"Living a fully ethical life involves doing the most good we can. - Peter Singer
"Common sense is not so common." - Voltaire

Thursday, May 31, 2012

Damaged Fairview ousts exec

Mark Eustis was linked to firm behind high-pressure debt collections

by Maura Lerner and Tony Kennedy
The Star Tribune
Star Tribue Staff Writers
Originally published May 24, 2012

Mark Eustis, CEO of Fairview Health
Mark Eustis couldn't have known it at the time, but his downfall as president of Fairview Health Services began last summer with the report of a stolen laptop. Within 10 months, the incident had grown into a public relations nightmare that Fairview couldn't shake.

On Thursday, Eustis, 59, abruptly announced plans to retire, one day after Fairview's board voted not to renew his contract. It was just four weeks after Attorney General Lori Swanson released a scathing report about debt collectors badgering patients for money inside Fairview hospitals.

Initially, the board had said Eustis' job was safe. But criticism has mounted over Fairview's association with Accretive Health, the for-profit company Swanson blamed for the collection practices.

Eustis found himself at the center of the turmoil because he was instrumental in hiring Accretive and has a son who works for the firm.

(cut)

Dr. Steve Miles, a University of Minnesota physician and bioethicist, said the most disturbing revelations weren't just about heavy-handed debt collectors, but internal e-mails in which Accretive employees talked about patients as "lowlifes" and "deadbeats."

The entire article is here.

Thanks to Gary Schoener for this lead.

Stalking Patients at Hospitals

By Michele Goodwin
The Chronicle of Higher Education - Blogs
Originally posted on May 23, 2012

Next week, Sen. Al Franken, a Minnesota Democrat, will chair a field hearing on the effectiveness of federal laws to protect patients’ access to care and privacy.  The hearing comes on the heels of Minnesota Attorney General Lori Swanson‘s accusing Accretive Health–one of the nation’s largest debt-collection agencies–of excessive and possibly illegal tactics, including strong-arming patients in Minnesota hospitals.  A voluminous six part report can be found here.  However, the issue extends beyond Minnesota as Accretive has contracts with hospital systems throughout the nation.

According to the attorney general’s report, the Illinois-based collection agency hid in hospital waiting rooms and even stalked patients in convalescing rooms to collect payments before and after treatments.  Those desperate tactics are particularly troubling because they occur when patients are seeking emergency medical care.  The cases highlighted by Swanson’s office detail clandestine debt collection schemes that not only misrepresent hospital staff, but may have a deterrent effect on individuals seeking treatment.

The entire story is here.

Wednesday, May 30, 2012

The rise of the pop psychologists

By Margaret McCartney
The British Journal of Medicine
Originally published May 21, 2012

Soundbites, opinion, and statements from experts are integral to many newspaper stories and magazine television programmes.

Psychological and psychiatric comment are often sought, be it for a morning television programme featuring the motivations of celebrities or whether Anders Breivik, the Norwegian on trial for mass murder, is sane.

Informed debate and information sharing necessitates that healthcare expertise should be used.

But what is appropriate for healthcare professionals to comment on, and who is best qualified to take the call?

So called celebrity psychology--used to explain or discuss behaviour--is burgeoning in the entertainment industry, and central to many reality TV shows.

Emma Kenny, who has a psychology degree and is a member of the British Association of Counselling and Psychotherapy, says on her website that she has been "resident psychologist" on many television shows.

On ITV's This Morning she appeared with Samantha Brick, who had written an article stating that she is disliked by many women because she is attractive.

In the discussion Kenny said, "If, as a person, everywhere I go, I am met with a certain reaction from people . . . I have to embrace the fact that actually it might be me that needs to change and not the society around me. The very fact that you are entertaining these relationships with people--you instantly have a paranoia."1

Kenny runs a service called Exclusive Ethics, which helps programme makers to work within the 2009 Ofcom broadcasting code (the code contains provisions designed to ensure the emotional welfare of television participants), and offers to compile psychological profiles of contestants.

The entire article is here.

Thanks to Ken Pope for this information.

Tuesday, May 29, 2012

Dr. Marjorie Cooper, Baylor University – Ethics and Religious Belief

By Bradley Cornelius
Northeast Public Radio - WAMC
Academic Minute


Dr. Cooper
In today’s Academic Minute, Dr. Marjorie Cooper of Baylor University explains research examining why religious belief doesn’t always translate into ethical behavior.

(cut)

Overall,  both Nominals and Devouts showed better ethical judgment than Skeptics.  However, the more narcissistic the subjects, the worse their ethical judgment became.  In fact, at higher levels of narcissism, the ethical judgment of Nominals and Devouts was no better than that of Skeptics.

The brief transcript and audio file is here.

The paper in the Journal of Business Ethics is here.

South Shore Hospital to pay $750,000 to settle data breach charges

By Hiawatha Bray
The Boston Globe
Originally published on May 25, 2012

It will cost South Shore Hospital in Weymouth $750,000 to settle charges related to a 2010 data breach that compromised the personal information of more than 800,000 people.

The settlement, approved Thursday in Suffolk Superior Court, included a civil penalty of $250,000 and $225,000 for a fund to be used by the office of Massachusetts Attorney General Martha Coakley to promote education on the protection of personal data. South Shore Hospital was also credited for $275,000 it spent on security measures following the breach.

The entire story is here.

Monday, May 28, 2012

Mental problems top illness for GIs

By Sig Christenson
San Antonio Express-News
Originally published May 19, 2012

More active-duty troops were hospitalized for mental illnesses last year than any other major malady, a new military report says.

