health2001-2

Information about Multiple Sclerosis

(As related to the plot development in West Wing TV drama)

``That was realistic,'' she says. ``They treated him like he was no longer in control -- giving him instructions over and over as if he couldn't remember them.''

In her own life, Curras has had to fight her older children's attempts to take away custody of Francesca for fear Curras can't take care of her.

``As long as I can live and breathe and think, I can take care of her,'' she declares.

The TV program also thrills Karen Dresbach, president of the South Florida chapter of the National Multiple Sclerosis Society.

Dresbach's group struggles to increase public awareness of the disease in which the body's immune system attacks the lining that insulates nerve fibers in the brain and spinal cord, slowing or halting the nerve impulses that control bodily movement. That heightened awareness is needed in part to fight the kind of workplace bias that the fictional president is facing.

``Our job is to educate employers that people with MS are just as motivated, qualified and as good a contributor as somebody without the disease. The disease does not consume them,'' says Dresbach who sympathizes with President Bartlet's decision to hide his MS from the public for many months.

``People have lost promotions, even lost their jobs because employers don't understand the disease.''

A Harris Poll in April indicated that nearly 40 percent of MS sufferers had hidden their diagnosis from family members, friends or colleagues. Thirty six percent said MS has had a negative impact on their personal relationships.

More important, the poll showed that 42 percent of people with MS are not taking any of the promising new drugs recently approved by the Food and Drug Administration -- because they did not have a doctor, thought they didn't need medicine while the disease was in remission or couldn't afford the drugs.

Of the 350,000 people in the United States that have the disease, probably as many as 225,000 could be helped by the new medications, he said. But only about 135,000 are receiving them.

He urged those with MS symptoms -- including fatigue, tingling, numbness, blurred vision, muscle weakness, impaired balance, forgetfulness or difficulty concentrating -- to see their doctors for diagnosis.

Research, casting doubt on 'placebo effect,' seeks change
By Linda A. Johnson
ASSOCIATED PRESS

One of the most strongly held beliefs in medicine - that dummy pills or other sham treatments greatly help many patients - has been called into question by Danish researchers who found little or no "placebo effect" in dozens of studies.
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Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, said: "I was shocked by this study. This just goes completely against the grain."

In many medical studies, patients in one group receive an experimental treatment, while a comparison group gets a look-alike dummy pill or other placebo. Neither the patients nor the doctors know who is getting what. The goal is to see whether the medicines being tested do more good than the patient's will to get better.

Studies occasionally include a third group not getting either a placebo or the treatment being tested. Those patients receive nothing, or just get the standard treatment for a condition if the study is testing whether combining a new treatment with the current one is better.

The Danish researchers combined the findings of 114 such studies from around the world, involving dozens of conditions ranging from colds and seasickness to Alzheimer's disease and schizophrenia, to see how the fake treatment stacked up to no treatment.

In most of the studies, the placebo group fared about the same as the group getting no treatment. The exceptions were studies of pain treatments and some others with subjective results, meaning patients reported how much symptoms bothered them, rather than having an objective measure such as blood pressure.

Placebo recipients in the pain studies averaged a 15 percent reduction in pain, and patients in the other subjective studies had smaller improvements.

Many studies and textbooks suggest that about one-third of patients given placebos in medical experiments get better, presumably because they believe they are getting an effective treatment. But the new research casts doubt on this long-held belief.

"The high levels of placebo effect which have been repeatedly reported in many articles, in our mind are the result of flawed research methodology," said Dr. Asbjorn Hrobjartsson, a professor of medical philosophy and research methodology at the University of Copenhagen, who ran the study with colleagues at the Nordic Cochran Center there.

The researchers and other experts said the improvements in subjective measures might be explained by "reporting bias," where patients, thinking they are getting a powerful treatment, incorrectly judge their condition or overstate any improvement to please their doctor.

Dr. Stephen Schneider, a professor of medicine at the University of Medicine and Dentistry of New Jersey in New Brunswick, has worked on many trials where patients on placebo improved. He said some of those patients would have gotten better with no treatment. In addition, he said, simply participating in a medical study induces patients to eat better, exercise more or otherwise pay more attention to their health.

That includes giving people with colds antibiotics, which have no effect; recommending that patients with the flu take heavy doses of vitamin C, also shown to make no difference; or prescribing a drug that is unlikely to work but might give hope to a patient with a terminal illness.

From the Miami Herald
24 May 2001

Aging and car culture on collision course
Traffic accidents expected to escalate as more and more people reach their 70th year.
By Stephen Seplow
INQUIRER STAFF WRITER

With the number of elderly Americans on the road increasing steadily, the country appears headed for an epidemic of traffic accidents - and fatalities - involving older drivers.

Age erodes the skills required for safe driving: judging distances, processing information and reacting quickly.

The number of drivers 70 and older is growing rapidly - faster than in any other age group. The number increased nearly 40 percent from 1989 to 1999, to 18.5 million, and is projected to continue climbing.

