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March 2008 Archives

March 2, 2008

Best Hey Jude Ever...

Janet S. sends news that a star is born, or was born not too long ago.

Posted by Dr. Bill Thomas on March 2, 2008 10:54 AM |Permalink |Comments (1)

March 3, 2008

A Good NORC Story

NORC?

This is housing that is available to tenants of ALL AGES but which, over time, evolves to include a significant proportion of households that are headed by seniors. NORCs may or may not include supportive services and activities for senior tenants. This housing is NOT licensed or regulated by a government agency. Subsidized versions may be supervised by a government housing agency.

Here is the lead...

A movement is gaining momentum to help seniors retain their independence by remaining in their homes as they get older. By Shari Roan Los Angeles Times Staff Writer
March 3, 2008

THE broken rib could have been a disaster for Claire Soroko. She had been saying goodbye to friends Christmas Day when she stumbled from an outdoor step and banged into an iron handrail, breaking a bone in her chest. Afterward, she couldn't clean, drive or even dress herself.

"I really don't have anyone," says Soroko, a Park La Brea resident in her 70s. "My daughter and son-in-law are very busy. I couldn't ask them to come and stay with me."

Such accidents can often mean the end of living independently. Twenty percent of falls among elderly people require medical attention, and serious injuries, such as hip fractures, often require nursing-home care.

But today's older Americans are increasingly adamant in their desire to avoid nursing homes or assisted living. And they now have a movement to back them up. Called "aging in place," it has a beautifully simple premise: Keep seniors safe, well-cared for -- and in their homes.

In Soroko's case, more than 500 Park La Brea residents 60 and older have formed a novel network to ensure that its members can remain in their homes despite illness or physical decline -- homes that many have known since the complex opened during World War II. Soroko called the agency's office upon returning from the hospital. By the end of the day, the staff had lined up daily caregivers, transportation to doctor's visits and the hair salon, and visits from neighbors who brought meals and encouragement.

As the nation's demographic shifts to the old and older, such community associations are at the forefront of redefining how older Americans live. About 10% of Americans 65 and older live in nursing homes, assisted living or residential care settings. But that number rises dramatically among people who reach their 80s or 90s. Americans are living longer than ever--and their ranks are growing. The number of people 65 and older is expected to double in the next 2 1/2 decades as 78 million baby boomers, the oldest of whom are turning 62 this year, enter their golden years.

Together with businesses and technological advances, these associations could change the portrait of growing old in America.

Where the heart is

THERE is simply no place like home -- living surrounded by favorite photographs and worn furniture, familiar smells and the comforting rhythm of the neighborhood, from the thud of the mail arriving each morning to the whoosh of the school bus passing by each afternoon.

"We have an image in our heads that as soon as you retire you sell your home and move to Florida," says Elinor Ginzler, director of livable communities for AARP. "But according to census data, less than 10% of people 60 and older had moved in a five-year period. We're connected to the house we're living in and the neighborhood we're living in."

In fact, 90% of adults 60 and older say they want to stay in their home or community rather than uproot themselves late in life, a 2006 AARP study found.

In the past, there were few resources to help people remain at home amid the problems and frailties of old age. But changing demographics, economics and attitudes are making "aging-in-place" ever more possible.

"The baby boomers are a generation of problem-solvers," says Peter Bell, president of the National Aging in Place Council in Washington, D.C. "We use education, technology and resources to change things -- not just accept them as they are. I think we also recognize we can do things better collectively rather than individually."

Here is the rest...

Posted by Dr. Bill Thomas on March 3, 2008 12:44 PM |Permalink |Comments (0)

More Slow Medicine

Here is a review of a book advocating "slow medicine."

My Mother, Your Mother Embracing "Slow Medicine," the Compassionate Approach to Caring for Your Aging Loved Ones. By Dennis McCullough, M.D. HarperCollins. 263 pages. $25.95

It was two decades ago that a group of culinary mavericks took a giant step backward down the evolutionary trail with the "slow food" movement. Instead of fast food produced by the assembly lines of giant consortiums, they championed products of small-scale agriculture — time-consuming to prepare, beautiful to behold, very good for you.

Now (and, some might add, at last) doctors are following suit, rejecting the assembly line of modern medical care for older, gentler options. The substituted menu is not for all patients — at least not yet. For the very elderly, however, most agree the usual tough love of modern medicine in all its hospital-based, medication-obsessed, high-tech impersonality may hurt more than it helps.

In its place, doctors like Dr. Dennis McCullough, a family physician and geriatrician at Dartmouth Medical School, suggest "slow medicine" — as he puts it, "a family-centered, less expensive way."

This medicine is specifically not intended to save lives or to restore youthful vigor, but to ease the inevitable irreversible decline of the very old.

His bottom line is this: It is up to friends and relatives to rescue the elderly from standard medical care. And slow medicine, like slow food, involves a lot of hard work. Readers who sign on will acquire a staggering list of tasks to perform, some of which may be just as tiring and tear-producing as chopping onions.

All the while, medical care for the parent should favor the tried and true over the high tech. For instance, McCullough points out that instead of a yearly mammogram, a manual breast exam may suffice for the very old, and home tests for blood in the stool may replace the draining routine of a colonoscopy.