The Armed Forces Health Surveillance Center said 21,735 troops from the services were admitted to hospitals because of mental problems, up dramatically from previous years.

Most were men, with mental disorders the leading cause of hospitalizations for soldiers and Marines — the services that have carried the greatest burden in Iraq and Afghanistan.

Hospitalization rates for all causes among active-duty troops were up during the past decade, with one in every 15 troops treated, but mental-illness admissions grew 50 percent over the past five years.

The entire story is here.

Sunday, May 27, 2012

Jury to set damages in abuse case

By Annysa Johnson
JSOnline - Milwaukee-Wisconsin Journal Sentinel
Originally published May 22, 2012

Fr. John Patrick Feeney
The jury in a landmark sex abuse case against the Catholic Diocese of Green Bay is expected to take up the issue of punitive damages Wednesday.

An Outagamie County jury on Monday awarded $700,000 to brothers Todd and Troy Merryfield, who were molested as children by the now defrocked Father John Patrick Feeney in the 1970s. Jurors found that the diocese defrauded the Merryfields because it knew Feeney was a danger to children and assigned him to their parish without telling members of his history.

The entire story is here.

Thanks to Ken Pope for this lead.

See the linked story.

Psychologist testifies on behalf of Catholic Diocese of Green Bay in fraud case

by Jim Collar
Gannett Wisconsin Media
http://www.greenbaypressgazzette.com/
Originally published May 18, 2012

A psychologist hired by the Catholic Diocese of Green Bay said two brothers who were sexually assaulted by a priest in 1978 suffered only minor trauma as a result.

Attorneys for the church began calling their witnesses Thursday in the Outagamie County civil lawsuit alleging fraud against the diocese. Brothers Todd and Troy Merryfield say the diocese knew former priest John Feeney sexually assaulted others before 1978 and fraudulently misrepresented his safety when assigning him to Freedom’s St. Nicholas Church.

In their 2008 civil lawsuit, the Merryfields cite “profound psychological damage” as a result of the assaults.

The entire story is here.

Thanks to Ken Pope for this lead.

Saturday, May 26, 2012

Backers of health insurance rate regulation edge closer to ballot

Los Angeles Times
Originally published May 19, 2012

Supporters of a proposed ballot measure seeking tighter regulation of health insurance rates in California turned in 800,000 petition signatures, confident that they will qualify for the Nov. 6 election.

In the coming weeks, county election offices and the California secretary of state will determine whether the measure meets the requirement for 504,760 valid signatures of registered voters. The deadline to qualify is June 28.

The initiative is expected to spark an expensive campaign battle over rising health insurance rates, which have angered thousands of California consumers in recent years. This measure seeks to regulate rate increases for health policies sold to individuals and small businesses, which cover about 5 million people. It doesn't affect plans purchased by larger employers that cover about 15 million Californians.

The entire story is here.

For Hospitals and Insurers, New Fervor to Cut Costs

By Reed Abelson
The New York Times - Health
Originally published May 23, 2012

Giselle Fernandez is only 17 but she has had more than 50 operations since she was born with a rare genetic condition. She regularly sees a host of pediatric specialists, including an ophthalmologist, an endocrinologist and a neurologist at UCLA Health System.

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After years of self-acknowledged profligacy, hospitals, doctors and health insurers say there is a strong effort under way to bring medical costs under control. Their goal is to slash the rate of growth in the nation’s $2.7 trillion health care bill by roughly half to keep it more in line with overall inflation.

Private insurers, employers and government officials are providing urgency to these efforts, and the federal health care law passed two years ago helped accelerate them.

Even if the Supreme Court decides next month to declare the entire law unconstitutional, many experts in the field say the momentum is likely to continue.

Friday, May 25, 2012

Waiting for Health Care

By Peter Nicks
The New York Times - Op-DOCS
Originally published May 20, 2012

“The Waiting Room” developed from stories my wife, a speech pathologist at Highland Hospital, told me about the struggles and resilience of her patient population. And a few years ago, as the contentious vote for health care reform got louder, it occurred to me that the people who were not participating in the debate were the very people we were fighting over: those stuck in waiting rooms at underfunded public hospitals all over the country. How would the patients in the waiting room at Highland Hospital respond to President George W. Bush’s statement, echoed by many others, that we already have universal health care in this country because, by law, nobody can be turned away from an emergency room for lack of ability to pay?

The entire story is here.

Individual Health Policies Fall Short, a Study Finds

By Reed Abelson
The New York Times - Health
Originally published May 23, 2012

More than half of all medical insurance policies sold to individuals now fail to meet the standards of coverage set by the federal health care law under review by the Supreme Court, a new study says.

Even if the law is upheld, employer-provided insurance plans are likely to continue to be more generous, but the law would significantly improve the quality of coverage for individuals in several ways, the researchers concluded.

Insurers would be required, for example, to limit how much people pay toward their own medical bills, even if they have a chronic and expensive condition. Insurers would also have to provide a comprehensive set of benefits, like maternity coverage that is now excluded by some policies, and cover pre-existing medical conditions, which may be excluded under certain policies.

Thursday, May 24, 2012

Patient information breach confirmed

Officials: Staffer copied confidential data at Reading Hospital for training purposes

By Dan Kelly and Ron Devlin
The Reading Eagle
Originally published May 18, 2012

Reading Hospital's medical records system was breached recently by an employee who copied sensitive patient information and used it for training purposes, hospital officials confirmed Thursday.

Medical test results, diagnoses, prescribed medications and other data legally classified as Protected Health Information on 12 patients was made public without the hospital's knowledge or the patients' consent.

Susan Heffner, privacy officer for the hospital, said it was the hospital's first breach of patient health information.

