expected to serve─not only to benefit aspiring doctors but more importantly to protect patients from harm from exhausted MDs. But medical educators and surgeons have pushed back on these limits. They say they are too strict. Some contend that routine 16-hour shifts, which also can stretch to 28-hour stints, are needed to prepare future surgeons to ensure they’re state-of-the-art with continunity of care and solid hand-offs of patients.

Some respected institutions participated in what was termed rigorous research. Others, however, blasted the work from its outset, saying elite institutions were, in violation of their own practices, using a couple hundred residents, and more importantly their patients, as human guinea pigs. Even after the study concluded, physician-experts were divided on its results: the published work says no harm, no foul in surgical residents’ long and longer hours; a contrary view found that one of the big sticking points─continunity of care and hand-offs─worked fine with shorter hours, so why change?

Physicians, heal thyself. As I wrote recently, students themselves have drawn damning portraits of the stress, cruelty, and harshness of medical training; MDs are reporting with greater frequency that they’re experiencing great stress and burn-out; the nation faces doctor shortages; and medical schools are revamping themselves and launching new institutions aimed at a different, better way to produce tomorrow’s caregivers. For their profession’s sake─and, for goodness’ sake, for patients’ well-being─doctors can’t keep crushing their young. We could feed our kids gruel and crusts, and force them to work Dicksensian hours in freezing, dangerous factories. We won’t. Why would we want to roll back reforms that prevent bleary, cranky MDs from treating sick and frightened patients?

Some quick updates on stories I have been following:

What does it take to make hospitals safer so patients aren’t harmed? Big stuff and small, some of it surprising─and all of it mattering a lot. For instance:

  • Getting caregivers to wash their hands. It’s the top cause of debilitating and sometimes deadly hospital-acquired infections. Some institutions empower nurses to police and remind dirty doctors; some install video cameras to catch scofflaws; others run frequent and largely successful ─for awhile─ publicity campaigns.
  • Paying extra attention to hygiene with procedures, often considered routine, that break the skin, even a little bit. This has paid off in big reductions in some hospitals in infections linked to catheters put in veins and arteries, especially the central line (for IVs).
  • Preventing surgical teams from hauling into operating rooms items like backpacks, cell phones or scrubs also worn outside surgery areas. Hospitals have cut dangerous surgery-related infections by getting these bug-carrying items out, paying heightened attention to antibiotic and sterilization regimens, and other steps.
  • Ensuring medical teams focus with sick patients on warning signs of infections in the bloodstream — sepsis; 700,000 U.S. patients develop these infections annually and 200,000 of them die. The common danger signs that someone may have sepsis include extremes in heart and breathing rates and body temperatures, combined with low blood pressure. A rush blood test, with timely administration of fluids and antibiotics, experts say, can significantly cut deaths and harm from septic shock and sepsis. When caregivers increase their awareness of sepsis, death and injury rates from it dip as much as a third.

Do any of these steps sound too hard or too expensive? The New York Times ran a two-part Op-Ed by a solutions-focused journalist, detailing  ideas that doctors, nurses, hospitals, and other experts have shared to further reduce patient harms in hospitals.

Hospitals these days don’t compete much with each other, especially as institutions consolidate and get absorbed into chains, allegedly to be more cost-efficient. So why, the Times asks, can’t they do better in informing each other about best practices to deal with the array of challenges they collectively face in curbing a huge problem in healthcare? As the paper describes the core concern:

Each year, in the United States, millions of patients are harmed while receiving care in hospitals. They get infections, experience adverse reactions to drugs, develop dangerous bed sores, or come down with pneumonia from the very ventilators meant to help them breathe. The estimates of the number of people who die each year as a result of hospital errors have ranged from as many as 98,000 in a landmark Institute of Medicine report from 1999 to as many as 440,000 in a 2013 study. It’s believed that most of these deaths could be prevented if health care providers always adhered to evidence-informed practices.