The parent's doctors should be nudged to justify flashy but exhausting diagnostic tests, and to constantly re-evaluate medication regimens. The high-blood-pressure pills that are life-saving at 75 may cause problems at 95, and paid companionship or a roster of visitors may prove to be antidepressants at least as effective as any drug.

The pace of care should be slowed to a crawl. For doctors, that means starting medications at low doses and increasing them gradually. For children, that means learning not to panic and yell for an ambulance on every bad day. And for a good overall picture of a parent's condition, a child is well advised to ignore the usual medical and nursing jargon and to focus instead on the sound of the parent's own voice. "No one," McCullough says, "can be a bigger expert on a parent's voice than a former teenager trained in the same household."

Posted by Dr. Bill Thomas on March 3, 2008 7:58 PM |Permalink |Comments (0)

March 4, 2008

Be the Change...

You want to see...

Regular readers know that I value the power of the internet to help people create and then distribute news ideas and new arrangements of existing themes inside of our culture.

I think that this video does a good job doing just that...

Posted by Dr. Bill Thomas on March 4, 2008 5:16 AM |Permalink |Comments (3)

Generation Jones

This is news to me.

Posted by Dr. Bill Thomas on March 4, 2008 6:18 AM |Permalink |Comments (0)

March 5, 2008

Doctor, Doctor-- Give Me the News

Here is a sample comment posted on a mostly doctors-only discussion thread. The term "midlevels" refers to nurse practitioners and physician assistants.

"Is it my imagination or is the line between midlevels and physicians in office-based practice becoming nonexistent? FNPs can practice without a doctor on site, as long as one is available to back them up and sign their charts. They can bill using their own UPIN numbers, and Medicare reimburses them at 85% of the physician rate. In my community, some list themselves with physicians in the Yellow Pages under Family Medicine. Some are busier than the FPs. And a few don't correct their patients when they refer to them as 'Doctor.'"

Posted by Dr. Bill Thomas on March 5, 2008 6:53 AM |Permalink |Comments (2)

March 6, 2008

Age Bashing McCain

Regular readers are likely to know that John McCain is not my preferred Presidential candidate but, still, I am annoyed at the "he's too old to be president" line of attack.

The goal is a society that does not judge people by their skin color, their religion (or lack thereof), their reproductive organs or their chronologic age. The goal is a society that seeks, to the greatest degree possible, to judge people according to their individual merits and weaknesses.

Older Person
African-American
Woman

One way or another, America is going to have a "first" as the next president.

I would like a campaign that is less concerned about "firsts" and more concerned about the issues that face all Americans.

I'm just sayin'...

Posted by Dr. Bill Thomas on March 6, 2008 2:01 PM |Permalink |Comments (1)

March 7, 2008

Power Up Friday: Be Cool Edition

Dr. Al Power writes...

Here's my take on Bill's March 5th post, "Doctor, Doctor, Give Me the News":

The advancement of the nurse practitioner profession has caused a great deal of controversy in the medical community. From where I sit, it appears that the majority of doctors are happy with NPs in a subservient role, but get nervous when they "strike out on their own", or expand their realm of practice.
There is no doubt that MDs have a great deal of specialized training and skills. However, most of them are using this training to go into specialized fields, and there are few who are willing to provide general care for the population at large, especially for older adults in nursing homes or other communities.
There are many things that doctors do that can be done as well by nurse practitioners. To me, there is something amiss with doctors being so territorial about this. Are they really concerned about quality of care? Or is it more of a "turf war", or a fear of loss of income to someone that a patient might prefer seeing?
A basic premise of the advancement of knowledge should be that it is shared freely with all who wish to attain it. To jealously guard a realm of practice from others who wish to make a contribution will only hurt the community as a whole, and reduce access to care. There is a parallel here with doctors of past decades, who objected to their patients having access to medical information that made them want to be more active partners in their care.
Wake up, folks! There are many excellent NPs out there, providing excellent care. As an internist and geriatrician, if I have a patient that is complex, I often engage the help of a specialist. There's no reason why an NP cannot do the same. If MDs were more pro-active in working with NPs in this manner, we would have a much better, more efficient system of health care.
I work with two geriatric NPs at my nursing home. I think they understand geriatric medicine better than many, if not most docs in town.
Finally, let's stop guarding our titles so fiercely. A "doctor" may be one of various kinds of healers, or one who has obtained advanced knowledge in a variety of fields. No one complains about saying "Dr. Martin Luther King", or addressing their dentist, veterinarian or school superintendent that way. So why get so bent out of shape if an NP was referred to as "doctor"? What are we afraid of?

Al Power, MD

Posted by Dr. Bill Thomas on March 7, 2008 5:59 AM |Permalink |Comments (2)

March 10, 2008

TGB's "This Week in Elder News"

[A sample of Elder news from Ronni Bennett at TGB: In this regular Saturday feature you will find links to news items from the preceding week related to elders and aging, along with whatever else catches my fancy that I think you might like to know. Suggestions are welcome with, however, no promises of publication.]

