Archive for the ‘Aging’ Category

October 31, 2013

What Percentage of Older Women Are Satisfied with Their Body Image? Survey Says …

Body image is often thought of as a concern for teen girls and younger women, and the abundance of resources on this topic are skewed toward those age groups.

But a new study published in the Journal of Women and Aging illustrates how few of us are happy with how our bodies look, even as we get older: Only 12 percent of women reported being satisfied with their body size.

While the number is pathetically low, it’s not surprising considering how many of us are self-critical about our appearance. Even if we are not actively dieting, our culture — and sometimes our own families and friends — make it impossible to tune out messages that we should be younger, thinner and prettier.

Researchers from UNC Chapel Hill conducted an internet-based survey of 1,789 U.S. women age 50 and older to find out more about their perspectives. Participants were overwhelmingly white (92.3 percent), and the average age was 59. Close to half (42 percent) had a body mass index (BMI) that put them within “normal” weight ranges for their height.

For the study, participants were shown silhouettes of nine bodies of various sizes and asked which silhouette most resembled their own body, and which body size they preferred. Women who preferred the shape closest to their own were considered to be satisfied with their bodies. Women who preferred a different body shape were categorized as dissatisfied.

In discussing their findings, the authors point out that women who are generally satisfied “appear to exert considerable effort to achieve and maintain this satisfaction, and they are not impervious to experiencing dissatisfaction with other aspects of their appearance, particularly those aspects affected by aging.”

For instance, many of the women who fell into the “satisfied” group were unhappy with specific body parts, including their stomach (56.2 percent), face (53.8 percent), and skin (78.8 percent) — although they reported dissatisfaction at lower rates than the women who were dissatisfied overall with their bodies.

And while the majority (88 percent) of women who were satisfied were considered “normal” weight, 40.6 percent said they would be moderately or extremely upset if they gained just 5 pounds.

Satisfaction with one’s body shape/size also does not grant immunity to negative thinking:

- A third (34.1 percent) reported thinking about their weight “daily” or “always.”
- Half (50.7 percent) expressed envy of younger women’s appearance.
- More than three-quarters (77.1 percent) reported that their shape played a primary role in their self-evaluation — about the same percentage of women who were unsatisfied with their appearance.

The women were also asked about their weight, height, ethnicity, symptoms of eating disorders, diet, and weight-control behaviors (like dieting and frequent weighing), concerns about their weight and shape, and quality of life. There was no difference between the satisfied and unsatisfied groups when it came to skipping meals or extreme/disordered weight control measures.

Satisfied women reported somewhat more exercise (average of 5.1 hours vs. 3.8 hours), and the authors note that “exercise may directly (and indirectly) enhance body esteem in women.”

Women who were unsatisfied with their bodies were significantly more likely to report that a physical or medical condition affected their weight or appetite (30.3 percent vs. 9.2 percent). The were also more likely to do frequent body checking, attempt weight loss, spend more than half their time dieting, and report having tried low-calorie diets or diet plans.

The authors were not able to determine whether these activities led to dissatisfaction, or whether body dissatisfaction more often led to these activities. The study also doesn’t address the effect that negative messages and stigma may have on satisfaction rates.

The authors recommend that health-care providers discuss weight, shape, and aging-related concerns with all mature women, and “maintain sensitivity when talking about weight management.”

For a more personal take on these survey results, read Rachel Zimmerman’s post at WBUR’s Common Health. Zimmerman reflects on how she spends an “inordinate, and frankly embarrassing amount of time thinking about food, planning meals and strategizing about how to control [her] weight.”

And for more information, check out Our Bodies Ourselves resources on body image. For help related to eating disorders, see the National Eating Disorders Association.

November 9, 2012

Questions Remain about Osteoporosis Drugs and Unusual Fractures

Bisphosphonates, a category of drugs that includes Fosamax and Boniva, are commonly prescribed to treat and prevent osteoporosis. Unfortunately, concerns have been raised about possible adverse effects of these drugs when used for longer than 3 – 5 years.

There are many unanswered questions about the long-term use of bisphosphonates.  A 2012 New England Journal of Medicine perspective piece notes that it is unclear how long most people should take the drugs, whether certain groups of patients are more likely to benefit from longer term use of the drugs, how long benefits of the drugs last after stopping them, and whether there are reliable measures to help make that decision in individual patients.

One of the concerns regarding long-term use is the potentially higher risk of unusual thigh bone fractures (often called “atypical femur fractures”).

A new study published in the The Journal of Clinical Endocrinology & Metabolism attempts to shed more light on the potentially higher risk of these fractures. The researchers collected the stories of 78 women and 3 men who suffered an atypical femur fracture after taking a bisphosophonate for treatment or prevention of osteoporosis. Medical histories were collected to see how long people had been on the drugs, if they experienced another fracture in the other leg, how long they were in pain before the fractures were actually diagnosed, and other factors.

They found that 77% of the patients were in pain before they were initially diagnosed with a fracture, and they were in that pain for an average of about 9 months (ranging from 1 to 24 months). The authors write, “Sixty-one patients had sought treatment for persistent thigh, leg, or hip pain and had multiple studies and procedures that did not discover the problem.” Almost 40% of the patients ended up with another fracture on the other side. About a third of the patients also had metatarsal (foot) fractures, while 2.5% had a pelvic fracture and 3.7% experienced jaw osteonecrosis. Despite the lack of certainty about long-term safety of these drugs, the patients on average had been taking them for more than 9 years.

The authors note that while patient reports may sometimes be inaccurate or incomplete, they hoped the reports would provide more complete information than that found in bits and pieces across medical charts. Although additional rigorous study is still needed, the authors raise important questions about whether we should also be concerned about foot fractures with these drugs, and whether patients receive timely diagnosis when they do experience bad outcomes.

A systematic review on the risk of fracture was reportedly discussed at a recent American College of Rheumatology meeting – we’ll keep an eye out for those findings being published.

June 5, 2012

Hormone Therapy and Chronic Disease Prevention

This month, the U.S. Preventive Services Task Force released a new report which is informing their updated recommendations on hormone therapy for chronic disease prevention in menopausal women. Bone fractures, dementia, stroke, and urinary incontinence were among the chronic conditions they examined.

