Legal Euthanasia: a discussion

I use the term "discussion" lightly when referring to this topic, but in 2002, the Netherlands became the first country to legalize euthanasia as an option for patients who were terminal.  The practice had been taking place since the 1970s, but finally it was signed into law.  There were strict laws and licenses that must be in place for it to take place, and Dutch doctors had a long list to check. Patients must be adults.  There must be suffering.  There must also be no other alternative for the patient.  A second doctor must be consulted to concur with the desires of the patient and the conclusion of suffering and terminal disease.

Christians immediately have thoughts of suicide and how this is a sin.  We classify life as human and it is wonderful that someone took their beloved pet to the vet to end their life humanely.  I did this for my dog, and I can say, it was the most amazing experience to know that he was in my arms and that I did not allow him to suffer as he would have in the last maybe two days of his life.  But wait.  He was a DOG.  We are different, or are we?

I know that personally there was a young lady that I met through one of my jobs years ago.  She was in her twenties, had never been married and had no children.  She had an older boyfriend.  She had been diagnosed with breast cancer and had waited a little too long on having a double mastectomy.  She did not have clean borders of the tumor.  The cancer had spread, and she had gone through many rounds of chemotherapy and radiation.

By the time she became my patient as a home infusion pharmacist, I was intrigued by her case.  Her age (she was four years older than me), her name (we had the same initials), and the thought of how she would probably never marry and definitely never have her own biological children.  I knew she was terminal based on the pain pump I was in charge of filling and keeping running for her so she would be in no pain during the months of her life.

We spoke on the phone weekly, sometimes two to three times a week.  She was always upbeat and positive, and after ten years, I can still hear her voice.  She was going on a trip to Florida with her boyfriend and wanted to jet ski in the ocean. She wanted to take her pain pump with her and jet ski.  We made it happen.

And now years later, The Lancet releases an article basically saying legalizing has not added more cases of euthanasia in  Netherlands.

The introduction of legalised euthanasia in the Netherlands has not led to an increase in the number of cases according to a team of Dutch university researchers, writing in The Lancet magazine.

While there was a slight decrease in the years after euthanasia was made legal in 2002, assisted suicide has now returned to pre-legalisation levels of around 2.8% of all deaths, the researchers from four Dutch teaching hospitals and the national statistics office CBS found.

And while opponents of euthanasia had warned the legislation would lead to a sharp rise in involuntary euthanasia among terminally-ill patients, there has actually been a reduction in this sort of deaths, professor Bregje Onwuteaka-Philipsen from Amsterdam's VU university told the Volkskrant.

Based on interviews with 6,000 doctors and research into 7,000 deaths, the team found just 300 cases of euthanasia where the patient had not given explicit consent in 2010, compared with around 1,000 in the years prior to legalisation.

Openness

'This is probably because there is more openness and doctors talk to their patients at an earlier stage,' Onwuteaka-Philipsen told the paper.

The researchers also found some 600 people forced an end to their own lives in 2010 by stopping eating and drinking. In around half of these cases, euthanasia had been refused.

Euthanasia is legal in the Netherlands under strict conditions. For example, the patient must be 'suffering unbearably' and the doctor must be convinced the patient is making an informed choice. The opinion of a second doctor is also required.

Although it's not legal in the US, believe me, it sort of goes on.  It is an unspoken way to die or at least comfort in the very very end.  I know that my patient "BB" went peacefully.  I know that there were many times she kept urging me to come meet her.  I was leery because I knew that I was already attached. Her pump would beep for whatever reason, she would call me.  I had specific orders from the oncologist that I could basically freely increase her dilaudid based on her pain level.  There was a trust thing between the three of us.

I finally did go meet her.  She was laying in bed at 33 years old with just a little bit of time yet.  Her sweet family brought out pictures of her before the cancer changed her so much.  She was beautiful.  I just hope to see her again, shake her hand (or hug her) and tell her how much of an impact she had on my life.  She missed out on so much yet she impacted others in ways she probably never knew.

What does this have to do with euthanasia?  I believe that it should be legal.  It's humane.  No one should have to suffer today.

Physical Punishment and Mental Disorders

I do not care for statistics.  It's not in my DNA to ENJOY them but this is the perfect example why all pharmacists (and the lay public, for that matter) should understand and interpret study results.  Just the other night, I was watching the news and the anchor states, "Parents should think twice about spanking their children."  Most people would look at the anchor, hear the words, and then turn right around and pass it on as though it was spoken by God Himself. A study was cited:

BACKGROUND: The use of physical punishment is controversial. Few studies have examined the relationship between physical punishment and a wide range of mental disorders in a nationally representative sample. The current research investigated the possible link between harsh physical punishment (ie, pushing, grabbing, shoving, slapping, hitting) in the absence of more severe child maltreatment (ie, physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect, exposure to intimate partner violence) and Axis I and II mental disorders.

