Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, philosophy and health care

Wednesday, November 30, 2011

Three Weeks to Stop Medicare Cuts

Ethics is more than a code.  Ethical behavior extends beyond treating our patients to advocating on behalf of our patients.

Even if you do not work with Medicare patients, many insurance companies base reimbursement schedules on Medicare rates.

TO:   All Psychologists 
RE:    Three Weeks to Stop Medicare Cuts

Legislative leaders have begun to discuss options to address critical, time-sensitive issues by the end of the year, including the expiration of unemployment benefits, the Alternative Minimum Tax patch, tax extenders and Medicare extenders.

Now is the time for psychologists to make their voices heard and remind Congress that their patients and practices will soon face a 5% cut to psychotherapy payments in addition to a 27.4% Sustainable Growth Rate (SGR) cut to all services scheduled for 2012 if they fail to act. 

Congress has blocked the SGR cut 12 times since 2001 and the APA Practice Organization has successfully secured the psychotherapy restoration 3 times since 2008, but practitioners face a tougher climate this time around in light of the unprecedented focus on deficit reduction and the broadening divide between legislative leaders.

Your profession needs you to take action NOW to ensure legislators are attentive to these critical priorities.

Take Action Now!


Click here to urge your Senators and your US Representative to halt Medicare cuts to psychological services.

Please TAKE ACTION by Tuesday December 6.

Feel free to leave a comment on this blog so that other psychologists know how easy and simple the process really is......as well as the importance of this advocacy effort!

Message:

 My patients and practice are only a few weeks away from major reimbursement cuts that will impact patient access and put my small business at risk.  As a psychologist and constituent, I urge you to extend the Medicare mental health add-on through 2012.

 Congress has repeatedly found extension of the 5% psychotherapy payment restoration necessary to address the unintended impact of CMS's last Five-Year Review on access to Medicare mental health services.  An extension is necessary until completion of the current Five-Year Review of psychotherapy codes, which has been delayed into 2012.

 As Congress works toward end-of-year action on several pressing priorities, please make my patients and the mental health extender a priority, as well as halting the 27.4% Sustainable Growth Rate (SGR) cut.  Thank you for your time and consideration.

 Additional Background:

CONGRESS SHOULD PROTECT MEDICARE MENTAL HEALTH PAYMENT

To ensure the viability of the Medicare outpatient mental health benefit, Congress should extend through 2012 the restoration of cuts to Part B mental health services made in 2007.

Mental Health Extender.  Congress restored payments temporarily but they now need to be extended.  Through the Medicare Improvements for Patients and Providers Act of 2008, Congress partially restored the cuts made by the Centers for Medicare & Medicaid Services (CMS) "Five-Year Review" through 2009. Subsequent laws then extended the restoration through December 2011. The valuation of psychotherapy codes in the 2011 Five-Year Review has been delayed into 2012.  Congress should pass new legislation to extend payments through 2012, until the Five-Year Review is completed.

Effect on Beneficiaries. Extending psychologist payments cut by the Five-Year Review is crucial to protecting access to Medicare mental health services.  Psychologists and social workers provide almost all of the Medicare psychotherapy and testing services, but many have indicated that they may have to reduce their caseloads or leave Medicare if they are faced with these reimbursement cuts. The cost of protecting mental health services is very low, increasing costs by only $30 million per year.

Cut By MEI Rebasing.  A CMS technical advisory panel will be asked to examine the effect of a 4% cut to Medicare part B reimbursement for psychologists in January 2011 due to "rebasing" of the Medicare Economic Index (MEI).  In the 2011 fee schedule, CMS used more recent survey data that showed practice expense and malpractice became a larger share of the payment formula while provider's time became smaller. This increased payments for some services, particularly of professionals who utilize expensive technology.  Due to budget neutrality requirements, CMS reduced other reimbursement work values, which hit services of psychologists and social workers the hardest because they are typically provided at lower cost and lower overhead.

These cuts are not related to the Sustainable Growth Rate.  Psychologists were saved from a second and even more devastating reduction when Congressional action halted the projected 25% SGR cut through December 31, 2011.  Ultimately Congress must replace the flawed SGR formula with one that responsibly and permanently addresses provider payments.

Psychologists will leave Medicare.  In a 2008 survey, 11% of psychologists reported that they have dropped out of Medicare participation and a primary reason cited was low reimbursement rates.

People May Lie More Often in Emails, Instant Messages

By Randy Dotinga
MedicineNet.com

New research suggests that people are more likely to lie to strangers when they're communicating via email or instant messages rather than when they are talking face-to-face.

"It's not news that we lie. What's new is that we lie even more online," said study author Mattitiyahu Zimbler, a graduate student and senior researcher at the University of Massachusetts-Amherst.

In the study, the researchers recruited 220 undergraduate students and told them to converse with people of the same gender for 15 minutes, via email, instant message or face-to-face.