In the 2005 recommendations, USPSTF recommended against routine use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women, and against estrogen alone for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy. The new research looked at 9 newer studies – mostly from the Women’s Health Initiative – in order to review and update those recommendations.

Based on their review of the evidence, the authors concluded that both regimens – estrogen plus progestin, and estrogen alone – decrease risk of bone fracture but increase risk for stroke, thromboembolic events (blood clots in the legs or lungs), gallbladder disease, and urinary incontinence. Estrogen plus progestin was found to increase risk for breast cancer and probably dementia, while estrogen alone may slightly decrease risk for breast cancer.

The draft new recommendations are very similar to the 2005 ones. The USPSTF “concludes with high certainty that there is zero to negative net benefit for the use of combined estrogen and progestin therapy for the prevention of chronic conditions, and concludes with moderate certainty that there is no net benefit for the use of estrogen alone.” They also explain that the recommendations do not apply to women younger than age 50 who have undergone surgical menopause, and they don’t address use of hormone therapy for the management of menopausal symptoms like hot flashes or vaginal dryness.

There were some limitations of this research described by the authors, like the small number of new studies, variations in the studies that make it hard to combine their findings, and lots of study participants who dropped out before the trials were finished. In addition, most of the women in the studies were 60 to 69 years old. Additional research is needed that looks at women who are transitioning through menopause or immediately postmenopausal.

A Washington Post article puts the findings in context, explaining:

One form of hormone replacement therapy — estrogen alone — did appear to slightly reduce the incidence of breast cancer. Invasive breast cancer looms large as a concern to many women, but affects just 11 percent of them past menopause.

That possible protective effect became less consequential when weighed against hormone therapy’s impact on far more likely risks to women’s health…It fails to reduce the risk of heart disease, which will affect 30 percent of women who live past menopause. It slightly increased the likelihood of dementia, which will affect 22 percent of all post-menopausal women. It was linked to a higher likelihood of stroke, affecting 21 percent of these women.


September 26, 2011

La FDA Reevalúa los Riesgos de los Medicamentos para la Osteoporosis

Escrito por Rachel; traducido del orginial en inglés Sept. 20, 2011.

OBOS has received funding to make blog entries available in Spanish. We hope to expand outreach efforts in the coming year.

Los bisfosfonatos (p.e. Fosamax, Boniva, etc.) son medicamentos para el tratamiento y la prevención de la osteoporosis en mujeres postmenopáusicas, pero hay preocupación por los posibles efectos secundarios causados por el uso de estos medicamentos por periodos largos.  Entre los posibles efectos secundarios se incluyen: fracturas atípicas de fémur (muslo), osteonecrosis (muerte de la mandíbula), y cáncer de esófago.

El otoño pasado, la FDA pidió cambios en las etiquetas de los bisfosfonatos para incluir advertencias sobre riesgos de fracturas, para explicar que no se sabe exactamente el tiempo que se debe consumir el medicamento, y recomendar que pacientes y doctores reevalúen periódicamente el uso del medicamento.

Recientemente, algunos comités de la FDA encargados de los medicamentos para la salud reproductiva y del manejo de la seguridad/riesgo de las medicinas, se reunieron para discutir el consumo extendido (>3-5 años) de bisfosfonatos, y sus posibles complicaciones.

En un documento informativo preparado para la reunión, la FDA revisó evidencias sobre estos relativamente raros pero preocupantes efectos, y concluyó: “La seguridad para el consumo prolongado de  bisfosfonatos aún no es clara, por cuanto los resultados de los estudios sobre la posible relación entre la osteonecrosis de la mandíbula, las fracturas atípicas de fémur, o el cáncer del esófago, y el uso de bisfosfonatos para la prevención y el tratamiento de la osteoporosis son conflictivos.”

La agencia concluyó que la evidencia sugiere un aumento en la incidencia de osteonecrosis de la mandíbula con un uso prolongado, especialmente de 4 años o más, pero que se necesitan estudios más profundos.  También dice, “Las fracturas atípicas….parecen tener una asociación importante con los bisfosfonatos, pero no hay actualmente consenso en cuanto a la manera como el uso acumulado de bisfosfonatos aumenta los riesgos de este tipo de fractura poco común.  Finalmente, no hay evidencia definitiva para apoyar la relación entre el cáncer de esófago y el uso prolongado de bisfosfonatos.”

En cuanto a los posibles beneficios resultantes del uso prolongado de bisfosfonatos para reducir fracturas relacionadas con la osteoporosis, la agencia no encontró beneficios evidentes.  “Los resultados sugieren que no hay ventajas de importancia en continuar usando esta medicina por más de 5 años.”

El New York Times también informa acerca de las recientes reuniones de la FDA, y destaca: “El comité convocó a más estudios para establecer la eficacia del medicamento en la meta deseada de prevenir fracturas.  Así mismo, los asesores recomendaron que la FDA examine la razón por la que el medicamento es recetado como medicina preventiva a mujeres que nunca han tenido osteoporosis.”

Para más información sobre este tema, vea nuestras previas entradas de blog, y la Red Nacional de la Salud de la Mujer (the National Women’s Health Network), la cual también pregunta si este producto debe ser comercializado y recetado como medicina preventiva para mujeres con buena salud.

September 20, 2011

FDA Takes Another Look at Osteoporosis Drug Risks

Bisphosphonates (e.g. Fosamax, Boniva, and the like) are drugs prescribed for treatment and prevention of osteoporosis in postmenopausal women, but concerns have been raised about possible adverse effects of using the drugs for long periods of time, such as “atypical” femur (thigh) fractures, osteonecrosis (death of the jaw bone), and esophageal cancer.

Last fall, the FDA requested changes to bisphosphonate labels to warn of the fracture risk, explain that the optimal amount of time to take the drug is not known, and recommend that patients and their doctors periodically reevaluate whether the drug should be continued.

Recently, FDA committees on reproductive health drugs and drug safety/risk management met to discuss long-term (>3-5 years) use of bisphosphonates and these potential complications.