"This was old school," Heffner said. "Someone made paper copies of records."

The entire story is here.

Sanctioned Psychiatrist Gets First NIH Grant in 3 Years

by Jocelyn Kaiser
ScienceInsider
May 22, 2012

Dr. Nemeroff
A psychiatrist whose failure to disclose drug company income contributed to a furor over conflicts of interest in biomedical research has just received his first National Institutes of Health (NIH) grant in 3 years.

Charles Nemeroff's lax reporting of at least $1.2 million in drug company payments to his employer, Emory University, and similar payments to other academic psychiatrists prompted a 2007 Senate investigation.

Nemeroff stepped down as chair of psychiatry at Emory, and NIH suspended a $9-million grant he held for a depression study. In December 2008, Emory barred him from applying for NIH funding for 2 years.


Wednesday, May 23, 2012

Leading Psychiatri​st Apologizes for Study Supporting Gay 'Cure'

By Benedict Carey
The New York Times
Originally published on May 18, 2012


Dr. Spitzer
The simple fact was that he had done something wrong, and at the end of a long and revolutionary career it didn’t matter how often he’d been right, how powerful he once was, or what it would mean for his legacy.

Dr. Robert L. Spitzer, considered by some to be the father of modern psychiatry, lay awake at 4 o’clock on a recent morning knowing he had to do the one thing that comes least naturally to him.      

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Now here he was at his computer, ready to recant a study he had done himself, a poorly conceived 2003 investigation that supported the use of so-called reparative therapy to “cure” homosexuality for people strongly motivated to change.

What to say? The issue of gay marriage was rocking national politics yet again. The California State Legislature was debating a bill to ban the therapy outright as being dangerous. A magazine writer who had been through the therapy as a teenager recently visited his house, to explain how miserably disorienting the experience was.

And he would later learn that a World Health Organization report, released on Thursday, calls the therapy “a serious threat to the health and well-being — even the lives — of affected people.”

Tuesday, May 22, 2012

Clinical Challenges in the Internet Era

By Glen O. Gabbard, M.D.
American Journal of Psychiatry

Here's a central passage from the initial case presentation:

[begin excerpt]

Much to the treatment team's surprise, within a week of Mr. R's first outpatient appointment, Mrs. R had begun posting disparaging comments on various web sites about the quality of her son's care, specifically naming the treating resident.

The comments described the treating resident as well as other members of the treatment team in derogatory terms. 

In addition, Mrs. R made comments that were vehemently antipsychiatry, including a statement that psychiatrists collude with pharmaceutical companies to generate profit rather than treat illness.

She posted multiple comments in the days following certain clinic visits; the comments could be found easily by anyone who did a Google search using the treating resident's name.

The comments initially appeared on both a personal blog and a highly popular web site, later cropping up also on web sites that serve as general forums for consumer dissatisfaction and on news outlets as user-generated content.

(cut) 

Two main concerns arose from the ensuing dialogue. Foremost was the potential for the mother's online comments to undermine Mr. R's care. For example, awareness of his mother's comments could exacerbate Mr. R's paranoia, leading to a disruption in his trusting relationship with the resident and a possible interference with his adherence to treatment. Moreover, the tone of the mother's comments suggested a fundamental disagreement with the treatment team's approach to her son's care, one that could potentially lead to an impasse. In the absence of a satisfactory working relationship with Mr. R's mother, the team would need to consider discharging him with a referral to another provider. Were they to do so, however, apart from feeling disappointed at not being able to continue providing Mr. R's care, the team would risk appearing either to be punishing him for his mother's actions or abandoning him for no clear reason. Either interpretation might fuel the paranoid perceptions he had regarding mental health care providers.

The second concern was that the mother's comments could damage the reputation of the treating resident. The resident initially did not think to be worried about his reputation, since he felt confident that he was well regarded by those who knew him and had observed his work with patients. Once this concern was raised, however, the resident thought of the potential impact the mother's public comments might have if he sought employment or further training outside his current institution. Given the fact that there is only limited public commentary concerning residents, a few negative Internet postings might adversely affect the opinions of potential patients, peers, or employers. Hence, the situation presented a quandary regarding how to respond to the comments posted online by Mr. R's mother while trying to avoid both potential harm to the patient and potential harm to the resident.

 (cut)

 Discussion: 

When I was asked to consult on this case, I felt a good deal of empathy for the resident.

Here he was, delivering good psychiatric care to a young man with severe illness, but receiving criticism rather than appreciation from the family. 

I recognized that there is now a public exposure inherent in psychiatric practice that can be daunting even to experienced clinicians but may be especially painful to vulnerable residents who are striving to become competent psychiatrists. 

[end excerpt]

Here's how the article ends:  

What can we do as a profession in the face of these challenges? The proliferation of Facebook, Internet forums, Twitter, blogs, and chat rooms is a juggernaut that cannot be stopped. We must live with these new intrusions into our professional lives and develop creative solutions. Institutions can develop policies so that ad hoc groups do not have to be assembled whenever delicate situations with potential liability arise.

Psychiatrists and other mental health professionals can do periodic Internet searches of themselves to keep abreast of any personal or professional information about them that may have implications for their reputation. In some cases, web site administrators may be contacted who will remove what is posted. Those who use social networking sites like Facebook should probably use all available privacy settings so that personal information about them is not available to the public.

The education of psychiatric residents and other mental health professionals should include discussions of common challenges that occur in the Internet era so that clinicians have some preparation for dealing with them when they emerge. Finally, guidelines regarding how to continue the treatment and how to respond to the attacks should be developed. Academic psychiatry has a long tradition of establishing protocols to deal constructively with difficult events in the trainee's life, such as patient suicide or assault. Similar forms of support and assistance can be brought to bear to assist with challenges stemming from the Internet."