The participants introduced themselves to each other and researchers recorded their conversations. Then the researchers asked the participants to look at transcripts and note when they lied.

The researchers found that the participants averaged about 1.5 lies during each 15-minute period.

The lies tended to be minor, often matters of omission. One said, "I am short, credit-wise," instead of acknowledging the failing of classes. Some said they were doing "well" or "good" when that wasn't actually the case; one said "I wanted to be a waitress," when that wasn't true.

The entire article can be found here.

Tuesday, November 29, 2011

Doing the Ethical Thing May Be Right, but It Isn’t Automatic

By ALINA TUGEND
The New York Times

FOR the last few weeks, the sex abuse scandal at Penn State and the harassment claims against the Republican presidential candidate Herman Cain have been fodder for discussion at my house. The same is true, I assume, around the country.

Putting aside the specifics of each case, one question that has come up is, “What would I do?”

That is, if I saw what seemed to be a crime or unethical act committed by a respected colleague, coach, teacher or friend, would I storm in and stop it? Would I call the authorities immediately? Would I disregard the potentially devastating impact on my job or workplace or beloved institution?

Absolutely, most of us would probably reply. I think so, others might respond. And the most honest answer? I don’t know.

As much as we would like to think that, put on the spot, we would do the right — and perhaps even heroic — thing, research has shown that that usually isn’t true.

The rest of the article is here.

Monday, November 28, 2011

Ohio State Board of Psychology Telepsychology Rule Amendments

Ohio SBOP Telepsychology Rule Amendments

Editorial: Ricky Wyatt

By Lawrence Downes

Ricky Wyatt
After Ricky Wyatt died, the circle that gathered around him to say goodbye was small. Just a clutch of people in a funeral chapel in Tuscaloosa, Ala., friends and family members and some of those who had traveled beside him on a long journey toward justice for the mentally ill and disabled.

The journey was Wyatt v. Stickney, the federal class-action lawsuit filed in 1970 against an Alabama state hospital and later expanded to other facilities. It was the first and most consequential of the legal challenges to the abuse and neglect that had doomed hundreds of thousands of patients to hellish lives in public psychiatric hospitals. It threw open the doors to treatment and to new homes in the community and, for the first time, established standards of adequate care and patients’ rights to receive it.

The whole editorial is here.

Another more detailed article on Ricky Wyatt is here.

A summary of Wyatt v. Stickney is here.

Sunday, November 27, 2011

Canadian Model Standards for Telepsychology Service Delivery

Adopted June 4, 2011

Canadian Model Standards for Telepsychology

Report: 1 in 5 of US adults on behavioral meds

NEW YORK (AP) — More than 20 percent of American adults took at least one drug for conditions like anxiety and depression in 2010, according to an analysis of prescription data, including more than one in four women.

The report, released Wednesday by pharmacy benefits manager Medco Health Solutions Inc., found that use of drugs for psychiatric and behavioral disorders rose 22 percent from 2001. The medications are most often prescribed to women aged 45 and older, but their use among men and in younger adults climbed sharply. In adults 20 to 44, use of antipsychotic drugs and treatments for attention deficit hyperactivity disorder more than tripled, and use of anti-anxiety drugs like Xanax, Valium and Ativan rose 30 percent from a decade ago.

The statistics were taken from Medco's database of prescriptions and is based on 2.5 million patients with 24 months of continuous prescription drug insurance and eligibility.

The entire story is here.

Saturday, November 26, 2011

Texas Lawsuit Identifies Problems In Medicare Hospice Provisions

By Jordan Rau
Kaiser Health News Staff Writer
Originally published 11/16/11

A lawsuit filed in Dallas against one of the nation's largest hospice companies identifies how Medicare's payment methods can offer unintended financial incentives to inappropriately move patients from HMOs into hospice programs and then into hospitals.

In a complaint unsealed last week in a federal court, a former general manager of Vitas HealthCare Corp.'s San Antonio office alleged the company defrauded Medicare through a "conspiracy" with two HMO companies. Vitas and the companies have denied the allegations. The Department of Justice and the state of Texas have declined to join with the plaintiffs in the suit "at this time."

Here's how the complaint alleges the arrangement worked: Since Medicare Advantage pays HMOs monthly per-patient fees, the HMOs had a financial incentive to avoid chronically ill patients, who need lots of treatments. So the HMOs referred many of their chronically ill patients for hospice care at Vitas, which accepted them even though their conditions weren't considered terminal.

The entire story can be read here.

Friday, November 25, 2011

Report of the Ethics Committee, 2010

American Psychologist
July-August 2011
Volume 66, No. 5, 393-403


Here is some data from APA's Ethics Committee.
APA Ethics Committee 2010

Thursday, November 24, 2011

PA State Board of Psychology Update: November 2011

Psychology November 2011

Wednesday, November 23, 2011

Congress examines health data thefts

By Jeremy Herb
The Star Tribune

In the wake of high-profile health-care data breaches in Minnesota this year, Sen. Al Franken on Wednesday examined how sensitive data can be better protected as more of it moves to the "wild, wild West" of the Internet.

