Webinar Series: Seattle’s Earthquake Response Seattle’s Earthquake Response: Wednesday, June 16, 2021, 6 – 7:30pm Staff from the Seattle Fire Department will provide an overview of how the City directs life safety response operations after a major earthquake This will include information on how they prioritize their response efforts with limited resources, how they begin requesting outside assistance, and what the public can do to prepare. Future webinars in this series will provide more detail on specific areas of response, including utility restoration, transportation restoration, and emergency shelter and feeding. The first webinar in this series, Overview of Response Priorities and Coordination, is available to watch on our YouTube channel. Captioning available in English, Simplified and Traditional Chinese, Korean, Russian,Spanish and Vietnamese.Click here to sign up for reminder emails. Go to the weblink to join at the time of the webinar: bit.ly/SeattleEQ-FireResponseWebinar The City of Seattle encourages everyone to participate in its programs and activities. For disability accommodations, materials in alternate formats, or accessibility information, contact OEM at 206-233-5076 or OEM@seattle.gov. Providing at least 72 hours notice will help ensure availability; sign language interpreting requests may take longer. A full schedule of upcoming webinars is available at seattle.gov/emergency-management/about-us/event-calendar.
Posted inenvironment|Comments Off on Webinar on Earthquake Response Wednesday June 16th
Just across the 520 bridge is a nice place to stroll either with or without your dog. Part of the park is off-leash. The main interest near the ponds are the very active Great Blue Herons. This rookery has been home to these giant birds inthe many years I’ve walked there.
Rookery of Great Blue Herons in Medina, WA
Posted inAnimals, Nature|Comments Off on A walk in Medina Park
The roses are now in full bloom. It’s a great time to visit this site located at the main entrance of the Zoo. Enter off of 50th St. This main entrance to the Zoo is closed at present so there’s plenty of parking right next to the rose garden entrance. There is no fee. Check out the varieties here: https://www.zoo.org/roses.
Ed Note: Would you want to take a drug which didn’t receive even one “yes” vote from the expert FDA Advisory Panel? One study showed no benefit, the second study showed marginal benefit. The side effects are significant. This drug may well be overused. The FDA approved it anyway. The “why” answer is likely a combination of drug lobbying and wishful thinking in desperate circumstances.
The drug, Aduhelm, a monthly infusion priced at $56,000 per year, was approved this week despite weak evidence that it helps patients.
Dr. Aaron Kesselheim, who resigned this week from an F.D.A. advisory committee, speaking at a panel in 2018. “This might be the worst approval decision that the F.D.A. has made that I can remember,” he said Thursday.
In a powerful statement of disagreement with the Food and Drug Administration’s approval of Biogen’s controversial Alzheimer’s drug, three scientists have resigned from the independent committee that advised the agency on the treatment.
“This might be the worst approval decision that the F.D.A. has made that I can remember,” said Dr. Aaron Kesselheim, a professor of medicine at Harvard Medical School and Brigham and Women’s Hospital, who submitted his resignation Thursday after six years on the committee.
He said the agency’s approval of the drug, aducanumab, which is being marketed as Aduhelm, a monthly intravenous infusion that Biogen has priced at $56,000 per year, was wrong “because of so many different factors, starting from the fact that there’s no good evidence that the drug works.”
Two other members of the committee resigned earlier this week, expressing dismay at the approval of the drug despite the committee’s overwhelming rejection of it after reviewing clinical trial data in November.
The committee had found that the evidence did not convincingly show that Aduhelm could slow cognitive decline in people in the early stages of the disease — and that the drug could cause potentially serious side effects of brain swelling and brain bleeding. None of the 11 members of the committee considered the drug ready for approval: Ten voted against and one was uncertain.
“Approval of a drug that is not effective has serious potential to impair future research into new treatments that may be effective,” said Dr. Joel Perlmutter, a neurologist at Washington University School of Medicine in St. Louis, who was the first to resign from the committee.
“In addition, the implementation of aducanumab therapy will potentially cost billions of dollars, and these dollars may be better spent in either developing better evidence for aducanumab or other therapeutic interventions,” Dr. Perlmutter added.
