We trust you have your own busy agendas. So join us as we hoist the ever-present cup of stimulation — our choice today is gingerbread — and attack the fast-growing to-do list. We hope you have a smashing day and, of course, do stay in touch. Our settings are adjusted to accept postcards and telegrams. …

Activist investor Carl Icahn plans to oust directors at Illumina, laying the groundwork for a second board challenge at the gene-sequencing company months after shareholders elected one of his director candidates, Reuters writes. Icahn disclosed his plans without offering details in a letter to other shareholders less than 24 hours after Illumina said it will divest blood test maker Grail. In Monday’s letter, Icahn blamed the Grail acquisition, which has faced regulatory challenges since 2021, for a 75% drop in Illumina’s share price that he says wiped away $55 billion in value for shareholders. The stock was up more than 2% at $130.39 on Monday.

As more data emerge that obesity drugs like Wegovy can reduce complications from heart and kidney problems as well, scientists have been wondering whether these benefits are driven by weight loss alone or also by other mechanisms. A new study suggests that one possible contributor is the drugs’ ability to reduce inflammation independent of weight loss, STAT tells us. In mice experiments, scientists found that the treatments, known as GLP-1-based drugs, acted through the brain to reduce inflammation throughout the body. This was over a short period of time before the mice lost weight, according to the study, published Monday in Cell Metabolism.

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Four Latin American countries use thermotherapy to treat cutaneous leishmaniasis in vulnerable populations

Oscar Reyes

18 Dec 2023

“Food poisoning is a syndrome caused by consuming food contaminated with microorganisms, toxins, or chemicals. It is associated with more than 250 pathogens, particularly when food is mishandled,” the specialist explained.

The foods most commonly linked to food poisoning include undercooked or improperly reheated meats, eggs, creams, mayonnaise, unpasteurized milk, seafood, fruits, and vegetables.

She noted that symptoms of food poisoning, such as nausea, vomiting, diarrhea, abdominal cramps, general malaise, and sometimes fever, usually appear abruptly and can start within six hours after consuming contaminated food.

“A sign of food poisoning is that multiple people who consumed the same contaminated source are affected. Symptoms typically last a few days, and most people recover well without medical treatment. However, in immunocompromised individuals (like cancer patients, those on steroids, or other immunosuppressive medications), and patients with comorbidities like heart disease, chronic kidney disease, and diabetes, the illness can be more severe or prolonged, requiring specialized medical care,” stated the specialist from the center accredited by the Joint Commission International (JCI).

According to international food safety standards, Dr. Castillo recommends eight tips to reduce the risk of contracting foodborne illnesses: wash hands and surfaces where food will be handled; wash fruits and vegetables; separate foods to avoid cross-contamination between fruits, vegetables, meats, seafood, poultry, and eggs; wash utensils that have been in contact with these foods, especially if they were raw.

Additionally, she advises cooking food to the correct temperature; ensuring that reheated food is completely cooked or heated before consumption; not leaving perishable foods out of the refrigerator for more than an hour; and not marinating foods on the kitchen counter, instead marinating in the refrigerator.

About CEMDOE:

CEMDOE is an outpatient medical institution accredited by the Joint Commission International. It focuses on providing comprehensive, safe, and quality care centered on the patient and their family. The center offers over 45 specialties, a clinical laboratory, a state-of-the-art imaging center, endoscopy, a multipurpose operating room, hemodialysis, and a specialized diabetic foot area. CEMDOE is part of INTEGRA, a health asset manager.

The FDA conducted an investigation into morel mushrooms after the severe illness outbreak linked to Dave’s Sushi in Bozeman in late March and April. The investigation found that undercooked or raw morels were the likely culprit, and it led the agency to issue its first guidelines on preparing morels.

“The toxins in morel mushrooms that may cause illness are not fully understood; however, using proper preparation procedures, such as cooking, can help to reduce toxin levels,” according to the FDA guidance.