 Thanks to Ken Pope for this information.


Membership is needed to acces this information.

Gabbard GO. Clinical challenges in the internet era. Am J Psychiatry. 2012
May;169(5):460-3. PubMed PMID: 22549206.

Monday, May 21, 2012

Army to Review Its Handling of Psychiatric Evaluations

By James Dao
The New York Times
Originally published on May 16, 2012

The Army said Wednesday that it had ordered a service-wide review of how its doctors diagnose psychiatric disorders, indicating that complaints about unfair diagnoses at a sprawling base in Washington State have been echoed on installations around the country.

The review, announced jointly by the Army secretary, John M. McHugh, and chief of staff, Gen. Raymond T. Odierno, will focus on whether consistent and accurate diagnoses are being issued by the disability evaluation system, which determines whether injured soldiers are fit to remain on duty.

Concerns about the system emerged last fall after soldiers at Joint Base Lewis-McChord in Tacoma told Senator Patty Murray, a Democrat of Washington, that their diagnoses of post-traumatic stress disorder had been changed by doctors at Madigan Army Medical Center to lesser conditions. The soldiers asserted that the changes were done to save the Army money.

Sunday, May 20, 2012

Utah hiring crisis team to manage health data breach

Personal Data: Health Agency ramps up efforts to help victims, rebuild public trust

By Kirsten Stewart
The Salt Lake Tribune
Originally published May 14, 2012

The state of Utah is hiring a public relations firm to handle "crisis communications" in the wake of a health data breach that put the personal information of 780,000 people at risk.

The contract will be short-lived and will cost between $100,000 and $200,000, according to a solicitation published on May 11.

It calls for building a communications plan to "rebuild trust with the public, specifically those who were directly impacted by the breach and those who rely on the [Utah Department of Health] for critical health services."


Thanks to Ken Pope for this lead.

Franciscan U. Ends Student Health Insurance

By Libby A. Nelson
The Chronicale of Higher Education
Originally published May 16, 2012

A Roman Catholic college in Ohio announced Tuesday that it will discontinue its student health-insurance plan in the upcoming academic year rather than offer students a plan that would soon include free birth control. The college said the decision was driven by both financial and moral concerns, but it appears likely to become another point of contention in the ongoing debate about contraception, health insurance and religious institutions.

Students at Franciscan University of Steubenville will have to find other insurance coverage next year, the college said in a statement on its website. Coverage for employees will not change. About 200 of the university's 2,100 students currently rely on the college health plan.

The entire story is here.

Saturday, May 19, 2012

Maryland becomes 13th state to mandate telehealth services coverage

Law may be part of a growing trend toward reimbursement for telehealth services


By Legal & Regulatory Affairs staff

May 10, 2012—On October 1, 2012, Maryland will become the 13th state to require private sector insurance companies to pay for telehealth services. Maryland joins California, Colorado, Georgia, Hawaii, Kentucky, Louisiana, Maine, New Hampshire, Oklahoma, Oregon, Texas and Virginia in mandating that private payers cover telehealth services that are considered medically necessary and would otherwise be covered when provided face-to-face.

While reimbursement varies by insurer and state, this latest legislation seems to be part of a growing trend toward reimbursement for telehealth services.

The entire release is here.

Friday, May 18, 2012

Court of Appeal Says Psychologist Can Be Disciplined For Misconduct as Family Law Special Master

By MetNews Staff Writer
Metropolitan News-Enterprise
Originally Published May 11, 2012

The state Board of Psychology properly disciplined a licensee for unethical conduct while serving as a special master in a contentious family law case, the Third District Court of Appeal ruled yesterday.

The justices affirmed Sacramento Superior Court Judge Patrick Marlette’s denial of Dr. Randy Rand’s petition for writ of mandate. Rand was challenging the board’s order placing him on probation for five years, based on findings of unprofessional conduct, gross negligence, violation of statutes governing the practice of psychology, and dishonesty.

The entire article is here.

Thanks to Ken Pope for this information.

Los Angeles-Area Psychologist Surrenders License

Psychiatric Crime Database
A Public Service of the Citizens Commission on Human Rights
Originally Published May 10, 2012

On March 6, 2012, psychologist Ross U. Porter surrendered his license to the California Board of Psychology in lieu of facing a hearing on twelve counts of negligence.

According to the Board’s document which laid out the accusations against him, Porter engaged in multiple relationships with the daughter of a family to whom he provided individual and family therapy. The family, described in the state’s documents as “The ‘A’ Family,” consisted of a mother, father and six children.

(cut)

Porter encouraged Angela to interact socially with his family and to do volunteer work in conjunction with a fundraiser for Porter’s non-profit organization he ran called Stillpoint. Porter also hired and paid her to baby sit and house sit for him. When a health care practitioner engages a patient in his or her business or social activities, it is considered potentially harmful to the patient and is a violation of the American Psychological Association’s ethical principles, as well as a violation of sections of the California Business and Professions Code.

(cut)

In late 2008, during a therapy session with Angela and her parents, Porter recommended that Angela be allowed to move into his home for an indefinite period of time. It was agreed and she moved in.

The whole story is here.

Thursday, May 17, 2012

Can You Call a 9-Year-Old a Psychopath?