The paper duly notes that the scope and scale of the care Americans demand is enormous─”35 million hospital admissions 136 million emergency room visits.” As I have written before, the Obama Administration, as part of the Affordable Care Act, has campaigned to get hospitals to slash patient infections and harms, and officials have added financial incentives and penalties for institutions to do so.

The rates are decreasing. This work isn’t easy. Just consider what might seem a simple issue: coping with the rise of advanced medical devices that beep with alarms or warnings to nurses. This technology has created bedlam in many hospital units, where nurses run from room to room to silence the cacophony; medical staff can get inured to the racket or confused as to which alarms are most urgent, leading to patient harms, including deaths (a couple of dozen annually, by some estimates). By allowing caregivers to adjust devices so they are appropriately sensitive to a specific patient, and by eliminating machines that reset their alarms on their own, one hospital it cut its alarms from 90,000 to 10,000 a week. When the medical staff doesn’t suffer alarm fatigue, it can provide better care.

A lot more needs to be done to make hospitals safer. As I have written, patients undergo incredible, lingering suffering as a result of horrible experiences in hospitals. But hospitals’ sharing best practices could be valuable, dislodging the hand-wringers in medicine to reckon with a major issue.

Americans spend almost $23 billion for mental health care, and lost productivity from mental illness costs the nation almost as many billions of dollars at the workplace. It has become such a significant health care concern that an influential health care advisory body has stepped up its advice to all physicians in the United States to regularly screen for the the group of mental illnesses commonly known as depression.  The new advice, for the first time, also underscored the importance of the screenings for women who are pregnant and who have just given birth.

Early reaction has been largely favorable to the recommendation by the U.S. Preventive Services Task Force, the independent body that recommends best practices for prevention and early detection of a whole range of serious diseases.

The USPSTF previously had suggested doctors use standard questionnaires and other diagnostic tools to detect depressive symptoms, especially if follow-up care could be provided. The task force said mental health care since has become more widely available. Its recommendation for pregnant and new moms to be screened was welcomed. As one psychologist in the Pacific Northwest told NPR: “Historically, depression in these populations has been under-recognized and under-treated.”

Women, quoted in the public radio story as well as in the Times, told of the anguish they had suffered with post-partum depression, one of several depressive disorders. A North Carolina psychiatrist told the Times that many women shy away from talking to their doctors on their own about depression, because, if a mother is “feeling so anxious [as if] you’re going to come out of your skin or feeling that you’re going to harm your baby, you may think: ‘Oh, my God, I’m having these crazy feelings and nobody’s talking about it. I must be a terrible mother.’ ”

Based on the USPSTF recommendation, depression screenings now will be covered by insurance under the Affordable Care Act. Proponents of the ACA, also known as Obamacare, long have argued that it would boost coverage for mental health care. However some research and experts question whether the administration has fallen short of the act’s stated goal of parity for mental health care compared to physical diseases.

Depression’s role, toll

In its screening recommendation, the USPSTF said that front-line, primary care physicians could be valuable in battling depression.  Treatment for the ill, which includes the longer-standing approach of psychotherapy, has seen some advances, particularly with new drugs. The medications require close medical supervision, and they can be problematic for younger patients. The meds are powerful, and have not been approved for use in children, though some physicians — for reasons that defy good sense, in my view — prescribe these and other psychiatric drugs even to tots, as I have written before.

Living with depression can be a struggle; any efforts by the health care system to assist those afflicted should be welcomed. The call for broader screening recognizes that mental illnesses are becoming an even greater problem in this country. Depression and the despair it can create no doubt contributes to the surprising recent finding that American whites, both young and middle aged, are seeing shorter lifespans, as I have written lately. Further research on this topic is highlighting the contributing factors, too, of poor health and healthcare. Although popular culture slowly has caught up with the disorders’ debilitating effects and its links to many famous creative individuals, society still far too often stigmatizes those with mental illnesses.  This needs to stop.

