Better Health Care Newsletter - December 2024

In this season of giving and gratitude, let’s consider the ways we can magnify the best spirit of the holiday season. Starting with our own self-interest:

Kindness towards others reaps its own return, as the dollars-and-(common)-sense Wall Street Journal reported, noting:

“Generosity is a powerful drug even in small doses. Donations to a worthy cause or acts of kindness to friends give your mind and body a boost. Yes, the side effects of a charitable act may include a better mood, lower blood pressure, and a longer life, according to studies from brain scientists and economists. You might experience a spike in serotonin and dopamine, hormones associated with happiness, and a drop in cortisol, researchers say. (You also get some tax benefits.) Before you start using your checkbook as a prescription pad, there is one caveat. How you give money and time matters more than how much, says Sara Konrath, a social psychologist leading a research lab at the Indiana University Lilly Family School of Philanthropy.”

The newspaper advises givers to optimize their efforts by being passionate and not reflexive about their chosen people and causes, following up on how recipients spend gifts, and offering up their time as an invaluable resource.

For those who are concerned about others’ health and well-being, the needs are great and the options many. So let’s take a few moments to consider what we can do to help loved ones plus others near and far, knowing that our generosity enriches ourselves as well as the world.

Swimming lessons: It’s not just for summers! Why not start now with indoor pools, giving youngsters a head start toward safer summer fun? The American Red Cross (click here) or the YMCA (click here) offer a starting point to search out what’s available. It’s also worth a check with local school districts and recreation departments.

Why do this? The federal Centers for Disease Control and Prevention reported earlier in 2024 that:

“[More than] 4,500 people drowned each year in the United States from 2020–2022. This is about 500 more drowning deaths each year compared to 2019. Groups already at higher risk saw the greatest increases in deaths, including young children and older adults of all races and ethnicities, and black people of all ages …Drowning is the leading cause of death among children ages 1–4. Drowning increased by 28% among children ages 1–4 in 2022 compared to 2019.”

By the way, swimming lessons also would be a great idea for older adults, as the CDC reported: “Adults 65 years of age and older had the second highest rate of drowning. Drowning increased by 19% in adults ages 65–74 in 2022 compared to 2019.”

Driving lessons: While this instruction once was a valued part of public-school curriculums, many districts have decided it was too costly and now leave it to outside providers. For parents, this expense can be an obstacle. The data show that, for safety’s sake, the investment can be worthwhile, as the National Highway Traffic Safety Administration has found, warning that:

“Motor vehicle crashes were the leading cause of unintentional death in 2020 for the 15- to 24-year-old age group in the United States … In 2021, some 2,116 drivers 15 to 20 years old were killed, and an estimated 203,256 were injured in motor vehicle crashes …. In comparison with adult drivers, young drivers are substantially over-involved in crashes. In 2021 drivers 20 and under made up 5.1% of licensed drivers in the United States, yet they made up 8.5% of total drivers in all fatal crashes and 12.6% of drivers in all crashes.”

States have toughened licensing for young drivers, gradually increasing what they are allowed to do with vehicles and passengers, and often requiring education programs. Parents have online resources to consult as they decide whether programs will be beneficial to their novices, especially about increasing their awareness against distracted driving or getting behind the wheel while impaired (lack of sleep, substance abuse).

Bonus tip: Older drivers can benefit from specialized driver education programs, including those offered by AARP and AAA.

Gun safes: As the U.S. Surgeon General and other leading medical authorities have noted, firearms are taking an unacceptable toll on the nation’s young, as well as those who are prone to preventable suicide.

The surgeon general, Dr. Vivek Murthy, warned on weapon violence:

“Since 2020, firearm-related injury has been the leading cause of death for U.S. children and adolescents (ages 1–19), surpassing motor vehicle crashes, cancer, and drug overdose and poisoning. In 2022, 48,204 total people died from firearm-related injuries, including suicides, homicides, and unintentional deaths. This is over 8,000 more lives lost than in 2019 and over 16,000 more lives lost than in 2010.”

Firearms play a disproportionate role in suicide — a leading cause of preventable death, Murthy reported, noting that the “rate of firearm-related suicide in the United States increased by 20% across the population, with the highest increases among younger people.”

The holidays can be stressful and distressing to many folks, challenging their mental health.

If you or someone you know is thinking about harming themselves or attempting suicide, tell someone who can help right away. Call 911 for emergency services. Go to the nearest hospital emergency room. Call or text 988 to connect with the 988 Suicide & Crisis Lifeline . The Lifeline provides 24-hour, confidential support to anyone in suicidal crisis or emotional distress. Support is also available via live chat . Para ayuda en español, llame al 988.