By Jennifer Kahn
The New York Times
Originally published May 11, 2012

One day last summer, Anne and her husband, Miguel, took their 9-year-old son, Michael, to a Florida elementary school for the first day of what the family chose to call “summer camp.” For years, Anne and Miguel have struggled to understand their eldest son, an elegant boy with high-planed cheeks, wide eyes and curly light brown hair, whose periodic rages alternate with moments of chilly detachment. Michael’s eight-week program was, in reality, a highly structured psychological study — less summer camp than camp of last resort.

Michael’s problems started, according to his mother, around age 3, shortly after his brother Allan was born. At the time, she said, Michael was mostly just acting “like a brat,” but his behavior soon escalated to throwing tantrums during which he would scream and shriek inconsolably. These weren’t ordinary toddler’s fits. “It wasn’t, ‘I’m tired’ or ‘I’m frustrated’ — the normal things kids do,” Anne remembered. “His behavior was really out there. And it would happen for hours and hours each day, no matter what we did.” For several years, Michael screamed every time his parents told him to put on his shoes or perform other ordinary tasks, like retrieving one of his toys from the living room. “Going somewhere, staying somewhere — anything would set him off,” Miguel said. These furies lasted well beyond toddlerhood. At 8, Michael would still fly into a rage when Anne or Miguel tried to get him ready for school, punching the wall and kicking holes in the door. Left unwatched, he would cut up his trousers with scissors or methodically pull his hair out. He would also vent his anger by slamming the toilet seat down again and again until it broke.

Wednesday, May 16, 2012

Addiction Diagnoses May Rise Under Guideline Changes

By Ian Urbina
The New York Times
Originally published May 11, 2012

In what could prove to be one of their most far-reaching decisions, psychiatrists and other specialists who are rewriting the manual that serves as the nation’s arbiter of mental illness have agreed to revise the definition of addiction, which could result in millions more people being diagnosed as addicts and pose huge consequences for health insurers and taxpayers.

The revision to the manual, known as the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., would expand the list of recognized symptoms for drug and alcohol addiction, while also reducing the number of symptoms required for a diagnosis, according to proposed changes posted on the Web site of the American Psychiatric Association, which produces the book.

In addition, the manual for the first time would include gambling as an addiction, and it might introduce a catchall category — “behavioral addiction — not otherwise specified” — that some public health experts warn would be too readily used by doctors, despite a dearth of research, to diagnose addictions to shopping, sex, using the Internet or playing video games.

Diagnosing the D.S.M.

By Allen Frances
The New York Times - Opinion
Originally published May 11, 2012

At its annual meeting this week, the American Psychiatric Association did two wonderful things: it rejected one reckless proposal that would have exposed nonpsychotic children to unnecessary and dangerous antipsychotic medication and another that would have turned the existential worries and sadness of everyday life into an alleged mental disorder.

But the association is still proceeding with other suggestions that could potentially expand the boundaries of psychiatry to define as mentally ill tens of millions of people now considered normal. The proposals are part of a major undertaking: revisions to what is often called the “bible of psychiatry” — the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M. The fifth edition of the manual is scheduled for publication next May.

I was heavily involved in the third and fourth editions of the manual but have reluctantly concluded that the association should lose its nearly century-old monopoly on defining mental illness. Times have changed, the role of psychiatric diagnosis has changed, and the association has changed. It is no longer capable of being sole fiduciary of a task that has become so consequential to public health and public policy.

The entire story is here.

Tuesday, May 15, 2012

Publishers and Georgia State See Broad Implications in Copyright Ruling

By Jennifer Howard
The Chronicle of Higher Education
Published May 14, 2012

The publisher plaintiffs in the closely watched lawsuit over Georgia State University's use of copyrighted material in electronic reserves say they are "disappointed" with much of the ruling handed down by a federal judge on Friday. But they made the best of it in statements issued Monday, playing up points on which the judge had agreed with them. And one plaintiff, Oxford University Press, said that the decision "marks a significant first step toward addressing the need for clarity around issues of copyright in the context of higher education."

Meanwhile, in its own series of public comments, the university praised the judge's careful handling of a complex issue. It called the ruling, by Judge Orinda D. Evans of the U.S. District Court in Atlanta, "significant not only for Georgia State University, but for all educational fair use in general," in the words of President Mark P. Becker.

Kerry L. Heyward, the university's chief lawyer, added that the case "highlights the importance of fair use in providing academic faculty a cost-effective, legal way to spread important knowledge to their students." And Nancy H. Seamans, the university's dean of libraries, took a wider view of Georgia State's approach to fair use, saying that the university's policy on e-reserves "was based on practices from the broader academic library community."

The entire story is here.

Judge rules largely for GSU in copyright case

By Bill Rankin and Laura Diamond
The Atlanta Journal-Constitution
Originally published May 14, 2012

A federal judge in Atlanta has ruled in favor of Georgia State University on almost all infringement claims filed by three publishing houses in a closely watched case that tested the nature of copyright law in the digital age.

Senior U.S. District Judge Orinda Evans rejected 69 copyright claims against GSU filed by Cambridge University Press, Oxford University Press and SAGE Publications. The publishers had accused GSU of "massive" copyright violations by allowing professors to download and reproduce excerpts from published works for course materials.

(cut)

GSU, applying a 2009 policy, tried to comply with the Copyright Act, Evans said. "The truth is that fair use principles are notoriously difficult to apply," she wrote.


Thanks to Gary Schoener for this information.

Ignorance no defense for celebrity health records snoop

By Amanda Bronstad
National Law Journal
Originally published May 11, 2012

The Ninth Circuit has refused to toss out charges that a former researcher illegally obtained medical records of patients such as Arnold Schwarzenegger and Tom Hanks.