Schizophrenia research

It may be science that will help change negative attitudes toward mental illness by illuminating these disorders more. And, even as lots of public attention got paid to depression, a new, large study on the causes of schizophrenia also has snagged the media spotlight. As the New York Times described it:

[The study] will not lead to new treatments soon, experts said, nor to widely available testing for individual risk. But the results provide researchers with their first biological handle on an ancient disorder whose cause has confounded modern science for generations. The finding also helps explain some other mysteries, including why the disorder often begins in adolescence or young adulthood.

Researchers delved deep, down to the molecular and genetic level to better understand the root causes of schizophrenia,  a chronic and severe mental disorder that experts say affects how a person thinks, feels, and behaves, causing some patients to seem as if they have lost touch with reality. It is one of the more severe mental disorders, with symptoms most frequently starting in the teen to young adult years. Two to three million Americans have schizophrenia. Clinicians, because they don’t know schizophrenia’s causes, treat its symptoms with potent antipsychotics, psychotherapy, and individual, group, or institutional care.

When partisans want to terrify Americans about their access to health care, they use a code term: rationed care. It turns out that doctors and hospitals nationwide already have made that frightening prospect real: They tell the New York Times that drug shortages have forced them to make tough choices about limiting which patients get optimal treatment for serious conditions, including bladder and ovarian cancer, leukemia, Hodgkin’s lymphoma, myeloma, hemorrhages during heart surgery, and kidney disease.

Most practitioners and institutions don’t inform patients about drug shortages or curtailed care. Some hospitals and doctors say the whole situation puts them in a major ethical quandary.

It’s curious, though: the story doesn’t address as much as it might, in my view, a more fundamental issue: Big Pharma greed.

Let’s start with the terrible basics — how sweeping shortages  of important drugs have become and the consequences. As the Times says:

In recent years, shortages of all sorts of drugs — anesthetics, painkillers, antibiotics, cancer treatments — have become the new normal in American medicine. The American Society of Health-System Pharmacists currently lists inadequate supplies of more than 150 drugs and therapeutics, for reasons ranging from manufacturing problems to federal safety crackdowns to drug makers abandoning low-profit products. But while such shortages have periodically drawn attention, the rationing that results from them has been largely hidden from patients and the public.

Individual physicians and institutions on their own not only must figure how to work around missing medications. They also must determine who gets the short supply. It is done, “ad hoc,” and more often than not without patients knowing.

The treatment questions swiftly get confounding: If a medication is rationed, do ailing kids get it before sick grownups do? Does the sickest pediatric cancer patient get the drug in short supply? Or does it go to the child with the best prospects? If dosages are determined by size and weight, do we give limited, needed medications to several skinny patients or one who is sick and obese? Do we let a patient just bleed a little more during surgery and take that risk when drugs aren’t available?

The Times points out that, even with elective procedures, patients aren’t told and aren’t consulted about drug shortages that may affect them. Although many institutions have standing, well-organized, and well-run ethics committees, hospitals often don’t engage them in the considerations about rationed drugs; individual physicians all too often are left on their own, or within specialty practice groups, to struggle with profound questions about care. The Times describes well and painfully the human dimensions of drug shortages.

This issue is hardly new. It has blown up recently, especially because, as I have written, Big Pharma profiteers have sought to press the boundaries of greed and decency. They are taking old, familiar drugs, some of them vital to relatively small groups of patients, and jacking up prices to gain new revenues.

Big Pharma also is having its cake and eating it by exploiting patent protections. Yes, it costs a lot to develop effective meds. But companies get to keep their formulations secret for decades so they reap long profits. Even after drugs fade from their initial burst of profitability, they continue to generate revenues — it’s a question of how much. Companies drop long-standing and still-effective drugs to make more money on newer meds. When certain pharmaceuticals can be produced by others, especially through compounding pharmacies, costs here also are a huge driver. Some academic medical centers are large enough so they can run their own pricey, compounding pharmacies to expand their medication options. But we’ve also seen how greed can kill in corner-cutting compounding companies.

