A sour end to 2012: Will 2013 be better?

Fireworks explode over Times Square as the crystal ball is hoisted before New Year celebrations in New York December 31, 2012. REUTERS/Joshua Lott
Fireworks explode over Times Square as the crystal ball is hoisted before New Year celebrations in New York December 31, 2012.
REUTERS/Joshua Lott

Many Americans seem to be in a sour mood as 2013 begins, after Hurricane Sandy ravaged parts of the East Coast, a gunman massacred 20 school children in Connecticut and a long, contentious election campaign was followed by failure to resolve the “fiscal cliff” issue by year-end.

Americans have not been very optimistic since the Great Recession of 2008-2009, but the gloom had begun to lift this year until the blast of bad news as 2012 ended, IPSOS pollster Cliff Young said on Monday. IPSOS polling showed that some angst set in as the year ended.

Sixty-eight percent of respondents said the economy was on the wrong track at the end of 2012, IPSOS said, and 64 percent had a negative opinion of national politics.

“I do think these events had some sort of effect on people’s short-term prospects,” Young said.

But the headlines of 2012 belie a number of positive underlying trends in America, and Young said he expects public opinion to turn more positive in the new year.

Here is a summary of some of the positive trends in health, health, security, the environment, personal finance and education:

COLLEGE EDUCATION: More than 30 percent of Americans 25 years of age or older have finished four years of college, the highest level since 1940. Another 26 percent of adults have completed one to three years of college such as a community college, according to Census Bureau data.

This is important because the lifetime earnings of a person with a college associate’s degree working from age 25 to 64 will be $442,000 more than that of a high school graduate. A bachelor’s degree could yield $1 million more in lifetime earnings, a Census Bureau study found.

http://www.census.gov/hhes/socdemo/education/index.html

CONSUMER DEBT: While Americans are known as big spenders on credit, some surveys show that since the Great Recession of 2008-09, consumers are becoming more frugal. The average consumer with an account had credit card debt of $5,371 in November, 2012, down from $6,503 the same month a year ago, according to consumer organization Credit Karma. Average mortgage and auto debt also was down and even student loan debt, which has been rising, inched lower in November.

The end of the year usually brings increases in credit card debt due to holiday shopping, but consumers seem to be spending more responsibly and paying more with cash. Spending has been more conservative in general over the last four years since the recession, and credit card companies are lowering debt limits, Credit Karma said.

CHARITABLE GIVING: Despite the uncertain economy, Americans continue to be generous to charities. Donations rose to $298.42 billion in 2011, the highest since the Great Recession, although giving has not yet reached pre-recession levels.

Giving by Americans increased 4 percent in 2011 compared with 2010, with individual donations accounting for nearly three-quarters of the total, according to the 57th annual report by the Giving USA Foundation and the Center on Philanthropy at Indiana University.

Corporate donations remained flat at $14.5 billion last year, foundations made almost $42 billion in grants – an increase of 1.8 percent – while gifts from estates jumped more than 12 percent to $24.4 billion.

The money went to around 1.1 million registered charities and some 222,000 American religious groups.

Religious groups received the most donations – about one- third of the total – but dropped 1.7 percent in 2011 to $95.8 billion. The only other sector to record a drop in donations was giving to foundations, which fell 6.1 percent to $25.8 billion.

http://www.reuters.com/article/2012/06/19/us-usa-charity-idUSBRE85I05T20120619

CANCER: Cancer claims the lives of more than half a million Americans every year and is the second leading cause of death after heart disease. But the numbers of deaths and people afflicted with the disease continue to decline, according to the Centers for Disease Control and Prevention. While the latest data is for 2008, officials said the trend continued in more recent years.

The federally funded CDC attributes the decline to identifying populations with unhealthy sedentary lifestyles and obesity, and intervening in a targeted way to improve their health and prevent cancer.

The highest rate of cancer deaths in the United States is for lung cancer, followed by prostate, breast cancer among women, colon, pancreatic, ovarian cancer and leukemia.