METHODS: Data were from the National Epidemiologic Survey on Alcohol and Related Conditions collected between 2004 and 2005 (N = 34 653). The survey was conducted with a representative US adult population sample (aged ≥20 years). Statistical methods included logistic regression models and population-attributable fractions.

This is a retrospective study which automatically introduces bias.  Correlation does not imply causation.  That's the biggest issue I see with this study.  For example, the media will pick up a press release about this type of study and report that spankings make children grow into adults with mental disorders, but correlation does not imply causation.  For example, children who were spanked may end up with a mental disorder, but there is no proof that it was the spanking itself that caused the mental illness but perhaps several other factors or combinations of factors.  Even schizophrenia and depression have had genetic components.  What happened to pure genetics?

The next big issue with this study is they looked at many types of mental illnesses since it is not very efficient to run a large study, gather data, and analyze it to look at only one type of mental illness.  Scientific studies, however, rely on statistical analysis to determine whether something is true.  Even if your estimated error is less than one percent, in a study examining thousands of items some will appear to have an effect even though they are just statistical aberrations.  These false positives are then reported, and when a new study fails to confirm them as true, the press reports a scientific “change of mind”.

Finally, when a cohort study is retrospective, the problem is compounded since retrospective studies often rely on memory.  If you developed a mental illness, you may have a different memory recall of punishment and its effect and your perception vs if you did not have a mental disorder.

Be careful with retrospective studies!   As in this case, there are many flaws and biased automatically introduced.

I definitely understand the rationale for wanting to run this study as many parents are probably over the top with physical punishment; however, I don't believe those parents that reserve a spanking for a type of punishment as abusive or that their child will end up with a mental illness due to that one decision.  Too bad the media doesn't know how to interpret studies!

Another critique:

While the new study rules out the most severe cases of physically lashing out at children, "it does nothing to move beyond correlations to figure out what is actually causing the mental health problems," says psychologist Robert Larzelere of Oklahoma State University,. He criticized the study's reliance on memories of events from years earlier, and says it's not clear when punishment occurred.

Afifi acknowledges that it's difficult to change people's mind on this topic, but says "we're confident of the reliability of our data, and the data strongly indicate that physical punishment should not be used on children — at any age. And it's important for parents to be aware of that."

June 27 is National HIV Testing Day

HIV (human immunodeficiency virus) is the virus that causes AIDS. Today, in honor of National HIV Testing Day, the healthcare community encourages you to get tested for HIV. The only way to know if you have HIV is to get tested. Many people with HIV don’t have any symptoms. In the United States, 1 in 5 people living with HIV don't know they have it.

Even if you don’t feel sick, getting early treatment for HIV is important: early treatment can help you live a longer, healthier life.

Am I at risk for HIV?

HIV is spread through some of the body’s fluids, like blood, semen (cum), vaginal fluids, and breast milk. HIV is passed from one person to another by:

• Having unprotected sex (vaginal, anal, or oral) with a person who has HIV
• Sharing needles with someone who has HIV
• Breastfeeding, pregnancy, or childbirth if the mother has HIV
• Getting a blood transfusion that has HIV (very rare in the U.S.)

HIV testing is covered for many people under the Affordable Care Act, the health care reform law passed in 2010. Depending on your insurance plan, you may be able to get tested at no cost to you. Talk to your insurance provider.

Be the Match!

After years and years of wanting to join the bone marrow registry, I finally discovered that you don't even have to leave your house to join!  At Be the Match, the new name for the bone marrow registry, all you have to do is fill out a questionnaire and then wait for a kit to be delivered by mail within two weeks.  Then, taking a few swabs in your mouth, you send back and wait.  I hope to be able to help someone one day in this aspect. Take a look at the myths and facts of bone marrow donation before dismissing this opportunity to help save a life!

Too Stupid to Be Free?