Even then, a risk remains, according to the FDA: “Properly preparing and cooking morel mushrooms can reduce risk of illness, however there is no guarantee of safety even if cooking steps are taken prior to consumption.”

Jon Ebelt, spokesperson for Montana’s health department, said there is limited public health information or medical literature on morels. And samples of the morels taken from Dave’s Sushi detected no specific toxin, pathogen, pesticide, or volatile or nonvolatile organic compound in the mushrooms.

Aaron Parker, the owner of Dave’s Sushi, said morels are a “boutique item.” In season, generally during the spring and fall, morels can cost him $40 per pound, while morels purchased out of season are close to $80 per pound, he said.

Many highly regarded recipe books describe sauteing morels to preserve the sought-after, earthy flavor. At Dave’s, a marinade, sometimes boiling, was poured over the raw mushrooms before they were served, Parker said. After his own investigation, Parker said he found boiling them between 10 and 30 minutes is the safest way to prepare morel mushrooms.

Parker said he reached out to chefs across the country and found that many, like him, were surprised to learn about the toxicity of morels.

“They had no idea that morel mushrooms had this sort of inherent risk factor regardless of preparation,” Parker said.

According to the FDA’s Food Code, the vast majority of the more than 5,000 fleshy mushroom species that grow naturally in North America have not been tested for toxicity. Of those that have, 15 species are deadly, 60 are toxic whether raw or cooked — including “false” morels, which look like spongy edible morels — and at least 40 are poisonous if eaten raw, but safer when cooked.

The North American Mycological Association, a national nonprofit whose members are mushroom experts, recorded 1,641 cases of mushroom poisonings and 17 deaths from 1985 to 2006. One hundred and twenty-nine of those poisonings were attributed to morels, but no deaths were reported.

Marian Maxwell, the outreach chairperson for the Puget Sound Mycological Society, based in Seattle, said cooking breaks down the chitin in mushrooms, the same compound found in the exoskeletons of shellfish, and helps destroy toxins. Maxwell said morels may naturally contain a type of hydrazine — a chemical often used in pesticides or rocket fuel that can cause cancer — which can affect people differently. Cooking does boil off the hydrazine, she said, “but some people still have reactions even though it’s cooked and most of that hydrazine is gone.”

Heather Hallen-Adams, chair of the toxicology committee of the North American Mycological Association, said hydrazine has been shown to exist in false morels, but it’s not as “clear-cut” in true morels, which were the mushrooms used at Dave’s Sushi.

Mushroom-caused food poisonings in restaurant settings are rare — the Montana outbreak is believed to be one of the first in the U.S. related to morels — but they have happened infrequently abroad. In 2019, a morel food poisoning outbreak at a Michelin-star-rated restaurant in Spain sickened about 30 customers. One woman who ate the morels died, but her death was determined to be from natural causes. Raw morels were served on a pasta salad in Vancouver, British Columbia, in 2019 and poisoned 77 consumers, though none died.

Before the new guidelines were issued, the FDA’s Food Code guidance to states was only that serving wild mushrooms must be approved by a “regulatory authority.”

The FDA’s Food Code bans the sale of wild-picked mushrooms in a restaurant or other food establishment unless it’s been approved to do so, though cultivated wild mushrooms can be sold if the cultivation operations are overseen by a regulatory agency, as was the case with the morels at Dave’s Sushi. States’ regulations vary, according to a 2021 study by the Georgia Department of Public Health and included in the Association of Food and Drug Officials’ regulatory guidelines. For example, Montana and a half-dozen other states allow restaurants to sell wild mushrooms if they come from a licensed seller, according to the study. Seventeen other states allow the sale of wild mushrooms that have been identified by a state-credentialed expert.

The study found that the varied resources states use to identify safe wild mushrooms — including mycological associations, academics, and the food service industry — may suggest a need for better communication.

The study recognized a “guidance document” as the “single most important step forward” given the variety in regulations and the demand for wild mushrooms.