The court rejected arguments that the HIPAA-related charges should have been dismissed because Huping Zhou didn't know what he was doing was illegal.

The entire article is here.

A subscription is needed for this site.

Thanks to Ken Pope for this informaiton.

Monday, May 14, 2012

Psychiatry Manual Drafters Back Down on Diagnoses

By Benedict Carey
The New York Times - Health
Originally published May 8, 2012

In a rare step, doctors on a panel revising psychiatry’s influential diagnostic manual have backed away from two controversial proposals that would have expanded the number of people identified as having psychotic or depressive disorders.

The doctors dropped two diagnoses that they ultimately concluded were not supported by the evidence: “attenuated psychosis syndrome,” proposed to identify people at risk of developing psychosis, and “mixed anxiety depressive disorder,” a hybrid of the two mood problems.

They also tweaked their proposed definition of depression to allay fears that the normal sadness people experience after the loss of a loved one, a job or a marriage would not be mistaken for a mental disorder.

But the panel, appointed by the American Psychiatric Association to complete the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., did not retreat from another widely criticized proposal, to streamline the definition of autism.

Autism Criteria Critics Blasted by DSM-5 Leader

By John Gever, Senior Editor
MedPage Today
Origianlly Published May 8, 2012

The head of the American Psychiatric Association committee rewriting the diagnostic criteria for autism spectrum disorders took on the panel's critics here, accusing them of bad science.

Susan Swedo, MD, of the National Institute of Mental Health, said a review released earlier this year by Yale University researchers was seriously flawed. That review triggered a wave of headlines indicating that large numbers of autism spectrum patients could lose their diagnoses and hence access to services.

Swedo spoke at the American Psychiatric Association's (APA) annual meeting, in her role as chairperson of the work group developing new diagnostic criteria for neurodevelopmental disorders in DSM-5, the forthcoming fifth edition of the APA's Diagnostic and Statistical Manual of Mental Disorders.

She was especially incensed by reports in consumer media about the Yale group's study, led by a New York Times article with a "blaring" headline that read, "New Definition of Autism May Exclude Many, Study Suggests." The Yale study, according to the Times article, found that most patients with Asperger's syndrome and about 25% of those with overt autism would not qualify for those diagnoses under DSM-5.

Sunday, May 13, 2012

Measuring the Prevalence of Questionable Research Practices With Incentives for Truth Telling

*Psychological Science* has scheduled an article for publication in a future issue of the journal: "Measuring the Prevalence of Questionable Research Practices With Incentives for Truth Telling."

The authors are Leslie K. John of Harvard University, George Loewenstein of Carnegie Mellon University, & Drazen Prelec of the Massachusetts Institute of Technology.

Here is the abstract:
Cases of clear scientific misconduct have received significant media attention recently, but less flagrantly questionable research practices may be more prevalent and, ultimately, more damaging to the academic enterprise. Using an anonymous elicitation format supplemented by incentives for honest reporting, we surveyed over 2,000 psychologists about their involvement in questionable research practices. The impact of truth-telling incentives on self-admissions of questionable research practices was positive, and this impact was greater for practices that respondents judged to be less defensible. Combining three different estimation methods, we found that the percentage of respondents who have engaged in questionable practices was surprisingly high. This finding suggests that some questionable practices may constitute the prevailing research norm.
Here's how the article starts:

Although cases of overt scientific misconduct have received significant media attention recently (Altman, 2006; Deer, 2011; Steneck, 2002, 2006), exploitation of the gray area of acceptable practice is certainly much more prevalent, and may be more damaging to the academic enterprise in the long run, than outright fraud.

Questionable research practices (QRPs), such as excluding data points on the basis of post hoc criteria, can spuriously increase the likelihood of finding evidence in support of a hypothesis.

Just how dramatic these effects can be was demonstrated by Simmons, Nelson, and Simonsohn (2011) in a series of experiments and simulations that showed how greatly QRPs increase the likelihood of finding support for a false hypothesis.

QRPs are the steroids of scientific competition, artificially enhancing performance and producing a kind of arms race in which researchers who strictly play by the rules are at a competitive disadvantage.

QRPs, by nature of the very fact that they are often questionable as opposed to blatantly improper, also offer considerable latitude for rationalization and self-deception.

Concerns over QRPs have been mounting (Crocker, 2011; Lacetera & Zirulia, 2011; Marshall, 2000; Sovacool, 2008; Sterba, 2006; Wicherts, 2011), and several studies--many of which have focused on medical research--have assessed their prevalence (Gardner, Lidz, & Hartwig, 2005; Geggie, 2001; Henry et al., 2005; List, Bailey, Euzent, & Martin, 2001; Martinson, Anderson, & de Vries, 2005; Swazey, Anderson, & Louis, 1993).

In the study reported here, we measured the percentage of psychologists who have engaged in QRPs.

As with any unethical or socially stigmatized behavior, self-reported survey data are likely to underrepresent true prevalence.

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The study "surveyed over 2,000 psychologists about their involvement in questionable research practices."

The article reports that the findings "point to the same conclusion: A surprisingly high percentage of psychologists admit to having engaged in QRPs."

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Most of the respondents in our study believed in the integrity of their own research and judged practices they had engaged in to be acceptable.

However, given publication pressures and professional ambitions, the inherent ambiguity of the defensibility of "questionable" research practices, and the well-documented ubiquity of motivated reasoning (Kunda, 1990), researchers may not be in the best position to judge the defensibility of their own behavior.

This could in part explain why the most egregious practices in our survey (e.g., falsifying data) appear to be less common than the relatively less questionable ones (e.g., failing to report all of a study's conditions).