In a briefing document prepared for the meeting, the FDA reviewed evidence on these relatively rare but concerning effects, and concluded, “The safety of long-term bisphosphonate therapy continues to be unclear as study results are conflicting as to whether or not ONJ [jaw osteonecrosis], atypical femoral fractures or esophageal cancer are associated with use of bisphosphonates for the prevention and treatment of osteoporosis.”

The agency further concluded that the evidence suggests an increased prevalence of jaw osteonecrosis with longer use, especially of 4 or more years, but that larger studies are needed. It also writes that “Atypical fractures…appear to have a strong association with bisphosphonates but there is no current consensus on the extent to which cumulative use of bisphosphonates increases the risk of this rare type of fracture. Finally, no definitive evidence is available to support an association between esophageal cancer and long-term use of bisphosphonates.”

In discussing whether long-term use of bisphosphonates would have a benefit of reducing osteoporosis-related fractures, the agency found no clear benefit of continuing, stating, “These results suggest no significant advantage of continuing drug therapy beyond 5 years.”

The New York Times also has coverage of the recent FDA meeting, and notes: “The committee also called for more study of the overall effectiveness of the drugs in their desired goal of preventing fractures. And the advisers recommended that the F.D.A. take a close look at why the drugs are prescribed as preventive medicine for women who do not even have osteoporosis.”

For more on this topic, see our previous posts, and the National Women’s Health Network, which also raises the issue of whether these drugs should be marketed and prescribed for prevention to healthy women.

February 28, 2011

More Attention to Potential Risks from Bisphosphonates

We have previously written about the apparently small risk of a rare bone fracture associated with drugs meant to prevent bone fractures in people with osteoporosis. These drugs are called bisphosphonates, known under trade names such as Fosamax and Boniva.

Today, NPR’s Morning Edition has a good overview of this topic, noting the dilemma for women weighing whether to take such drugs. Bisphosphonates can help some women prevent serious hip fractures, but they may be associated with a increased risk of other atypical fractures in some women, especially those who use the drugs long-term.

There’s a new study on this topic in the Journal of the American Medical Association as well. The study found that treatment with a bisphosphonate for more than five years was associated with an increased risk of subtrochanteric or femoral shaft fractures, though the risk of these fractures is low.

The FDA announced a labeling change to the drugs in October 2010 to note the possible risk of thigh bone fractures.

January 5, 2011

The New Year in Health Care Reform: Good News and Bad for Older Americans

The new, more Republican Congress is now in session, and we’re already seeing talk of repealing last year’s health care reform legislation. For now, older Americans can benefit from some of last year’s changes that are now becoming active, including:

  • The effect of the “doughnut hole” in Medicare Part D coverage should be reduced through a 50% discount on brand-name prescription drugs in the coverage gap. Senate Democrats are focusing on this benefit as one that should not be repealed by the new House and are vowing to block any such repeal.
  • Free preventive services, such as cancer screenings and annual wellness exams, will be available for seniors on Medicare.

Another expected benefit looks like it will be reversed:

  • The New York Times reports that Medicare regulations are being revised “to delete references to end-of-life planning as part of the annual physical examinations covered under the new health care law, administration officials said Tuesday.” This is the provision which would have paid for the visits for Medicare recipients to talk to their physicians about their end-of-life wishes, which was distorted into political talk about “death panels.” The administration is citing a lack of public comment opportunity on the provision for its reversal.

An overview of other newly available healthcare benefits is available here.

September 2, 2010

Government Report Outlines Health Status of “Older Americans”

I missed this earlier in the summer, but wanted to let you know about a government report, Older Americans 2010: Key Indicators of Well-Being, which provides information on the health status of Americans aged 65 years and older, including life expectancy, chronic health conditions, symptoms of depression, prescription drug costs, obesity, physical activity, mammograms, and more. Several of the topics are split into male and female data, such as the percentage of women and men who have heart disease, hypertension, and other conditions, so this could be a good quick reference source for understanding some aspects of the health status of women older than 65.

Random Aside: does the generic descriptor “older Americans” bother anyone else? It always makes me ask, “Older than what/who?”

August 3, 2009

Political Diagnosis: The Summer Recess Healthcare Legislation Wrap, Plus the Latest on Efforts to Derail Reform and Dismiss Abortion

Super Fun Health Graphic: Are you an employed single mother? Or maybe you own a small business? Either way, The New York Times explains how bills working their way through Congress might affect you:


A Hot, Hot Summer: By a 31-28 vote, the House Committee on Energy and Commerce on Friday approved a health reform bill that would cover about 95 percent of Americans. It includes the so-called public option, a government insurance plan that would compete with private insurers. The bill allows the federal government to negotiate with drug companies for lower prices under Medicaid and limits how much insurers can increaes premiums. Subsidies would be provided to lower-income families to help cover the cost of insurance.

Two other committees — Ways & Means, and Education & Labor – approved legislation in mid-July. The full House will take up the bill, HR 3200, when it returns from August recess. Now everyone’s waiting on the Senate Finance Committee, chaired by Sen. Max Baucus (D-Mont.), to move its health reform bill out of committee — a move that isn’t likely to happen until after summer recess. Lawmakers and experts weigh in on what’s slowing everything down.

The Energy and Commerce committee vote was largely along party lines, with five Democrats joining all 23 Republicans opposed to the bill. In a story about how the White House might be ready to move forward without building broader bipartisan support, The New York Times notes that lobbying efforts are going to be “unusually heavy” this month. Indeed, House Republican leader, Rep. John Boehner of Ohio, has promised a “hot summer” for Democrats.

How much hotter than health reform = death can it get? Opposition to health reform already has become increasingly vocal, what with conservative talk radio fueling fear among senior citizens that healthcare reform will lead to end-of-life “rationing” and “euthanasia.” Ceci Connolly of the Washington Post writes:

Not since 2003, when Congress and President George W. Bush became involved in the case of Terri Schiavo, who lay in a vegetative state in a hospice in Florida, have lawmakers waded into the highly charged subject, said Howard Brody, director of an ethics institute at the University of Texas Medical Branch at Galveston.

The attacks on talk radio began when Betsy McCaughey, who helped defeat President Bill Clinton’s health-care overhaul 16 years ago, told former senator Fred D. Thompson (R-Tenn.) that mandatory counseling sessions with Medicare beneficiaries would “tell them how to end their life sooner” and would teach the elderly how to “decline nutrition . . . and cut your life short.”