Hallen-Adams said raw morels are known to be poisonous by “mushroom people,” but that’s not common knowledge among chefs.

In the Dave’s Sushi case, Hallen-Adams said, it was obvious that safety information didn’t get to the people who needed it. “And this could be something that could be addressed by labeling,” she said.

There hasn’t been much emphasis placed on making sure consumers know how to properly prepare the mushrooms, Hallen-Adams said, “and that’s something we need to start doing.”

Hallen-Adams, who trains people in Nebraska on mushroom identification, said the North American Mycological Association planned to update its website and include more prominent information about the need to cook mushrooms, with a specific mention of morels.

Montana’s health department intends to publish guidelines on morel safety in the spring, when morel season is approaching.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Since states started rolling back pandemic-inspired flexibilities that allowed physicians to easily practice telehealth across state lines, virtual health care providers have criticized state-based medical licensure rules as unnecessarily burdensome, expensive, and detrimental to patient care.

Now, two of them are arguing in a lawsuit that they can also be unconstitutional.

On Wednesday, a neurosurgeon, an oncologist, and two New Jersey-based patients sued the state’s medical board, alleging that the state’s licensure requirements for doctors practicing via telemedicine restrict livesaving access to specialty care. The case marks a newly aggressive strategy as health care systems and regulators continue to debate the role of state medical licensing in an increasingly virtual health care system.

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The study findings published in BMJ Open have demonstrated the frequency and degree of alcohol consumption to be the risk factors for hyperuricemia (HUA), especially in males. Moderate drinking was also observed to be a risk factor for HUA among men in the study.

"Different from the benefits of moderate drinking found in other research, HUA risk among moderate drinkers is 1.23 times than that of never drinkers among those in males," the researchers reported. "HUA risk is higher for those who usually drink alcohol l than for those who never drink alcohol among the total population."

"The risk of HUA caused by harmful drinking is the highest, which is 1.81 times that of never-drinkers among the total population and 2.13 times than that of never-drinkers among males," they added, "However, among females, HUA risk was not found to change with drinking."

Hyperuricaemia is becoming a common chronic disease with a worldwide economic and health burden. Considering the widespread consumption of alcohol in the world, some clinicians' review of dietary advice for HUA and gout patients shows that the most general advice is complete avoidance or restriction of alcohol intake, in which this suggested frequency is usually beyond weight loss.

The influence of drinking frequency and degree on hyperuricaemia needs further exploration. Therefore, Siyu Chen, School of Public Health, Chongqing Medical University, Chongqing, China, and colleagues aimed to investigate the relationship between alcohol consumption and hyperuricaemia based on a large population.

The researchers enrolled 20,833 participants aged 30–79 years in the China Multi-Ethnic Cohort, Chongqing region. The serum levels of fasting blood glucose, uric acid, and blood lipids were tested. A standardised questionnaire was used to collect basic demographic statistics such as gender, age, education level, marital status, detailed information on alcohol consumption, and family annual income.

The study led to the following findings:

• After controlling for potential confounders, compared with participants who never consumed alcohol, participants who drank 3–5 days per week had the highest HUA risk (OR: 1.51) and those who drank alcohol harmfully had the highest risk of HUA (OR: 1.81).
• Those who drank moderately had no significant association with the risk of HUA. However, among men, compared with participants who never consumed alcohol, those who drank moderately were also a risk factor for HUA (OR: 1.23) and those who drank alcohol harmfully had the highest risk of HUA (OR: 2.13).
• Compared with participants who drank alcohol moderately, the OR for those who drank alcohol harmfully had the highest risk of HUA was 1.88, and the corresponding OR for each level increment in the degree of alcohol consumption was 1.22.
• Among men, compared with participants who drank alcohol moderately, those who drank alcohol harmfully had the highest risk of HUA (OR: 1.93), and the corresponding OR for each level increment in the degree of alcohol consumption was 1.24.

