Clifford – Christmas was a beautiful day although cloudy and Clifford people enjoyed it to the utmost. Everybody went visiting or received visitors, and on Christmas Eve the churches celebrated with excellent exercises by the children and abundantly laden Christmas trees. Christmas evening brought a heavy rain storm, which turned to snow during the night and Sunday morning gave us a typical December snow. It moderated, however, about eleven o’clock and gave us the welcome sunshine.

Dimock – Work has again commenced in the large Winans’ Stone Quarry after a short lay off, owing to the extreme cold weather. Also L. F. Thornton is buying all kinds of good furs at his house near W. J. Cronk’s store.

Springville – We are fortunate to have a good doctor in time of need, as our life-long physician is getting along in years, which makes it easy for both, who have a large practice.

South Montrose – Everyone acquainted with Percy Ballantine knows that he never does things by halves, and when it was announced that he and Mrs. Ballantine would give a Christmas’ party for the large number employed at Louden Hill Farm, their splendid country home, everyone knew that the affair would be “done up brown.” Roast turkey, roast duck, roast pig, baked salmon, grapes, oranges, radishes, in fact everything in the line of fruits and vegetables available at this time of the season was provided. “Santa Claus” distributed suitable gifts and a stringed orchestra engaged for the party, played for a dance. Some of the nationalities represented by their employees are: American, English, Irish, Scotch, Japanese, Hungarian, Italian, German, Welsh and Dutch. Also Mrs. Stella Crisman won fifth prize in the kerosene contest conducted by the Atlantic Refining Co., for best “100 ways to use kerosene.” The prize was an oil heater.

Susquehanna – Electricity has been installed in the Erie shops for running four high power motors which run a large part of the machines. The steam boilers formerly used will be used for heating and operating the new compressor.

New Milford – Prof. and Ms. Claude Hardy, of Wilbraham, Mass., are spending their holiday vacation with relatives—Mrs. Hardy’s parents, Mr. and Ms. J. Green and with Mr. Hardy’s relatives of this place. Mr. Hardy is professor of languages in Wilbraham Academy, one of the oldest and most popular educations institutions in the United States. ALSO Ben C. Norris, proprietor of the Keystone Poultry farm, at this place, is getting over 200 eggs a day from his pullets. With eggs at forty-two cents per dozen, that is doing well.

Herrick Center – People here have finished two weeks of volunteer good road building and as a result the main street has been paved at a cost of only $25. The entire length of the street was filled with crushed stone then rolled and finally covered with a dressing of boiler cinders. The stone crusher used in the work cost the town $2.00 a day for nine days. The traction engine and the teams and labor were furnished gratis, while the Erie company furnished the cinders. Also Sheriff Reynolds was officially engaged in this place yesterday, making the trip with a horse and sleigh, He said the day was exceedingly bleak and dreary out on the hill tops, but found the sleighing fairly good, with few bad drifts to encounter.

Harford – The Christmas exercises of the congregational Sunday school, which was held last Friday evening, proved a success. A large attendance and the programs surely showed the Christmas spirit. Santa Claus was especially “cute” and pleased the children. Also Hon. Charles Hebu Dickerman, one of Columbia county’s most prominent residents, well-known in financial, business circles throughout the state, died at his home in Milton, on Friday evening, Dec. 17. He was the son of Dr. Clark Dickerman and Sarah Adelia Chandler. He was born in Harford and there received his early education and graduated from Franklin Academy. He then engaged in teaching in Susquehanna and Luzerne counties. In later years he was associated with others in the manufacture of freight cars at Milton and interested in numerous financial institutions in that part of the state.

East Kingsley – A venturesome crowd of young people from this place started for a sleigh ride on Sunday but owing to the snowdrifts they countered, they were obliged to return home and wait for more favorable weather.

North Bridgewater – Game Worden, Warren F. Simrell, after a couple of weeks investigation of the wounding of a doe in this place—the animal being so badly wounded that it was later killed—issued warrants for the arrest of Wm. Dennison and his father-in-law, Melvin Chapman, living in that vicinity. He succeeded in serving the warrant on Dennison, who was given a hearing before Justice F. A. Davies on Wednesday. Chapman had disappeared and could not be found. Dennison claimed no complicity in the affair. He was admitted to bail, a second hearing to take place next Wednesday.