It is easier to generate a post hoc explanation to justify removing nuisance data points than it is to justify outright data falsification, even though both practices produce similar consequences.

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Another excerpt: "Given the findings of our study, it comes as no surprise that many researchers have expressed concerns over failures to replicate published results (Bower & Mayer, 1985; Crabbe, Wahlsten, & Dudek, 1999; Doyen, Klein, Pichon, & Cleeremans, 2012, Enserink, 1999; Galak, LeBoeuf, Nelson, & Simmons, 2012; Ioannidis, 2005a, 2005b; Palmer, 2000; Steele, Bass, & Crook, 1999)."

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More generally, the prevalence of QRPs raises questions about the credibility of research findings and threatens research integrity by producing unrealistically elegant results that may be difficult to match without engaging in such practices oneself.

This can lead to a "race to the bottom," with questionable research begetting even more questionable research.

----------------------
Thanks to Ken Pope for this information.

The abstract and article are here.

Report Finds Academic Fraud Evidence in UNC Department

By Dane Kane
http://www.newsobserver.com/
Originally published May 6, 2012

An internal investigation into UNC-Chapel Hill’s Department of African and Afro-American Studies has found evidence of academic fraud involving more than 50 classes that range from no-show professors to unauthorized grade changes for students.

One of the no-show classes is the Swahili course taken by former football player Michael McAdoo that prompted NCAA findings of impermissible tutoring, and drew more controversy when the final paper he submitted was found to have been heavily plagiarized.

The investigation found many of the suspect classes were taught in the summer by former department chairman Julius Nyang’oro, who resigned from that post in September. The university now says Nyang’oro, 57, who was the department’s first-ever chairman, is retiring July 1.

“Professor Nyang’oro offered to retire, and we agreed that was in the best interest of the department, the college and the university,” said Nancy Davis, associate vice chancellor for university relations.

The entire story is here.

Saturday, May 12, 2012

Suicide: The fourth-leading cause of American deaths abroad

By Gary Stoller
USA Today
Originally published May 4, 2012


Tom Miller jumped from the eighth floor of a hotel in the Philippines in February, and Gerhard Habel hanged himself in his apartment in Thailand last April.

These incidents aren't entirely unrelated. Suicide by an American in a foreign country is a more common occurrence than might be thought. It's the fourth-leading cause of death abroad from non-natural causes after road accidents, homicides and drowning, according to the Centers for Disease Control and Prevention.

The deaths of Miller and Habel stand out, though, because they were reported to the media by local police, and some information about the tragedies was made public.
Though more than 125 American suicides abroad are reported annually to the State Department, there is no public profile of most who commit the tragic act. For privacy reasons, the State Department will not provide victim information such as name, age, gender or addresses abroad.

"The travel medicine community could take preventative steps if there was more knowledge about risk factors and circumstances of those individuals who are committing suicide abroad," says Stephen Hargarten, director of the Injury Research Center at the Medical College of Wisconsin.

The Tragic Suicide Death of Junior Seau


By John M. Grohol, PsyD.
World of Psychology Blog

The evidence is in, and the death of NFL football player Junior Seau has been ruled a suicide. The speculation is that he suffered from depression as a result of the concussions he sustained as a pro football player in the U.S. Seau spent most of his football career as a San Diego Charger.

Many in the news media are portraying this as some sort of new news — that having your head repeatedly banged and bashed can cause long-lasting brain damage. Even with a padded helmet, there’s been a wealth of research demonstrating that head injuries still occur. The human head just wasn’t meant for years and years of such repeated abuse.

It’s also not the first time we’ve known of this link between football playing, concussions, and being at a much higher risk for depression (and even dementia). Perhaps this time the message will get through.

Friday, May 11, 2012

Providers to Test Power of Apology in Malpractice Claims


By Robert Lowes
Medscape Medical News
Originally published April 27, 2012

The Massachusetts Medical Society (MMS) wants to prove that clinicians and hospitals can keep medical malpractice out of the courtroom by owning up to their mistakes with apologies — and sometimes cash as well.

The result, says the MMS, will be not only fewer lawsuits but also improved patient safety, less defensive medicine, and lower costs.

Earlier this month, the MMS and 5 other state healthcare organizations announced the start of a pilot program to promote a process called Disclosure, Apology, and Offer, or DA&O. It's a kinder and gentler approach to medical liability reform compared with measures such as caps on noneconomic (pain and suffering) and punitive damages, which are viewed in some quarters as abridging the legal rights of patients.

Like most of organized medicine, MMS supports these traditional liability reforms, but it also sees merit in avoiding the courts.

"The current liability system impedes open communication," says Alan Woodward, MD, a past MMS president and chair of its professional liability committee. "It creates a culture of blame, finger-pointing, and secrecy. We're trying to turn that around into an advocacy system that supports both patients and providers."


Thanks to Gary Schoener for this lead.

Insurers Embrace "Virtual" Doctor Visits

By Phil Galewitz
KHN Staff Writer
Originally published May 6, 2012

Tired of feeling "like the walking dead" but worried about the cost of a doctor's visit, Amber Young sat on her bed near tears one recent Friday night in Woodbury, Minn.

That's when she logged onto an Internet site, run by NowClinic online care, a subsidiary of UnitedHealth Group (which also owns UnitedHealthcare), and "met" with a doctor in Texas.

After talking with the physician via instant messaging and then by telephone, Young was diagnosed with an upper respiratory illness and prescribed an antibiotic that her husband picked up at a local pharmacy. The doctor's "visit" cost $45.

"I was as suspicious as anyone about getting treated over the computer," said Young, 34, who was uninsured then. "But I could not have been happier with the service."