The study demonstrated a positive relation between the frequency and degree of alcohol consumption and the risk of hyperuricemia. This positive connection was obvious among men, but weak among women. Moderate drinking was also revealed to be a risk factor for HUA among men in the study.

"There is a need for further interventional and prospective research to verify the causal relationship and clarify the specific mechanism," they concluded.

Reference:

Chen S, Ding R, Tang X, et alAssociation between alcohol consumption and risk of hyperuricaemia among adults: a large cross-sectional study in Chongqing, ChinaBMJ Open 2023;13:e074697. doi: 10.1136/bmjopen-2023-074697

In the 18th century mosquito-borne diseases such as malaria were thought to be caused by bad air ("mala aria") from marshlands, however in later years other scientists made new discoveries and realised that infectious illnesses were caused by a germ, giving rise to the germ theory. This theory of an infectious disease being caused by a germ was the construct for a new approach to managing infectious diseases globally. However, as time evolves, more empirical evidence has been found and used in various fields of medicine to reduce the public health burden through the implementation of evidence-based interventions and strategies.

Mosquito-borne diseases have continued to be a grave global public health issue, contributing to considerable economic cost in many countries. Diseases such as malaria, yellow fever and dengue are endemic in most of the tropical and subtropical parts of the world, and since January 2023 there have been more than 1,000 confirmed cases of dengue in Jamaica. Many Caribbean states have also experienced increased numbers of mosquito-borne diseases since the beginning of the year, despite the implementation of numerous mosquito-control strategies.

Strengthen entomological capacities through better use of environmental data

Many factors such as climate change, unplanned urbanisation, human behaviour, and globalisation are contributing to the emergence and re-emergence of mosquito-borne diseases in recent years. Using data captured from environmental surveillance is therefore necessary to combat these challenges and ensure the effective implementation of mosquito-control programmes. Mosquito-control programmes devoid of scientifically gathered data are often plagued with repeated problems and ineffective use of resources. Constant gathering and use of data, such as the mosquito index — in particular breteau and container indices), identification of potential and common sites for mosquito breeding, distribution of wetlands, levels of precipitation, atmospheric temperatures and wind speed — allow for implementation of effective strategies necessary to curtail incidents of mosquito-borne diseases. Dengue fever is a major public health problem throughout most tropical and some subtropical regions worldwide, and so is Zika fever and other arboviral infections such as chikungunya. Malaria is endemic to many Caribbean countries and remains a major killer of children, particularly in sub-Saharan Africa where it results in the death of a child every two minutes. Environmental data, if captured and used properly, can strengthen entomological capacities as the information provides an understanding of patterns, causes and effects of mosquito-borne diseases, as well as areas that require priority attention to avert possible outbreaks of mosquito-borne diseases.

Common failings of mosquito-control programmes:

1. Failure to capture and incorporate environmental data such as atmospheric temperatures, levels of precipitation, wind speed and land cover conditions when planning and implementing mosquito-control strategies.

The atmospheric temperature of an area and land cover conditions are useful pieces of information that can be used to predict the likelihood of mosquito proliferation atmospheric temperatures within particular ranges that encourage the reproduction of mosquitoes. Female mosquitoes cannot develop eggs at temperatures below 50°F (10°C). Atmospheric temperatures of 27-32 °C are favourable for the rapid completion of the mosquito life cycle. The condition of land cover also has a direct bearing on the effectiveness of mosquito-control strategies. In urban areas of Brazil, environmental surveillance data shows a positive relationship between environmental temperatures, land cover, and Aedes agypti mosquito breeding. In Brazil, roofs made of asbestos and concrete have also been proven to provide favourable sites for Aedes aeygptyi breeding. Mosquitoes are biting nuisances, resulting in cases of urticarial rashes and other dermatological infections. Effective programmes are therefore necessary for a multiplicity of reasons.