A key area that Murthy and others have zeroed in on to prevent firearm violence focuses on improved storage of weapons, including wider use of safes and separating guns and ammo. Individual gun owners can adopt steps like these with relatively low cost and effort, while increasing protection against accidental deaths and injuries among the young who find, play with, and accidentally fire weapons. The options are plentiful for such products.

Research is showing that owners can protect others by ensuring their firearms are kept securely — locked away, unloaded, and with ammo stored separately, and far from curious kids and those who, in a momentary crisis, might cause themselves serious harm.

Medical care in this country — getting it and affording it — can be a crushing concern.

This can be especially true due to the sky-high cost of prescription medications, shortages of lifesaving basics, and the sustained harm of medical indebtedness. Samaritans are tackling these nightmares:

Donating unused meds: On opposite sides of this country, Brown and Stanford universities, separately, have helped to start nonprofits to assist patients slammed by the high costs of prescription drugs for conditions like heart disease, cancer, HIV, and other significant illnesses.

They do so by recognizing that pricey medications too often go unused by patients when their specialists change their treatment, or they succumb to their disease. The surplus drugs, which can cost $5,000 to $10,000 per therapeutic regimen, get swept up and incinerated by hospitals, or loved ones dispose of them — creating potential environmental hazards if they get flushed in toilets or put down household drains. In the meantime, patients who are under- or uninsured can’t access life-changing and life-saving medications due to their cost.

Enter initiatives like Stanford-launched Sirium, or Brown-incubated Medi-Circle. They have developed online platforms on which patients and loved ones can donate costly, unused (blister-pack sealed) medications. These are collected, inspected for quality control by pharmaceutical experts, and distributed to patients with demonstrated financial and medical need.

AARP, the nation’s largest group lobbying on behalf of older Americans, has posted an informative article about prescription drug donation programs that provides key background information for those interested in giving or receiving this medical assistance.

Donate blood: Donated blood becomes an instant, urgent need for those involved in terrible vehicle wrecks. Or for those who must undergo major surgery. It is a big, sustained demand for patients with chronic illnesses, including certain cancers.

As the American Red Cross advises, “every 2 seconds someone in the U.S. needs blood and or platelets.“ Approximately 36,000 units of red blood cells are needed every day in the U.S. But insufficient numbers of Good Samaritans donate and do so regularly, leaving the nation’s health care system — and countless patients across the country — in constant worry about supplies.

Not everyone may give blood, and there are eligibility requirements to safeguard donors and the supply. Giving is painless. And hospitals, clinics, and blood-banking institutions, with a boost from charitable organizations, try to make the process as convenient as possible.

Erase medical debt: As patients and their loved ones quickly learn, the prices for medical services can be overwhelming, leaving years of financial burdens for those who undergo all manner of care. The nonprofit, independent KFF Health News services posted an article in October with a painful reminder of the prevalence of this problem — even as efforts have grown to deal with it:

“New laws to curb aggressive hospital billing, to expand charity care for lower-income patients, and to rein in debt collectors have been enacted in more than 20 states since 2021 … [Still, about] 100 million people in the U.S. are burdened by some form of health care debt, forcing millions to drain savings, take out second mortgages, or cut back on food and other essentials, KFF Health News has found. A quarter of those with debt owed more than $5,000 in 2022.”

Doctors, hospitals, and other providers have hardly relented in their campaigns to squeeze patients — especially the poor, working poor, and uninsured or underinsured — for every penny they possess, although collection efforts frequently go for naught.

That leaves financial institutions to bundle, buy, and sell medical debt with what can be cruel indifference.

Undue Medical Debt — a national 5013(c) founded by, yes, two former debt-collection executives — shows how gifts from the charitable can wipe out substantial medical debts, with a $100 contribution, for example, eliminating $10,000 in others’ obligations. Churches and other groups, as well as politicians and governments, have stepped up to help erase medical debt. These efforts have gotten increasing public attention, including by HBO satirist John Oliver (see his piece by clicking here) and in a poignant New York Times article about a terminal cancer patient with a last wish to help others — effectively clearing an estimated $20 million owed by people she did not know.

To be candid, recent research has disappointed some supporters of efforts to deal with medical debt. As the New York Times reported:

“[A] study published by a group of economists [followed] 213,000 people who were in debt and randomly selecting some to work with [Undue Medical Debt] … the researchers found that debt relief did not improve the mental health or the credit scores of debtors, on average. And those whose bills had been paid were just as likely to forgo medical care as those whose bills were left unpaid.”