While lung cancer causes a greater rate of deaths, it is not the most frequent cancer. More Americans contract prostate cancer than any other type of the disease, followed by women with breast cancer. Lung cancer is third, followed by colon cancer, women with cancer of the uterus, and urinary bladder cancer.

http://www.cdc.gov/media/releases/2012/p0328_Cancer_deathrates.html

SMOKING: The number of Americans who smoke continues to gradually decline, to 19 percent of adults over 18 in 2011, the latest year for which statistics are available, from 19.3 percent in 2010. The news is even better for young adults: the rate of smoking among 18- to 24-year-olds dropped to 18.9 percent in 2011 from 24.4 percent in 2005.

The best trend of all is that four out of five teenagers do not smoke, and teen smoking has been on the decline since 2000, although the rate of decline has slowed.

Fewer people addicted to tobacco means lower health costs and fewer deaths, such as from lung cancer, down the road, according to the CDC.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6144a2.htm?s_cid

http://www.cdc.gov/media/releases/2012/p0809_youth_tobacco.html

TEEN PREGNANCY: The number of births to girls aged 15 to 19 fell 8 percent in 20ll to a record low level. Teens seems to be less sexually active and more of those who are active seem to be using birth control, the CDC said.

http://www.cdc.gov/teenpregnancy/

CHILD OBESITY: After years of grim news about Americans getting fatter and sedentary, overweight children fixated on video games, the first signs of hope emerged this year. The CDC said new data showed a “modest” decline in child obesity in recent years. Two possible reasons – higher rates of breastfeeding and rising awareness of the importance of physical activity among young kids. A CDC study found 13 percent of preschoolers surveyed were obese in 1998, growing to 15 percent in 2003, but again falling below 15 percent by 2010, the most recent study year.

http://www.reuters.com/article/2012/12/25/us-obesity-kids-idUSBRE8BO07J20121225

DRINKING AND DRIVING: The incidence of Americans driving after drinking too much has declined by 30 percent over the past 5 years although it remains a serious problem. Four-in-five drunk drivers are men and especially men from ages 21 to 34.

The best news is that drinking and driving among teenagers has fallen 54 percent since 1991. Only about 10 percent of teens ages 16 years or older had driven after drinking in 2011 compared with more than 20 percent two decades ago.

The reasons for this success include a minimum drinking age of 21 in all states, zero tolerance laws, graduated drivers’ license systems and better parental monitoring, according to the CDC.

http://www.cdc.gov/vitalsigns/DrinkingAndDriving/

http://www.cdc.gov/media/releases/2012/p10_02_teen_drinking.html

LAW ENFORCEMENT DEATHS: Deaths of law enforcement officials in the line of duty fell by 23 percent in 2012 after two years of sharp increases. Some 127 federal, state and local officers were killed, with traffic accidents the top cause of death, followed by shootings.

The National Law Enforcement Officers Memorial Fund attributed the reduction to better safety for police such as use of bullet-proof vests.

While national headlines have regularly featured terrible shootings such as those at an elementary school in Newtown, Connecticut and a movie theater in Aurora, Colorado, the number of police officers killed in shootings fell 32 percent in 2012.

http://www.nleomf.org/facts/research-bulletins/

AIR QUALITY: In 2010, about 90 million tons of pollution were emitted into the atmosphere in the United States, according to the Environmental Protection Agency. These emissions form ozone and particles, reduce visibility and deposition of acids, and visibility impairment.

But the good news is that pollution in the air we breathe is down substantially in all categories. In the three decades since 1980, emissions of carbon monoxide from cars, ozone, lead, nitrogen, sulfur and particulate matter such as soot all have declined. Carbon monoxide is down 82 percent, lead down 90 percent, nitrogen down 52 percent and sulfur declined 76 percent.

http://www.epa.gov/airtrends/aqtrends.html

TRASH: Americans generated about 250 million tons of trash in 2010, most of which fouls the environment or goes into landfills. We may be starting to reform our wasteful ways, according to data from the EPA. The amount of waste generated per person per day had declined to 4.43 pounds by 2010 from 4.67 pounds five years earlier, according to the EPA.