2. Failure to adequately incorporate and use technology when implementing mosquito-control strategies.

It is a proven fact that GIS (geographic information systems) technology has significantly transformed mosquito-control strategies in many countries worldwide. GIS enables the visualisation and analysis of geographical data, thereby providing valuable insights into mosquito population dynamics. GIS can be used to map mosquito larvae and adult habitats as well as human populations which are at a greater risk for mosquito exposure and mosquito-borne infections. Through GIS mapping, areas of priority that require ongoing entomological management can be easily identified. Using GIS technology permits the development and use of mosquito-control treatment area maps and leads to better schedules for mosquito-control activities — all of which are necessary to ensure proper management and use of programme resources.

3. Relaxing mosquito-control activities in dry months.

At no time should mosquito-control activities be relaxed. While it is a known fact that some species of female mosquitoes lay their eggs above the waterline in water-holding containers it is also proven scientifically that other species will lay their eggs on damp soil — even when there is no flooding. Water levels on land of 12.7 mm (1/2 inch) or above can cause mosquito eggs to hatch. GIS technology provides data that enables consistent monitoring for timely and proactive implementation of larviciding and adulticiding activities so as to avert increases in indices.

4. Failure to use evidenced-based data in conducting adultidicing (fogging) activities.

If desired mosquito-control targets, such as those set by the World Health Organization, are to be met then the natural behaviour of a particular mosquito specie must be considered. For example, research shows that the Aedes aegyptyi mosquito is diurnal and engages in peak biting activities in the environment approximately two hours after sunrise and several hours before sunset. It is therefore advisable that for rapid reduction in adult mosquito population, adulticiding activities should be done in the same area at dusk and at dawn; wind speed should also be less than 1.6 km/h. Wind speed directly impacts the proper dispersal and effectiveness of insecticides in the atmosphere.

What else is needed for effective mosquito control?

• Mosquito-control programmes require increased investment to strengthen programmatic capacity. The provision of tools and equipment that capture environmental data is mandatory for the success of any mosquito-control programme. Installation and monitoring of rain gauges throughout communities will provide data to identify when increased mosquito control activities are required. Installation and monitoring of light traps and Ovi traps provide useful data to guide mosquito-control activities in areas such as ports of entry. According to International Health Regulations (IHR), a minimum of 400-meter zones around seaports, airports, and ground crossings are to be maintained as a vector-free zone so that the transmission risk of pathogens imported with vectors or reservoirs can be minimised or nullified.

• The use of chemicals, including insecticides, is the first line control for mosquitoes all over the world, however many of these chemicals are known to have damaging effects on the environment. To minimise the need for the use of chemicals in mosquito control, consistent education strategies geared towards environmental sanitation are required. Capturing and using environmental data — such as the sanitary status of a particular community — will identify conditions which are likely to support mosquito-breeding activities in domestic and other settings so that strategies geared towards source reduction can be implemented in a timely manner. Strategies such as community clean-up days implemented ahead of expected seasons of rainfall can prove useful in reducing mosquito indices.

It is a proven fact that much has been done to curtail the incidence and prevalence of mosquito-borne diseases in Jamaica. Amidst these achievements, better use of environmental data as a tool for reducing mosquito-borne diseases can benefit the nation vastly by ensuring more efficient use of resources and reduction of many public health burdens associated with mosquito-borne diseases nationally.

Dr Karlene Atkinson is a public health specialist and lecturer at the School of Public Health, University of Technology, Jamaica.

Thousands of readers reacted to the articles in the “Dying Broke” series about the financial burden of long-term care in the United States. They offered their assessments for the government and market failures that have drained the lifetime savings of so many American families. And some offered possible solutions.

In more than 4,200 comments, readers shared their struggles in caring for spouses, older parents, and grandparents. They expressed anxieties about getting older themselves and needing help to stay at home or in institutions like nursing homes or assisted living facilities.

Many suggested changes to U.S. policy, like expanding the government’s payments for care and allowing more immigrants to stay in the country to help meet the demand for workers. Some even said they would rather end their lives than become a financial burden to their children.