Thefts of laptops containing patient data from Fairview and North Memorial hospitals earlier this year were just a small slice of health data thefts in the United States. In a 15-month span, the Department of Health and Human Services (HHS) found that more than 50 laptops were stolen from hospitals, clinics and medical centers.

The entire story can be found here.


Healthcare Industry Still Struggling with Information Breaches

By Carlton Purvis
www.securitymanagement.com

The healthcare industry experiences more data breaches than any other industry, according to Privacy Rights Clearinghouse (PRC) data.

PRC maintains a database of privacy breaches from 2005 to the present. When available, the database includes what type of information was breached, how many records were affected, the organization that was storing the data, the types of records accessed, and a narrative of the circumstances surrounding the breach.

In 2011, 170 of 481 publicly disclosed breaches happened in the medical industry. Most of the breaches (50 breaches containing at least four million records) happened after portable data devices went missing. In several cases, the information was on laptops and flash drives that had been stolen or lost.

The entire story is here.

Tuesday, November 22, 2011

Database on Doctor Discipline Is Restored, With Restrictions

By Duff Wilson
Health

A federal health agency on Wednesday restored to its Web site a database of doctor disciplinary actions two months after removing it from the Internet in response to a doctor’s complaints.

But the return of the information came with a catch. It has a new requirement that anyone who uses it must first promise not to link information in the database with publicly available information, like court files, that would identify individual doctors.

And that was exactly the way journalists for many news organizations had used the national data bank, which masked individual doctors’ names, as material for articles about weaknesses in the oversight of doctors with dozens of malpractice cases and gaps in disciplinary actions.

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But journalists and other researchers have linked specific malpractice payments in court cases with the specific amounts reported in the Public Use file to fairly easily crack the code, add up cases against doctors, and report the results.

Dr. Sidney M. Wolfe, director of health research at the Washington nonprofit group Public Citizen, said it was “obnoxious” and “unacceptable” for the administration to impose the condition on journalists and researchers.

The entire story can be read here.

A prior blog entry on this issue can be found here.

Monday, November 21, 2011

Safety in Youth Sports Act becomes Law in Pennsylvania

PPA Press Release
Originally released 11/14/2011



Governor Corbett signed the Safety in Youth Sports Act today in a ceremony at Lower Dauphin High School, Dauphin County. The state General Assembly passed it on November 1. The legislation is Senate Bill 200, introduced by Sen. Patrick M. Browne (R-Lehigh). It was shepherded through the House by Rep. Timothy P. Briggs (D-Montgomery), who had introduced the companion bill, House Bill 200.

This bill established standards for managing concussions to student athletes. In order to return to play the athlete must be cleared by a licensed psychologist trained in neuropsychology, by a physician who is trained in the evaluation and management of concussions, or by certain other health care providers under the supervision of the physician. The Pennsylvania Psychological Association's advocacy was instrumental in this bill's passage. The association's past president, Dr. Mark Hogue stated, "This new law will be extremely important to any athlete who suffers a concussion. Athletes who return to play prematurely are at risk of a second concussion, which can be life-threatening." Dr. Hogue is a clinical and sport psychologist from Erie.

The bill will require the state Departments of Health and Education to develop and post on their websites information on the nature of concussions in athletic activities and the risks associated with continuing to play or practice after a concussion. Student-athletes and their parents or guardians must sign an acknowledgment of receipt of an information sheet on concussions prior to participation in athletics. It will require coaches to complete a concussion management certification training course before coaching any athletic activity. During an athletic contest coaches will be required to remove athletes from competition if they exhibit signs of a concussion.

The legislation will become effective on July 1, 2012, in time for the next school year. It does not pertain to private schools, but only to public schools. It covers interscholastic athletics as well as other sports associated with a school entity, and includes cheerleading, practices, and scrimmages.

In N.H.L., Disclosure of Concussions Is Lagging

By Jeff Z. Klein
The New York Times
Hockey

Concussions continued to cast a long shadow over the N.H.L. on Thursday.

The Rangers said there was no update on the condition of defenseman Marc Staal, who has not played this season and is still recovering from a concussion sustained in February that the club did not disclose until September.

Pittsburgh’s Sidney Crosby, who has been sidelined by a concussion since early January, was cleared for contact a month ago and has practiced all week, including Wednesday, when he took several hard hits. Despite speculation that he would return for Friday’s home game against the Dallas Stars, Coach Dan Bylsma said Crosby would not play in either of the team’s games this weekend. That leaves Tuesday’s game against the Colorado Avalanche as the earliest possible return date for Crosby.