House Minority Leader John A. Boehner (R-Ohio) and Republican Policy Committee Chairman Thaddeus McCotter (Mich.) said they object to the idea because it “may start us down a treacherous path toward government-encouraged euthanasia.”

Lawmaker, Protect Thyself: House Speaker Nancy Pelosi (D-Calif.), according to the NYT, “distributed cards outlining key points of the House’s health care approach” to all 256 Democrats heading to their home districts for August recess. She might want to send them home with their own personal armor.

Politico reports on growing incivility at town hall meetings led by Democratic representatives: “Screaming constituents, protesters dragged out by the cops, congressmen fearful for their safety — welcome to the new town-hall-style meeting, the once-staid forum that is rapidly turning into a house of horrors for members of Congress.”

Think Progress notes that “much of these protests are coordinated by public relations firms and lobbyists who have a stake in opposing President Obama’s reforms.”

The lobbyist-run groups Americans for Prosperity and FreedomWorks, which orchestrated the anti-Obama tea parties earlier this year, are now pursuing an aggressive strategy to create an image of mass public opposition to health care and clean energy reform. A leaked memo from Bob MacGuffie, a volunteer with the FreedomWorks website Tea Party Patriots, details how members should be infiltrating town halls and harassing Democratic members of Congress.

Visit Think Progress for the memo, which Lee Fang says “resembles the talking points being distributed by FreedomWorks for pushing an anti-health reform assault all summer.”

All this makes the 1994 version of Harry & Louise look like the nicest, most honest couple you’d ever meet (funny how life repeats itself, with a twist).

Center of Debate: Back to the legislation approved by the Energy & Commerce committee … By a vote of 30 to 28, the committee approved an amendment (pdf) that states abortion would not be included in the “essential benefits package” to be defined by the government.

Dan Gilgoff at U.S. News & World Report explains the details:

The amendment, proposed by Democratic Rep. Lois Capps, prohibits the federal government from compelling private providers participating in the federal healthcare exchange to cover abortion. But it also bars the government from prohibiting those plans from offering such coverage. And it requires that at least one of the private plans participating in the exchange cover abortion—and at least one of the plans to not. [...]

Democratic defenders of the Capps amendment say it applies the Hyde Amendment, which for more than three decades has prohibited Medicaid from funding abortions except in very limited circumstances, to the new government-controlled healthcare. Private healthcare providers are free to cover abortion, but not with federal funds. The public plan would cover abortion, but not with federal funds; a Capitol Hill aide tells me money for abortions would come from what participants pay into the public plan.

Abortion has been the political football since the debate over healthcare commenced this year.

“One of the very real dangers in the debate on how to fix American healthcare is that women’s health will become a bargaining chip, with the GOP and anti-abortion forces trying to frame healthcare reform as an endrun to government ‘interference’ in our lives by ‘mandating’ abortion and gasp, contraception,” writes Lucinda Marshall.

And over at RH Reality Check, Amanda Marcotte looks at how the media has been reinforcing unexamined arguments against public funding for abortion, and she explains the true story:

Here’s the unvarnished truth: There is no way that any kind of public health care plan will have elective abortion coverage. Nor is there any real chance of abortion becoming mandated coverage. It’s more likely that breast implants will be paid for by tax money. It’s more likely that a public insurance option will provide everyone wth an iPod Touch. Believe me; even most pro-choicers gave up a long time ago on hoping that we could overturn the Hyde Amendment that bans women who are on federally funded insurance programs from getting elective abortions covered, and there’s no way that this will change if the number of women on federally funded health insurance grows. And even though it would only be fair and cost-effective to mandate coverage for elective abortion, in this country that’s sadly a pipe dream.

Plus: For more on fact vs. fiction, read this AP story on distortions in the health care debate. Meanwhile, Princeton economics professor Uwe E. Reinhardt offers a glimpse of what a health reform bill would look like if it conformed with the American public’s idea of “common sense” in health care. And Bill Moyers on Friday re-aired a must-see interview with former insurance industry executive Wendell Potter. Watch it or read the transcript. You may come away mad, but you won’t be disappointed.

Want to Cut Costs? Over Here, Mr. President: Also at RH Reality Check, Jennifer Block, author of “Pushed: The Painful Truth About Childbirth and Modern Maternity Care,” writes about where healthcare cost savings can be found:

A new economic analysis forecasts savings of $9.1 billion per year if 10 percent of women planned to deliver out of hospital with midwives. (Right now, just one percent do). If America is serious about reform, midwifery advocates are saying, “Hey, how about us?”

Childbirth, in fact, costs the United States more in hospital charges than any other health condition — $86 billion in 2006, almost half paid for by taxpayers. This high price tag — twice as high as what most European countries spend — buys us one of the most medicalized maternity care systems in the industrialized world. Yet we have among the worst outcomes: high rates of preterm birth, infant mortality, and maternal mortality, with huge disparities by race.

Tell Me: What’s Wrong With Single-Payer Again?: David Brooks and Gail Collins try to figure it out. Collins starts with this set-up:

Since something like a third of the cost of health care is in administration, and the problem with reorganizing health care has to do with all the multitudinous plans and policies, a single-payer system would be far and away the most cost effective answer. We don’t talk much about it because it isn’t politically possible. But it isn’t politically possible because we don’t talk about it. The opponents of a public plan are afraid that people would all gradually migrate toward it, causing the insurance industry as we know it to wither away. Wouldn’t that be a good thing?

In Other News, Senate Committee Grasps Reality: It seems that funding for abstinence-only sex education is losing its luster. The Senate Appropriations Committee on Thursday approved its fiscal year 2010 spending bill (HR 3293) for health, education and labor programs, minus funding for the controversial program. The $730 billion bill, approved by a vote of 29-1, includes $104.5 million for a comprehensive “Teen Pregnancy Prevention” program and no funding for abstinence-only sex ed. Abstinence-only advocate Sen. Sam Brownback (R-Kan.) cast the only “no” vote.

“After more than a decade, Congress has finally begun to put teenagers’ health above politics and ideology,” Michael Macleod-Ball, acting Director of the ACLU Washington Legislative Office, said in a statement. “The Committee’s actions represent a looming victory for young people, parents and advocates of science-based approaches.”