Another positive trend is that recycling is increasing. Of the 250 million tons of trash produced in 2010, more than 85 million tons or 34.1 percent was recycled or composted.

http://www.epa.gov/waste/nonhaz/municipal/msw99.htm

Copyright 2012 Thomson Reuters

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Alaska plane crash kills former senator, four others

(AP)

Former Sen. Ted Stevens lay dead in the mangled fuselage of the plane. A 13-year-old boy escaped death but watched his father die a few feet away. Medical workers spent the miserable night tending to survivors’ broken bones amid a huge slick of fuel that coated a muddy mountainside.

The gruesome details of the plane crash that killed Stevens and four others emerged as investigators tried to figure out how the float plane crashed into a mountain during a fishing trip. Three teenagers and their parents were on the plane, including the former head of NASA.

Authorities were studying weather patterns to understand if overcast skies, rain and gusty winds played a role in a crash that claimed the life of the most revered politician in Alaska history.

The Republican was remembered as a towering political figure who brought billions of dollars to the state during his 40 years in the Senate — a career that ended amid a corruption trial in 2008. He was later cleared of the charges.

A pilot who was one of the first to arrive at the scene described a horrific scene of airplane wreckage, fuel, rainy weather, dead bodies and frightened survivors.

As he helped shuttle a doctor and two EMTs to the scene about three hours after the crash, Tom Tucker described seeing a survivor still strapped in the front seat with the nose of the plane disintegrated. His head was cut, and his legs appeared to be broken.

“The front of the aircraft was gone,” Tucker said. “He was just sitting in the chair.”

He and other responders made a tarp tent over the missing cockpit to keep him dry. It was rainy and cold, and he believes the passengers’ heavy duty waders protected them when they went into shock.

“These individuals were cold. We covered them up with blankets and made them as comfortable as we could.”

The flights at Dillingham are often perilous through the mountains, even in good weather. NTSB chairwoman Deborah Hersman said weather conditions at the time of the accident included light rain, clouds and gusty winds.

Hersman said the group had eaten lunch at a lodge and boarded a 1957 red-and-white float plane between 3 p.m. and 3:15 p.m. local time for a trip to a salmon fishing camp. The FAA had previously said the plane took off between 1 p.m. and 2 p.m.

Lodge operators called the fish camp at 6 p.m. to inquire when the party would be returning for dinner, but were told that they never showed up. Civilian aircraft were dispatched, and pilots quickly spotted the wreckage a few miles from the lodge, Hersman said.

The doctor and EMTs were flown to the area and hiked to the wreckage as fog and rain blanketed the area and nightfall set in, making it impossible for rescue officials to reach the scene until daybreak.

The Federal Aviation Administration said the DeHavilland DHC-3T was registered to Anchorage-based General Communications Inc., a phone and Internet company.

The victims were identified as Stevens; pilot Theron “Terry” Smith, 62, of Eagle River; William “Bill” Phillips Sr.; Dana Tindall, 48, an executive with GCI; and her 16-year-old daughter Corey Tindall.

The four survivors were former NASA administrator Sean O’Keefe and his teenage son; William “Willy” Phillips Jr., 13; and Jim Morhard, of Alexandria, Va. They were taken to Providence Hospital in Anchorage with “varying degrees of injuries,” Alaska State Troopers said on Tuesday.

Former NASA spokesman Glenn Mahone said O’Keefe, 54, and his son had broken bones and other injuries.

Sean O’Keefe was listed in critical condition late Tuesday afternoon, while son Kevin was listed in serious condition and sleeping.

Stevens and O’Keefe were fishing companions and longtime Washington colleagues who worked together on the Senate Appropriations Committee that the Republican lawmaker led for several years. Stevens became a protege to the younger O’Keefe and they remained close friends over the years. Morhard and the elder Phillips also worked with Stevens in Washington.

Plane crashes in Alaska are somewhat common because of the treacherous weather and mountainous terrain. Many parts of the state are not accessible by roads, forcing people to travel by air to reach their destinations.

Stevens was one of two survivors in a 1978 plane crash at Anchorage International Airport that killed his wife, Ann, and several others.

Stevens was a legend in his home state, where he was known as “Uncle Ted.” The wiry octogenarian was appointed in December 1968 and became the longest-serving Republican in Senate history.