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The N.H.L. has earned praise this season for taking measures to reduce concussions, including introducing stronger rules against boarding and checks to the head, and strictly enforcing those rules through fines and suspensions. But questions persist about a league policy that allows teams to be vague about disclosure of injuries, and a recent incident suggested that in-game concussion protocols might be inconsistently applied.

The entire story can be read here.

Sunday, November 20, 2011

Doctors Might Miss Some Cases of Child Abuse

By Robert Preidt
MedicineNet.com

Many cases of child abuse are not reported by primary health care providers, a new study suggests.

Primary care providers (PCPs) are usually doctors but can also be physician assistants and nurse practitioners.

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The PCPs and child abuse experts agreed about the suspicion of abuse in 81% of the cases, but PCPs did not report 21% of injuries that the experts said they would have reported to child protective services (CPS).

The story can be read here.

The research article can be found here.

Saturday, November 19, 2011

U.C.L.A. Health System Warns About Stolen Records

LOS ANGELES (AP) — UCLA’s system of hospitals and clinics warned more than 16,000 patients that their personal information was on a computer hard drive stolen in the burglary of a doctor’s home, officials said Friday.

The UCLA Health System sent letters to the 16,288 patients affected, warning them of possible identity theft and giving them contact information for a data security company the system has enlisted for help.

Someone using the documents for identity theft was “very unlikely,” but there was a possibility, the statement said.

“UCLA’s concern for its patients is absolute, and we deeply regret any breach of confidentiality and the stress and concern it might cause,” it said.

The whole story can be found here.

Electronic medical records rarely encrypted: expert

(Reuters) - Electronic medical records, which the Obama administration would like to see widely used, are rarely encrypted so a data breach could be triggered by the simple theft of a laptop or misplaced thumb drive, a privacy expert told lawmakers on Wednesday.

Regulations require healthcare providers to report data breaches unless the data lost had been encrypted.

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"The bottom line is that people have a right to privacy and to know that their data is safe and secure, and right now that right is not a reality," Franken said after the hearing.

The entire story can be found here.

Friday, November 18, 2011

Health Guideline Panels Struggle with Conflicts of Interest

By Duff Wilson
The New York Times
Money and Policy

All 16 members of the United States Preventive Services Task Force were vetted to ensure they had no financial conflicts that would prohibit them from voting, according to the panel’s vice chairman, Dr. Albert L. Siu.

But three other federal panels that are quietly developing major public health guidelines on the leading causes of cardiovascular disease — hypertension, cholesterol and obesity — operate under less stringent ethics recommendations.

And one potential conflict after another has surfaced among the members, with some receiving speakers’ fees from drug companies, others consulting for pay and others doing company-financed research.
In all, about 20 of the three panels’ members, including some co-chairmen, have been advised that they should not vote on crucial issues as they prepare to issue the health guidelines next year — because they are too closely connected to industries with a keen interest in the panels’ recommendations.

Nearly a decade ago, the work of similar panels was so marred by charges of industry bias that the National Institutes of Health extensively heightened the scrutiny for individual panelists. But the decline in federal financing for medical research continued to pose problems, leaving many researchers to rely more heavily on private industry support. Specific new rules have been adopted to reduce the impact of conflicts of interest on guideline-writing panels.

But the N.I.H. groups, which meet behind closed doors, partly to avoid outside influence, had already been appointed when some of those rules were issued. Their finished work could wield a powerful influence on medical care, insurance and lifelong treatment for hypertension, obesity and cholesterol.

The entire article can be found here.

Thursday, November 17, 2011

Is journalism the drug industry’s new dance partner?

Ray Moynihan
By Ray Moynihan, author, journalist, and conjoint lecturer, University of Newcastle, Australia

Exploring the new frontier in influence peddling

Just as many doctors contemplate an end to their dance with drug company marketers, a fresh new crew is stepping lively onto the floor: journalists and media organisations looking for easy ways to fund their reporting, travel, and education.

The BMJ reported last week that the Murdoch empire’s flagship newspaper in Australia has accepted an undisclosed amount of sponsorship money from the drug industry for a series of articles on health policy—and that the idea arose from a meeting between advertising agents.

Defending the deal, the Australian’s editor said that independence and integrity were maintained; but as others pointed out, this new form of financial closeness between journalists and the companies they scrutinise raises real concerns.

A few years ago the industry body Medicines Australia started sponsoring annual journalism awards, with the prize for the health journalist of the year award including $A1000 cash (£660; €760; $US1060) and an international study tour. Presumably all recipients will swear that the award and the world trip had no undesirable effects on their future coverage, and they may well be right.

What we're witnessing is a slow and subtle attempt to buy influence and goodwill within the media, which in general have become increasingly rigorous in their coverage of the unhealthy aspects of pharmaceutical marketing.

The article can be found here.