Today marks the launch of a new group blog, Wowowow which stands for “The Women on the Web”. The blog features a bunch of New York’s elite, elder women such as gossip maven Liz Smith, actors Candace Bergen and Whoopi Goldberg, TV journalist Leslie Stahl, “Miss Manners” otherwise known as Judith Martin, comedian Lily Tomlin and a few more. I have no idea yet how “wow” this idea is, but you can read more about it here.

Dr. Robert N. Butler who invented the term “ageism” and who is CEO and president of the International Longevity Center-USA, published an issue brief on elders and drug safety [pdf]. Although elders use 40 percent of all prescription drugs, the FDA does not require us to be included in trials on efficacy and safety. This is crucial information you and your physician should know.

On the same topic, manufacturers increased the prices of prescription drugs by an average of 7.4 percent last year - two-and-a-half times the rate of inflation. The price of the sleep drug Ambien jumped 27.7 percent.

Tenure can be hard to come by for college professors; many wait decades. But 68-year old Victoria Rauch Lichterman, assistant professor of humanities at New York City College of Technology who focuses on the negative effects of ageism, was recently granted tenure after just six years of teaching at the school. Score one for elder academics. [Hat tip to Naomi Dagen Bloom of A Little Red Hen]

When Crabby Old Lady posted her objections last Tuesday to Hillary Clinton Feminists, she quoted but did not comment on a NOW leader’s swipe at black women who choose not to vote for Senator Clinton because – well, Crabby is white and doesn’t believe she can properly speak for black women. Now, G Bitch has done it for Crabby in a colorfully worded and no-uncertain-terms rant.

When, through some glitch in the system, Social Security declares you dead, it is nearly impossible to convince the agency your heart still beats. “’I don’t think people realize how difficult it is to be dead when you’re not,’ said [Laura] Todd, who is very much alive…even though the federal government has said otherwise for many years.” It happens more often than you would think. Between January 2004 and September 2005, Social Security had to resurrect 23,366 beneficiaries and plenty more who remain active and above ground are still on the dead list.

Posted by Dr. Bill Thomas on March 10, 2008 1:24 PM |Permalink |Comments (0)

March 11, 2008

That Can't Be Good

Mike Nizza at the New York Times blog, The Lede, takes note of a recent report that shows measurable levels of prescription drugs in municipal water supplies.

There are traces of sedatives in New York City’s water. Ibuprofen and naproxen in Washington, D.C. Anti-epileptic and anti-anxiety drugs in southern California.
A 2,550 word article from The Associated Press is drawing attention to the widespread problem of trace amounts of pharmaceutical chemicals turning up in the drinking water supply of millions of Americans, but no one seems to know how to react. The report itself culminated with a doctor offering a tried-and-true deduction for the Ages: “That can’t be good.”

(full article here)

But how bad is it, exactly? The answers range in degrees of confidence and alarm, though no one was ready to predict imminent doom.

‘’We recognize it is a growing concern and we’re taking it very seriously,'’ said Benjamin H. Grumbles, the Environmental Protection Agency’s water chief. But the government has not established any safety limits for pharmaceutical drugs in drinking water, as it has for many other chemicals; the agency is just learning how to detect low concentrations of drugs in water, let alone assess the risk posed by them.

The American Water Works Association, a trade group representing thousands of water utilities, seemed to suggest that the problem is the testing data, not the water. A California water official warned The A.P. before it published the article that that the public “doesn’t know how to interpret the information” from the tests.

I will echo the "tried and true" conclusion of the doctor cited in the article--- "That can't be good." Although Nizza seems skeptical, there is good reason to believe"that can't be good" in advance of results from large clinical trials.

A drug is, by definition, a chemical compound which has, at low doses, a specific biological effect. Drugs used by humans are designed to have a specific biological effect--- on humans. So here is the thing that Nizza is not getting. Tiny doses of drugs given to millions of people for many years (through the water supply) are likely to create changes in the health status of at least some of those people. No one one can say what those changes might be-- and that can't be good.

The other issue is that people are, rightly I think, quite sensitive to the purity of their water supply. For decades, the addition of fluoride to water supplies was the subject of great political conflict (conservatives thought it was a communist plot-- not kidding) the irony is that we have conclusive proof that fluoridated water is a public health boon. Unfortunately it is highly unlikely that hundreds of millions of people mindlessly ingesting a random cocktail of prescription drugs (even at very low doses) is going to lead to anything other than major public health problems.

Checkout Tailspin's full rundown of blog chatter over this one.

Posted by Dr. Bill Thomas on March 11, 2008 9:11 AM |Permalink |Comments (1)

Intergenerational Equity

Wow, Brent Green really nails this issue, it's pretty in depth and worth a look.

Posted by Dr. Bill Thomas on March 11, 2008 2:46 PM |Permalink |Comments (0)

March 12, 2008

Elders as Peacemakers

A global village needs global elders to help bring peace into places where there is strife.

This is their story.

Posted by Dr. Bill Thomas on March 12, 2008 5:50 AM |Permalink |Comments (1)

Good Old Brain Surgery

Healing is an ancient art...

Greek archaeologists said Tuesday they have unearthed evidence of what they believe was brain surgery performed nearly 1,800 years ago on a young woman — who died during or shortly after the operation.