Nina Corbett, co-owner of the Windmill Grille in Dillingham, was saddened by the loss of Stevens.

“We’re such a youthful state,” she said Tuesday night while taking a break from serving pizza, hot sandwiches, tap beer and wine from a box to visiting fishmeran in the restaurant along the road to the town’s airport.

“He’s the only senator we’ve ever known.”

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Associated Press writers Rachel D’Oro in Anchorage; Becky Bohrer in Juneau, Alaska; Pauline Jelinek, Matt Apuzzo, and Natasha Metzler in Washington, D.C.; Mike Schneider in Orlando, Fla., contributed to this report.

Copyright © 2010 The Associated Press

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Overtreated to death

The doctors finally let Rosaria Vandenberg go home.

For the first time in months, she was able to touch her 2-year-old daughter who had been afraid of the tubes and machines in the hospital. The little girl climbed up onto her mother’s bed, surrounded by family photos, toys and the comfort of home. They shared one last tender moment together before Vandenberg slipped back into unconsciousness.

Vandenberg, 32, died the next day.

That precious time at home could have come sooner if the family had known how to talk about alternatives to aggressive treatment, said Vandenberg’s sister-in-law, Alexandra Drane.

Instead, Vandenberg, a pharmacist in Franklin, Mass., had endured two surgeries, chemotherapy and radiation for an incurable brain tumor before she died in July 2004.

“We would have had a very different discussion about that second surgery and chemotherapy. We might have just taken her home and stuck her in a beautiful chair outside under the sun and let her gorgeous little daughter play around her — not just torture her” in the hospital, Drane said.

Americans increasingly are treated to death, spending more time in hospitals in their final days, trying last-ditch treatments that often buy only weeks of time, and racking up bills that have made medical care a leading cause of bankruptcies.

More than 80 percent of people who die in the United States have a long, progressive illness such as cancer, heart failure or Alzheimer’s disease.

More than 80 percent of such patients say they want to avoid hospitalization and intensive care when they are dying, according to the Dartmouth Atlas Project, which tracks health care trends.

Yet the numbers show that’s not what is happening:

  • The average time spent in hospice and palliative care, which stresses comfort and quality of life once an illness is incurable, is falling because people are starting it too late. In 2008, one-third of people who received hospice care had it for a week or less, says the National Hospice and Palliative Care Organization.
  • Hospitalizations during the last six months of life are rising: from 1,302 per 1,000 Medicare recipients in 1996 to 1,441 in 2005, Dartmouth reports. Treating chronic illness in the last two years of life gobbles up nearly one-third of all Medicare dollars.

“People are actually now sicker as they die,” and some find that treatments become a greater burden than the illness was, said Dr. Ira Byock, director of palliative care at Dartmouth-Hitchcock Medical Center. Families may push for treatment, but “there are worse things than having someone you love die,” he said.

Gail Sheehy, author of the “Passages” books, learned that as her husband, New York magazine founder Clay Felker, spent 17 years fighting various cancers. On New Year’s Day 2007, they waited eight hours in an emergency room for yet another CT scan until Felker looked at her and said, “No more hospitals.”

“I just put a cover over him and wheeled him out of there with needles still in his arms,” Sheehy said.

Then she called Dr. R. Sean Morrison, president of the American Academy of Hospice and Palliative Medicine and a doctor at Mount Sinai School of Medicine in New York.

“Nobody had really sat down with them about what his choices are and what the options were,” said Morrison, who became his doctor.

About a year later, Felker withdrew his own feeding tube, and “it enabled us to go out and have a wonderful evening at a jazz club two nights before he died” in July 2008, Sheehy said.

Doctors can’t predict how soon a patient will die, but they usually know when an illness has become incurable. Even then, many of them practice “exhaustion medicine” — treating until there are no more options left to try, said Dr. Martha Twaddle, chief medical officer of Midwest Palliative & Hospice Care Center in suburban Chicago.

A stunning number of cancer patients get aggressive care in the last days of their lives, she noted. One large study of Medicare records found that nearly 12 percent of cancer patients who died in 1999 received chemo in the last two weeks of life, up from nearly 10 percent in 1993.