Cite this as: BMJ 2011; 343:d6978

Glaxo to Pay $3 Billion to Settle U.S. Cases on Sales, Marketing

By Phil Serafino and Makiko Kitamura
Bloomberg News

GlaxoSmithKline Plc (GSK) agreed to pay $3 billion to resolve U.S. criminal and civil investigations into whether the U.K. company marketed drugs for unapproved uses and other matters, its biggest legal settlement.

Negotiations over the terms will be completed next year, the London-based company said in a statement today. The cost is covered by existing legal provisions and will be paid from the company’s cash resources, Glaxo said.

The potential settlement brings Glaxo closer to putting years of legal probes behind it. The company set aside 2.2 billion pounds ($3.5 billion) in the fourth quarter last year in anticipation of reaching an agreement on the cases. Glaxo said it will have about 1 billion pounds of its 2.9 billion pounds in total legal provisions remaining after today’s settlement is completed, and it hasn’t decided what to do with the money.

“This news essentially draws a line under a 10-year legal saga,” Gbola Amusa, an analyst at UBS AG in London who recommends buying Glaxo shares, said in an e-mail. “This removes significant uncertainty on ongoing legal issues.”

There rest of the story can be found here.

Wednesday, November 16, 2011

Culture of Denial and Child Sex Abuse

Voices In The Family - WHYY Radio
Originally posted 11/14/11

Alleged incidents of child sexual abuse brought to light at Penn State are disturbing. University stakeholders have been ousted. The campus remains a live wire of anger and confusion. As our hearts go out to children and families who have come forward with their stories, we find ourselves wondering, why did so many people fail to report what they saw or heard about?

Dan Gottlieb, PhD
Dan Gottlieb Ph.D, host of Voices in the Family, is a family therapist in private practice. He is a nationally recognized lecturer in the field of mental health, and a columnist for the Philadelphia Inquirer.

Dan Gottlieb asks: why the cultural hesitation and denial in sexual abuse cases, in general, when the well-being of children is at stake? We'll take a look at the psychology of institutional betrayal as well as prevention of abuse with Jennifer J. Freyd, Michael Stinson, Ken Singer, and Kelly Moore.

The entire podcast can be found here.

Child abuse: We’re making the problem worse

By Tracy Clark
Salon.com
Originally published 11/13/2011

The alleged Penn State sex abuse scandal may provide a powerful lesson about institutional corruption — but it’s also a good time for some self-examination. The general consensus among experts who treat sex offenders is that America has taken the wrong approach to dealing with child molesters. In fact, some say that we’re only making the problem worse.

Just last week, the Association for the Treatment of Sexual Abuse conference in Canada surveyed the latest research in the field. The narrative that emerged from the meeting is that we should place a stronger emphasis on something proved to actually reduce the recidivism rate: treatment. The potential for bias here is apparent — it’s like incarceration experts highlighting the importance of incarceration — but studies show that treatment, particularly group approaches, can be highly effective. (Although, as a 2009 report put it, “Despite these advances we, as a field, continue to fall well short of the community’s expectation of ‘no more victims.’”)

The entire story can be found here.

Two additional stories on the Penn State sexual abuse case can be found on the same page.

Pedophiles infiltrate respected institutions to find victims

By Greg Toppo
USA Today
Originally published November 14, 2011

The Penn State allegations may seem unthinkable: revered assistant coach and prominent community activist Jerry Sandusky preying on eight children. But such abuses of trust play out in the USA over and over again.

Respected people who set up charitable or social groups for children, only to be implicated in some form of child sexual abuse, are a frightening reality.

"I call them 'institutions of trust,' " says Portland, Ore., attorney Kelly Clark, who has represented more than 300 sex abuse victims. Some predators are so tacitly trusted "that when something like this happens, the instinctive reaction is, 'That can't happen here. We can't allow the mission to be compromised,' " he says.

Abuse experts say the common denominators in many such crimes are parents willing to allow noted people to have unrestricted access to their kids. Among recent cases:

•A Utah judge this month sentenced a 70-year-old orphanage co-founder to three consecutive terms of five years to life in prison after he pleaded guilty to three counts of abuse. Lon Kennard originally faced 43 counts dating to 1995, but most charges were dropped as part of a plea deal. Kennard's victims were among six children adopted from Ethiopia, where he and his wife helped establish an orphanage.

•A Miami jury on Thursday returned a $100 million verdict against a retired Roman Catholic priest accused of sexually abusing dozens of boys since the 1980s in the city's Little Haiti neighborhood. More than 20 people say Neil Doherty, 68, trolled for victims wearing his priest's collar.

The rest of the story can be found here.

Tuesday, November 15, 2011

Psychologist Suicide

By Tori DeAngelis
November 2011, Vol 42, No. 10
Print version: page 19

A colleague's death is hard to contemplate. But the suicides of two psychologists in 2008 — as well as those of noted psychologists Michael J. Mahoney, PhD, in 2006, and Lawrence Kohlberg, PhD, in 1987 — prompted an ad hoc APA committee to look closely at what is known about this hazard and what the profession can do about it.