The rest of the article is here.

Posted by Dr. Bill Thomas on March 12, 2008 10:43 AM |Permalink |Comments (0)

March 14, 2008

More Age-Bashing McCain

[Guest-post by UMBC's Kavan Peterson]

Following-up on Bill's post "Age Bashing McCain", The New York Times explores how "codger jokes" have become a mainstay of late-night-comedy in contrast to taboos over gender and race jokes:

“Mr. Leno and his counterparts have been merciless with Mr. McCain, peppering their monologues with digs about dementia, pills, prostates and Miracle Ears. In a nightly schtick, David Letterman compares Mr. McCain to ‘the old guy in the barbershop,’ ‘a mall-walker,’ ‘a Wal-Mart greeter’ and more. Conan O’Brien said recently, ‘After John McCain swept yesterday’s primaries, he purposely stole a line Barack Obama’s been using: I’m fired up and ready to go. When Obama heard this, he stole a line McCain’s been using: I’m old and not sure where I am.’”

Hat-tip to Ronni Bennett for dissecting this story.

Posted by Kavan Peterson on March 14, 2008 10:23 AM |Permalink |Comments (1)

March 17, 2008

Wall Street Melt Down

Look out for a wild ride on Wall Street this week...

For starters, from cnn.com

JPMorgan Chase & Co. said Sunday that it would acquire troubled Wall Street firm Bear Stearns amid deepening fears that Bear's demise could have sent shockwaves across the already shaky financial markets.

The deal values Bear Stearns at $236 million, or just $2 a share. The company's stock closed at $30 on Friday, down a staggering 47% for the day.

The Federal Reserve and other regulators support the deal: With the global credit crisis worsening, the Fed has been taking dramatic action to help banks and prevent widespread panic through the financial markets.

Over the past three days, roughly 200 JPMorgan staffers were working on the deal, assessing the strengths of Bear Stearns' different businesses and its exposure to toxic mortgage securities, JPMorgan executives said in a conference call Sunday night.

Bear Stearns has a book value of $84 per share. Executives said the sharp discount in the purchase price provides a cushion to protect JPMorgan in turbulent times and would provide the company "margin for error."

We will be covering this this week. Let's also remember that these are the geniuses into whose hands were encouraged to place Social Security.

Right.

Posted by Dr. Bill Thomas on March 17, 2008 5:33 AM |Permalink |Comments (0)

Fiddle Meet Rome

Nero had nothing on these guys...

From Reuters

NEW YORK (Reuters) - Bear Stearns Cos Inc (BSC.N: Quote, Profile, Research) Chairman Jimmy Cayne was playing cards in a tournament late last week while his company's future appeared to be at risk, according a published report.

As the bank hammered out an emergency funding deal on Thursday with the Federal Reserve and JPMorgan Chase (JPM.N: Quote, Profile, Research), which resulted in Bear's shares falling by as much as half, Cayne was playing in the North American Bridge Championship in Detroit, The Wall Street Journal reported on its Web site on Friday.

Cayne, who in January stepped down as Bear Stearns' long-time chief executive, is no stranger to controversy about his hobbies. Last year he was criticized for spending too much time playing bridge and golf while Bear stumbled on wrong-way bets on subprime mortgages.

Speaking of golf, CNBC had this report from the summer...

CNBC has learned that the Hollywood Country Club in Deal, New Jersey is examining whether Bear Stearns CEO Jimmy Cayne changed his golf scores to allow him to win the July 4th tournament at the club.
Cayne's golf-game had made news earlier in the month after news reports said he had gone on a golf outing during some of the worst days in Bear's subprime hedge fund crisis.

The Hollywood Golf Club president Harvey York has formed a three person committee to examine a complaint against Cayne, according to CNBC reporter Charlie Gasparino.

Gasparino spent some time on the phone Friday with York to gauge the seriousness of the allegation.

He told Gasparino that allegations of cheating occur all the time. York said the committee has thus far found no confirmation of cheating on Cayne's part.

Posted by Dr. Bill Thomas on March 17, 2008 8:54 AM |Permalink |Comments (0)

Whose Safety Net?

Matthew Yglesias agrees with me and argues the point more clearly to boot...

As I said before, I don't necessarily have a problem with the government intervening to help stabilize the financial markets if that's what's necessary for the economy. There's no sense letting a sense of spite directed at the wizards of high finance get in the way of doing what needs to be done. But surely Democrats could seize this opportunity to make the case for the rest of the social contract. After all, it was just a couple of months ago that the GOP was blocking efforts to temporarily increase food stamp benefits and extend unemployment insurance and doing so in the name of free markets and moral hazards.

It's preposterous. This is the time to be making the case for progressive taxation and for a safety net that works for the broad mass of people, not just a selective one for people who reap the windfall during boom times and then walk away from losses when things go bust.

Posted by Dr. Bill Thomas on March 17, 2008 11:30 AM |Permalink |Comments (0)

Jimmy Cayne Was His Name..

Former Bears Sterns left quite a trail of wreckage behind him.

This report from Yalman Onaran at Bloomberg is from November of 2007.

Remember as you read this that these are the geniuses who were going to run a "privatized" Social Security system.