Shannon P. Hatch, a spokeswoman for the F.D.A., said the agency does not comment on matters related to individual members of advisory committees.
Biogen plans to begin shipping out the drug in about two weeks. It expects more than 900 sites across the country, typically memory clinics that see patients with dementia, to soon be ready to administer the drug.
The F.D.A.’s decision to green-light it, announced Monday, marked the first approval of an Alzheimer’s treatment in 18 years. Patient advocacy groups had pushed for approval because there are only five other medications available for the debilitating condition and they only address dementia symptoms for a matter of months.
But since at least last fall, several respected experts, including some Alzheimer’s doctors who worked on the aducanumab clinical trials, have said the available evidence raised significant doubts about whether the drug is effective. They also said that even if it could slow cognitive decline in some patients, the suggested benefit — a slowing of symptoms for roughly four months over 18 months — might be barely noticeable to patients and would not outweigh the risks of brain side effects.
Beyond the steep price tag of the drug, additional costs to screen patients before treatment and for regular MRIs required to monitor their brains for problems could add tens of thousands of dollars to the tab. Medicare is expected to shoulder much of the bill.
“Giving patients a drug that doesn’t work and of course has important risks that are going to require multiple MRIs at a price of $56,000 a year is putting patients in a really challenging position and putting doctors in a difficult position as well,” Dr. Kesselheim said.
Beyond their conviction that the existing evidence for Aduhelm’s benefit is weak, the advisory committee members who resigned — as well as several prominent Alzheimer’s experts — objected to two major aspects of the F.D.A.’s approval decision.
One issue is that the F.D.A. approved the drug for a much broader group of patients — anyone with Alzheimer’s — than many experts were anticipating. The clinical trials tested the drug only on patients with early-stage Alzheimer’s or mild cognitive impairment from the disease.
The other issue is that a significant part of the F.D.A.’s rationale for granting approval was its contention that the drug’s ability to attack the amyloid protein in patients’ brains would help slow their cognitive symptoms.
“This is a major problem,” Dr. Perlmutter said.
While amyloid is considered a biomarker of Alzheimer’s disease because its accumulation in the brain is a key facet of the condition, there has been very little scientific evidence that reducing amyloid can actually help patients by easing their memory and thinking problems.
Clinical trials of other amyloid-reducing drugs over more than two decades have failed to offer evidence that the medications slowed cognitive decline. Consequently, many experts had said it was especially important to have solid evidence for Aduhelm’s ability to address symptoms.
In November, F.D.A. officials told the advisory committee members that the agency would not be counting the drug’s ability to reduce amyloid as an indication that it might be effective. But in Monday’s decision, the F.D.A. announced that it had done just that.
“FDA has determined that there is substantial evidence that Aduhelm reduces amyloid beta plaques in the brain and that the reduction in these plaques is reasonably likely to predict important benefits to patients,” the F.D.A.’s director of the Center for Drug Evaluation and Research, Dr. Patrizia Cavazzoni, wrote on the agency’s website about the decision to make the drug available under a program called accelerated approval.
But advisory committee members said the committee was never told that the agency was planning to consider approval based on amyloid reduction and that their opinion was never sought about that significant change. Dr. Perlmutter said the committee was “not made aware of any additional information or statistical analyses that would support” approval.
Dr. David Knopman, a clinical neurologist at the Mayo Clinic, wrote in an email to F.D.A. officials informing them of his resignation from the advisory committee on Wednesday: “Biomarker justification for approval in the absence of consistent clinical benefit after 18 months of treatment is indefensible.”
Dr. Knopman, who had recused himself from the November meeting because he had served as a site principal investigator for one of the aducanumab trials, added that “the whole saga of the approval of aducanumab, culminating on Monday in the accelerated approval, made a mockery” of the advisory committee’s role.
Dr. Peter Stein, who directs the F.D.A. Center for Drug Evaluation and Research’s Office of New Drugs, said in a briefing with reporters after the decision that agency reviewers were persuaded by what he described as a strong relationship between plaque reduction and potential clinical benefit with Aduhelm, which he said had not been seen in previous studies of drugs designed to clear amyloid.
Dr. Stein also defended the agency’s decision to approve the drug for such a broad group of patients, saying it could be relevant beyond the early stages of Alzheimer’s.