Big Pharma has inflicted the drug shortage woes worldwide, though Canada, for example, has taken some actions that are worth U.S. consideration (including a government-sponsored web site that lists drugs in short supply and lets the public know what’s being done). Numerous health policy researchers are working on the issue. Congress also has given the FDA new powers, since 2011 or so, to try to address supply issues. Clearly, even more needs to be done on this issue with patients’ needs, not those of Big Pharma, at the fore.

michblogIn protecting its citizens, Michigan already is taking a deserved drubbing for its shameful government  negligence in allowing the lead pollution of Flint‘s drinking water. Officials now need to get their act together to stop a different kind of public policy embarrassment: Expert medical witnesses who abandon any pretext of objectivity and instead work hard to help insurance companies cheat injured people.

This legal controversy is developing in the Detroit suburbs.  It ought to deeply trouble anyone concerned with the First Amendment, and the civil justice system and its fair application of the law in cases of vulnerable litigants who have suffered medical injuries.

On its face, this looks like a doctor versus lawyer dispute. It’s more than that.

In civil lawsuits in which an injured person is suing the person or company that caused the harm, courts in Michigan and across the country allow defendants or their insurance companies to require the injured person to submit to an “independent medical examination.”

That sounds only fair, doesn’t it? But if you have spent any time in court, as I have, you quickly learn that certain of these so-called independent medical examiners are not independent at all, and lawyers and their injured clients need to prepare and watch out for them.

In the Michigan case, a psychiatrist did an “independent” medical exam on a man who suffered a brain injury in an accident. She wrote a report claiming that the injured man was much better; in fact, she said, he had told her he was “improving.”

The man’s lawyer had taken the trouble to record the doctor’s examination (over the defense lawyer’s objection, and only after the court okayed the recording), and he proved at trial that the patient had actually told the doctor, “I don’t think I’m improving.” That was one of many sharp differences he showed between what the doctor claimed the injured man had told her versus what he actually did say.

So after he won the trial, the lawyer wrote a blog post questioning whether the doctor had perjured herself in her testimony. A strong accusation, but lawyer Steven Gursten presented the recording of the interview and compared it to her report, and asked readers to judge for themselves.

Here’s where it gets problematic: The doctor not only disagreed, she also got mad enough to file a formal complaint against the lawyer with the state’s legal licensing board.

She also happens to sit as a member of that board.

She wants the lawyer investigated as to his fitness to hold his license. She demands that the board act to get the lawyer to pull down his blog post, which she says misrepresents the facts and defames her.

The lawyer isn’t backing down. He’s got a lot at risk.

What’s at stake

So, too, does the state of Michigan and the civil justice system. Pop media don’t provide 100% accurate portrayals. But there are all too many painful depictions in the movies and on TV of hired-gun expert witnesses, shading the truth and harming ordinary folk in court cases. For those with injuries serious enough to pursue claims in a lawsuit, the experience in court can be downright scary, and hard enough already without having to worry about the independence and impartiality of some of the system’s key players. This particular doctor had become so notorious in Michigan before the current kerfuffle that plaintiff lawyers conducted seminars on how to deal with her in court.

I’m also concerned that the part of the government that licenses lawyers could get itself involved in censoring them. This isn’t just about an attorney’s First Amendment rights. It’s about all of our rights as Americans to know, clearly and robustly, what happens in the courts and with the proper administration of the law. As a former journalist and an attorney, I know that the complaining psychiatrist would bear a heavy burden if, instead of seeking to yank the lawyer’s license, she had pursued a defamation-libel case against him and had to ask a judge to pull down his blog post. Courts, rightly, set a sky-high First Amendment-based bar when public officials and public figures  seek to curtail public information about the performance of our government, especially our courts.

If you look at the lawyer’s blog post, it is impressive in its documentation of his assertions of dubious if not false testimony by an expert witness.  Lawyers can rip apart witness inconsistency or falsehood in cross-examination. Judges can assist in bringing forth legally salient facts, in excluding bad evidence or testimony, and in taking steps against witnesses whose credibility falls so far as to make them–and the civil justice system–disreputable.