The group – led by Phillip M. Kleespies, PhD, of the VA Boston Healthcare System and made up of members of APA's Advisory Committee on Colleague Assistance, the APA Practice Directorate and the APA Div. 12 (Clinical) Section on Clinical Emergencies and Crises — examined research in four critical areas: suicide rates, risk factors, impact on others and how colleagues support psychologists in distress. They also examined the current state of prevention and intervention, and suggested ways to enhance training in this vital area.

(cut to the final portion)

"Suicide by psychologists, individuals with special expertise in human behavior, seems to be particularly fraught with challenges and raises concerns specific to psychology such as doubt in the value of therapy," they write. "Identifying risks, reducing the stigma associated with acknowledging hopelessness or despair, and overcoming other barriers to intervention are critical to reducing the incidence of suicide."

The entire story can be read here.

Chantix's Suicide Risk Makes It Unsuitable As First Line Smoking Cessation Drug

By Catharine Paddock, PhD
Medical News Today

A new study finds that the smoking-cessation drug varenicline (Pfizer's Chantix) has too poor a safety profile to make it suitable for first-line use. Researchers from Wake Forest Baptist Medical Center, and other research centers in the US, found the drug, known as Champix outside the US, was 8 times more likely to result in reports of suicidal behavior or depression than nicotine replacement products. They report their findings in the 2 November issue of PLoS One, an online journal of the Public Library of Science.

The findings contradict those of a recent review by the US Food and Drug Administration (FDA) that found varenicline, which already carries an FDA "black box warning", did not increase the risk of being hospitalized for psychiatric problems such as depression.

The entire story can be found here.

Monday, November 14, 2011

12 Are Charged in Medicare Fraud Schemes Said to Cost $95 Million

By Kirk Semple
The New York Times
City Room
Originally published November 2, 2011

Federal agents swarmed several medical clinics and homes in New York City on Wednesday, arresting 10 people on charges of running Medicare fraud schemes that bilked the government out of $95 million, federal officials said.

Another defendant charged in one of the schemes surrendered later to the authorities and a 12th defendant was still at large on Wednesday afternoon, the officials said.

The defendants included three medical doctors, a doctor of osteopathy and a chiropractor, the United States Department of Justice said in a news release.

The cases are part of an aggressive campaign by the Justice Department and the Department of Health and Human Services to combat the escalating problem of health care fraud. In 2007, a special team was formed to combat fraud in Medicare, the federal program that helps provide health care for older people.

The entire story can be read here.

Sunday, November 13, 2011

Privacy and Security for EHR: US and EU Compared

PRIVACY AND SECURITY IN THE IMPLEMENTATION OF
HEALTH INFORMATION TECHNOLOGY (ELECTRONIC
HEALTH RECORDS): U.S. AND EU COMPARED

By Janine Hiller, Matthew McMullen, Wade Chumey, and David Baumer

Abstract

The importance of the adoption of Electronic Health Records (EHRs) and the associated cost savings cannot be ignored as an element in the changing delivery of health care. However, the potential cost savings predicted in the use of EHR are accompanied by potential risks, either technical or legal, to privacy and security. The U.S. legal framework for healthcare privacy is a combination of constitutional, statutory, and regulatory law at the federal and state levels. In contrast, it is generally believed that EU protection of privacy, including personally identifiable medical information, is more comprehensive than that of U.S. privacy laws. Direct comparisons of U.S. and EU medical privacy laws can be made with reference to the five Fair Information Practices Principles (FIPs) adopted by the Federal Trade Commission and other international bodies. The analysis reveals that while the federal response to the privacy of health records in the U.S. seems to be a gain over conflicting state law, in contrast to EU law, U.S. patients currently have little choice in the electronic recording of sensitive medical information if they want to be treated, and minimal control over the sharing of that information. A combination of technical and legal improvements in EHRs could make the loss of privacy associated with EHRs de minimis. The EU has come closer to this position, encouraging the adoption of EHRs and confirming the application of privacy protections at the same time. It can be argued that the EU is proactive in its approach; whereas because of a different viewpoint toward an individual’s right to privacy, the U.S. system lacks a strong framework for healthcare privacy, which will affect the  implementation of EHRs. If the U.S. is going to implement EHRs effectively, technical and policy aspects of privacy must be central to the discussion.

The entire .pdf can be found here.

Thanks to Ken Pope for this lead.

Children’s hospital loses personal info of 500,000 patients


wftv.com

In a potential security breach at Nemours Children’s Health System, officials say they have lost the personal information of thousands of Florida patients.

Company officials say the patient information was being stored in a filing cabinet at a facility in Delaware. Officials said inside the cabinet were nonpassword protected computer backup tapes containing the personal and financial information of 500,000 Florida patients.

The whole story and video can be found here.