Do politicians really feel that passing laws to change the SIZES of soft drinks will actually combat the obesity problem faced in the US? British researchers have been arguing that overpopulation discussions shouldn't be limited to head counts but should also factor in the weight of people. America is GUILTY of being a part of the heaviest nations in the country. New York City and now Cambridge, MA is starting the political process of passing laws that demonstrate that we as consumers know less about what's good for us. North America has 6% of the world's population, but guess what? We have 34% of world biomass due to obesity. Obesity equals money and a drain on the entire health system. I believe that corporations could start changing things at work. Since we are a country at work, including a lot of women, we could start changing the menus at cafeterias. We could start changing the menus at fast food restaurants. The problem I have with the idea of government mandating this is the argument that is essential to more or less government. Does government know better than me when it comes to decisions about my health? Does government believe that it can decide for me? This is a loss of freedom, but at the rate things are going, it's obvious that the freedoms Americans have been allowed to enjoy (eating a large fry at McDonald's and a supersize coke, for example) might be taken away in the future.

For example, where I work, there is a salad bar, but the main food is pretty unhealthy. The portion sizes given could easily feed 2-3 people. This is in a hospital. Just upstairs from this cafeteria, cardiac bypasses are being performed to try to correct the very result of the damage caused by genetics and more often our diets. Irony at best. I'm guilty. Believe me, I struggle with my own weight being about 5'7" and around 150 lbs today is a little too much weight for my frame. I know that my IBW is 133 lbs. This means that I am 17 lbs overweight. Seriously. I believe it, too. Yes, I look thin to some, I suppose, but that is because of what I'm compared to. If the majority of Americans are overweight and obese, well there you go.

So basically, if the entire world was as heavy as we are, that would be equivalent to an extra 1,000,000,000 people.

Put less in your mouth. Move. PLEASE. Please before government mandates it. Though, at this point while sitting in Panera and blogging and seeing the people around me -- maybe it's time we lose a little freedom for the common good of people.

Maybe we are too stupid to be free.

I guess

Pass the Ritalin Please

Methylphenidate.  Ritalin.  Concerta.  Etc...  THE MOST PRESCRIBED MEDICATION FOR KIDS AGES 12-17. What in the world?

I guess I'm kind of shocked and then again, maybe I'm not as shocked.  ADHD is on the rise.  There's no doubt about it.  I worry about it in my own children, and I also worry that I'll dismiss any possible behavior ADHD-like to just being a kid.  I waver between the parents that over react to those that don't.

I remember when I was in pharmacy school, we would joke around that Sesame Street caused ADHD.  If Sesame Street caused it, you know that crazy shows like Yo Gabba Gabba with seizure-like strobes and constant music in your face jumping from topic to topic will cause it!  There are links to video games and ADHD.  There are links to TV and ADHD.  Scary considering even my vehicle has a TV in it helping to ease the kids on the way to visit the grandparents.

But, then there's the argument of what ADHD even is.  I know in retail pharmacy, a pharmacist has GOT to be able to juggle several different things at once.  I remember having a telephone in my ear, writing something down, and answering someone at the register all simultaneously.  I am a multitasking extraordinary gal.  But even on webmd, look at these signs of adult ADHD:

1.  Adult ADHD Problem No. 1: Difficulty Getting Organized

For people with ADHD, the increased responsibilities of adulthood -- bills, jobs, and children, to name a few -- can make problems with organization more obvious and more harmful than in childhood. While some ADHD symptoms are more annoying to other people than to the person with the condition, disorganization is often identified by adults struggling with ADHD as a major detractor that affects their quality of life.

SERIOUSLY?  There are not enough hours in the day to be organized with two small children and a full-time job.  I bet that the majority of all parents fall into this category.

2.  Adult ADHD Problem No. 2: Reckless Driving and Traffic Accidents

Attention deficit hyperactivity disorder makes it hard to keep your attention on a task, so spending time behind the wheel of a car can be difficult. ADHD symptoms can make some people more likely to speed, have traffic accidents, and lose their driver’s licenses.

Speeding?  Ok, yes I may find myself rushing to work because there was an epic meltdown at the daycare and I am late for work.  Especially since I clock in to work.  Seriously?  Let's not even mention most of the moms out there or a lot of them that text and drive.  Ok, so maybe I haven't had a traffic accident or lost my license, but maybe I was just lucky.

3.  Adult ADHD Problem No. 3: Marital Difficulties

Many people without ADHD have marital problems, of course, so a troubled marriage shouldn’t be seen as a red flag for adult ADHD. But there are some marriage problems that are particularly likely to affect the relationships of those with ADHD. Often, the partners of people with undiagnosed ADHD take poor listening skills and an inability to honor commitments as a sign that their partner doesn’t care. If you’re the person suffering from ADHD, you may not understand why you’re partner is upset, and you may feel you’re being nagged or blamed for something that’s not your fault.