One point that manic advocates of the free market frequently fail to acknowledge is that in a time when regular folks are increasingly exposed to the fierce competition and uncertainty that come with globalized markets, it becomes even more important to have a real, incorruptible and highly trustworthy public sector safety net.

I give you, titan of Wall Street (emeritus) Jimmy Cayne...

Nov. 1 (Bloomberg) -- Bear Stearns Cos. Chief Executive Officer James ``Jimmy'' Cayne denied that he ``engaged in inappropriate conduct'' and said he remained ``intensely focused'' on the firm.

Cayne's comments, made in an internal memo sent to employees, came after the Wall Street Journal, in a front page story earlier today, cited unidentified people as saying he smoked pot at bridge tournaments. The story also said Cayne, 73, spent 10 of 21 working days in July outside the office while two of the company's hedge funds collapsed.

``I stand by the record of success the firm has had over the 14 years that I have had the privilege of leading this great organization,'' Cayne said in the memo. ``Thank you for your continued dedication to Bear Stearns, and don't be distracted by the noise. I am certainly not.''

The collapse of the market for securities linked to subprime mortgages in July sparked the worst credit markets since Russia's debt default in 1998. Earnings at New York-based Bear Stearns, the No. 2 underwriter of bonds backed by mortgages after Lehman Brothers Holdings Inc., dropped 61 percent, the biggest decline in more than a decade. The company has cut 900 jobs, or about 6 percent of its workforce.

Bear Stearns fell 3.4 percent to $109.69 in New York Stock Exchange Composite trading. The stock has dropped 30 percent this year, the worst performance among the five biggest securities firms, Goldman Sachs Group Inc., Morgan Stanley, Merrill Lynch & Co. and Lehman. All are based in New York.

Bear Stearns spokeswoman Elizabeth Ventura confirmed the contents of the memo and declined to comment further. Cayne wasn't available for comment.

Cayne ousted Co-President Warren Spector in August, holding him responsible for the hedge-fund losses. Spector, 49, was considered a potential successor to Cayne.

Posted by Dr. Bill Thomas on March 17, 2008 7:02 PM |Permalink |Comments (0)

March 18, 2008

More on Age Bashing...

From the comments, Jon offers this take on ageist prejudice...

Original post here

Regardless of your political views, perpetuating ageist thinking is a disservice to our elders and society in general. Of greater concern than the “McCain-is-old-bashing” going on late night TV shows, is how ageist views also crop-up in “serious” discussions about the election or candidate qualifications, but in more subtle ways.
The presumption seems to be that the chronological age of a candidate (such as Senator McCain or Ralph Nader) in and of itself creates a “negative” hurdle that the candidate must explain away. But where are the questions about whether or how the chronological age of these candidates could be a positive characteristic in relation to carrying out the duties and responsibilities of the President of the United States?

Even it we can’t stamp out ageist thinking in the short term, the debate needs to be expanded to take in to account the positive and developmental aspects of aging as well.

Posted by Dr. Bill Thomas on March 18, 2008 6:39 AM |Permalink |Comments (0)

One Fish Two Sexes...

A little while back I blogged about the presence of trace amounts of prescription drugs in our water supplies. I agreed with the expert who asserted, "That can't be good."

Now the Washington Post offers an update on the problem of intersex fish in the Potomac River.

The article focuses on the more general issue of "endocrine disruptors" rather than just medications but the fundamentals are the same. If we use it-- sooner or later it is going to wind up in our water supply.

The Potomac River contains an array of man-made chemicals that could play havoc with animals' hormone systems, federal scientists have found in their best glimpse yet of the river's problems with a mysterious new class of pollutant.
The research, unveiled at a conference last week, found more than 10 of the compounds, including pesticides, herbicides and artificial fragrances. Through an accident of chemistry, formulas designed to kill bugs or add smell to soap might also interfere with vital signals in fish, amphibians and other creatures.

The scientists said they hoped this new research might explain one of the Potomac's most bizarre discoveries: Some male fish have begun growing eggs. Scientists said there was no evidence of a threat to human health.

Taken with a recent report that drinking water samples from the river contain traces of drugs, the results provide troubling evidence about the river's health. People living along the Potomac, the results showed, have widely tainted it with pollutants that scientists are just beginning to understand.

"The types of things we're finding are the types of things that are associated with everyday life," said David Alvarez, a U.S. Geological Survey research chemist who analyzed samples from the Potomac. The contaminants flow into the river from sewer plants and in rainwater washing off of farm fields and suburban lawns, he said.

"If it's something we're using, ultimately it's going to end up in the water," Alvarez said.

The chemicals in the study presented at the conference, held in Berkeley Springs, W.Va., are suspected by scientists to be "endocrine disruptors." This group of contaminants interferes with natural hormone systems, twisting or aborting the processes that hormones control. The conference was sponsored by the Metropolitan Washington Council of Governments.

Much about the compounds is still unclear, including which of them really do have bad effects.

In 1996, the Environmental Protection Agency was ordered by Congress to create a testing program to identify endocrine disruptors, but the tests have not begun.