As is to be expected, those who fall into deep medical debt often have an array of financial and personal problems and alleviating one concern (like indebtedness for care) does not resolve the many others, researchers found. But advocates say the palpable experiences of those who benefit from being freed of the burden of medical debt effectively recalls that adage about lighting one candle versus just cursing the darkness …

The world received painful reminders again this year of the ordeals of supplying human basics like medical care, medicines, and food in situations in which human-made and natural calamities rage.

Fortunately, courageous humanitarians go into dire circumstance to assist those in need — and they, in turn, need support from donors:

Medical care amid catastrophes: In hot spots like Gaza, Ukraine, Lebanon, and Sudan, the global nonprofit Doctors Without Borders — also known by its French name Médecins sans Frontieres — delivered emergency medical aid under dire conditions. As the group’s website reports: “Since our founding in 1971 MSF has helped tens of millions of people and grown from a group of 13 doctors and journalists to an international movement of more than 69,000.” The organization, working in 70 nations now, reports that over the years it has offered more than 16 million medical consultations, more than 3 million vaccinations, and admitted almost 1.4 million patients to its hospitals.

Doctors Without Borders emphasizes that “In conflict zones, [the group] does not take sides. We provide medical care based on needs alone and work to reach the people most in need of help. Nearly one-fourth of MSF’s projects are dedicated to assisting people living in conflict.” The organization also races to provide desperately needed medical services after earthquakes, floods, tsunamis, and catastrophic storms, as well as outbreaks of deadly infections. It offers sustained, vital medical assistance to what amounts to a global torrent of displaced people and refugees.

Medical preparedness in our homes: If reading this section of the newsletter makes you say, “Hmmm …” and you wonder how you or loved ones might fare in sudden, difficult situations, an important gift might be to take on some planning — especially when key family and friends are close by and in helping moods.

The federal Centers for Disease Control and Prevention estimates that “129 million people in the U.S. have at least one major chronic disease (e.g., heart disease, cancer, diabetes, obesity, hypertension) … Over the past two decades [this] prevalence has increased steadily, and this trend is expected to continue … An increasing proportion of people in America are dealing with multiple chronic conditions; 42% have two or more, and 12% have at least five …”

These statistics indicate that lots of folks have significant, recurring medical needs — whether with prescription medications or medical devices (electrical or electronic). What are Plans B and C if unforeseen forces disrupt services, including those of a medical nature, and for more than a few hours?

The federal government offers planning guides (such as this one from the CDC or from the Ready.gov site. These do not address what could become a vital gift — who in a family or among friends or colleagues will tackle, in advance, potentially difficult situations and plan for them. This goes beyond what this newsletter has described in getting together a “go kit” for emergencies.

Who, for example, can work with a loved one or friend to help suss out their prescriptions, determining how various local, state, and federal regulations might allow a stockpile to be built of needed drugs for an emergency? Who can take a patient to the pharmacy and schedule time for emergency preparation? Who can pull together and copy important prescriptions and medical records? (I’ve long advised that it is vital for patients to get and keep copies of their own medical records.)

Who might walk around the home of a friend or loved one, with candor and confidentiality, to determine if, say, an emergency generator might power important medical devices and whether any of that hardware also requires electronic or internet functionality, as well as electricity? Who might support a patient with mobility constraints in determining if or how they might exit their home and neighborhood if circumstances required? Who might set up the cell or telephone calling tree, so people can alert those near and dear to them that they are OK or need help in a disaster and to maintain crucial emergency communications?

Who? Well, me and you.

Feeding the hungry: Hunger and lack of food is an unrelenting problem, especially after disasters. It is not a nightmare just in the developing world.

Since 2010, a novel group of people with expertise in food have tried to ensure that nutritious meals, a fundamental of human welfare, get to those in the worst circumstances. Chefs around the globe have answered the emergency calls and rallied around José Andrés and the World Central Kitchen charity he founded with his wife.

The organization in recent times has rushed food assistance to those in need after:

✓ flooding in Spain, Poland, Brazil, and Bangladesh
✓ hurricanes in Florida, Georgia, Tennessee, Louisiana, and North Carolina
✓ combat and strife in the Middle East
✓ wildfires in Chile, North Texas, Greece, and California.

Andrés, who launched his superstar culinary career in Washington, D.C., has defined the group’s global mission: “World Central Kitchen started with a simple idea at home with my wife, Patricia: when people are hungry, send in cooks. Not tomorrow, today …When you need medical service, you bring doctors and nurses. When you need the rebuilding of infrastructure, you bring in engineers and architects. And if you have to feed people, you need professional chefs.”

The group welcomes volunteers, as well as donations of many different kinds.

