Thats right. Whether you like it or not, a vital part of who you are may now belong to someone else. Let me just examine him. People are worried more than ever about how the chemicals were exposed to are affecting our health. Among them, a family of chemicals used in everyday plastics known as phthalates, which congress banned in toys after a study by dr. Shanna swan. Welcome to 60 minutes on cnbc. Im lesley stahl. Well be exploring the world of science in this episode. Later well bring you Morley Safers story about the human genome patents being awarded to Biotech Companies and the proprietary control they now have over part of who you are. And then my report on a ubiquitous chemical called phthalates, which is in everything from perfume to childrens toys, but which may also be causing birth defects. But first, steve krofts story on the enormous amount of money being spent to treat people as they approach the end of their lives. How much money . Well, in 2009, medicare paid 55 billion for doctor and hospital bills for patients as they approached the last two months of life. To give you some perspective, thats more than the budget for the department of Homeland Security or the department of education. And as we reported in 2009, most of those bills were paid for by the government with few or no questions asked and with an estimated 30 of the treatments having no meaningful impact. Ms. Klish, its dr. Byock. Marcia klish is either being saved by medical technology or being prevented from dying a natural death. Were just here checking on you. Shes been unconscious in the intensive care unit at Dartmouth Hitchcock Medical Center in lebanon, new hampshire, for the better part of a week. One of her doctors, ira byock, told us it costs up to 10,000 a day to maintain someone in the icu. This is the way so Many Americans die. Something like 18 to 20 of americans spend their last days in an icu. And, you know, its extremely expensive. Its uncomfortable. Many times they have to be sedated so that they dont reflexively pull out a tube, or sometimes their hands are restrained. This is not the way most people would want to spend their last days of life. And yet this has become almost the medical last rites for, you know, people as they die. Okay, lets go see her. Dr. Byock leads a team that treats and counsels patients with advanced illnesses. Hello, there. He says modern medicine has become so good at keeping the terminally ill alive by treating complications of underlying disease that the inevitable process of dying has become much harder and is often prolonged unnecessarily. Families cannot imagine there could be anything worse than their loved one dying. But in fact, there are things worse. Most generally, its having someone you love die badly. And what do you mean by dying badly . Dying suffering. Dying connected to machines. I mean, denial of death at some point becomes a delusion, and we start acting in ways that make no sense whatsoever, and i think thats collectively what were doing. A vast majority of americans say they want to die at home, but 75 die in a hospital or a nursing home. How do so many people end up in the hospital . Its the path of least resistance. Dr. Elliott fisher is a researcher at the Dartmouth Institute for health policy, which did a Detailed Analysis of medicare records for patients in the last two years of their lives. He says it is more efficient for doctors to manage patients who are seriously ill in a hospital situation and that there are other incentives that affect the cost and the care that patients receive, among them, the fact that doctors get paid based on the number of patients that they see and that most hospitals get paid for the patients they admit. The way weve set up the system right now, primary care physicians dont have time to, you know, spend an hour with you, see how you respond, if they wanted to adjust your medications. The easiest thing for everybody up the stream is to admit you to the hospital. I think 30 of hospital stays in the United States are probably unnecessary given what our research looks like. Thats a staggering figure. Its a huge amount. And once someone is admitted to the hospital, fisher says theyre likely to be seen by a dozen or more specialists who will conduct all kinds of tests, whether theyre absolutely essential or not. They did xrays. They did blood workup. They did lung capacity tests. Meredith snedeckers 85yearold mother spent her last two months shuttling between a nursing home and a Community Hospital in new jersey, suffering from advanced heart and liver disease. Dorothy glass was a former nurse who had signed a living will expressing her wishes that no extraordinary measures be taken to keep her alive. But that didnt stop a legion of doctors from conducting batteries of tests. I cant tell you all the tests they took, but i do know that she saw over 13 specialists. What kind of specialists . Neurological. Gastroenterologists. She even saw a psychiatrist because they said she was depressed, and she told the psychiatrist, of course im depressed. Im dying. When we reviewed the medical records, we discovered that there werent 13 specialists who attended to her mother; there were 25, each of whom billed medicare separately. The hospital told us that all the tests were appropriate, and an independent physician who reviewed the case told us it was fairly typical. Among the tests conducted was a pap smear which is generally only recommended for much younger women, not an octogenarian who was already dying of liver and heart disease. In medicine, we have turned the laws of supply and demand upside down. What do you mean . Supply drives its own demand. If you are running a hospital, you have to keep that hospital full of paying patients in order to, you know, meet your payroll, in order to pay off your bonds. So the more mri machines you have, the more people are going to get mri