Saturday, November 12, 2011

DSM 5 Against Everyone Else

By Allen Frances, M.D.
Psychology Today Blog

Allen Frances, MD
So far, opposition to DSM 5 has been expressed by the following organizations: British Psychological Society; American Counseling Association; Society for Humanistic Psychology (APA Division 32); Society for Community Research and Action: Division of Community Psychology (APA Division 27); Society for Group Psychology & Psychotherapy (APA Division 49); Developmental Psychology (APA Division 7); UK Council for Psychotherapy; Association for Women in Psychology; Constructivist Psychology Network; Society for Descriptive Psychology; and the Society of Indian Psychologists.

An editorial by the Society Of Biological Psychiatry wondered whether DSM 5 was necessary at all. The community of personality disorders researchers is virtually unanimous in its opposition to the DSM 5 personality disorders section. There has also been widespread opposition to the sections on somatic, autistic, gender, paraphilic, and psychotic disorders.

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Strikingly, there seems to be virtually no support for DSM 5 outside the very narrow circle of the several hundred experts who have created it and the leadership of the American Psychiatric Association (APA) which stands to reap large profits from its publication. There is no group and precious few individuals outside of APA who have anything good to say about DSM 5. And even within the DSM 5 work groups and the APA governance structures, there is widespread discontent with the process and considerable disagreement about the product.

The entire blog can be accessed here.


Friday, November 11, 2011

Ghost Writing Persists in Major Medical Journals

By Robert Preidt
MedicineNet.com

Honorary and ghost authors were involved in 21% of articles published in six leading medical journals in 2008, which shows that this type of inappropriate authorship remains a problem, a new study says.

Honorary authors are people named as authors despite not making a substantial enough contribution to take responsibility for the research. Ghost authors are people who play a major role in the research or who participate in writing the article, but are not named as authors.

The lack of transparency and accountability associated with both types of inappropriate authorship has been a concern for decades, according to the study authors.

The entire report can be read here.

The original article concludes:

"Ensuring appropriate authorship remains an important issue for authors, academic and research institutions, and scientific journals. Full transparency in authorship is essential for maintaining integrity and accountability in scientific publication and ensuring public confidence in medical research. The results of this study should raise awareness among the scientific community about the importance of ensuring appropriate authorship credit and responsibility. Future research should continue to monitor inappropriate authorship and investigate ways that the scientific community could increase its effectiveness in addressing the problem."

Further information about the original article can be found here.
BMJ 2011; 343:d6128 doi: 10.1136/bmj.d6128 (Published 25 October 2011)
Cite this as: BMJ 2011; 343:d6128

Dutch 'Lord of the Data' Forged Dozens of Studies

By Gretchen Vogel
Science Magazine

Diederik Stapel
One of the Netherlands' leading social psychologists made up or manipulated data in dozens of papers over nearly a decade, an investigating committee has concluded.

Diederik Stapel was suspended from his position at Tilburg University in the Netherlands in September after three junior researchers reported that they suspected scientific misconduct in his work. Soon after being confronted with the accusations, Stapel reportedly told university officials that some of his papers contained falsified data. The university launched an investigation, as did the University of Groningen and the University of Amsterdam, where Stapel had worked previously. The Tilburg commission today released an interim report (in Dutch), which includes preliminary results from all three investigations. The investigators found "several dozens of publications" in which fictitious data has been used. Fourteen of the 21 Ph.D. theses Stapel supervised are also tainted, the committee concluded. 

The entire story can be read here.

Diederik Stapel returned his doctoral degree as reported today (11/11/11) in Science Insider.

An additional and more comprehensive report (added 11/17/11) can be found here.

Photo by Jack Tummers.

Thursday, November 10, 2011

Dilemma 7: An Invitation to Assess


You are checking your email after a busy day. The following email catches your attention.


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From: PsychBuilder – High Tech Psychology at Low Cost
Sent: Monday, November 10, 2011 6:37 PM
Subject: Online Assessment Tool to Promote your Practice

Dear Psychologist,

My name is Dr. Rob West, President and CEO of PsychBuilder Inc. located in San Jose, California. My company has developed a unique opportunity for you and your associates. PsychBuilder Inc. developed the first internet-based administration and scoring of the Personality Assessment Symptom Scale-2, the PASS-2. Psychologists have used the PASS-2 for psychological diagnoses and evaluations for a number of years. The PASS-2 is administered online, from any computer, iPad, or iPhone connected to the internet. The test usually takes approximately 40 to 60 minutes to administer. Results will be available to you and the patient online.

Important to an entrepreneurial psychologist like you, this assessment bridges the gap between psychology and primary care. Numerous patients from family practice offices can be given the internet link (http://www.psychbuilder.org/) and a security code to complete the PASS-2. The test is designed to determine if the patient can benefit from psychotherapy, psychotropic agents, or other psychological services. While it is not a complete assessment, it can guide patients to you for further psychological consultation.