As for this licensing board, its members should know that attention is growing about this case. Like it or not, they now are subject to judgment in the harsh court of public opinion, where, candidly, they start in the hole: Can the public trust the board to render an impartial judgment on a complaint by one its own members? I hope this board, immediately, gets the complainant to recuse herself. Similar panels have, in my opinion, acted to advance the profession and buttress public confidence. They have rejected law licenses for a noteworthy plagiarist but have allowed them for meritorious candidates who were undocumented immigrants. At the same time, officers of the court also have turned a blind eye to unfolding wrongs in the system, notably in a developing scandal about snitches as witnesses in criminal cases in Orange County, California.

For injured folks like the kind my law firm represent, this case is an eye-opener about how one-sided the process can be, and how “independent” medical examinations are anything but independent much of the time. The lesson for any injury victim must be, if you find yourself in the clutches of a biased, non-objective medical examiner, to make sure that everything said is documented and is 100% accurate and truthful.  Here’s some advice we give our clients about how to approach the “independent medical examination.” Only rigorous preparation and complete accuracy will defeat these biased doctors.

Oh, and a good video or audio recording of the proceedings helps too.

As the East Coast digs out from the big snow, winds, and the freezing weather, many around us also will be coming down with colds and flu. Public health officials forecast the infections of the seasonal illnesses will markedly increase in the days ahead. It’s a perfect time to talk about antibiotics. In brief, they don’t work against the virus-caused flu; they’re not recommended for most colds, which also are virus-caused, and many bronchial conditions. Don’t think about them to medicate kids’ ear infections. We all need to join in the campaign to curb overuse of invaluable antibiotics — and here are some reminders how and why.

The Centers for Disease Control and Prevention recently joined with the American College of Physicians to issue new guidelines, urging caregivers to be careful in prescribing antibiotics, even for more severe bronchial infections. Here’s why:

Antibiotics are prescribed at more than 100 million adult ambulatory care visits annually, and 41% of these prescriptions are for respiratory conditions (1). Inappropriate antibiotic use for [acute respiratory tract infections] is an important contributor to antibiotic resistance, an urgent public health threat (2). In the United States, at least 2 million antibiotic-resistant illnesses and 23 000 deaths occur each year, at a cost to the U.S. economy of at least $30 billion (2). Increased community use of antibiotics is highly correlated with emerging antibiotic-resistant infections. In places with greater prescribing of broad-spectrum antibiotics … rates of multidrug-resistant pneumococcal disease are higher. …

Professional groups of pediatricians and family physicians, just to remind, have warned against wasteful, ineffective, and potentially harmful prescribing of antibiotics for kids with ear infections.

The rampant overuse of antibiotics, scientists say, has led to the rise of antimicrobial resistance that has become a global health threat. Breeders have fed the medications freely to produce bigger pigs and cattle that fetch higher market prices. But this only has helped to make drug-resistant superbugs a spreading bane, creating havoc in hospitals and caregiving institutions (nursing homes), as well as public spaces like gyms where kids and athletes work out and contract MRSA infections. Global antibiotic overuse, one research study recently calculated, could create a “doomsday scenario” in which no effective antimicrobial treatments are available:

Under this scenario, hospital-acquired infections and other diseases like HIV, TB and malaria would be beyond the reach of medical help. We found that this scenario would cost the world 444 million adults by the year 2050. This decrease in global population would translate into an annual loss to the world economy of up to $3 trillion, or roughly the equivalent of the current combined annual output of New York and Texas.

Fast food chains, never operations eager to forego a buck nor to accept anything but the most expeditious supply, have stepped up and many slowly are committing to serving only antibiotic-free beef and chicken. Big Pharma, in my view, operates only rarely with benevolence and broad interests beyond the monetary. But the antibiotic crisis is so grave that dozens of companies have committed to developing new medications and therapies.