To learn more about battling food insecurity nationally and in the Washington region, click on these links (they represent a slice of the many charitable groups involved in the struggle): D.C. Central Kitchen, Maryland Food Bank, SOME (So Others Might Eat), Capital Area Food Bank, and D.C. Hunger Solutions.

Need more ideas on charitable giving or smart family gift-giving?

Our law firm maintains a list of charities we support. Check it out by clicking here.

Over the years, this newsletter has offered various annual suggestions on ways to help others, including all you need to know about:

✓ Becoming an organ donor.
✓ Participating in medical research.
✓ Donating no longer needed durable goods, and eyeglasses and hearing aids

My colleagues and I enjoy a great gift all year long, of course — the opportunity to work with terrific clients and all the wonderful folks who make the firm a success.

This will be a holiday season in which some festive folks forgo that extra bit of liquid cheer — and maybe the multiple trips to the overflowing food buffets.

That more careful consumption may be due to the public heeding officials’ warning that excessive consumption of alcohol — a problem that became significant during the boredom and loneliness of the pandemic — has not eased and, in fact, it is worsening as a big health problem.

As the New York Times reported:

“The percentage of Americans who consumed alcohol, which had already risen from 2018 to 2020, inched up further in 2021 and 2022. And more people reported heavy or binge drinking. ‘Early on in the pandemic, we were seeing an enormous surge of people coming in to the clinic and the hospital with alcohol-related problems,’ said Dr. Brian P. Lee, a hepatologist at Keck Medicine of the University of Southern California and the principal investigator of [a] study, published in Annals of Internal Medicine. ‘People assumed this was caused by acute stress, like what we saw with 9/11 and Katrina, and typically it goes back to normal after these stressful events are over,’ he added. ‘But that’s not what we’re seeing.’”

The newspaper reported this in a separate article:

“The number of deaths caused by alcohol-related diseases more than doubled among Americans between 1999 and 2020, according to new research. Alcohol was involved in nearly 50,000 deaths among adults ages 25 to 85 in 2020, up from just under 20,000 in 1999. The increases were in all age groups. The biggest spike was observed among adults ages 25 to 34, whose fatality rate increased nearly fourfold between 1999 and 2020.

“Women are still far less likely than men to die of an illness caused by alcohol, but they also experienced a steep surge, with rates rising 2.5-fold over 20 years. The new study, published in The American Journal of Medicine, drew on data from the [CDC].”

The CDC has put up online a questionnaire and guide for folks who may be concerned about their boozing and want ways to reduce their consumption.

As for overdoing the eating during this time of year, the U.S. Department of Agriculture has posted online a handy reference of sensible, healthy food preparation and consumption for the holidays.

Just a friendly reminder: The excess pounds picked up in November and December are hard to get rid of and can create plenty of problems as a result.

Are you one of the many grownups stressing out over how to get the latest perfect (and pricey) holiday toy for a youngster in your family?

In a word: Relax!

Kids may clamor for items on various seasonal hot lists of presents for the young. But the holiday experiences — not the material things — will be the stuff of which lifetime memories are made.

Pediatricians, in fact, have counseled that children benefit greatly from simple, basic, and less costly toys, even in this digital era replete with electronic devices. The optimal gifts spur kids’ imagination, let them socialize with others more, and have a history of building their physical and cognitive abilities. Try gifts of age-appropriate books, blocks, easy puzzles, coloring and drawing materials, safe dolls, and balls.

Think twice about adding an adorable pet to the household for the holidays. Animals require a lot of care and resources, and, the kids’ begging notwithstanding, grownups must conscientiously assess the commitment required. If you have pets, keep in mind how the holidays affect them, too.

Safety must be a prime consideration for children’s presents. The federal Consumer Product Safety Commission has posted excellent information online on this topic (click here to see it).

The agency and others advise this: Avoid toys with parts that can be broken off or with pieces that can be put in the mouth and swallowed or that can choke a child. Look out for items with sharp edges or loose strings, ribbons, or cords. Use caution about ordering from vendors online. Some of them may be overseas, where product laws are lax on issues like flammability of clothing or durability of goods.

Be wary of gifts that make lots of noise or feature bright lights.

Batteries, especially of the button variety, pose high hazards — not only for tots who may ingest them but also with charging and fire hazards in devices fancied by older kids.

The pleading by the young may peak at this time of year for video games, cell phones, tablets, and other electronic gadgets and gear. If you’re old enough to know why the barn door gets shut ahead of trouble, then you’ll also appreciate how vital it is to set rules and boundaries about e-devices and their use before young folks get hold of them.

With increasing attention on potential harms inflicted on the vulnerable young by social media and its misuse, grownups must pay special attention to this problem — both as kids get new devices to go online and as youths spend the holidays at home.