Read the entire story here.

Thursday, May 10, 2012

Yoo Can't Be Sued for Allegedly Authorizing Torture

By Scott Graham
The Recorder
Essential California Legal Content
Originally published May 2, 2012

John Yoo is off the hook.

John Yoo
A panel of the U.S. Court of Appeals for the Ninth Circuit that included two Democratic appointees ruled Wednesday that the former Bush administration lawyer cannot be sued personally for allegedly authorizing the torture and months-long detention of an American citizen deemed an enemy combatant.
 
The court ruled that 10 years ago, when Yoo was with Justice Department's Office of Legal Counsel, it was not "beyond debate" that suspected terrorists were entitled to the same constitutional protections as ordinary accused criminals. In fact, the court held, that law remains unsettled to this day.
 
Thus, Yoo, now a professor at UC-Berkeley School of Law, enjoys qualified immunity from a suit by Jose Padilla, who alleges he was brutalized by the government while being denied access to counsel or his family for 21 months. Although the government dropped the most serious charges against him, Padilla was ultimately convicted in 2007 of conspiring to murder, kidnap and maim people overseas, and was sentenced to 17 years in prison.

The entire story is here.

Thanks to Gary Schoener for this story.

Abbott Settles Marketing Lawsuit

By Michael S. Schmidt and Katie Thomas
The New York Times - Business Day
Originally published May 7, 2012

The pharmaceutical company Abbott Laboratories said on Monday that it had reached an agreement with the federal and nearly all state governments to pay $1.6 billion in connection with its illegal marketing of the anti-seizure drug Depakote.

The settlement comes as the Justice Department and the states have increased scrutiny of the sales and marketing practices of pharmaceutical companies, particularly in cases in which they market drugs for uses that are not approved by the Food and Drug Administration.

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Doctors may prescribe drugs for any purpose, but pharmaceutical companies are prohibited from promoting drugs for conditions that are not approved by the agency.

Wednesday, May 9, 2012

GPs Reminded to Regularly Assess Depressed Patients for Risk of Suicide

Originally Published on May 4, 2012

GPs are being advised to ensure patients with depression are regularly assessed for a risk of suicide. The Medical Defence Union (MDU) issued the advice after being notified of a small number of complaints in which GPs were criticised for failing to appreciate that the patient was a suicide risk.

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The MDU's advice for GPs to help them avoid such problems includes:
  • Be aware of the current guidance on the treatment of depression, including the role of non-drug interventions.
  • Ensure patients understand what is being prescribed and have been warned about the risks involved, any side-effects and alternatives to treatment.
  • Have a system in place to review patients on long-term medication.
  • All patients who present with depression need to be assessed regularly for risk of suicide.
  • Be prepared to refer patients for specialist treatment where necessary and have a system to track referrals.
  • Take care with prescriptions for drugs with similar names and with dosages.

The entire story is here.

NY Fines 15 Insurers over Mental Health Notices

Associated Press
The Wall Street Journal
Originally published May 9, 2012

ALBANY, N.Y. — New York regulators have fined 15 insurers $2.7 million for failing to notify small businesses they were eligible to buy special coverage for mental illnesses and children with serious emotional disturbances.

Superintendent of Financial Services Benjamin Lawsky says they are the first fines under Timothy's Law, named for a teen who committed suicide after his parents were unable to obtain needed mental health treatment. The law took effect in 2007.

The rest of the story is here.

More information on Timothy's Law is here.

Psychoactive Medication Use Among Children In Foster Care

The Children's Hospital of Philadelphia
"Hope Lives Here"
Originally published April 30, 2012

A few months after the federal Government Accountability Office (GAO) issued a report on the use of psychoactive drugs by children in foster care in five states, a national study from PolicyLab at The Children's Hospital of Philadelphia describes prescription patterns over time in 48 states. The updated findings show the percentage of children in foster care taking antipsychotics - a class of psychoactive drugs associated with serious side effects for children - continued to climb in the last decade. At the same time, a slight decline was seen in the use of other psychoactive medications, including the percentage of children receiving 3 or more classes of these medications at once (polypharmacy).

Psychoactive drugs prescribed at higher rates for foster children

As public scrutiny has increased about the use of psychoactive medication by children over the past decade, children in foster care continue to be prescribed these drugs at exceptionally high rates compared with the general population of U.S. children. According to the PolicyLab study, 1 in 10 school-aged children (aged 6-11) and 1 in 6 adolescents (aged 12-18) in foster care were taking antipsychotics by 2007.

The entire story is here.

Contact: Dana Mortensen, Children's Hospital of Philadelphia, 267-426-6092

Tuesday, May 8, 2012

Vignette 13: Troubles in the ICU

You are a psychologist in a busy acute care hospital where you receive frequent consultation requests by the trauma service.  A physician requests a psychological evaluation of a 46-year-old man who attempted suicide via over dose of prescription medications along with alcohol. You arrive in the intensive care unit where the patient’s respiratory status is rapidly deteriorating. He is marginally coherent and unable to give any consistent responses.  However, upon his arrival in the emergency department, the medical record quotes the patient as saying, “This wasn’t supposed to have happened.”

The ICU nurse asks you to offer an opinion regarding the patient’s capacity to accept or refuse intubation.

While you are there, a family member arrives with a copy of a notarized advance directive, created within the last year, which specifically outlines the patient’s wishes not to be placed on a ventilator or any artificial life support. The ICU staff asks for your input.

What are the ethical issues involved?

What would you do in this situation?

Would your answer differ if the advanced directive was created 7 years ago or greater?

Would your answer differ if there were no advanced directives?