Antibiotics may be overused in patients suffering from dementia in its final stages

A woman dying of Alzheimer's has a fever. Should she be given antibiotics?

Many people would say yes. But a new study suggests that antibiotics are overused in people dying of dementia diseases and should be considered more carefully because of the growing problem of drug-resistant superbugs. The study raises ethical questions about when it's acceptable to withhold treatment, and whether public health issues should ever be considered.

"Advanced dementia is a terminal illness," said study co-author Dr. Susan Mitchell, a senior scientist with the Harvard-affiliated Hebrew Senior Life Institute for Aging Research in Boston. "If we substituted 'end-stage cancer' for 'advanced dementia,' I don't think people would have any problem understanding this."

In the study, in Monday's Archives of Internal Medicine, more than 200 people with advanced dementia were followed for 18 months or until their deaths. Researchers reviewed medical records to see what kind of care they were given and found that 42 percent received antibiotics within two weeks of their deaths. The closer they were to death, the more likely they were to receive antibiotics.

Doctors should discuss antibiotics with family, just as they would discuss placing a feeding tube, Mitchell said. She said giving antibiotics is sometimes appropriate, but if the family's goal is to keep a loved one comfortable, rather than to prolong life, alternatives such as oxygen and Tylenol can help.

PFIZER TO CANCEL AD WITH JARVIK

Under criticism that its ads are misleading, Pfizer said Monday it would cancel an advertising campaign using the artificial heart pioneer Dr. Robert Jarvik as a spokesman for its cholesterol drug Lipitor.

Pfizer has spent more than $258 million advertising Lipitor since January 2006, most of it on the Jarvik campaign, as the company sought to protect Lipitor, the world's best-selling drug, from competition by cheaper generics. Lipitor, with sales of $12.7 billion last year, is protected by patent until 2010.

The ad campaign had come under scrutiny from a congressional committee that is examining consumer drug advertising and has asked whether the ads misrepresented Jarvik and his credentials. Although he has a medical degree, Jarvik is not a cardiologist and is not licensed to practice medicine.

HEALTH SPENDING: $4 TRILLION IN 2017?

By 2017, consumers and taxpayers will spend $4.3 trillion on health care, accounting for one of every $5 spent, the federal government projects.

The 6.7 percent annual increase in spending -- nearly three times the rate of inflation-- will be largely driven by higher prices and an increased demand for care, the Centers for Medicare and Medicaid Services said. But other factors include a growing and aging population. The first wave of baby boomers become eligible for Medicare beginning in 2011.

With the aging population, the federal government will be picking up the tab for a growing share of medical expenses. Overall, federal and state governments accounted for about 46 percent of health expenditures in 2006.

In 2006, people and the government spent $2.1 trillion on health care, an average of $7,026 a person. In 2017, health spending will cost an estimated $13,101 a person.

MEN ARE URGED TO GET BONE-DENSITY TEST

New guidelines by the National Osteoporosis Foundation are calling for all men older than 70 to get a routine check for bone-thinning osteoporosis.

Postmenopausal women are still at greatest risk of osteoporosis -- women 65 and older have long been urged to get the bone-density test -- but a quarter of hip fractures occur in men.

There's news for women, too: A new computerized tool uses more than bone-density tests to predict who is at highest risk of breaking a bone in coming years -- by adding in such important risk factors as whether a parent ever broke a hip. It's an effort to better target who really needs treatment and who can safely skip it, even before someone's bones become thin enough to be officially labeled an osteoporosis patient.

For adults older than 50, the guidelines also recommend 1,200 milligrams a day of calcium and 800 to 1,000 international units a day of vitamin D.

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