The problem is not simply that there are more old people behind the wheel. Like other Americans, they are driving more miles than ever.

The result is all but certain to be increased trouble on the nation's roads.

"There is no question that is going to be the end result," said Anthony Stein, president of Safety Research Associates, a Los Angeles-area consulting firm.

Not every elderly driver poses risks. Many who might be a danger on the roads recognize the hazards and stop driving.

Others, like Ruth Kaminsky, 76, a bubbly woman from Upper Merion who has put more than 56,000 miles on her red 1998 Buick, drive confidently and crisply.

"I'll put in 400, 500 miles on a weekend," she said after a recent line-dancing session at the Upper Merion senior citizens center.

Other drivers show the effects of age. A 70-year-old Levittown man appeared on the Bristol Township police reports twice in two weeks last winter.

Once, he drove his 1989 Volvo off the street and through someone's shrubbery. Two weeks later, he backed out of his driveway, hit a parked car, and left the scene. He told police that there was very little contact and that he didn't realize such a minor collision was considered an accident.

Drivers are most prone to accidents in their early years behind the wheel and again after age 70, federal statistics show.

After the teenage years, the rate of accidents per mile driven drops steadily with age, reaching a low of 3.5 accidents per million miles driven for Americans ages 65 to 69, the federal data show.

But at age 70, the trend reverses. Motorists age 70 to 74 have nearly 5 accidents per million miles on the road. For those between 75 and 79, the rate is 7.26 accidents per million miles. By 85, it climbs to 14.07, exceeded only by the teenage rate.

Age is also a factor in the ability to survive accidents. Being more brittle, elderly people are far more likely to be severely injured or killed.

In the Philadelphia region, drivers 70 and older were involved in 9 percent of all accidents between 1995 and 1999 but accounted for 15 percent of all deaths.

Nationwide, traffic fatalities decreased by 9 percent between 1989 and 1999 but increased 14 percent for those older than 70.

Now, about 6,000 people older than 65 die each year in car accidents.

That number is expected to rise more than fourfold over the next 30 years, to 25,000 per year, said John Eberhard, senior research psychologist for the U.S. Department of Transportation.

Drivers older than 75 take precautions as they notice their faculties slipping, surveys show. They don't drive much at night, avoid long trips on highways, and stick to familiar local streets.

Ironically, some of these precautions increase the risk of accidents, Eberhard said. On local streets, drivers face greater dangers than on highways. There are more intersections, more turns, more signs and signals to decipher, and more opportunities for confusion.

All of this requires "faster decisions than do freeway driving situations," Eberhard said.

Unfortunately, those quick decisions are needed just when the decision-making apparatus is slowing down.

A typical problem is a diminished ability to judge the speed of oncoming traffic and the time needed to make a left-hand turn safely.

"Older-driver crashes are most often associated with failing to yield to traffic when merging, not responding properly to stop signs and traffic lights, or making unsafe turns," Eberhard said.

Young drivers' accidents, in contrast, are often the result of drinking or speeding.

Public attention is riveted by the rare instance when an older driver plows onto a crowded sidewalk or through a storefront. But far more common for older drivers are two-car accidents at intersections.

Nationally, half of all fatal accidents involving drivers older than 80 are intersection collisions. For drivers up to age 50, the figure is 23 percent.

A pervasive problem for the elderly is Alzheimer's disease, which afflicts 20 percent of people 75 and older and half of those older than 85.

"They are good in easy situations but don't do well in stressful ones," said Dara Jamieson, a geriatric psychiatrist at Pennsylvania Hospital.

Jamieson recalled a particularly memorable case of a quick mind slowing down. In Chester County in 1986, Helen Taussig, 88, a renowned pediatric cardiologist, drove out of a parking lot and into traffic in Kennett Square. Her vehicle was broadsided by an oncoming car, and she was killed.

Injuries to the other, younger driver, were comparatively mild: a broken nose and chest injuries.

Despite the evidence that elderly drivers pose greater risks on the road, most states, including Pennsylvania and New Jersey, do not require retesting of older motorists.

Pennsylvania does randomly choose 1,650 drivers 45 and older - a sample weighted toward those older than 85 - each month to undergo vision and medical tests as a condition of getting their driver's licenses renewed.

About 1 percent of those tested see their licenses revoked, said Rebecca Bickley, director of the Bureau of Driver Licensing.

She attributed that to the effectiveness of another state law requiring physicians to report patients of any age who they believe may pose a danger on the road. It is a requirement that supersedes doctor-patient confidentiality.

Bickley said the state receives about 25,000 such reports a year. About half are for people younger than 45 suffering from uncontrolled seizures, diabetes, or serious head injuries. About half of those tested lose their licenses.

New Jersey requires physicians to report only seizure conditions but encourages them to report other serious medical problems as well. The state received about 6,800 reports last year; more than half resulted in license revocations.