tests. Absolutely. Well, there are people that would argue this is great medicine that tested for every conceivable possible malady you might have. The best care may well be staying home with the trial of a new medication rather than being admitted to a hospital where you can be exposed to a hospitalacquired infection. We have a system that rewards much, much more care. In almost every business, costconscious customers and consumers help keep prices down but not with health care. And thats because the customers and consumers who are receiving the care arent the ones paying the bill. The perverse incentives that exist in our system are magnified at end of life. David walker used to be the governments top accountant, the head of the Government Accountability office, the gao. He now heads the peter g. Peterson foundation, which is a strong advocate for reducing government debt. He says that 85 of the Health Care Bills are paid by the government or private insurers, not by patients themselves. In fact, most patients dont even look at the bills. Does that make any sense . Most things you buy, the customer has some impact. We have a system where everybody wants as much as they can get, and they dont understand the true cost of what theyre getting. The one thing that could bankrupt america is outofcontrol health care costs, and if we dont get them under control, thats where were headed. As well see when 60 minutes on cnbc returns, patients with their familys support often find it easier to hope for medical miracles than to discuss how they want to die. 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[ spanish ] what airline . [ passenger ] united. [ mandarin ] which airline . [ passenger ] united. [ arabic ] which airline . [ passenger ] united. [ italian ] where are we going . [ passenger ] united. [ male announcer ] more destinations than any other airline. [ thai ] which airline do you fly . [ passenger ] united. [ male announcer ] thats great, big world friendly. As steve kroft reported in november of 2009, endoflife Health Care May prolong life, but the cost of doing that may also bankrupt the country. With endoflife care, there are also delicate cultural and political considerations. Patients with their familys support want to cling to life, and it is often easier to hope for medical miracles than to discuss how they want to die. Hey, charlie, i want you to meet somebody. How you doing . When we met charlie haggard, he was 68 years old and suffering from liver and kidney failure. He wanted a double transplant which would cost about 450,000. But doctors told him he was currently too weak to be a candidate for the procedure. At a meeting with charlies family and his doctors, dr. Byock raised the awkward question of what should be done if charlie got worse and his heart or lungs failed. Dr. Byock told him that resuscitation rarely works on someone in charlies condition and that it could lead to a drawnout death in the icu. Either way you decide, we will honor your choice, and thats the truth. Should we do cpr if your heart were to suddenly stop . Yes. Youd be okay with being in the icu again . Yes. I know its an awkward conversation. It beats second place. [laughs] you dont think it makes any sense. It wouldnt be my choice. Its not what i advise people. At the present time, its their right to request it. And medicare has to pay. And medicare pays for it. Charlie haggard died a few months later. A Family Member told us his condition had deteriorated so much, they decided to let him go peacefully. But when it comes to expensive hightech treatment with some potential to extend life, there are few restrictions. By law, medicare cannot reject any treatment based upon cost. It will pay 40,000 for a 93yearold man with terminal cancer to get a surgically implanted defibrillator if he happens to have heart problems too. I think you cannot make these decisions on a casebycase basis. It would be much easier for us to say, we simply do not put defibrillators into people in this condition. Meaning, your age, your functional status, the ability to make full benefit of the defibrillator. Now, thatsagain, thats going to outrage a lot of people but you think that should happen. I think at some point, it has to happen. Well, this is a version, then, of pulling grandma off the machine. You know, i have to say, i think thats offensive. I mean, i justi spend my life in service of affirming life. I really do. And to say were going to pull grandma off the machine by not offering her a liver transplant or her fourth cardiac bypass surgery or something is really just scurrilous. And its certainly scurrilous when we have 46 million americans who are uninsured. Every other major industrialized nation but the United States has a budget for how much taxpayer funds are allocated to health care, because theyve all recognized that you can bankrupt your country without it. So youre talking about rationing. Listen, we ration now; we just dont ration rationally. Theres no question that theres going to have to be some form of rationing. Let me be clear. Individuals and employers ought to be able to spend as much money as they want to have things done, but when youre talking about taxpayer resources, theres a limit as to how much resources we have. But if recent history is any guide, rationing has become the third rail of american politics, even though dr. Elliott fisher says we already limit health care based on income and whether people have insurance. After analyzing medicare records for endoflife treatment, hes convinced that there is so much waste in the present system that if it were eliminated, thered be no need to ration beneficial care to anyone. Multiple studies have concluded that most patients and their families are not even familiar with endoflife options and things like living wills, home hospice, and pain management. And the real problem is that many of the patients who are being