The same statement notes that the measure must still go to the full Senate for a vote, “where misguided efforts to reinsert funding for abstinence-only programs are possible.”

Take Action
From the Big Push for Midwives, sign the “I pushed for out-of-hospital maternity care” petition in support of  including out-of-hospital maternity care and Certified Professional Midwives, who are specially trained to provide it, in federal healthcare reform legislation.

July 29, 2009

Obama Town Hall on Health Care Reform

President Obama yesterday held an AARP-sponsored town hall on health care reform that was streamed live online — you can watch it now at the AARP website. A White House transcript is also available here.

If you scroll down about 2/3 of the way through the transcript, you’ll find that Obama was asked and answered another question along the lines of the “health reform = death for old people” rumors Christine addressed in a recent post. The audience member says, “I have been told there is a clause in there that everyone that’s Medicare age will be visited and told to decide how they wish to die.”

The comment refers to a section of the House reform bill that would provide for consultation every five years about advance care planning, including explanations of things like living wills and power of attorney that people may want to consider, as well as information about end-of-life services such as hospice and palliative care.

As the moderator of the town hall noted, “This is being read as saying every five years you’ll be told how you can die.”

Obama replied:

Well, that would be kind of morbid. I think that the idea in that provision, which may be in the House bill — keep in mind that we’re still having a whole series of negotiations, and if this is something that really bothers people, I suspect that members of Congress might take a second look at it. But understand what the intent is. The intent here is to simply make sure that you’ve got more information, and that Medicare will pay for it.

So, for example, there are some people who — they get a terminal illness, and they decide at a certain point they want to get hospice care. But they might not know how to go about talking to a hospice, what does it mean, how does it work. And they don’t want to — we don’t want them to have to pay for that out of pocket. So if Medicare is saying you have the option of consulting with somebody about hospice care, and we will reimburse it, that’s putting more power, more choice in the hands of the American people, and it strikes me that that’s a sensible thing to do.

Rachel Maddow last night had a segment on Republicans’ interpretation of the bill:

Visit for Breaking News, World News, and News about the Economy

July 27, 2009

Stop the Madness: Health Care Reform Does Not Equal “Senior Death Warrant”

“Senior Death Warrant” is the title of a ridiculous chain email created to frighten the public as the Obama administration attempts to overhaul health care for first time in decades. Unfortunately, it’s not so easy to laugh off this message, especially as it keeps appearing in forums and on other websites.

Here’s how it begins:

The actress Natasha Richardson died after falling skiing in Canada. It took eight hours to drive her to a hospital. If Canada had our healthcare she might be alive today. We now have helicopters that would have gotten her to the hospital in 30 minutes. Obama wants to have our healthcare like Canada ‘s and England’s.

In England anyone over 59 cannot receive heart repairs or stents or bypass because it is not covered as being too expensive and not needed.

I got this today and am sending it on. If Obama’s plans in other areas don’t scare you, this should. [...]

Please do not let Obama sign senior death warrants.

Everybody that is on this mailing list is either a senior citizen, is getting close or knows somebody that is.

Most of you know by now that the Senate version (at least) of the “stimulus” bill includes provisions for extensive rationing of health care for senior citizens… The author of this part of the bill, former senator and tax evader, Tom Daschle was credited today by Bloomberg with the following statement. Bloomberg: Daschle says “health-care reform will not be pain free. Seniors should be more accepting of the conditions that come with age instead of treating them.”

There’s more, and you can read it in its entirety at, along with a point-by-point breakdown of all the incorrect information contained within.

For starters, here’s what found when it looked into the claim about people over age 59 not receiving coronary care in England:

We called the United Kingdom’s Department of Health and a spokesman told us: “It is not true that anyone aged over 59 years cannot receive heart repairs, stents or bypass surgery on the basis of their age.”

He also said that medical procedures in the U.K. are not routinely denied for older people. The National Health Service, the U.K.’s public health care service, has a constitution which prohibits discrimination on the basis of age and other factors. “The NHS Constitution states that the NHS provides a ‘comprehensive service, available to all irrespective of gender, race, disability, age, sexual orientation, religion or belief,’ ” the spokesman said.

We also contacted a nonprofit group, England’s Age Concern and Help the Aged, which works to stop age discrimination in various facets of life, including employment and health care. Age Concern’s press office had never heard of any kind of prohibition on heart surgery for those 60 and older.

Women, who generally live five to 10 years longer than men, need to know that health care reform in the United States will not lead to a rationing of care for seniors. Here’s what reports on the stimulus bill:

Some conservatives have said that a council overseeing the government’s funding of comparative effectiveness research (research into which medicines and procedures work best and are most cost-effective) will “ration” health care. But the council created by the stimulus legislation (now public law (pdf)) doesn’t have any power to do that. In fact, the legislation stipulates that “[n]one of the reports submitted under this section or recommendations made by the Council shall be construed as mandates or clinical guidelines for payment, coverage, or treatment.”

As for former Sen. Tom Daschle, he never said, “Seniors should be more accepting of the conditions that come with age instead of treating them.” Here’s the real deal:

Instead, those are the words of the former Republican lieutenant governor of New York, Betsy McCaughey, who wrote an opinion piece for Bloomberg News and offered her reading of comments in Daschle’s book. Back in February, we dissected McCaughey’s column, pieces of which have popped up in chain e-mails, and found it to be full of errors. McCaughey also passes off opinion as fact, and in the case of Daschle, she paraphrases him, which is clear from the lack of quote marks in the column.

What Daschle did say is a far cry from “seniors should be more accepting of the conditions that come with age instead of treating them.” Instead, he wrote (without mentioning age) in his book “Critical: What We Can Do About the Health-Care Crisis”: “The use and overuse of new technologies and treatments is grounded in American culture. … More so than people in other countries, [Americans] just aren’t inclined to fatalistically accept a hopeless diagnosis or forgo experimental interventions if there is even the slightest chance of success.”

If you see the “senior death warrant” email posted anywhere, please respond by posting this link:

Plus: National Women’s Law Center is calling for a national call-in day on health reform on Tuesday, July 28 (that’s tomorrow). Call your U.S. representatives to tell them to support the House’s health care reform bill (H.R. 3200).