Forest Lake – Charles R. Potts, of Haywarden, Saskatchewan, Canada, surprised his relatives at this place by coming to visit them on Dec. 22nd. Mr. Potts, since his absence from the county, spent twenty-three years in Iowa, going to Canada nearly four years ago, where he took up a half section of land. His efforts this year have been rewr4ded with 3,800 bushels of wheat and 1,800 bushels of oats. All the labor was performed by himself, until the time of harvesting.

Fair Hill, Forest Lake Twp. – The Ladies’ Aid society will meet for dinner, in the lecture hall, next Thursday, Jan. 6. The men will cut wood for the church.

South Gibson – Mrs. Sabra Carpenter celebrated her 96th birthday on the 23d at her home. A long life! In looking back she can recall many changes that have taken place.

Brackney – Frank Shea, of Flowery Valley, came to this place on Saturday evening. When he started to return he found that the snow drifts were many, and so was delayed until Monday morning, but from all appearances, we think he was busily engaged during his brief stay.

Alford – One of our lecturers in the High School course joined the ranks of the jokers when he told his Montrose audience that he had spent two days at Alford one afternoon waiting for a train. But Alford stays on the map just the same: it has now become a permanent and quite important railroad junction. This will assure the future of Alford, as a junction point, and will undoubtedly have a tendency to build a larger town there. It remains for the property owners there to wake up and take cognizance of the new situation and be first on the spot to take advantage of business developments.

News Brief: Congress has been asked to appropriate $7,500 to purchase the suit of clothes Abraham Lincoln wore the night of his assassination in Ford’s theater, in 1865. Representative Robert, of Massachusetts, has introduced a bill to acquire the relic, owned by a Washington Business man, for the Lincoln memorial. Also Col. John S. Mosby, of Washington, the famous Confederate raider, celebrated his 82nd birthday last week. The old warrior, still in the full vigor of health, received felicitations from many friends and letters from some of the prominent men on the Union side whom he had made prisoners during the Civil War. During recent years Col. Mosby has devoted himself to writing his reminiscences. He enlisted in the Confederate cavalry at an early age, and soon distinguished himself as a leader. His raid on McClellan’s rear guard on the Chickahominy river was perhaps his most notable exploit.

Thank you.  Those two simple words cannot begin to express my gratitude for the support that so many of you have given me throughout these past 12 years as your District Attorney.  It has been a privilege and honor to have served as the chief law enforcement officer of our beautiful county for three terms.  In many ways, it is hard to imagine that the years have slid by so quickly – but looking back across 6,000 or so criminal prosecutions, I realize that time does have a way of slipping away on us.

When I was an assistant district attorney from 1999 through 2003, I struck up a friendship with a local reporter and column writer named P.J. Amadio who wrote for the Susquehanna County Transcript.  P.J. had a weekly column that mostly focused upon the shortcomings of county government, which provided him with a wealth of writing material.  P.J. had an easy writing style – and people seemed to enjoy following his column even if they disagreed with him.

When I became District Attorney, I wanted to create something that provided people with information about the work we do here - and I approached P.J. to get his thoughts.  During our discussions, an idea evolved into something akin to P.J.’s weekly column which would appear in the Transcipt.  The Transcript’s editor, Chuck Ficcaro, agreed to run the column if I agreed to write it – and so “From the Desk of the D.A.” was born. 

After running for several weeks in the Transcript, the editor from the Susquehanna County Independent called me and wanted to know if the Independent could also run the column.  I called Chuck Ficcaro at the Transcript and he was gracious enough to agree to share the column so that it would appear in both county papers.

The column slowly evolved into more than simply a nuts and bolts legal blog – the topics ranged widely depending upon what came out when I sat down to type.  This column became something very personal – rightly or wrongly – and it often strayed far from the legal battlefield into political musing and personal reflections. 

But as I continued to write, I came to the conclusion that there was tremendous value to the reader in really knowing who I was and what I believed.  The column provided the springboard for so many good conversations – not only with those who agreed with me, but also with people who disagreed with me (some even with initial hostility).  I got to meet so many people who would come up to me to discuss a column or make a suggestion for an upcoming column.  I am very grateful to both the Transcript and the Independent for giving me the opportunity to connect with my constituents in such a wonderful way.