Marital problems?  This again is vague.  You are going to have marital problems trying to juggle all that is life.

4.  Adult ADHD Problem No. 4: Extreme Distractibility

Attention deficit hyperactivity disorder is a problem with attention regulation, so adult ADHD can make it difficult to succeed in today’s fast-paced, hustle-bustle world. Many people find that distractibility can lead to a history of career underperformance, especially in noisy or busy offices. If you have adult ADHD, you might find that phone calls or email derail your attention, making it hard for you to finish tasks.

Uh... yeah.  This is me.  But isn't this everyone????

5.  Adult ADHD Problem No. 5: Poor Listening Skills

Do you zone out during long business meetings? Did your husband forget to pick up little Jimmy at baseball practice, even though you called to remind him on his way home? Problems with attention result in poor listening skills in many adults with ADHD, leading to a lot of missed appointments and misunderstandings.

Ok, so maybe hubby forgot because he was up all night with a teething toddler?  Maybe I zone out during meetings because I'm just TIRED.  Ever think of that one?

6.  Adult ADHD Problem No. 6: Restlessness, Difficulty Relaxing

While many children with ADHD are “hyperactive,” this ADHD symptom often appears differently in adults. Rather than bouncing off the walls, adults with ADHD are more likely to show restlessness or find they can’t relax. If you have adult ADHD, others might describe you as edgy or tense.

Who has time to relax?  I'm still trying to organize as in #1!!!

7.  Adult ADHD Problem No. 7: Difficulty Starting a Task

Just as children with ADHD often put off doing homework, people with adult ADHD often drag their feet when starting tasks that need a lot of attention. This procrastination often adds to existing problems, including marital disagreements, workplace issues, and problems with friends.

I can start a task... it's finishing!!!

THE LIST GOES ON.

So basically I'm just trying to point out that life with small children and working is going to make any adult seem to be suffering from these symptoms.  Children?  I believe that so much more is expected of them at school and they are fighting within themselves to listen and be still during school.

We are RUSHING to use medications as a quick fix.  How about find out WHY little Johnny is having trouble at school?  How about some behavioral therapy?  How about having a good school?  How about not just turning to medications that have some pretty bad side effects?  You don't want to stunt your kids' growth right?  Methylphenidate may slow children's growth or weight gain. Your child's doctor will watch his or her growth carefully.  Along with other side effects listed on the link above.

We need to take this study seriously.

Distracted Driving

I don't know about you, but lately on my commute to work, I have been paying attention to the number of drivers are distracted while driving. Whether it is actually reading a book while speeding down the interstate or texting and driving, it seems the trend is increasing. I have to make a concerted effort myself at times not to pick up my phone while my car is moving forward, though I still struggle during red lights!

I can remember way back in high school when the dangers were alcohol or even the one teen nearby who had reached way down to retrieve a CD to play while on a deadly curve and crashed ending her life. Back then, we didn't have cell phones so readily available.

Today, a typical teenager sends and receives about 100 texts per day, and more than half of all teens surveyed according to the CDC who released the results from an anonymous survey recently, state they text and drive.

Perhaps with the recent ruling of a Massachussets teenager to be criminally held responsible for texting while driving things may change. Aaron Deveau was sentenced to 2 1/2 years behind bars with a year to serve and the remainder suspended for the deadly crash that happened in February 2011 taking the life of a 55 year old man and seriously injuring his girlfriend. Deveau must also serve 40 hours of community service and surrender his driver's license for 15 years. He was only 17 years old when the crash occurred.

One split moment. One second.

If this doesn't send a message of the implications of making such a decision to text and drive, I'm not sure what can. I know it does me.

The Sun-kissed Glow; The Precancerous Glow

It's that time of year again.  Summer.  Although it is not June 21st yet, it is that time of year where millions of people take a weekend vacation to the beach.  Including my family.  I noticed right away that one of my children seemed to be glowing a bit red where I had missed applying sunscreen.  Not good.  Her little area beneath one eye is pink now and puffy and to be honest, I just don't even look at tans the way I used to. I hate to admit that once upon a time in my teens and twenties, I coveted and regularly paid for tanning appointments.  A tan made me feel thinner which I desperately wanted to be.  My mother regularly tanned as well, though she won't now thanks to a brush with squamous cell carcinoma.  Seriously, if you tan or love to tan, give it up.  It's just not worth it later in life.  Hers looked like a wart.  I think she has at least 10 stitches?  Whatever the outcome, it is not worth it.