April 15, 2009

Critique of Osteoporosis as a Disease and Related Drug Concerns

Osteoporosis, a loss of bone mass that can precede serious and costly breaks or fractures, is of particular concern to women – current estimates suggest that “osteoporosis is a major public health threat for 44 million Americans, 68 percent of whom are women… One out of every two women and one in four men age 50 and older will have an osteoporosis-related fracture in their lifetime.”

Often overlooked in discussions of the condition, however, are questions related to the efficacy and potential harms of the tests and treatments used to measure and prevent bone loss.  In particular, women’s health advocates have concerns about the overuse of medications in women who have risk factors for osteoporosis, but do not actually have the disease itself.

The April issue of the American Journal of Nursing (AJN) includes a piece, “The Marketing of Osteoporosis,” which comments on the promotion of drugs to symptom-free women for bone fracture prevention.

Author Maryann Napoli (of the Center for Medical Consumers) writes:

“In the name of prevention, millions of Americans have accepted the idea that it’s reasonable to treat a risk factor such as bone loss or high cholesterol as if it were a disease…More people should question the wisdom of starting long-term drug therapy. Often the magnitude of the risk factor has been overestimated, or the danger of the disease itself exaggerated, by people trying to sell you something-like a drug you must take for the rest of your life.”

She describes how what was once a risk factor (bone loss) came to be thought of as a disease (osteoporosis), and notes the role of pharmaceutical companies such as Merck in shaping this thinking, as well as in encouraging women to have bone density scans and take drugs as a “preventive” measure.

Napoli notes that as drugs such as alendronate came on the market, middle-aged rather than elderly women became the targets of osteoporosis-related advertising and drugs. She explains:

“A multipage glossy ad campaign that ran frequently in the Annals of Internal Medicine, for example, featured a thin, 40-something white woman with a crumbling ancient stone column in the background. “Don’t wait for a fracture…. No matter what her degree of osteoporotic bone loss.” I wrote to the editor-in-chief of Annals, pointing out that alendronate had no proven benefit in women in early middle age or in those without a history of fracture. I never received a reply, but the journal stopped running the ad about six months later….

Today, women in the osteoporosis drug ads are usually in their early 60s. The 2002 guidelines for osteoporosis screening from the Agency for Healthcare Research and Quality recommend that bone-density scanning not begin until age 65 (or 60 in some high-risk cases).”

Christine has previously written about the potentially serious side effects medications for postmenopausal osteoporosis and non-drug prevention options, and OBOS’s Judy Norsigian and Heather Stephenson addressed the issue in a commentary for Women’s eNews, “Let’s Make May the Month to Tame Osteoporosis Hype.”

Side note: The current cover of the AJN features a piece of art called Nursing Bra, part of the Artfull Bras Project, a collection of 50 bras created by the Quilters of South Carolina to raise breast cancer awareness.

July 17, 2008

Bone-Building Drugs May Cause an Uncommon Fracture

A story making headlines this past week raises questions about what we know/don’t know about a class of drugs commonly used to treat osteoporosis.

The New York Times looks at a rare type of leg fracture in the upper thighbone — a fracture that typically affects people in car accidents or very frail older people — which is showing up in women who have used a class of bone-building drugs called bisphosphonates for five years or more. Tara Parker-Pope writes:

Some patients have reported that after weeks or months of unexplained aching, their thighbones simply snapped while they were walking or standing.

“Many of these women will tell you they thought the bone broke before they hit the ground,” said Dr. Dean G. Lorich, associate director of orthopedic trauma surgery at NewYork-Presbyterian/Weill Cornell and the Hospital for Special Surgery. Dr. Lorich and his colleagues published a study in The Journal of Orthopaedic Trauma last month reporting on 20 patients with the fracture. Nineteen had been using the bone drug Fosamax for an average of 6.9 years.

To be sure, the problem appears to be rare, notes Parker-Pope, and the drugs have proved useful for women with severe osteoporosis. But it’s enough of a concern that Merck, the drug company that makes Fosamax, said it will study whether the fracture is occurring more in bone-drug users.

Up to this point, “the fracture pattern did not emerge in placebo-controlled studies of bone drugs. But those studies have lasted only three to five years, although follow-up studies of the drug users have lasted longer. Now that the fracture pattern has been identified, researchers expect more doctors to publish reports,” writes Parker-Pope.

Meanwhile, studies show that there’s there’s not much to be gained by taking bisphosphonates for more than five years, and some doctors recommend that long-term users take a break from the drugs.

The story also notes another rare side effect associated with the drugs: osteonecrosis of the jaw, which destroys a patient’s jawbone. Though it mostly affects cancer patients taking an intravenous form of the drug, ordinary users have also reported the side effect.

June 28, 2008

Double Dose: Planned Parenthood Expands Reach; Pack Journalism in Search of a Pregnancy “Pact” in Gloucester; Teen Pregnancies at 30-Year Low; Mandating Insurance Coverage for Anorexia; Will Women Give Hormone Maker a Second Chance? …

Planned Parenthood Expands its Reach: “Flush with cash, Planned Parenthood affiliates nationwide are aggressively expanding their reach, seeking to woo more affluent patients with a network of suburban clinics and huge new health centers that project a decidedly upscale image,” reports the Wall Street Journal.

Unfortunately the full story is available to subscribers only, but the WSJ health blog has a summary that includes these remarks:

Despite some critiques to the contrary, Planned Parenthood insists it’s not compromising is long-held focus on serving the poor with birth control, sexual-health care and abortions. Officials there say they take a loss of nearly $1 on each packet of birth-control pills distributed to poor women under a federal program that funds reproductive care. But they make a profit of nearly $22 on each month of pills sold to an adult who can afford to pay full price. That money helps subsidize other operations, including care for the poor as well as pursuing Planned Parenthood’s political agenda.

“It is high time we follow the population,” said Sarah Stoesz, who heads Planned Parenthood operations in three Midwest states. She recently opened three express centers in wealthy Minnesota suburbs, “in shopping centers and malls, places where women are already doing their grocery shopping, picking up their Starbucks, living their daily lives,” she said.