Many readers blamed the predominantly for-profit nature of American medicine and the long-term care industry for depleting the financial resources of older people, leaving the federal-state Medicaid programs to take care of them once they were destitute.

“It is incorrect to say the money isn’t there to pay for elder care,” Jim Castrone, 72, a retired financial controller in Placitas, New Mexico, commented. “It’s there, in the form of profits that accrue to the owners of these facilities.”

“It is a system of wealth transference from the middle class and the poor to the owners of for-profit medical care, including hospitals and the long-term care facilities outlined in this article, underwritten by the government,” he added.

Other readers pointed to insurance policies that, despite limitations, had helped them pay for services. And some relayed their concerns that Americans were not saving enough and were unprepared to take care of themselves as they aged.

What Other Nations Provide

Other countries’ treatment of their older citizens was repeatedly mentioned. Readers contrasted the care they observed older people receiving in foreign countries with the treatment in the United States, which spends less on long-term care as a portion of its gross domestic product than do most wealthy nations.

Marsha Moyer, 75, a retired teaching assistant in Memphis, Tennessee, said she spent 12 years as a caregiver for her parents in San Diego County and an additional six for her husband. While they had advantages many don’t, Moyer said, “it was a long, lonely job, a sad job, an uphill climb.”

By contrast, her sister-in-law’s mother lived to 103 in a “fully funded, lovely elder care home” in Denmark during her last five years. “My sister-in-law didn’t have to choose between her own life, her career, and helping her healthy but very old mother,” Moyer said. “She could have both. I had to choose.”

Birgit Rosenberg, 58, a software developer in Southampton, Pennsylvania, said her mother had end-stage dementia and had been in a nursing home in Germany for more than two years. “The cost for her absolutely excellent care in a cheerful, clean facility is her pittance of Social Security, about $180 a month,” she said. “A friend recently had to put her mother into a nursing home here in the U.S. Twice, when visiting, she has found her mother on the floor in her room, where she had been for who knows how long.”

Brad and Carol Burns moved from Fort Worth, Texas, in 2019 to Chapala, Jalisco, in Mexico, dumping their $650-a-month long-term care policy because care is so much more affordable south of the border. Brad, 63, a retired pharmaceutical researcher, said his mother lived just a few miles away in a memory care facility that costs $2,050 a month, which she can afford with her Social Security payments and an annuity. She is receiving “amazing” care, he said.

“As a reminder, most people in Mexico cannot afford the care we find affordable and that makes me sad,” he said. “But their care for us is amazing, all health care, here, actually. At her home, they address her as Mom or Barbarita, little Barbara.”

Insurance Policies Debated

Many, many readers said they could relate to problems with long-term care insurance policies, and their soaring costs. Some who hold such policies said they provided comfort for a possible worst-case scenario while others castigated insurers for making it difficult to access benefits.

“They really make you work for the money, and you’d better have someone available who can call them and work on the endless and ever-changing paperwork,” said Janet Blanding, 62, a technical writer in Fancy Gap, Virginia.

Derek Sippel, 47, a registered nurse in Naples, Florida, cited the $11,000 monthly cost of his mother’s nursing home care for dementia as the reason he bought a policy. He pays about $195 a month with a lifetime benefit of $350,000. “I may never need to use the benefit[s], but it makes me feel better knowing that I have it if I need it,” he said in his comment. He said he could not make that kind of money by investing on his own.

“It’s the risk you take with any kind of insurance,” he said. “I don’t want to be a burden on anyone.”

Pleas for More Immigrant Workers

One solution that readers proposed was to increase the number of immigrants allowed into the country to help address the chronic shortage of long-term care workers. Larry Cretan, 73, a retired bank executive in Woodside, California, said that over time, his parents had six caretakers who were immigrants. “There is no magic bullet,” he said, “but one obvious step — hello, people — we need more immigrants! Who do you think does most of this work?”