Along the Potomac, researchers have long suspected that hormone-mimicking chemicals were the cause of the "intersex" fish. The first of these creatures, male fish with eggs growing in their sex organs, were noticed in a rural West Virginia tributary in 2003.

Posted by Dr. Bill Thomas on March 18, 2008 10:06 AM |Permalink |Comments (0)

Cab Dollery on the Bailout

Cab Drollery

What is going on in the bailout is well explained at Roubini's Global EcoMonitor.

Unless public money is used on a very temporary basis to achieve an orderly wind-down or merger of Bear Stearns this is another case where profits are privatized and losses are socialized. By having thrown down the drain the decades old doctrine and rule that the Fed should not lend or bail out non-bank financial institutions the Fed has created an extremely dangerous precedent that seriously aggravates the moral hazard of its lender of last resort support role. If the Fed starts on the slippery slope of providing massive liquidity support to non-bank financial institutions that have recklessly managed their risks it enters into uncharted territory that radically changes its mandate and formal role. Breaking decades-old rules and practices is a radical action that seriously requires a clear public explanation and justification.

The laws were carefully written over centuries because they provide the protections we all need. We all includes business interests. The world is in a financial crisis because the bases of the whole system, the laws, were violated.

The prosecution for this crime against humanity, which actually parallels that of the violation of every standard, must proceed.

309 days is too long.

****************************

It isn't just the family budgets that are facing shortfalls. States administer most of the programs that affect us directly, schools, roads and the like. With tax bases decimated, tax revenues are shrinking.

Programs for the elderly are being slashed in Maine. Government jobs are being eliminated in New Jersey. Prison construction has been put off in Virginia. Some schools in California will end their music programs.

About half of the state legislatures nationwide are scrambling to plug gaps in their budgets, shot through by rapid declines in corporate and sales tax revenue, distressed housing markets and a national economy on the verge of a recession.

Many states are reporting their largest budget shortfalls since the recessions of 2001 and 1991-2. In some states where tax increases are generally anathema, including Maryland and Kentucky, governors are looking to raise some levies.

“It is not just the standard downturn where unemployment rises for a while, income tax and sales tax revenues are weak, and ultimately the economy recovers,” said Iris Lav, the deputy director of the Center on Budget and Policy Priorities, a liberal research group in Washington that tracks state budgets.

Ms. Lav pointed to a confluence of factors — including weak consumer spending, high energy prices, dropping housing values and growing foreclosure rates — that suggest states will face a protracted struggle to keep their budgets afloat.

“This all will make it harder to recover,” she said.

Too bad the Elite aka Superclass doesn't have kids in school or elderly parents

There's more good writing here...

Posted by Dr. Bill Thomas on March 18, 2008 3:22 PM |Permalink |Comments (0)

March 19, 2008

Boredom is More than Boring

Rick G, sends along notice of this insightful essay that ran in his local paper.

STANLEY M. ARONSON

A RECENT HEALTH newsletter for senior Rhode Island citizens declared that boredom has become a major societal problem, even a health hazard, for many elderly as they enter “the sudden silence gained by retiring.” Many social workers agree that the lack of a daily agenda, the absence of tangible, daily challenges and the low expectations that society demands of the newly retired all contribute materially to an emerging sense of uselessness, of cognitive unemployment, of being a member of the walking dead, experienced by so many elders as they enter the golden years.

Some whose active lives had been previously over-laden with overlapping responsibilities and successive challenges actually look forward to the appointment-free retirement years when the occasional visit to a physician’s office is the only notation in their week’s calendar. And boredom, for them, is not a blight but a benediction. Doing nothing, of course, is not the same as being bored. And an empty mind is not necessarily the precursor of doom, especially if that mind possesses a strong sense of identity. And furthermore, repose is not the same as depression. Did anyone ever describe a cat dozing in a sunny window as exhibiting boredom?

What, then, is boredom? Boredom defines a negative state, a kind of inner emptiness, a feeling of restless weariness, a purposelessness, an ennui. And unless the boredom is resolved or replaced by purposeful activity, many fear that they will then implode into a pile of dust. Boredom is a corrosive worldly weariness that can seep into every dark corner of the psyche, and sooner or later can infect all humans. Against boredom, said Nietzsche, even the gods themselves struggle in vain.

Boredom, for both young and old, is a destabilizing emotional state that may elicit anxiety, uncontrolled restlessness, even panic. And in a state of high boredom, people may then resort to irrational misadventure. Bertrand Russell once thought that at least half of the sins initiated by mankind are caused by a fear of boredom. Boredom, accordingly, may prompt a litany of unreasonable responses including overeating, compulsive infidelities and risky behaviors. Yet, according to historians, no society has yet surrendered to boredom nor had been pushed into collapse by its onslaught.

Being boring may, in fact, be one of the more enduring qualities of an aspiring politician. To bore when giving a speech is really to fill the air with repetitious platitudes, with meaningless pronouncements and with sedative declarations. The average listener, his thinking thus unchallenged, will therefore be content; the rare skeptic will mutter: “A very significant oration, but what does it mean?” And the newspaper, next morning, will assert that both the speaker and his speech were memorable.