Based upon the archived date on the computer, the first column that appeared under “From the Desk of the D.A.” was saved on March 2, 2004.  Some simple arithmetic demonstrates that over 600 columns have appeared in print over that period of time.  Understandably, some columns were better than others and I candidly admit that some were not very good at all.  Some of the columns were fun to write, others were difficult, and there were some that were just personally painful.  As I have told many people, the column has become a part of me – my weekly routine involves sitting down to write something for you.

As I was getting ready to close this chapter of my life, my plan had been to stop writing the column.  A judicial position has significant restraints on conduct that is outside the scope of normal judicial duties.  The one question that I received most often over the past year has been whether the column would continue to appear in the paper.  It was a humbling experience – and I was encouraged by so many readers to keep writing.

The Code of Judicial Conduct (Rule 3.1) regulates extrajudicial activities and encourages judges to “engage in appropriate extrajudicial activities.”  The comment to the Rule provides further that judges are “uniquely qualified to engage in extrajudicial activities that concern the law, the legal system, and the administration of justice, such as by speaking, writing, teaching, or participating in scholarly research projects.”  The Rule makes clear that these activities are encouraged and permitted only so long as they do not interfere with regular judicial duties.

Perhaps, this column can serve the purposes envisioned by Rule 3.1 as it relates to writing and educating the public on the law.  Given the kind encouragement I have received from so many readers, my plan now is to continue the column in accordance with the permissible objective of promoting the law and educating the reader.  So, the column will be back next week – a friend has come up with a new title for it – and I look forward to the privilege of continuing this tradition so long as time constraints allow for it to be done.

Please submit any questions, concerns, or comments to Susquehanna County District Attorney’s Office, P.O. Box 218, Montrose, Pennsylvania 18801 or at our website www.SusquehannaCounty-DA.org.

It is likely that every reader has heard about the “Black Lives Matter” movement; it received lots of attention in 2015. What is less known is that a relatively unknown epidemic has occurred in the white population, especially a particular generational cohort within that demographic group. While America slept white non-Hispanic Americans aged 45-54 during the years 1998 and 2013 have experienced rising morbidity and mortality rates.

The report, available online, is authored by Anne Case and Angus Deaton, of the Woodrow Wilson School of Public Policy and International Affairs, Princeton, NJ, and is entitled, “Rising Morbidity and Mortality in Midlife among White Non-Hispanic Americans in the 21st Century.” Their research paper asserts that while “general deterioration in midlife morbidity among whites has received limited comment, . . . the increase in all-cause midlife morbidity we describe has not been previously noted.”

I’ll spare you the jargon. White Americans, men and women, born between 1945 and 1965 died at rates increasingly higher (about 1% per year) during the years 1998 through 2013. That was in sharp contrast to what happened during the years 1978 through 1997, when mortality rates fell by 2% per year on average. The authors note, “For those aged 45-54, if the white mortality rate had held at its 1998 value, 96,000 deaths would have been avoided from 1999 to 2013. . . If it had continued to fall at its previous (1979-1998) rate of decline, 488,500 deaths would have been avoided in the period.”

Taken to its logical conclusion, we are missing nearly a half-million mid-to-older white Americans who “should” be with us. What happened? My initial thought at this discovery was that there must be increasing rates of premature diabetes, stroke, heart attack, and cancer. That is not the answer. The truth is much more disturbing. “. . . the three causes of death that account for the mortality reversal among white non-Hispanics [are] suicide, drug and alcohol poisoning (accidental and intent undetermined), and chronic liver diseases and cirrhosis.”

For context, the study documents that the narrowing of mortality rates (in comparison to that of other racial groups) is largely driven by increased white mortality. In other words, mortality among blacks and Hispanics continued to fall during the 1998-2013 period by small to moderate percentages. For example, death from cirrhosis and chronic liver diseases fell for blacks and rose (very significantly) for whites. Remember, we are only talking about the 45-54 cohort.