“Because amyloid is a hallmark of the disease through its entire course, the expectation is that this drug will provide benefit across that spectrum,” Dr. Stein said.
As a condition for the approval, the F.D.A. said it would require Biogen to conduct another clinical trial and would allow the company about nine years to complete it. Those terms also concern some experts. They say that during those years the drug will be available without restriction, and if the new trial does not find the drug beneficial, the agency can revoke its approval, but it is not required to and has not always done so with other drugs.
“The timeline that they provided for the so-called confirmatory trial, nine years, is problematic,” said Dr. Kesselheim, who also directs Harvard Medical School’s program on regulation, therapeutics and law. “There’s going to be a lot of use of the product during that time.”
Posted inDementia, Finance, Health|Comments Off on Three F.D.A. Advisers Resign Over Agency’s Approval of Alzheimer’s Drug
A woman who led police on a low-speed chase on her electric mobility scooter wasn’t operating a motor vehicle and should not have been convicted for fleeing or attempting to elude a police officer, an Oregon appeals court has ruled.
The trial judge should have granted an acquittal sua sponte in the prosecution of Jennifer Grace Gayman, the Oregon Court of Appeals ruled in a June 9 decision.
Gayman used the scooter because of a degenerative eye disease and a pulmonary disease, according to the Oregonian. Officers in Brookings, Oregon, stopped Gayman when she heading home from karaoke. Gayman was cited for operating her scooter on a sidewalk and crosswalk and for failing to wear a helmet.
One officer told Gayman that she could not continue to ride her scooter home without a helmet, and she would go to jail if she did so. Gayman drove her scooter home anyway, as officers trailed her with their lights and siren on in a low-speed pursuit that lasted two to three minutes.
Officers arrested Gayman for fleeing or attempting to elude a police officer when she arrived home.
The appeals court said the trial court had committed a plain error by failing to acquit.
“Here, the gravity of the error and the ends of justice move us to exercise our discretion to correct the error,” the court said.
“The actions of the state in this case—from the police officers’ decision to pursue defendant in a low-speed chase for the $25 specific-fine traffic violation of not wearing a helmet, to the prosecutor’s decision to pursue a felony charge under those circumstances, to the attorney general’s office’s decision to defend those decisions on appeal—should not be ignored.”
Posted inDisabilities, Law|Comments Off on Woman who led police on low-speed chase on her mobility scooter wins reversal of her conviction
By Timothy F. Geithner, Jacob J. Lew, Henry M. Paulson Jr., Robert E. Rubin and Lawrence H. Summers in the NYT
The authors are former U.S. Treasury secretaries. Mr. Geithner and Mr. Lew served under President Barack Obama, Mr. Paulson under President George W. Bush, and Mr. Rubin and Mr. Summers under President Bill Clinton.
Six hundred billion dollars per year, and growing: That is two-thirds of total nondefense discretionary spending by the federal government, about what is spent on defense operations, military personnel and procurement, and more than mandatory federal expenditures on Medicaid. It’s also approximately how much unpaid taxes cost the U.S. government. This must change, and it can.
The five of us served as Treasury secretary under three presidents, both Republican and Democrat, representing 17 years of experience at the helm of the department. While we are not in agreement on many areas of tax policy, we believe in the importance of strengthening the tax system to do more to collect legally owed but uncollected taxes — which, left unaddressed, could total $7 trillion over the next decade. We are convinced by the strength of our experiences that more can be done to pursue evasion in the ways outlined by President Biden’s recent proposal to increase the resources and information available to the I.R.S.
Over the past 25 years, I.R.S. resources have been steadily cut, with the ratio of enforcement funding to returns filed falling by around 50 percent. Today, the I.R.S. has fewer auditors than at any time since World War II. Faced with resource constraints, it is no surprise that the agency is not able to appropriately focus scrutiny on complex returns, where noncompliance is greatest. Of about four million partnership returns filed in 2018, the I.R.S. audited only 140 of them. It did not pursue 300 high-income taxpayers who together cost the agency $10 billion in unpaid taxes over a three-year period when they failed to even file returns. And audit rates of those in the top 1 percent have fallen most staggeringly over the course of the past decade, such that rural counties in the Deep South have some of the highest rates of examination in the country.