Humans are not taught how to grow old, either gracefully or in anger. We are uninstructed in managing the awesome change in our flight plans from “I am what I do,” to “I am only what I am.” Boredom in a child is a transitory happening, easily overcome by some novel amusement or new companionship and then is forgotten. But boredom in the elderly, on the other hand, represents a different mindset and, accordingly, represents a different and more complex array of problems. Boredom in the senior citizen, like pain, is the foe of his or her inner spirit of satisfaction and peace of mind; indeed, even his or her sense of equanimity and personal identity. Boredom in the senior citizen, unlike dandruff or thinning of scalp hair, must therefore be addressed assertively, recognizing it as the early warning of a mounting depression.

Boredom in an elder person is the person’s mind declaring that his or her inner resources are exhausted, that the world of challenges has withered and that his or her role as a varsity contestant in life is irreversibly past. Boredom in an 80-year-old is the worrisome forerunner of loss of focus, loss of self-esteem and possibly depression.

To be boring is like having halitosis: only the recipient becomes affected. But being depressed by boredom, in the elderly person, becomes a measurable risk to health and the harbinger of a troubled, spent soul.

Stanley M. Aronson, M.D., a weekly contributor, is dean of medicine emeritus at Brown University ( smamd@cox.net).

Posted by Dr. Bill Thomas on March 19, 2008 6:05 AM |Permalink |Comments (0)

A More Perfect Union

I started this week talking about the serious weaknesses that are inflicting our house of credit card, debt-based economic system. I'm still watching that story unfold and will have more on it over the next few days.

Yesterday, I took time to watch the speech Presidential candidate Barack Obama delivered in Philadelphia. "A More Perfect Union," addressed the question of race relations in America directly, in a thoughtful and ultimately very useful way. As a nation we need to hear more of this kind of talk. We are, truly, "many out of one" and we need to be reminded of this more often.

Here is the speech. I urge you to watch it, think about it, talk about it with the people you live with, work with and care about.

There is a deeper message here and it has to do with aging and the possibility of a savage and ongoing intergenerational conflict. White versus Black versus White versus Black? Yes, the history is there for all who care to read it. There is also the growing possibility of another cultural fracture, Old versus Young versus Old versus Young. Candidate Obama makes the point that powerful interests have worked relentlessly to enlarge and deepen the racial divide -- all in pursuit of their own narrow self-interests.

When I was writing about the collapse of the Bear Stearns investment house, I made the point that the Bush Administration had argued strenuously in favor of "privatizing" Social Security and placing the financial security of America's elders into the hands of men like Bear Stearns' Jimmy Cayne.

In support of its drive to privatize Social Security, the Administration did its best to open a rift between young and old. It sought to enlarge our differences and make us alien to each other. This strategy is at the root of so many of our social problems and it is what makes those problems seem so intractable.

Narrowing the gap, bringing Black and White together, Young and Old and Men and Women together is the essence of true leadership and true leadership is the life blood of any healthy human community.

The differences are real but we do not have to let others use them to divide us and deny us a better future.

Posted by Dr. Bill Thomas on March 19, 2008 11:29 AM |Permalink |Comments (2)

Rule by Division

Nathan Newman offers up a thoughtful post on race, class and power in America today...

Obama's speech was possibly the greatest speech on race and class in modern politics, highlighting the inextricable link between the two in America where each has shaped the other in our history. Instead of simplistic "can't we all get along" messages or [Bill] Clintoneseque statements about "strength through diversity", Obama took head on the festering anger fueling racism and racial resentment, brilliantly juxtaposing black anger and white anger and the way the privileged corporate class has exploited that racial division.

Read the whole thing here...

Posted by Dr. Bill Thomas on March 19, 2008 12:04 PM |Permalink |Comments (1)

March 20, 2008

Old Age Kit

Sorry, it's currently out of stock...

Ben Nyes...

Specialty Old Age Kit by Ben Nye. Foundation, highlight and shading patette, liner pencil, grey hair color and makeup sponges. Comes with easy step by step instructions. For stage or theatrical productions.

Posted by Dr. Bill Thomas on March 20, 2008 6:11 AM |Permalink |Comments (0)

March 21, 2008

Cost and Value

Nice conversation going on about the fundamental goals of health care reform...

This post from Ezra Klein's blog draw an important and often overlooked distinction. If you like thinking about our health care system and how it can be improved, his blog is a great place to start. He is reacting to a post written by Kevin Drum...

How Kevin was able to get an early glance at my next tattoo is anyone' guess (I had the whole thing translated into kanji, too!), but that's a pretty perfect description of how I understand the role of the progressive health reformer. It's also why I joke at panels that my plan for health reform is invading France and taking their system. I'm down with no blood for oil, but I'd give some blood for universal coverage.

Meanwhile, a quick thought on cost control: When talking about costs, folks need to distinguish whether they're talking about getting more value for each dollar or reducing total spending. The two might not be the same. Prevention, for instance, gets far more value out of each dollar. But if it keeps people alive a whole lot longer, that's more time for them to contract various illnesses, and when they grow old, to die from something expensive. So though prevention may mean our health dollars are doing a whole lot more good, it may not mean we're spending less as a total percentage of GDP. Conversely, we could outlaw coverage of statins, which would save some money, but kill a lot of folks. Now, I'm not saying the two ends are opposed. Indeed, getting good value is probably a complementary goal to spending less. But it's not the same thing.