After a patient completes the assessment, an email will be sent to you (based on the security code) and the patient within 24 hours, providing a secure link to review the results of the PASS-2. Patient contact information will be part of the administration process.

The cost of the online administration is $25, to be paid by the patient. For this to be a successful venture, we ask you to promote this program to your referring physicians, nurse practitioners, and physician assistants in order to enhance their ability to identify, evaluate and provide needed treatment for their patients.

We have great data on the PASS-2 for reliability and validity in identifying primary care patients who can benefit from psychological services. Unfortunately, many patients struggling with mental health issues in primary care settings are not properly identified or treated.

Because of busy primary care practices, the PASS-2 can be completed at home, if the office does not have internet access for patient use.

The physician, nurse practitioner, or physician’s assistant will offer patients this important opportunity via a specially designed 4 x 6 card. On that card, there will be information that explains the importance of completing this assessment, the cost, and that a licensed psychologist will review the results and contact the patient by phone within 3 to 5 business days.

An important factor is that there is no cost to you, as the psychologist. You will receive a high quality report that offers diagnostic possibilities, suicide potential, and treatment planning options for new patients.

I encourage you to review our web site at http://www.psychbuilder.com/. If you have further questions, feel free to contact me.

Sincerely,


Robert West, PhD, ABPP
Psychologist

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What are potential ethical issues with this invitation?


What clinical concerns arise for you in this scenario?


What should you do with this email solicitation?


What would you likely do with this email solicitation?

Wednesday, November 9, 2011

Losing the Battle: The Challenge of Military Suicide

Policy Brief
Center for a New American Security

Dr. Margaret C. Harrell and Nancy Berglass

This policy brief has four objectives. First, it examines the phenomenon of suicide within the U.S. military community, including both the frequency of suicide and the extent to which suicide is related to military service.  It outlines steps taken by the Department of Defense (DOD), the armed services and the Department of Veterans Affairs (VA) to reduce suicide in the armed forces and among veterans. It then identifies obstacles to reducing suicides further and makes recommendations to address each of those obstacles.

The entire publication can be found here.




Help for Service Members, Veterans and Military Families
Veterans Crisis Line: 1.800.273.TALK (8255), Press 1

Suicide, Warning Signs And Issues Faced By Friends And Family

Medical News Today

A study focusing on the family and friends of people who were suicidal has highlighted the main challenges they face when trying to judge whether a person is in danger and decide what they should do about it.

The research was carried out by Dr. Christabel Owens from the Peninsula College of Medicine and Dentistry, supported by Devon NHS Partnership Trust and funded by the UK Medical Research Council. The findings are published in the British Medical Journal on 22nd October 2011 (online 19th October 2011).

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The findings of the research show that relatives and friends did not always receive clear and unambiguous warning signals from the suicidal individual, and that, even when it was obvious that something was seriously wrong, they could not always summon the courage to take action.

Family members and friends of those who may be contemplating suicide are confronted by powerful emotional blocks, particularly fear. They may be afraid of intruding into another person's emotional life or afraid of damaging a cherished relationship by 'saying the wrong thing'. The whole situation is emotionally charged, and that affects the way in which people respond.

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Dr. Owens: "It is sad that, in the course of our research, we have repeatedly come across examples of people who did go to their GP, were given a cursory risk assessment and sent home with little or no support, and subsequently killed themselves. In other cases, a relative has taken their concerns to a GP and asked for advice, and has been told that the case cannot be discussed with them for reasons of patient confidentiality and that the person must visit the GP themselves."

The entire study can be found here.

Recognising and responding to suicidal crisis within family and social networks: qualitative study

BMJ 2011; 343:d5801 doi: 10.1136/bmj.d5801 (Published 18 October 2011)
Cite this as: BMJ 2011; 343:d5801

Tuesday, November 8, 2011

Ohio Teacher Convicted of Sex with Students

Stacy Schuler
LEBANON, Ohio — A high school teacher was convicted Thursday of having sex with five students, some of them football players, after a judge rejected an insanity defense that argued the teens took advantage of her.

Stacy Schuler was sentenced to a total of four years in prison for the encounters with the Mason High School students at her home in Springboro in southwest Ohio in 2010. She can ask a judge to free her from prison after six months.

The 33-year-old Schuler, who could have faced decades in prison, cried as she was handcuffed and led out of the courtroom.

The five teens testified that Schuler, a health and gym teacher, had been drinking alcohol at the time of the encounters and was a willing participant who initiated much of the contact. The teens were about 17 at the time. The age of consent in Ohio is 16, but it's illegal for a teacher to have sex with a student.

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Testimony from a defense psychologist had suggested that Schuler's medical and physical ailments, combined with her vegan diet and use of alcohol and an antidepressant, helped impair her ability to tell right from wrong.

A psychologist for the prosecution rebutted that testimony, saying that the use of alcohol does not meet the state standard for an insanity defense and that willingly getting drunk is not a legal defense for a crime.

The entire story can be found here.