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One reason for concern is that more Americans than ever
before are on high-deductible health plans. This fact means even
seemingly simple medical decisions could result in substantial
out-of-pocket costs for patients. Although no one knows exactly
what the current administration will do to change health care
coverage, it is likely the number of high-deductible plans and
also "consumer-driven health plans," such as health savings
accounts, will continue to grow. More than 25% of Americans
now say that someone in their household is struggling to pay
medical bills. This situation can lead to indebted Americans
putting oﬀ needed health care.
COSTS OF PETS
The AARP Bulletin recently had a piece entitled "How
Much Would You Spend to Keep Your Pet Healthy?" by Renee
Bacher (23). The big part of expenses for a dog or cat is routine
veterinary care. On average, the cost is $235 per year for a
dog and $160 for a cat. If a pet becomes ill or has an accident,
those expenses can skyrocket. Advances in veterinary medicine
mean there are options for a pet well beyond euthanasia. These
options produce both ethical and ﬁnancial dilemmas. Diagnostic procedures alone can cost between $1000 and $2000.
With a dog's lifespan averaging 11 years, expenses per year
include medical, $235; health insurance, $225; food, $319;
toys/treats, $55; and license, $15. Initial cost for neutering,
leash, etc. averages $565. For a cat, medical expenses average
$160; health insurance, $175; food, $224; toys/treats, $25;
and litter, $165. The lifetime expenses of a dog average nearly
$11,000 and for a cat, because they live on average 4 years
longer than a dog, just over $12,000.
HELPING PATIENTS MAKE INFORMED DECISIONS
Shared decision-making allows patients to engage in a
deliberative and communicative process with their clinicians
and be active participants in their care (24). Although data
are limited on how shared decision-making aﬀects long-term
health, studies show that it leads to more satisfying outcomes,
fewer invasive procedures, and lower costs. Additionally, those
who participate in health care decisions are less likely to regret
the choices they make and more likely to stick to the treatment regimens they select. Physicians now have new ﬁnancial
incentives to engage patients in decision-making. In 2015,
Medicare approved reimbursement for lung cancer screening
and low-dose computed tomographic scanning for certain atrisk patients-as long as they participate in a shared-decision
counseling session ﬁrst. A 2014 review in Cochrane Reviews
found that decision aids improve patients' knowledge of their
options, make them feel more informed and clear about what
matters most to them, and lead them to participate more in
decision-making. From 2005 to 2015, Massachusetts General
Hospital in Boston trained >900 clinicians and other staﬀers
to use shared-decision making with patients. A 2016 study
of the program in Health Aﬀairs found that training sessions
more than doubled the use of decision aids, and physicians
reported that the aids improved the quality of their patient
care and changed their discussions with patients. Decision
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aids ensure that patients have all the information they need to
make decisions, such as whether to have a particular operation
or not.
COCA CROP BOOM
After years of falling output, the size of Columbia's illegal
coca crop has exploded since 2013, and its results are starting to
appear on US streets (25). The surge in consumption in the US
can be traced to Columbia's bumper harvest. The country's illegal coca crop doubled between 2013 and 2015, reaching nearly
400,000 acres. That's almost twice as much as the combined
output of Peru and Bolivia, the world's second and third largest producers. Cocaine traﬃcking from Columbia is at record
levels according to our State Department. Since 2000, the US
has sent Bogotá more than $10 billion for counter-narcotic
security and assistance. That congressional funding is widely
credited with helping tip Columbia's 52-year civil conﬂict
in the government's favor and forcing Revolutionary Armed
Forces of Columbia (FARC) to the bargaining table. A peace
with Columbia's government was signed in November 2016.
Columbia's government is a determined partner in the drug war.
Narcotic seizures in the country are also at record highs. Most of
the Columbian cocaine reaching the USA is smuggled through
Mexico by the country's powerful drug cartels.
OPIOID ADDICTION
The opioid crisis in the USA keeps getting worse (26).
More than 33,000 Americans died from opioid overdose in
2015, the highest tally on record, and millions still abuse the
drug. Opioids are extraordinarily addicting. The pattern of
abuse is shifting: many people who become hooked on prescription opioids go on to use heroin, or worse, illicit fentanyl,
which is many times more potent. Fentanyl overdose, which
can occur almost instantly when the drug is taken, is the main
reason for the rising death rates. Federal and state oﬃcials are
trying several increasingly tough approaches. Nevertheless,
the crisis keeps expanding. Drug courts are putting addicts
who have been arrested for nonviolent crimes into treatment
programs that use methadone and buprenorphine for therapy.
These measures have doubled success rates. Many states are
making the antidote to fentanyl, naloxone, available over the
counter and putting it in the hands of the police and others
for quick use. A Senate bill would outﬁt the border police with
chemical screening devices to detect smuggled fentanyl. Maybe
the national guidelines for prescribing opioids by physicians
will help a bit.
BRAIN INJURIES FROM FALLS
The Centers for Disease Control and Prevention (CDC)
reported in March 2017 that brain injuries from falls resulting
in emergency room visits, hospitalizations, or death increased by
33% in people ≥75 years of age from 2011 to 2013, whereas for
those younger the increase was only 12% (27). Older people, of
course, are more likely to have impaired vision, dizziness, and
other destabilizing health problems, and they are less likely than
younger people to have the strength and agility to ﬁnd their feet

Baylor University Medical Center Proceedings

Volume 30, Number 3

Table of Contents for the Digital Edition of Baylor University Medical Center Proceedings July 2017