In looking at the cohort’s mortality rate, comparisons were made across racial groups for three broad levels of education: those with a high school degree or less; those with some college, but no bachelor’s (BA) degree; and those with a BA or more. Here’s the comparison by educational level for mortality due to cirrhosis and liver disease. For white non-Hispanics with a BA or more, mortality rates actually fell slightly. For those with some college the mortality rate increased slightly. But for those with no college, there was a huge spike.

“Although all three educational groups saw increases in mortality from suicide and poisonings, and an overall increase in external cause mortality, increases were [again] largest for those with the least education.” Suicide and poisoning rates for the 45-54 year-old cohort (for 1998-2013) were also broken down for each of the four census regions of the United States. Death rates for both suicide and poisoning increased in all four, with the highest in the South, followed by the West, Midwest, and Northeast, respectively. This is a nationwide problem, but more serious in some regions.

The paper goes on to note that “increases in midlife mortality are paralleled by increases in self-reported morbidity.” To measure morbidity (incidence of ill-health in the population) cohort members were asked to make health status self-assessments based on these factors: pain, psychological distress, difficulties with activities of daily living (ADLs), and alcohol use. The completed study, with a 95% CI (Confidence Interval) revealed deterioration in self-assessed health observed in each U.S. state analyzed separately. Health indicators recorded included the level of neck pain, facial pain, chronic joint pain, and sciatica. Difficulties with ADLs were recorded by documentation of significant midlife deterioration in walking a quarter mile, climbing 10 steps, standing or sitting for two hours, shopping, and socializing. (Those with difficulty socializing possess an increased risk factor for suicide.)

The percentage of white non-Hispanics reporting being unable to work doubled in the 1998-2013 period. And “as was true in comparisons of mortality rate changes, where midlife groups fared worse than the elderly, most of these morbidity indicators either held constant or improved among older populations over this period.”

The report notes that the increase in midlife morbidity and mortality for whites is not well understood. It notes the link to “an epidemic of pain,” as well as the opioid prescriptions and heroin being used to relieve pain. Pain prevalence, it notes, is often linked with alcohol abuse, drug overdose, and suicide.

These findings are helpful in understanding the observed increase in social security disability beneficiaries. Increases in musculoskeletal and mental health disabilities are certainly among the driving factors in the rapidly increasing level of claims. The increased morbidity levels also partly explain the decreasing labor force participation rate, particularly among women.

But having studied this report, I still have to ask myself why premature death and ill-health are so prevalent in midlife among whites. The white population in Susquehanna County is overwhelmingly white so it is particularly relevant to local residents. The 45-54 cohort, along with those within five years on either side of this age group, constitute a significant risk group, especially considering that the largest portion of this group have only a high school degree or less in our county. Real median household wages (adjusted for inflation) have been essentially stagnant since 1985. As a side-note, economist Harry Dent has statistically documented that 46 is the age at which Americans spend the most money; income may rise in later years, but Americans don’t spend the increase--they save or invest it.

So here we are, left with pain--physical and mental--and attempts to ameliorate it. Added to that is gnawing economic insecurity and inequality, both of which are often relational to one’s level of education. But those factors are certainly in evidence among the Hispanic, black, and Asian American populations; so why, we may ask, are morbidity and mortality rates falling for them, while rising for the white non-Hispanic 45-54 cohort? Could we be reaching a tipping point where the most successful segment of society is having opportunities for advancement closed off to them? Could it be that this is the first cohort to recognize, in such large numbers, that their lives will not reach the potential they envisioned, and likely their children’s lives will be even worse? I leave that for Gentle Readers to ponder, but I think we have a tremendous problem growing.

We agree that black lives matter. America would do well to remember that all lives matter. What can you do? If you have a middle-aged friend or relative who is (a) experiencing chronic pain, (b) doesn’t socialize well, (c) imbibes two or more drinks on a daily basis, (d) is prescribed opioid medication or uses heroin, or (e) all of the above, don’t hesitate to reach out to that person at this time of year--or any time of the year. Your touch might make a world of difference in another’s life. Long term, societal changes will have to be undertaken to turn this epidemic around. The referenced report doesn’t address what those changes are, but I think many have insights into what changes need to happen.