It’s good to know that global efforts are under way to address antibiotic overuse and its potentially dire consequences. As I have written, Congress and the Obama Administration significantly increased federal health care funding as part of a hectic, end-of-year budget action. Some of the increased funding will support efforts to combat antibiotic overuse and superbugs. This is a pitched battle that we cannot afford to lose and in which we all need to do our part.

Although experts may muster masses of data and point to reams of research, simple human stories sometimes persuade us best about dangers to our health. It’s tough not to ask why football holds such veneration as America’s favorite sport, for example, when one of its skilled players gets candid about his damaged post-professional life. And just maybe a mom’s tragic tale about her now-grown daughter’s circumscribed life might warn younger women about the real dangers of drinking during pregnancy.

Ex-pro opens up about football’s brutality

Who isn’t a Redskins fan in Washington? And, at this point, who among the football-obsessed hasn’t heard about the flap over a seemingly straight-forward news update about some football stars, including Antwaan Randle El, a one-time receiver for the Skins and the Pittsburgh Steelers. To the chagrin of those who jaw, endlessly, on sports talk shows, Randle El said he regrets playing football and wished he would have played baseball, instead. He said he was glad that a school football program that he was part of recently got canceled. Yes, the game opened lots of life’s doors and made him financially better off than he ever could have imagined. But the brutal pounding he took for years has affected his health and is starting to lessen his mental cognition, especially his memory, he said.

As I’ve written before, we need to look hard at how we protect young athletes from concussion and other head- and sports-related injuries. We need to get over glorifying the few players who make it into the pros without also considering how games can harm many young athletes.

But what occurred after Randle El said something plain and true about pro football shows we have far to go. He got zinged by the chattering sports crowd, so much so that he found himself back-tracking about his comments. That was a curious move. After all, he joined other NFL athletes in suing the league over player concussions. Further, his regrets first were aired in a project by a Pittsburgh publication, which tracked key Steelers from the Super Bowl X winning team; that piece was candid about the health toll that players suffered.

It hasn’t been much of a secret how pro football players end up wrecked and pain-wracked. Almost four decades have past since Peter Gent penned North Dallas Forty, a best-seller that then was turned into a fine movie about a fictional pro team modeled after the Dallas Cowboys. Nick Nolte, then a rising, young actor, nailed how the quarterback-protagonist of the movie abuses alcohol and drugs to deal with his unceasing pain from football injury. This is the model we want our kids to follow?

Mom tells of alcohol abuse, daughter’s fetal alcohol syndrome

If you know sexually active young people and you fret that they also drink far too much, then you might want to share a recent Washington Post piece about Kathy Mitchell, a sad but brave mom. She’s no saint. But Mitchell has shared her life story of alcohol abuse and how it resulted in her daughter Karli’s suffering with fetal alcohol syndrome in hopes of averting others’ tragedies.

Mitchell’s family ran a restaurant-night club. She started drinking early, getting so drunk, regularly, that she passed out often. She got so intoxicated that she fled the family wedding picture when her older sister married. Mitchell was 14. She got pregnant just after high school with Karli. Mitchell was drinking heavily, eating badly, smoking, and working long hours in bars and restaurants. Over time, after addiction to heroin, recovery, institutionalization, and other travails, Mitchell straightened out her life. She could not improve her daughter’s lot because she was afflicted with a syndrome identified in the early 1970s:

Karli is now 43 but is the developmental age of a first-grader. In the home she shares with her mother and stepfather, she collects dolls and purses, and pores over Hello Kitty coloring and sticker books. …In middle age, Karli has none of the awareness, self-determination and independence that most of us take for granted. She can’t recognize social cues, is easily led and manipulated, and can’t predict dangerous behaviors. She can only follow one rule at a time and doesn’t understand sequence. She can cross a street at a lighted crosswalk, but if the light is out, she’ll step in front of a car. She likes to wear pretty clothes, but she can’t remember to brush her teeth. To [Mitchell], Karli’s is simply a life snuffed of promise. ‘I adore my very sweet daughter,’ Kathy says. ‘She’s a forever innocent child. But not a day goes by that I don’t ask myself, ‘What if? What if alcohol hadn’t been a part of my life?’

