Viewpoints: Advance Directives And Dementia; When Scientific Trials Take Place In Court

JAMA: Advance Directives For Dementia
Standard advance directives are often not helpful for patients who develop dementia. Dementia is a unique disease from the standpoint of advance directives. ... Clinicians, perhaps unsure of the goals of care for such patients, often may continue to provide the same care they would have in the absence of dementia, without addressing whether plans should be adjusted. Clinicians and family members often find it easier to continue current treatment paths rather than having conversations about whether such care is what a person with dementia would have wanted. (Barak Gaster, Eric B. Larson and J. Randall Curtis, 11/6)

JAMA Internal Medicine: Scientific Trials—In The Laboratories, Not The Courts
In 2015, one of us published a peer-reviewed study, together with colleagues at the University of California, San Francisco, replicating prior research from the US Food and Drug Administration (FDA) detecting a designer stimulant, β-methylphenylethylamine, in sports, weight loss, and “cognitive function” supplements sold in the United States. The confirmatory study prompted the FDA to take enforcement action against companies selling the stimulant as a dietary ingredient. One of the companies that received an FDA warning letter sued the study’s authors for $200 million in damages for libel, claiming, without supporting scientific evidence, that multiple statements in the article were false. ... The case is just a recent example of using litigation to target scientists. ... When lawsuits target scientists, it does not matter that plaintiffs almost never win. It does not even matter if the case goes to trial. The goal is to intimidate. (Nicolas Bagley, Aaron E. Carroll and Pieter A. Cohen, 11/6)

Detroit Free Press: Without Cash, Trump's Opioid Emergency Declaration Is A Farce Destined To Fail
When I was 14 years old, my older brother Zach overdosed on heroin. It was, not surprisingly, the defining moment of my life; a moment when I came to appreciate the tremendous strength of my family, the vital importance of friends and the overwhelming compassion of my community. Eleven years later, the opioid crisis still feels visceral and raw; I watched my mentor and friend suffer through addiction, I cried endless tears after my time with him was forced into memory, and I’m reminded of him every time I meet new families suffering through the same. I know too well Zach’s struggle and the heartbreak of my family is not unique. In 2006, the year he died, 34,424 others died from an overdose as well. Last year, that agonizing statistic grew to over 64,000. (Connor Goddard, 11/5)

Columbus Dispatch: Medicaid Cuts Threaten Programs That Saved Me
Along with West Virginia, New Hampshire, Kentucky and Rhode Island, Ohio is in the top-five list of states that have the highest rates of drug-overdose deaths. ...Repealing the Affordable Care Act and making deep cuts to Medicaid in the federal budget would take health care away from the more than 1 million Ohioans who got coverage under the ACA. (Phillip Krauss, 11/6)

Chicago Tribune: How To Reduce The Deadly Toll Of Opioids
At the end of the 20th century, Americans were worried about the dangers posed by crack cocaine. They didn’t realize that another drug menace would soon eclipse it. Prescription opioids were gaining favor as a tool against undertreated pain. No one foresaw where this would lead: to an epidemic of opioid overdoses that the nation is only starting to confront with the urgency it warrants. (11/4)

Los Angeles Times: Working Past 65? Beware Of This Medicare Trap That Could Cost You Thousands In Taxes
We can say two things for sure about the American workforce and its health insurance. First, more Americans are working past the traditional retirement age of 65. Second, more are taking advantage of employer insurance plans that include tax-exempt Health Savings Accounts. Add these two facts together, and you end up with a pitfall that could cost unwary American workers as much as $2,700 a year in tax exemptions if they exercise their right to enroll in Medicare at 65. That pitfall exists because of the confusing way HSAs interact with Medicare, and because many big employers fail to help their older employees deal with the potential complexities—or even to know about them. (Michael Hiltzik, 11/6)

The New York Times: Don’t Nudge Me: The Limits Of Behavioral Economics In Medicine
Whenever I talk to physicians about outcomes that are worse than you’d expect, they are quick to point out that noncompliance — when a patient does not follow a course of treatment — is a major problem. Sometimes prescriptions aren’t filled. Other times they are, but patients don’t take the drugs as prescribed. All of this can lead to more than 100,000 deaths a year. (Aaron E. Carroll, 11/6)