Victoria Raab, 67, a retired copy editor in New York, said that many older Americans must use paid help because their grown children live far away. Her parents and some of their peers rely on immigrants from the Philippines and Eritrea, she said, “working loosely within the margins of labor regulations.”

“These exemplary populations should be able to fill caretaker roles transparently in exchange for citizenship because they are an obvious and invaluable asset to a difficult profession that lacks American workers of their skill and positive cultural attitudes toward the elderly,” Raab said.

Federal Fixes Sought

Other readers called for the federal government to create a comprehensive, national long-term care system, as some other countries have. In the United States, federal and state programs that finance long-term care are mainly available only to the very poor. For middle-class families, sustained subsidies for home care, for example, are fairly nonexistent.

“I am a geriatric nurse practitioner in New York and have seen this story time and time again,” Sarah Romanelli, 31, said. “My patients are shocked when we review the options and its costs. Medicaid can’t be the only option to pay for long-term care. Congress needs to act to establish a better system for middle-class Americans to finance long-term care.”

John Reeder, 76, a retired federal economist in Arlington, Virginia, called for a federal single-payer system “from birth to senior care in which we all pay and profit-making [is] removed.”

Other readers, however, argued that people needed to take more responsibility by preparing for the expense of old age.

Mark Dennen, 69, in West Harwich, Massachusetts, said people should save more rather than expect taxpayers to bail them out. “For too many, the answer is, ‘How can we hide assets and make the government pay?’ That is just another way of saying, ‘How can I make somebody else pay my bills?’” he said, adding, “We don’t need the latest phone/car/clothes, but we will need long-term care. Choices.”

Questioning the Value of Life-Prolonging Procedures

A number of readers condemned the country’s medical culture for pushing expensive surgeries and other procedures that do little to improve the quality of people’s few remaining years.

Thomas Thuene, 60, a consultant in Boston’s Roslindale neighborhood, described how a friend’s mother who had heart failure was repeatedly sent from the elder care facility where she lived to the hospital and back, via ambulance. “There was no arguing with the care facility,” he said. “However, the moment all her money was gone, the facility gently nudged my friend to think of end-of-life care for his mother. It seems the financial ruin is baked into the system.”

Joan Chambers, 69, an architectural draftsperson in Southold, New York, said that during a hospitalization on a cardiac unit she observed many fellow patients “bedridden with empty eyes,” awaiting implants of stents and pacemakers.

“I realized then and there that we are not patients, we are commodities,” she said. “Most of us will die from heart failure. It will take courage for a family member to refuse a ‘simple’ procedure that will keep a loved one’s heart beating for a few more years, but we have to stop this cruelty.

“We have to remember that even though we are grateful to our health care professionals, they are not our friends. They are our employees and we can say no.”

One physician, James Sullivan, 64, in Cataumet, a neighborhood of Bourne, Massachusetts, said he planned to refuse hospitalization and other extraordinary measures if he suffered from dementia. “We spend billions of dollars, and a lot of heartache, treating demented people for pneumonia, urinary tract infections, cancers, things that are going to kill them sooner or later, for no meaningful benefit,” Sullivan said. “I would not want my son to spend his good years, and money, helping to maintain me alive if I don’t even know what’s going on,” he said.

Considering ‘Assisted Dying’

Others went further, declaring they would rather arrange for their own deaths than suffer in greatly diminished capacity. “My long-term care plan is simple,” said Karen Clodfelter, 65, a library assistant in St. Louis. “When the money runs out, I will take myself out of the picture.” Clodfelter said she helped care for her mother until her death at 101. “I’ve seen extreme old age,” she said, “and I’m not interested in going there.”

Some suggested that medically assisted death should be a more widely available option in a country that takes such poor care of its elderly. Meridee Wendell, 76, of Sunnyvale, California, said: “If we can’t manage to provide assisted living to our fellow Americans, could we at least offer assisted dying? At least some of us would see it as a desirable solution.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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