The Post reports the findings of the American Association of Pediatricians that there is no known safe level of alcohol consumption by expectant moms. Meantime, the Post also provides data from the Centers for Disease Control and Prevention that 1 in 10 pregnant mothers say they drink while carrying a child.

Americans are legend for their discomfort in discussing death. That makes conversations about end-of-life care a big challenge, even though the medical attention paid to the dying can drive up health care costs.  A quarter of traditional Medicare spending for health care is for services provided to program beneficiaries in their last year of life—a proportion that has remained steady for decades. But new studies shed interesting light on the end-of-life experiences of patients with cancer, as well as how physicians themselves spend their last days. And it is worth watching how California grapples with the tough issues tied to doctors’ roles in assisting the dying in ending their lives.

Let’s look first at the provocative, published findings of an oncologist and a radiation oncologist about aggressive care for those with late-stage cancer. The researchers compared U.S. patients with patients in other countries. They focused on cancer because, “in developed countries, it is the second leading cause of death and the most expensive per patient.” The researchers found that just under a quarter of Americans with cancer die in hospitals — a lower rate than occurs in Canada, England, Norway, the Netherlands, Belgium, Germany, and six other industrialized nations they studied. Further, as they wrote in a New York Times Op-Ed:

America was not the most expensive country in which to die. On average, $21,840 was spent on the last six months of hospital-related care for dying cancer patients in Canada and $19,783 in Norway. In the United States, the bill was $18,500 per patient. (That figure does not include physician costs, which are part of hospital spending in other nations. Including them brings America’s costs up by about 10 percent, leaving us still below Canada and about equal with Norway.)

Americans, in the researchers’ view, did less well in admitting cancer patients more often than others internationally to costly intensive care in the last six months of their lives. Americans also received more chemotherapy than their global counterparts late in care when it’s unclear if it benefits the gravely ill.

As I have written, it is important for all of us to plan and to let loved ones know how we wish to be cared for when we are dying. The reseachers urged that physicians be more candid about prospects for the sick. They called for more palliative care and hospice resources. They found this nation making progress in confronting the chilling silence surrounding our deaths and the costs of end-of-life care. This led them, too, to question whether such care — as opposed to fee-for-service medicine — plays as significant role as it might seem in increasing health costs.

Families, by the way, appreciate when relatives with late-stage cancer and Medicare coverage get enrolled earlier in hospice care, other research shows. They also perceive that end-of-life care is better when physicians avoid admitting sick kin into ICUs within 30 days of death, and help the gravely ill die outside of hospitals.

Just so you know, while many of us would prefer to die at home, surrounded by loved ones and in comforting surroundings, most of us (72%) die in a medical facility of some kind, other new research finds. But slightly fewer health care professionals (63%), especially physicians, die in medical facilities, meaning more died at home. The researchers didn’t say why. They speculated that physicians may be more aware of life’s limits and reluctant to receive aggressive treatment in institutions where they have worked for most of their lives. The lead investigator made this key observation:  “I think [that] even if the people who should be the best at this are still not dying in the comfort of their home that we still have a lot more communication and understanding of medical options to get more people to die a ‘good death.’ ”

In the Golden State, the terminally ill, their families, lawmakers, and caregivers are struggling to determine how medical personnel should assist with “good death.” With the reluctant assent of its governor, a one-time Jesuit priest in training, California last fall became America’s fifth state to legally permit physicians to assist dying patients in ending their lives with medication. The California Medical Association recently has issued guidelines to doctors about this topic. The 15-page document addresses the array of moral, ethical, and professional issues that the doctors’ group insists practitioners should consider. News reports make the point that Catholic hospitals will not allow physicians to assist patients in ending their lives in their institutions.

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