By STANLEY A. TERMAN, KARL E. STEINBERG in the San Diego Tribune
Terman, Ph.D., M.D., is a psychiatrist and bioethicist. He lives in Sausalito. Steinberg, M.D., is a hospice and palliative medicine specialist, bioethicist and nursing home and hospice medical director in Oceanside. The opinions expressed are those of the authors, not the organizations with which they are associated.
No one doubts the importance of completing living wills — especially for advanced dementia — a cruel disease that most people dread since it can cause prolonged dying with severe, irreversible suffering as it imposes huge burdens on loved ones. But by themselves, living wills will not be adequate if your future physician refuses to honor its requests. A recommended request is: “Cease putting food and fluid into my mouth if I reach a specific condition.” Honoring this request can prevent being forced to endure years of suffering since you will not need to wait to die from a heart attack, or untreated infection such as pneumonia. After you no longer can feed yourself, the only legal, peaceful and effective intervention may be to cease assisted feeding and hydrating by another’s hand. This challenging and controversial intervention raises questions for your physician, and for you.
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Is your physician’s refusal to honor your wishes good or bad? “Good” means in your “best interest” such as preventing premature dying. “Bad” means forcing you to endure prolonged, and likely increased, suffering with little or no benefit.
Are physicians’ actions well-meaning or selfish? “Selfish” means refusal benefits your physician as it harms you. Physicians’ hubris leads to their desiring that their actions are viewed favorably — while you suffer longer, and more. Many physicians want to view themselves as heroes who sustained your life. But the ethical position of the American Medical Association is clear: “The social commitment of the physician is to sustain life and relieve suffering. Where the performance of one duty conflicts with the other, the preferences of the patient should prevail.”
A comprehensive question for physicians to ask: Are their actions legal, ethical and respectful? You have a claim right to self-determination (what happens to your body) and to avoid suffering. Claim rights impose a duty on others to act by honoring your rights, so … physicians should attempt to reduce your suffering and physicians should not violate your bodily integrity. This includes assisted oral feeding and hydrating — if you previously refused it. In addition to being unethical, force feeding may be illegal since battery is a crime. Yet some physicians argue they must consider all available information, strive to do no harm and maximize what they feel is your benefit. Hence, your living will’s future success depends on your resolving common conflicts during advance care planning.
Some questions for you: Do you prefer fast and easy living wills that ask you only to check a few boxes before signing? Do you consider your task complete once you clearly expressed your wishes? Is your living will specific enough to avoid conflict? Is it comprehensive so you don’t suffer from omitted conditions? Does it strive to be “clear and convincing” — the highest evidence standard in civil law? Will you record a persuasive video on which you state what you want, and explain why?
Even the above amount of effort may not be successful. A large, influential physician organization, The Society for Post-Acute and Long-Term Care Medicine, recommends not honoring requests to stop assisted feeding until you manifest behavior it interprets as either refusal or distress. Also, physicians and others can allege you changed your mind based on observing you open your mouth and swallow what others put in. But your apparently cooperative behavior may result from reflex or habit, after dementia has caused you to forget your critically important life values — to avoid suffering and imposing burdens on others.
Advance care planning must lay the groundwork to persuade future physicians to honor your end-of-life wishes. Living wills can include cogent arguments that cite clinical literature and case law to compel your physician to respond — especially if conflicts escalate to court. Among several recommended strategies, here are two.
Insist no one can claim you changed your mind to want spoon feeding — unless two experts qualified in the fields of dementia, capacity and assisted feeding so testify within a reasonable degree of medical certainty.
Store your printed forms and videos in an electronic registry so physicians and EMTs can expeditiously retrieve the current versions.
Admittedly, there is no proof (yet) that adding recommended strategies will increase your chance of success. (The reason: it will take years to gather enough data for those who completed advance care planning to eventually encounter conflicts.)
So can you trust doctors to honor your end-of-life wishes? Are you kidding? Current experience leads to this recommendation: Do not kid around. Put in the required time and effort to give yourself the best chance of experiencing a peaceful and timely dying.
