Hands to Help Seniors

A class of drugs called PD-1 inhibitors are showing extreme promise in fighting Hodgkin’s Disease, a debilitating condition that strikes almost 10,000 people per year.  The drugs free the body’s immune system to fight cancer and have shown that they shrink cancer in over half of the patients on the drugs, and these are people that have exhausted many other treatment options.  What’s exciting about this new class of drugs is that researchers believe they may also work on lung, kidney and some other types of cancers.  Although the trials thus far have been small, at the annual meeting of the American Society of Hematology, participants were excited about the potential for this class of drugs.  About 30% of those treated for Hodgkin’s disease either do not respond to current treatments or do initially but then relapse.

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A Federal judge yesterday issued a ruling blocking drug company Actavis from halting sales of the old version of Alzheimer’s drug Namenda so that it could make more money from a new version of the drug which has a longer patent life.  It’s become common practice for companies to come out with a slightly tweaked version of a drug so that it can keep its name-brand drug on the market when new generic versions are allowed to be manufactured by competitors.  For instance, the owner of the patent on the popular sleeping pill Ambien came out with a time-released version (Ambien-CR) in order to create new life for the Ambien brand.  But Actavis took this strategy even one step further.  It introduced Namenda XR, which is taken once per day rather than the old version of Namenda which was taken twice per day.  By taking Namenda off the market and introducing Namenda XR before generic Namenda came to market, it would get patients switched to what was essentially a new drug which couldn’t be substituted for a generic by the pharmacist.  “Our lawsuit against Actavis sends a clear message: Drug companies cannot illegally prioritize profits over patients,” New York attorney general Eric Schneiderman said.

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The latest issue of Kiplinger's Retirement Report brought up an important issue: Those with public pensions face reduced Social Security benefits.  The article interviewed Jim Knight, a 68 year old man who filed for benefits at age 66.  He started receiving payments of $1,000 per month.  However, a year later when he started getting his teacher’s pension check, his monthly Social Security check dropped to $600 per month.  “It’s unfair.  That money is mine,” he told a reporter.  Unfortunately, it is legal under the so-called “windfall elimination provision” or WEP which penalizes those who worked in the private and public sectors unless they have 30 years or more of substantial earnings or have a military pension.  Sadly, some people get hit twice.  If you are a public pensioner who applies for a spousal or survivor benefit, that too will be cut by two-thirds of the amount of the public pension.  

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There has been quite a bit of focus recently on improving awareness of planning for end-of-life care (often referred to as hospice) which includes things like signing a Physicians Order for Life-Sustaining Treatment (also known as a POLST).   This form outlines how you want physicians to treat you should you become incapacitated and unable to communicate your wishes.  We also recommend that you meet with friends, family, and anyone you have given power-of-attorney to or made a potential trustee on a living trust.  Talk to them frankly about what you would want to happen if you were put on life support or were in another medical emergency.  Unfortunately, experts are saying that many people signing these forms don’t fully understand what they mean.  There is a lot of medical jargon such as a “DNR” or do not resuscitate order which people need to fully understand before signing such forms.  In contrast to a POLST form, which spells out your wishes in certain circumstances, a DNR directs medical providers not to try to revive you if you have no pulse or aren’t breathing, however it doesn’t address other things like withdrawing or withholding care.  A number of studies have shown that even doctors are confused about the meaning of instructions in living wills and DNR orders.  Some doctors even mistakenly thought a living trust was the same as a DNR while others believe a DNR means that they should not provide any treatment at all.   This is quite frightening.  “The risk is that you don’t receive the necessary and standard-of-care treatment for a critical illness such as a heart attack, which could lead to death or permanent disability, whereas the standard-of-care treatment could save your life,” Dr. Ferdinando Mirarchi, lead investigator of what are called the TRIAD studies which found all of this confusion among doctors.  The bottom line is that you should have a POLST and appoint someone as your medical representative, fully explaining to them exactly what your wishes are in various medical scenarios so that there is no confusion.

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The Wall Street Journal recently ran a great article entitled, “Why Everything You Know About Aging Is Probably Wrong.”  A lot of the article was positive, stating that as people get older friendships, creativity and satisfaction with life all can flourish.  Many people, however, are extremely anxious about retirement.  Among those surveyed that are 18-64, 57% expect memory loss although it impacts only 25% of those over 65.  About 14% of seniors aren’t able to drive and yet about 45% of those 18-64 believe they won’t be able to.  The list goes on and on.  While most of the articles we read about seniors tend to focus on the negative, this one was great, aiming to dispel common myths such as depression being prevalent with the elderly.  Research actually indicates that emotional well-being continues to improve until the 70’s, at which point it levels off.  Even centenarians report overall high levels of well-being according to a 2014 study done by a number of researchers including Laura Cartensen, the director of Stanford University’s Center on Longevity.  It’s a long article but I would encourage you to give it a read, it synthesizes a lot of recent research which has been done on the elderly.  

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