Guidelines from an alliance of leading cancer centers say patients whose cancer has spread should stop getting anti-cancer medicine if sequential attempts with three different drugs fail to shrink their tumors. Yet according to IntrinsiQ, a cancer data analysis company, almost 20 percent of patients with colorectal cancer that has spread are on at least their fourth chemotherapy drug. The same goes for roughly 12 percent of patients with metastatic breast cancer, and for 12 percent of those with lung cancer. The analysis is based on more than 60,000 cancer patients.

Often, overtreating fatal illnesses happens because patients don’t want to give up.

Saideh Browne said her mother, Khadija Akmal-Lamb, wanted to fight her advanced ovarian cancer even after learning it had spread to her liver. The 55-year-old Kansas City, Mo., woman had chemo until two weeks before she died last August.

“She kept throwing up, she couldn’t go to the bathroom,” and her body ached, Browne said. The doctors urged hospice care and said, “your mom was stubborn,” Browne recalled. “She wanted her chemo and she wanted to live.”

Browne, who lives in New York, formed a women’s cancer foundation in her mother’s honor. She said she would encourage dying cancer patients to choose comfort care over needless medicine that prolongs suffering.

It’s easier said than done.

The American way is “never giving up, hoping for a miracle,” said Dr. Porter Storey, a former hospice medical director who is executive vice president of the hospice group that Morrison heads.

“We use sports metaphors and war metaphors all the time. We talk about never giving up and it’s not over till the fat lady sings …. glorifying people who fought to their very last breath,” when instead we should be helping them accept death as an inevitable part of life, he said.

This is especially true when deciding whether to try one of the newer, extremely expensive cancer drugs such as Avastin, Erbitux and Tarceva. Some are touted as “improving survival by 30 or 50 percent” when that actually might mean living three weeks or months longer instead of two.

“It’s amazing how little benefit those studies show,” Storey said, referring to research on the new drugs.

Dan Waeger tried just about all of them. A nonsmoker, he was diagnosed with lung cancer at age 22, and pursued treatment after treatment before dying nearly four years later, in March 2009.

“He decided if there were odds to be beat, he was going to beat the odds,” said his boss, Ellen Stovall, then-president of the National Coalition for Cancer Survivorship, where Waeger worked as a fundraiser and development manager.

“He received just about every experimental new drug for lung cancer that I’m aware of in his last two years of life. He would get a treatment on a Friday afternoon, be sick all weekend and come to work on Monday,” she recalled.

“He had these horrific rashes. He would get these horrible coughs that were not just the lung cancer. The treatments were making him cough up blood, just horrific side effects — vertigo, numbness, tingling in his hands and feet. He suffered.”

Waeger’s fiancee, Meg Rodgers, said they worried about exceeding the lifetime limits on his insurance, since the care was so expensive.

“I think every time he got a treatment, it was $10,000,” though he paid only a $10 copay, she said.

Yet it was clearly worth any price to him — he died a week before they were to be married, after receiving home hospice care for only two weeks.

“I honestly believe he would have done anything he could to live one more day,” Rodgers said.

Some health policy groups say cancer patients, as well as people with failing hearts or terminal dementia, should get better end-of-life counseling. Last year, a plan that would have let Medicare pay for doctors to talk about things like living wills was labeled “death panels” and was dropped.

Ultimately, how patients and their families make the journey is a matter of personal choice — and there are resources to help them, Stovall said.

“I’ve heard a lot of people over the years say what they would do if they had cancer until it is them. And then they will cling to even the smallest glimmer that something will help,” she said.

“Cancer that can’t be cured is often called daunting but not hopeless. So that’s what patients hear. Hope is the last thing to go. People don’t give that up easily.”

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AP Medical Writer Lindsey Tanner in Chicago contributed to this story.

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Online:

State advance directives: http://www.caringinfo.org/PlanningAhead.htm

Physician’s orders: http://www.ohsu.edu/polst/

Respecting Choices: http://respectingchoices.org

Copyright © 2010 The Associated Press

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