Pregnant in Gloucester: Concerning the 18 high school students pregnant in Gloucester, Mass, that have received national news coverage for supposedly choosing to get pregnant and raise their children together, Kelly McBride, who covers media ethics for Poynter Institute, has an excellent piece on pack journalism in search of a “pact..” Meanwhile, the high school principal who first said their was evidence of a pact defends his comments and his memory.

Plus: Courtney Macavinta of Respect RX discusses her own sex “pact” at age 15 and the cycle of disrespect that leads girls who don’t value themselves to make choices “in which the fine print (that life is about to get even harder) is written in invisible ink.”

Teen Pregnancies at 30-Year Low: Writing in the Chicago Tribune, Lisa Anderson reports on the latest pregnancy statistics released by the Guttmacher Institute.

Pregnancies — whether they end in birth, miscarriage or abortion — among women age 15 to 19 dropped to 72.2 per 1,000 women in 2004, down from a peak of 117 per 1,000 women in 1990 [...]

While some 700,000 women age 15 to 19 become pregnant every year, the rate has declined 36 percent since it peaked in 1990. The rate of abortions among teens also plummeted, to 19.8 per 1,000 women in 2004 from a high of 43.5 per 1,000 in 1988.

But researchers are keeping a close eye on the numbers, as there are some signs that the drop may be reversing:

Despite decades of improvement and for reasons yet unknown, there is statistical evidence that the drop in pregnancy rates, the age of first sexual activity and contraceptive use among teens stalled after 2001.

The exception may be in the teen birthrate. After a 14-year decline, the birthrate, meaning the number of live births, among women age 15 to 19 rose 3 percent in 2006 to 41.9 per 1,000 women from 40.5 per 1,000 women in 2005, according to the U.S. Centers for Disease Control and Prevention. Until more data are compiled, it is unclear whether the 2006 uptick in births was an isolated blip or the harbinger of a more significant and negative change on the teen reproductive landscape, according to David Landry, a senior research associate at the Guttmacher Institute.

Mandating Insurance Coverage for Psychiatric Ailments: Illinois will become the 17th state to mandate insurance coverage for treatment of anorexia and bulimia, assuming the governor signs a bill recently approved by the state Legislature.

Bonnie Miller Rubin and Ashley Wiehle of the Chicago Tribune write:

The measure is part of a larger national debate about addressing inequities in insurance coverage between psychiatric and physical ailments.

More than 12 million Americans, mostly young women, have eating disorders in their lifetime, according to the National Association of Anorexia Nervosa and Associated Disorders. The organization ranked risk of death as higher with anorexia than with any other mental illness. Among patients with anorexia, almost half of all deaths are suicides, according to ANAD. Yet many insurers balk at covering the tab, which can run as high as $2,500 a day.

“I’ve met so many parents who have had to refinance their homes,” said Rep. Fred Crespo (D-Hoffman Estates), one of the bill’s sponsors.

But others cite the financial cost of such a law. Richard Cauchi, health program director for the National Conference of State Legislatures, said Illinois has taken “an unusual action” for 2008, when the trend is to move away from mandates on business and governments.

“There’s more pressure now to repeal and restrict mandates than to enact new ones,” he said..

“Neglected Infections of Poverty”: “Despite plummeting mortality rates for most infectious diseases over the last century, a group of largely overlooked bacterial, viral and parasitic infections is still plaguing the nation’s poor, according to a report released this week,” writes Wendy Hansen in the L.A. Times.

“Many of the diseases are typically associated with tropical developing countries but are surprisingly common in poor regions of the United States, according to the analysis, published in the Public Library of Science journal PLoS Neglected Tropical Diseases.”

The study’s author, Dr. Peter Hotez, chairman of George Washington University’s department of microbiology, immunology and tropical disease, says there are 24 diseases affecting at least 300,000 Americans, and possibly millions. Poverty-stricken regions, including Appalachia, inner cities, the Mississippi Delta and the border with Mexico, are the areas most severely affected.

Will Women Give Hormone Maker a Second Chance?: “Can Wyeth win back the 40 million Premarin and Prempro users it’s lost since 2002 — along with $1 billion a year in profits — with a new menopause drug? Or will the once-bitten women who have filed more than 5,000 lawsuits claiming the hormones gave them cancer feel fooled twice?” asks Martha Rosenberg at, in this look at Wyeth’s hope of marketing Pristiq as the first nonhormonal treatment for menopause symptoms.

Don’t Ask, Don’t Tell Affects Women More: “The Army and Air Force discharged a disproportionate number of women in 2007 under the “don’t ask, don’t tell” policy that prohibits openly gay people from serving in the military, according to Pentagon statistics gathered by an advocacy group,” reports The New York Times.

While women make up 14 percent of Army personnel, 46 percent of those discharged under the policy last year were women. And while 20 percent of Air Force personnel are women, 49 percent of its discharges under the policy last year were women. By comparison for 2006, about 35 percent of the Army’s discharges and 36 percent of the Air Force’s were women, according to the statistics.

The information was gathered under a Freedom of Information Act request by the Servicemembers Legal Defense Network, a policy advocacy organization.

Gardasil Not Approved for Older Women: “U.S. regulators have told Merck & Co they cannot yet approve Merck’s application to expand marketing of its cervical cancer vaccine Gardasil to an older group of women, the drugmaker said on Wednesday,” reports Reuters.

“Merck had applied for the use of Gardasil in women ages 27 through 45. The U.S. Food and Drug Administration said in a letter regarding the application that it has completed its review and there are ‘issues’ that preclude approval within the expected review time frame, Merck said.”

Exercise as a Tonic for Aging: The New York Times reports on an updated series of physical activity recommendations for older adults from the American Heart Association and the American College of Sports Medicine, which are expected to match new federal activity guidelines due in October from the United States Health and Human Services Department.

“Contrary to what many active adults seem to believe, physical fitness does not end with aerobics,” writes Jane Brody. “Strength training has long been advocated by the National Institute on Aging, and the heart association has finally recognized the added value of muscle strength to reduce stress on joints, bones and soft tissues; enhance stability and reduce the risk of falls; and increase the ability to meet the demands of daily life, like rising from a chair, climbing stairs and opening jars.”