P.S. Online readers may access the report referenced in this story at www.pnas.org/cgi/doi/10.1073/pnas.1518393112

Why Are There No Generic Insulins?

Mrs. Brown was very agitated. She has no health insurance, even though the Affordable Care Act would have made it easier to purchase her medications. She takes several generic medications for her heart and diabetes. But she is still paying hundreds of dollars for her insulin each month. “Why are there no generic insulins?” she asked the pharmacist.

The pharmacist told her she was right. Generic drugs account for more than 80% of prescriptions filled today, saving the healthcare system billions of dollars a year. In contrast to about a $4 per month out-of-pocket cost for some generic drugs, monthly costs for brand-name insulins range from $120 to $400.

Six million Americans with diabetes take insulin, which was discovered in 1921 and first marketed in 1923 — almost 100 years ago – and still no generic. Other countries are lucky in that regard – countries in Europe, South America as well as India and Australia.

Diabetes is a life-threatening disease in which the body fails to properly use sugar from food due to insufficient insulin, a hormone produced in the pancreas. Diabetes can often be managed without drugs or with oral medications, but some patients need daily insulin injections. Insulin is a naturally occurring hormone that is necessary for the body to use the sugars found in foods as fuel for the cells in the body and brain. In people with type 1 diabetes, the body's immune system erroneously attacks the insulin-producing cells (called beta cells) in the pancreas. This destroys their ability to make enough insulin to survive. People with type 1 diabetes must inject insulin to stay alive. In type 2 diabetes, the body's cells become increasingly resistant to insulin, which causes the pancreas to make more and more insulin. Eventually, the pancreas can't keep up with the increasing demand. This is generally when people with type 2 diabetes need to take insulin injections.

Not having generic insulins on the market is a corporate conspiracy, say government-funded academics. Insulin is constantly being improved because so many people rely on it, which leads to a new patent. Insulin pens are very expensive and yet they are an improvement over the glass vials and syringes because many diabetics have eye problems and this can lead to under- or overdosing. Researchers in a 2015 article say people who need insulin cannot afford it, though it is hard to believe that is still possible in the age of the Affordable Care Act (Obamacare) and the Medicare that existed even before that. 

In their New England Journal of Medicine editorial, authors Jeremy Greene, MD, PhD, and Kevin Riggs, MD, MPH, describe the history of insulin as an example of "evergreening," in which pharmaceutical companies make a series of improvements to important medications that extend their patents for many decades. It keeps it off the generic market, the authors say, because generic manufacturers have less incentive to make a version of insulin that doctors perceived as obsolete. 

"Insulin is an inconvenient medicine even for people who can afford it," says Riggs, a research fellow in general internal medicine and the Berman Institute of Bioethics at Johns Hopkins University. "When people can't afford it, they often stop taking it altogether." Patients with diabetes who are not taking their prescribed insulin come to Riggs' and Greene's Baltimore-area clinics complaining of blurred vision, weight loss and intolerable thirst -- symptoms of uncontrolled diabetes, which can lead to blindness, kidney failure, gangrene and loss of limbs.

"This is a big issue. Some patients simply cannot afford to pay for the insulin that keeps their blood sugar down, even people who have health insurance," explained Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City. He added that if insulin prices remain out of reach for some, the health care system will end up paying more in hospitalizations and treatments for complications related to undertreated or untreated diabetes.

Consumers in Europe, Australia, India, and some South American countries are currently benefiting from access to biogenerics, such as generic insulin. Access to generic insulins in the United States could save consumers a lot of money.

What to do until America finally manufactures generic insulin? Go to the websites of the companies who make your insulin. Many of them have Patient Assistant Programs.  Another option is to use name-brand insulins at fraction of the cost. In addition to its line of generic drugs for $4, Wal-Mart also carries the ReliOn/Novolin line of insulins. ReliOn/Novolin® is manufactured for Wal-Mart by Novo Nordisk, and is available in 3 formulations: R (Regular), N (NPH), and 70/30 (70% NPH, 30% Regular). All 3 of these formulations are sold for around $50 for a three-month supply.

Ron Gasbarro, PharmD is a registered pharmacist, medical writer, and principal at Rx-Press.com. Write him with any ideas or comments at ron@rx-press.com.