treated aggressively, if you ask them, they would prefer less aggressive care. They would prefer to be cared for at home, theyd prefer to go to hospice, if they were given a choice, but we dont adequately give them a choice. At some point most doctors know that a patients not likely to get better. Absolutely. And after youve run through all the choices then. Sometimes theres a good conversation; often theres not. You know, patients are left alone to sort of figure it out themselves. Marcia klish might have lingered for quite some time in the intensive care unit at dartmouth hitchcock, but dr. Byock and his team had a number of meetings with her closest friend, barbara minchin. She said klish would not want to be kept alive on machines if there was no meaningful hope of recovery. It was decided that doctors would not try to resuscitate her if her condition worsened, which it soon did. Her heart has just flipped into a rhythm that doesnt allow it to beat effectively. She died a few moments later. This is a hard time in human life, but its just a part of life. Collectively, as a culture, we really have to acknowledge that were mortal, get over it, and start looking at what a healthy, morally robust way for people to die looks like. In march of 2010, president obama signed into law the muchdebated Health Care Reform legislation. The intent of the law is to slow the growth of medicare expenses, but none of the endoflife issues raised in our story are addressed in the new law. In fact, the new legislation actually reduces medicare payments for hospice programs which studies have shown are very costefficient. Our next story involves a widely used family of chemicals known as phthalates, which may be affecting our health and are found in everyday items like shower curtains, shampoos, perfumes, and even childrens toys. In fact, our exposure to phthalates is so ubiquitous, we all have traces of the chemical in our bodies. Even though phthalates have been used since the 1920s, a recent group of studies has shown that the chemical disrupts hormone activity and may be causing a slow and steady demasculinizing of men. And in 2009, congress followed europes lead and banned certain phthalates for use in childrens toys. Congress came under pressure to act because of a study by dr. Shanna swan, an epidemiologist at the university of rochester medical school. Dr. Swan compared the levels of phthalates in a group of pregnant women with the health of the baby boys they gave birth to. Did you find that the higher the level of phthalates in the mothers urine during pregnancy, the greater the problems in the young boys . Yes. What did you find in the babies . We found that the baby boys were, in several subtle ways, less completely masculine. Dr. Howard snyder, a pediatric urologist at Childrens Hospital in philadelphia, says swans findings line up with what hes seeing in newborn baby boys an alarming increase in deformed sex organs. Lie him down, and let me just examine him. Dr. Snyder operated on oneyearold griffin to correct something called hypospadias, a birth defect that causes problems in urination. But hes good now, right . Hes a healthy little guy, whos, i think, going to get through the rest of life just aiming without any difficulty at all. Thats great. We hear that there are more and more and more cases of hypospadias. Are you seeing a lot . 30, 40 years ago, the best data we had then was that hypospadias occurred in about one in every 300 live male births. Its up to now about one in 100, so theres been a threefold increase. Theres also been a twofold increase in another abnormalityundescended testicles. Snyder says something seems to be interfering in the womb with the production of testosterone causing the male organs to form improperly, and he suspects it may be phthalates. Youre moving in on these chemicals; you dont think whatever were seeing is smoking or diet or Something Else . I think its the chemical exposures that are most telling. He points to studies beyond shanna swans that seem to link phthalates to low sperm counts and low testosterone levels in adult males. Theres just too much incremental data that has built up to be ignored, and i think that its a real phenomenon. I really honestly do. Look around dr. Snyders hospital, and you see how phthalates can make their way into our bodies. Theyre in the i. V. Bags and the tubing, for instance. When premature babies hooked up like this were studied, researchers found that their phthalate levels soared. Who would have thought chemicals embedded in plastic leach out . Well, they do in small amounts, but studies are beginning to suggest that even small amounts can have an effect. If it is shown definitively that phthalates are dangerous, it wont be easy to get rid of them. To show us just how pervasive phthalates are in our lives, dr. Swan took us through a suburban house, sniffing, squirting, and squeezing our way around, looking for flexible plastic, things that typically contain phthalates, like vinyl rain coats. Soft and flexible. The bathroom shower curtain and. Duckies are squishy. The rubber duckies. The car. Turns out, they were also in things that arent so pliable. Dashboard. Steering wheel. Gear shift. And things you cant even see. And then that new car smell. Phthalates make fragrances linger longer, whether in cars. What about this . Or in air fresheners. What have you found in the bathroom thats suspicious to you . Phthalates get inside us in a variety of ways, for instance, from products we put on our skin. They help lotions spread and womens makeup retain its color. Heres powder. Swan says cosmetics alone could explain why women have higher levels of phthalates than men. What about lipstick . Yes. What about hairspray . Yes, definitely. Oh, my goodness. Nail polish. Nail polish remover. If you want to know if something youre using has phthalates, its hard to find out. Theres no requirement they b