May 23, 2008

Double Dose: Debate Over Domestic Gag Rule; Same-Sex Marriage Update in California; FDA Warning to Nursing Mothers; Legal Rights of the Uninsured …

Bush Ally Orr Leaves Just as Domestic Gag Rule Is Reconsidered: RH Reality Check has good coverage of the surprise resignation of Dr. Susan Orr, the assistant deputy secretary for population affairs. Orr previously worked for the Family Research Council — one of several conservative groups now pressuring President Bush to cut Title X family planning funding for clinics who also provide abortion services.

“Her most notable accomplishment in the year she has served is to defend the abstinence-until-marriage approach in the face of incontrovertible evidence it has failed,” writes Cristina Page. “Now that the Unplanned Family Research Council is within days of hitting another nail into Title X’s coffin, Dr. Orr suddenly and quietly resigns from her post so, one suspects, to not appear to have orchestrated the undermining of her own program from within.”

Read related posts by Amie Newman and Emily Douglas, and here’s more on the domestic gag rule by Marilyn Keefe of the National Partnership for Women & Families.

Plus: The Hill reports on how a group of centrist House Republicans are squaring off with GOP conservatives over modifying Title X regulations.

Domestic Partners Can Wed Without Dissolution: “Same-sex couples who are registered as domestic partners do not have to dissolve that union before getting married, attorneys that advise the state Legislature said Thursday, just as county clerks and other local officials met to determine how they will enact last week’s historic state Supreme Court ruling,” reports the San Francisco Chronicle.

Of course, there’s still the possibility of voters this November approving a constitutional amendment to limit marriage to opposite-sex couples. State Sen. Carole Migden, D-San Francisco warned that in light of future uncertainty, couples should not dissolve their domestic partnerships until that question is settled.

“It would be foolhardy to dissolve because it would create a period of vulnerability” for couples, Migden said.

For answers to more questions on the legality and logistics of same-sex marriage in California, check out this special news section.

FDA Warns Mothers About Nipple Cream: The Food and Drug Administration issued a warning to nursing mothers on Friday not to use or purchase Mommy’s Bliss Nipple Cream, marketed by MOM Enterprises Inc. of San Rafael, Calif., The product label says there’s no need to remove the cream before nursing, but it contains ingredients that may cause respiratory distress, vomiting and diarrhea in infants. Whoa.

The potentially harmful ingredients in the cream are chlorphenesin and phenoxyethanol. From the FDA release:

“Chlorphenesin relaxes skeletal muscle and can depress the central nervous system and cause respiratory depression (slow or shallow breathing) in infants. Phenoxyethanol is a preservative that is primarily used in cosmetics and medications. It also can depress the central nervous system and may cause vomiting and diarrhea, which can lead to dehydration in infants.”

“FDA is particularly concerned that nursing infants are being unwittingly exposed by their mothers to this product with dangerous side effects,” said Janet Woodcock, director of the Center for Drug Evaluation and Research. “Additionally, these two ingredients may interact with one another to further compound and increase the risk of respiratory depression in nursing infants.”

The FDA said it has not received any reports of injury to infants. The company has stopped selling the cream.

Chemicals in Nail Salons Affect Workers: A new survey from the Northern California Cancer Center and Asian Health Services of Oakland has found that Vietnamese nail salon workers suffer from acute health effects associated with the chemicals they use in that work, according to this release. Toxic and potentially hazardous ingredients, including solvents, plasticizers, resins and acids, are commonly found in nail care products.

“A majority of the workers reported health concerns from exposures to workplace chemicals,” reports Dung Nguyen of Asian Health Services who directed the face-to-face interviews with 201 Vietnamese nail salon workers at 74 salons. “Many of them reported having some health problem after they began working in the industry, particularly skin and eye irritation, breathing difficulties and headaches.” said Nguyen.

“Our findings highlight a critical need for further investigation into the breast cancer risk of nail salon workers, underscored by the workers’ routine use of carcinogenic and endocrine-disrupting chemicals, their prevalent health concerns about such chemicals, and their high level of acute health problems,” adds Thu Quach, MPH, of the Northern California Cancer Center.

The study was published online and is scheduled to appear in the October issue of Journal of Community Health.

New Safety Program to Monitor Medicare Drug Use: “Federal health officials will begin monitoring prescription drug usage by millions of Medicare participants in an effort to identify potential safety problems,” reports the Associated Press. Kevin Freking writes:

The Food and Drug Administration has been under increasing pressure to develop a comprehensive drug surveillance system since the painkiller Vioxx was pulled from the market in 2004 after it was linked to increased risk of stroke and heart attack.

New regulations announced Thursday by the Health and Human Services Department will enable the FDA, states and academic researchers to screen the Medicare claims data. Under the regulation, the Medicare data can be made available in 30 days.

My favorite quote from the story: “The era of wait and see is going to become the era of tell me right now,” the FDA commissioner, Dr. Andrew von Eschenbach, said.

At first glance it sounds great. But then you read that only general details about the cost of enacting this new “Sentinel Initiative” were provided and, as Rep. Rosa DeLauro, D-Conn., said, it’s still in the planing states. Our verdict: We’ll wait and see.

Legal Rights of the Uninsured: The Chicago Tribune blog Triage, written by Judith Graham, covers issues related to the health-care industry. Here’s an interesting post on the legal rights of the uninsured — which in Illinois refers to 1.75 million people, almost 60 percent of whom are employed. For starters:

There is no such thing as a “right to care” for people who don’t have health insurance, with one major exception.

If you’re experiencing a medical emergency, you can go to any hospitals and get treatment. Hospitals are enjoined from turning you away under the Emergency Medical Treatment and Active Labor Act (EMTALA), a federal act passed by Congress in 1986.

Plus: For up-to-date statistics and analysis of health care coverage and the uninsured, visit this section of the Kaiser Family Foundation. And check out the new Kaiser Fast Facts.

My Veggie Hero: Meet Johanna McCloy, who is taking on one ballpark at a time, trying to get vegetarian hot dogs added to the menu so all baseball fans can experience the joy of filling a bun with sauerkraut and mustard (ketchup? yeah, right). Check out her site, And go Cubs!