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Thanks, but no thanks

National | Just say no to another helping; "collusion of silence" over end-of-life care; Prozac's patent gets a longer life

Issue: "Judicial overreach?," Dec. 2, 2000

Seconds, please?
You may have overdone it over Thanksgiving, but before you indulge in another oversized holiday meal, consider this: A recent study suggests that an unusually heavy meal increases the risk of a heart attack. This isn't referring just to overeating. One huge meal can be harmful regardless of your normal diet. A big chow down roughly quadruples one's heart attack risk during the two hours after eating, according to the report. Doctors from Boston's Brigham and Women's Hospital say that the risk is 10 times normal during the first hour, but disappears after three hours. Researchers questioned 1,986 men and women about what they ate just before their heart attacks. Of these, 158 said they had consumed a heavy meal within the previous 26 hours, and 25 had a lot to eat during the two hours before their heart attacks. The doctors can't precisely explain how a big meal is harmful, but they have several guesses. They say it might trigger the release of hormones that put stress on the heart, or increase the blood's tendency to clot. Big meals aren't the only trouble trigger under scrutiny. Another study from Boston's Brigham and Women's Hospital looks at the causes of sudden cardiac arrest, which kills an estimated 225,000 Americans each year. The conclusion: lack of quality time with Mr. Treadmill. A 12-year study of thousands of male physicians showed that men who exercised at least five times a week had seven times less risk than those who only exercised once a week. Habitual exercise didn't cut the risk of cardiac death, according to the researchers, just the risk during exertion. Any activities that work up a sweat, even brisk walks or gardening, can count as exercise. Gerald F. Fletcher, an American Heart Association spokesman, said the group will put out new exercise guidelines early next year, recommending 30 to 60 minutes of "fairly vigorous" exercise four to six times per week: "You don't need to do it all at one time. You get credit for leisure-time activity," he said, from racket sports and dancing to house cleaning, on-the-job exercise, even running up and down stairs after toddlers. Uncertainty over one of life's certainties
What happens when people prepare to die? A major series of medical studies reports that death is an awkward issue in today's society, something that creates "a collusion of silence" between patients and doctors. The big news to come from the research is that only a few among the terminally ill consider suicide. Even with all the furor over physician-assisted suicide, it usually isn't a serious consideration. When it comes to end-of-life care, "euthanasia and physician-assisted suicide are largely irrelevant," concluded study author Ezekiel Emanuel of the National Institutes of Health. Still, polls suggest between 60 percent and 70 percent of Americans feel terminally ill people in pain should be able to end their lives, with a doctor's help if needed. Yet only one in 10 admitted considering it for themselves. Less than 2 percent of patients discussed the option with doctors, and 2.5 percent hoarded painkillers in case they decided to try suicide. Another big issue is that many terminally ill people pass away in unhappy places. Nearly 80 percent of Americans die in hospitals or nursing homes, very often bedridden, incontinent, and in pain. Another study argues that doctors don't realize other elements that dying patients list as most important to their last days: being mentally aware at the end, not being a burden on family, and coming to peace with God. Health-care providers debate how to improve care for the dying, but they have difficulty finding solutions. Part of the issue is the culture at large. Our society is taught to ignore death. If the subject comes up, it is treated as a journey to an ideal state (such as in the movie What Dreams May Come). More serious conversations treat death as annihilation, wiping out the person's existence. With a worldview like this, death is likely to remain what one doctor called "the unacknowledged elephant in the room." Protracted Prozac patent
The wonder drug of the '90s will remain a cash cow for its creator a little longer. The FDA extended Eli Lilly & Co.'s Prozac patent for an additional six months. This was granted because the company agreed to test the antidepressant on children. This extension holds back generic versions of the antidepressant until next August. Prozac makes big bucks for Lilly right now, around $167 million every month. More than 30 million patients have received prescriptions for the drug since it debuted in 1988. Lilly claims Prozac is not a cure for clinical depression, but merely takes care of some symptoms. The drug boosts the level of a brain neurotransmitter called serotonin, which is said to be imbalanced in depressed people. Some patients claimed dramatic improvements, and the drug became a national sensation. Hype sparked misconceptions that Prozac was a magic talisman that could solve life's problems. Today, the hype surrounding Prozac has died down considerably. Meanwhile, similar drugs named Paxil and Zoloft appeared and also became successes. Prozac's popularity is largely an American phenomenon. Of the pill's $2.61 billion in sales in 1999, about $2 billion of it was in the United States. But the family of a lawyer who killed his wife, then himself in 1998 is suing Lilly, claiming Prozac drove him to kill. Victor Ciabotti stabbed his wife Susan several times before strangling her, and then hanged himself with a rope in the garage. Ciabotti's brother-in-law is demanding $150 million from Lilly and his psychiatrist, claiming that Lilly knew about violent side effects through at least 200 similar lawsuits. In April, The Indianapolis Star reported that Lilly paid more than $50 million to settle quietly more than 30 similar lawsuits. Lilly defends its creation.

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