Getting more is not always necessarily better than getting less of something. We want better health care (and better measures of health) rather than just getting more care- regardless of its ultimate impact on public health.

Posted by Dr. Bill Thomas on March 21, 2008 6:16 AM |Permalink |Comments (0)

Spring Flowers

My good friend Liam Keene sends along this link.

Flower Garden

Go there and feel a little digital springtime.

Posted by Dr. Bill Thomas on March 21, 2008 6:22 PM |Permalink |Comments (0)

March 22, 2008

The Answer is... No.

Is this the end of old age?

The existence of exceptional individuals who can "still" do things that younger people do is not proof of a future that "turns back the clock on aging."

Sorry about that.

Posted by Dr. Bill Thomas on March 22, 2008 6:16 AM |Permalink |Comments (1)

March 24, 2008

The Incredible Shrinking Geriatricians

WOSU has the story....

Listen Here

COLUMBUS, OH (2008-03-21) The oldest baby boomers are about 10 years from the age when they will likely require additional medical attention. Some worry that the surge in numbers of people needing care could overwhelm the U.S. health care system which is already facing a few problems.
Geriatricians are doctors who specialize in the elderly. They are few in number, and the field is not attractive to medical students. Is this a cause for concern? Maybe. Maybe not.

To determine whether the future supply of doctors in Ohio will meet the projected demand, state policy makers commissioned a study by the research arm of the American Academy of Family Physicians. Dr. Robert Phillips directs the center that conducted the study. He says it found Ohio's supply of doctors to be healthy - with one big exception - geriatricians

Phillips says, while Ohio's population growth is shrinking, its older population is growing. He sees a current shortage "that's just going to get worse."

Read the whole story here

Meanwhile...

The New York Times on Wednesday examined a "migration" of "top tier" medical students from "branches of health care that manage major diseases toward specialties that improve the life of patients," such as dermatology and plastic surgery, and that improve the "lives of physicians, with better pay, more autonomy and more-controllable hours."
According to the Times, dermatology and plastic surgery are "among the most competitive" residency programs. Dermatology, plastic surgery and otolaryngology had the highest median medical board scores and the largest percentage of medical honor society members among 18 specialties, according to a report by the Association of American Medical Colleges and the National Resident Matching Program.

Internists in 2006 worked an average of 50 hours weekly, compared with about 40 hours weekly for dermatologists, according to an annual survey by the magazine Medical Economics. A recent survey conducted by the Medical Group Management Association found that internists have average annual incomes of $191,525, compared with $390,274 for dermatologists. In addition, dermatology "offers more independence from the bureaucracy of managed care because patients pay up front for cosmetic procedures not covered by health insurance," the Times reports.

"Medical school professors and administrators say such discrepancies are dissuading some top students at American medical schools from entering fields, like family medicine, that manage the most prevalent serious illnesses," according to the Times. Such students are "being replaced in part by graduates of foreign medical schools, some of whom return to their home countries to practice," the Times reports.

Posted by Dr. Bill Thomas on March 24, 2008 9:40 AM |Permalink |Comments (0)

March 25, 2008

Gallstones and Magnesium

An interesting study, just out shows that men who increase their dietary intake of Magnesium (a mineral) cut their risk of developing symptoms related to gallstones.

Consumption of a diet rich in magnesium appears to reduce the risk of symptomatic gallstone disease, according to findings from a US study of over 42,000 men.
Dietary consumption of magnesium has been declining over the years, lead author Dr. Chung-Jyi Tsai and colleagues note, due in part to the overprocessing of foods.

Magnesium deficiency is known to cause elevated triglyceride levels and decreased HDL cholesterol levels, both of which may raise the risk of gallstones. Still, the long-term effect of magnesium consumption level on the risk of gallstones in humans was not known.

Honestly, I think that this is the payoff paragraph.

"From many studies by this group and others, it appears that a generally healthy dietary pattern, with more plant-based foods, fiber, and increasing complex carbohydrates, and now increasing magnesium intake will decrease the risk of symptomatic gallstones and cholecystectomy," Dr. Cynthia W. Ko, from the University of Washington in Seattle, writes in an accompanying editorial. "This 'healthy' dietary pattern will also help in prevention of other chronic diseases in addition to gallstones."

This is the kind of research that I like and respect. Too many people are taking too many supplements that have never been adequately studied. I agree with the dictum...

There is no such thing as "alternative medicine."

There is medicine that works and medicine that does not work.

As for me, I prefer medicine that works.

The citation for this article is...

Am J Gastroenterol. 2008;103:375-382.

Posted by Dr. Bill Thomas on March 25, 2008 6:23 AM |Permalink |Comments (0)

March 27, 2008

The ProAging Network

Last week the Erickson School hosted a ProAging Network event for aging services workers in MD, PA, VA and DC. I shared some thoughts on my philosophy of Developmental Aging. Take a look:

Posted by Dr. Bill Thomas on March 27, 2008 10:21 AM |Permalink |Comments (1)

March 28, 2008

"Caring for Your Parents"