Posted inDementia, end of life, Food|Comments Off on Opinion: Can you trust doctors to honor your end-of-life wishes? Here’s what to consider.
Ed note: There’s long been a movement in geriatrics to use “slow medicine”–meaning just that! Don’t over test and over treat. Use lower doses of medications and avoid those with notorious side effects. Look at the big picture and the patient’s goals of treatment. This article highlights the movement.
The last straw, for Leslie Hawkins, was her mother’s 93rd-birthday gathering in 2018.
Her mother, Mary E. Harrison, had long contended with multiple health problems, including diabetes and the nerve pain it can cause; hypertension; anxiety; and some cognitive decline. She was prone to falling.
Still, she had been a sociable, churchgoing nonagenarian until Ms. Hawkins, who cared for her in their shared home in Takoma Park, Md., began seeing disturbing changes.
“She was out of it,” recalled Ms. Hawkins, 57. “She couldn’t hold a conversation or even finish a sentence.” On her mother’s birthday, she said, “A bunch of us went to Olive Garden, and Mommy sat there asleep, slumped over in her wheelchair. I decided, nope.”
Ms. Hawkins and one of her brothers took their mother to see a geriatrician at Johns Hopkins Hospital, where she could supply only three correct answers on the 30-question test commonly used to assess dementia. “She didn’t really participate,” said the geriatrician, Dr. Stephanie Nothelle.
Fortunately, Ms. Hawkins had brought a list of the 14 medications Ms. Harrison was taking, several of which alarmed her new doctor. “I started chipping away at them,” Dr. Nothelle said.
She recommended stopping oxybutynin, prescribed to treat an overactive bladder, because “it’s notorious for precipitating delirium and causing confusion in older adults,” she said. She also suggested eliminating the pain medication Tramadol, which has similar effects and contributes to unsteadiness and falls.
At their next visit in three months, Dr. Nothelle told the family, they would discuss stopping several more drugs, including gabapentin for neuropathy; a diabetes medication that lowered Ms. Harrison’s blood sugar to unnecessary levels; and a reflux drug that nobody could remember her needing.
The follow-up visit did not happen as scheduled. Ms. Harrison fell and broke her hip, requiring surgery and six weeks in rehab.
Still, her daughter had gotten the message: Her mother’s many drugs might be harming her. “I went online and looked everything up and I started questioning her doctors,” Ms. Hawkins said.
Fourteen prescriptions? “Unfortunately, that’s pretty common” for older patients, Dr. Nothelle said. The phenomenon is called polypharmacy, sometimes defined as taking five or more medications, as two-thirds of older people do.
Don’t be worried about your smartphone or TV spying on you. Your vacuum cleaner has been collecting dirt on you for years.
If you can’t think of a word, say “*I forgot the English word for it. That way people will think you’re bilingual instead of an idiot.
I’m at a place in my life where errands are starting to count as going out.
I’m getting tired of being part of a major historical event.
I don’t always go the extra mile, but when I do it’s because I missed my exit.
My goal for 2020 was to lose 10 pounds. Only have 16 to go.
Ate salad for dinner. Mostly croutons and tomatoes. Really just one big round crouton covered with tomato sauce, and cheese. FINE, it was a pizza…. OK, I ate a pizza! Are you happy now?
I just did a week’s worth of cardio after walking into a spider web.
I don’t mean to brag, but I finished my 14-day diet food supply in 3 hours and 20 minutes.
A recent study has found women who carry a little extra weight live longer than men who mention it.
Senility has been a smooth transition for me.
I may not be that funny or athletic or good looking or smart or talented … I forgot where I was going with this.
A thief broke into my house last night. He started searching for money, so I got up and searched with him.
I think I’ll just put an “Out of Order” sticker on my forehead and call it a day.
Just remember; once you’re over the hill you begin to pick up speed.
Having plans sounds like a good idea until you have to put on clothes and leave the house.
It’s weird being the same age as old people.
When I was a kid, I wanted to be older…this is *not* what I expected.
Life is like a helicopter. I don’t know how to operate a helicopter.
It’s probably my age that tricks people into thinking I’m an adult.
Marriage Counselor: Your wife says you never buy her flowers. Is that true? Me: To be honest, I never knew she sold flowers.