So, of course when you get to the beach and see hundreds of people flocking to the beach, you wonder... do people know about sunscreen?  Do they realize that the sunscreen industry is changing and that the FDA is also changing things?

Go ahead and lose the word sunscreen first.  Currently, sunscreen standards relate to UVB sun exposure, the primary cause of sunburns and a contributor to skin cancer and premature aging. Under the FDA's new rules, the sunscreens will also have to be tested and labeled to disclose UVA protection. Radiation from this type of sun ray is more deeply penetrating, passes through windows, and is linked to skin cancer and early aging.

This summer, if the FDA determines that a sunscreen protects both from UVA and UVB, it will be labeled broad spectrum.  Sunscreen will no longer be able to say they are waterproof or sweat proof.  No more labeling that a sunscreen can stay on longer than two hours without reapplying.

The playing field is about to become level, and it is most definitely time.

I personally use Blue Lizard Sunscreen, and I can't say enough good things about it.  My dermatologist recommended it, and I use it daily on my face!

Aeromonas Hydrophila

CNN LINK: So I had to embark upon understanding this flesh eating necrotizing fasciitis causing bacteria that has the life of Aimee Copeland on hold and on a ventilator in a hospital in Augusta, GA.   Only 24 years old, Aimee fell from a zip line and had a gash in her leg that was stitched up only to return to an ER a few days later with a bigger issue.  Necrotizing fasciitis.

Aeromonas hydrophila is a heterotrophic, Gram-negative, rod shaped bacterium, mainly found in areas with a warm climate. This bacterium can also be found in fresh, salt, marine, estuarine, chlorinated, and un-chlorinated water. Aeromonas hydrophila can survive inaerobic and anaerobic environments. This bacterium can digest materials such as gelatin, and hemoglobin. Aeromonas hydrophila was isolated from humans and animals in the 1950s. This bacterium is the most well known of the six species of Aeromonas. It is also highly resistant to multiple medications, chlorine, and cold temperatures.

Because of Aeromonas hydrophila’s structure, it is very toxic to many organisms. When it enters the body of its victim, it travels through the bloodstream to the first available organ. It produces Aerolysin Cytotoxic Enterotoxin (ACT), a toxin that can cause tissue damage.

Most of the time, this organism causes gastroenteritis.

Aeromonas is usually found in freshwater and marine environments; it is most prominent in the Northern Hemisphere during the warmer months. The skin of the lower extremities is the most common site of infection, usually after traumatic exposure to contaminated water or soil. Aeromonas infection and cellulitis often develop within 8 to 48 hours of exposure, and systemic signs are common. Manifestations may include hemorrhagic bullae, subcutaneous bleeding, and purpura.

Aeromonas is typically highly susceptible to penicillins combined with β-lactamase inhibitors, second- and third-generation cephalosporins, aminoglycosides, and fluoroquinolones.

When patients do not respond to antibiotics for presumed common cellulitis, it may be prudent to obtain further imaging such as CT or MRI of the affected limb to rule out soft tissue collections, soft tissue emphysema, and necrotizing fasciitis. Surgical debridement may be indicated for deep soft tissue infection, necrosis, and purulent collections that are inadequately draining.

I do hope Aimee makes a full recovery.  You can follow here progress here.

Depakote and Abbott's $1.6 Billion Mistake

Abbott never had FDA approval to promote Depakote for aggression and agitation in the elderly or schizophrenia. The total includes a criminal fine of $700 million and civil settlements with the states and federal government totaling $800 million. Abbott pleaded guilty to a criminal misdemeanor for misbranding the medication. Abbott is also going to pay 45 states $100 million to resolve liability with consumer protective laws. Luckily the Justice Department found no deaths due to this crime.

The company admitted that from 1998 through 2006, it "maintained a specialized sales force trained to market Depakote in nursing homes for the control of agitation and aggression in elderly dementia patients, despite the absence of credible scientific evidence that Depakote was safe and effective for that use," the Justice Department said in a news release.

"In addition, from 2001 through 2006, the company marketed Depakote in combination with atypical antipsychotic drugs to treat schizophrenia, even after its clinical trials failed to demonstrate that adding Depakote was any more effective than an atypical antipsychotic alone for that use."

Heaphy said Abbott earned about $13 billion from Depakote sales during the period investigated, but he said it was difficult to determine how much of that was the result of sales for illegal purposes. He expressed confidence that, once the fines are factored in, Abbott will not have profited from the improper practices.

Um... Ok. $13 billion minus $1.6 billion equals a profit.

No wonder this will keep happening.