If 2020 was a math word-problem: If you’re going down a river at 2 MPH and your canoe loses a wheel, how much pancake mix would you need to re-shingle your roof?
I see people about my age mountain climbing; I feel good just getting my . leg through my underwear without losing my balance.
So, if a cow doesn’t produce milk, is it a milk dud or an udder failure?
*Coronacoaster:* noun; the ups and downs of a pandemic. One day you’re loving your bubble, doing work outs, baking banana bread, and going for long walks; the next day you’re crying, drinking gin for breakfast and . missing people you don’t even like.
I’m at that age where my mind still thinks I’m 29, my humor suggests I’m 12, while my body mostly keeps asking if I’m sure I’m not dead yet.
You don’t realize how old you are until you sit on the floor and then try to get back up.
AARP launches fraud and scam support group for victims and family members
The AARP Fraud Watch Network and Volunteers of America (VOA) created a new, free program to help you. It’s VOA | ReST, which stands for resilience, strength and time. The program is designed to address the emotional impact of your experience. They offer free facilitated peer-discussion groups that seek to provide emotional support for you and others in similar situations. Family members are invited to participate at your discretion or take part in separate sessions for family members only.
The AARP Fraud Watch Network VOA | ReST program features small groups whose members are led in discussion by one or more trained peer facilitators. The aim is to help you re-establish trust, integrate your experience and build back your resilience despite a difficult and painful occurrence.
Online, hour-long sessions are scheduled nearly every day. You can join by a computer, tablet or smartphone. Discussions are confidential. You’re welcome to attend one session or several – it’s your choice.
Experiencing a scam can be devastating, but it doesn’t have to define you. Sign up for a session and take an important step toward emotional recovery. Visit www.aarp.org/fraudsupport to learn more about the free program and register today. Remember, you are not alone.
Posted inScams|Comments Off on Have you been a victim of fraud or a scam?
For all of us who feel only the deepest love and affection for the way computers have enhanced our lives, read on. At a recent computer expo (COMDEX) : Bill Gates reportedly compared the computer industry with the auto industry and stated,
“If Ford had kept up with technology like the computer industry has, we would all be driving $25 cars that got 1,000 miles to the gallon.”
In response to Bill’s comments,Ford issued a press release stating:
If Ford had developed technology like Microsoft, we would all be driving cars with the following characteristics (and I just love this part):
1. For no reason whatsoever, your car would crash………twice a day.
2.. Every time they repainted the lines in the road, you would have to buy a new car.
3.. Occasionally your car would die on the freeway for no reason. You would have to pull to the side of the road, close all of the windows, shut off the car, restart it, and reopen the windows before you could continue. For some reason you would simply accept this.
4…. Occasionally, executing a maneuver such as a left turn would cause your car to shut down and refuse to restart, in which case you would have to reinstall the engine.
5… Macintosh would make a car that was powered by the sun, was reliable, five times as fast and twice as easy to drive – but would run on only five percent of the roads.
6…… The oil, water temperature, and alternator warning lights would all be replaced by a single “This Car Has Performed An Illegal Operation” warning light.
7…… The airbag system would ask, “Are you sure?”before deploying.
8……. Occasionally, for no reason whatsoever, your car would lock you out and refuse to let you in until you simultaneously lifted the door handle, turned the key and grabbed hold of the radio antenna.
9…….. Every time a new car was introduced car buyers would have to learn how to drive all over again because none of the controls would operate in the same manner as the old car.
10……… You’d have to press the “Start” button to turn the engine off.
PS – I’d like to add that when all else fails, you could call “customer service” in some foreign country and be instructed in some foreign language how to fix your car yourself!
Seattle’s Earthquake Response: Wednesday, June 16, 2021, 6 – 7:30pm Staff from the Seattle Fire Department will provide an overview of how the City directs life safety response operations after a major earthquake This will include information on how they prioritize their response efforts with limited resources, how they begin requesting outside assistance, and what the public can do to prepare. Future webinars in this series will provide more detail on specific areas of response, including utility restoration, transportation restoration, and emergency shelter and feeding. The first webinar in this series, Overview of Response Priorities and Coordination, is available to 
