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

Friday, May 31, 2013

Not robots: children's perspectives on authenticity, moral agency and stimulant drug treatments

By Ilina Singh
J Med Ethics 2013;39:359-366 doi:10.1136/medethics-2011-100224

Abstract

In this article, I examine children's reported experiences with stimulant drug treatments for attention deficit hyperactivity disorder in light of bioethical arguments about the potential threats of psychotropic drugs to authenticity and moral agency. Drawing on a study that involved over 150 families in the USA and the UK, I show that children are able to report threats to authenticity, but that the majority of children are not concerned with such threats. On balance, children report that stimulants improve their capacity for moral agency, and they associate this capacity with an ability to meet normative expectations. I argue that although under certain conditions stimulant drug treatment may increase the risk of a threat to authenticity, there are ways to minimise this risk and to maximise the benefits of stimulant drug treatment. Medical professionals in particular should help children to flourish with stimulant drug treatments, in good and in bad conditions.

The entire article is here.

1 in 5 U.S. Kids Has a Mental Health Disorder: CDC

By Brenda Goodman
HealthDay Reporter
Originally published May 16, 2013

As many as one in five American children under the age of 17 has a diagnosable mental disorder in a given year, according to a new federal report.

Released Thursday, the report represents the government's first comprehensive look at mental disorders in children. It focuses on diagnoses in six areas: attention-deficit/hyperactivity disorder (ADHD), behavioral or conduct disorders, mood and anxiety disorders, autism spectrum disorders, substance abuse, and Tourette syndrome.

The most common mental disorder among children aged 3 through 17 is ADHD. Nearly 7 percent -- about one in 15 children -- in that age group have a current diagnosis, according to the report from the U.S. Centers for Disease Control and Prevention.

The entire story is here.

Thursday, May 30, 2013

A Big Thank You - 250,000 Page View Milestone

A Big Thank You to everyone who has visited this site, followed this site, and contributed to this site.  Ethics education is an exciting and fun area for psychologists as well as those professionals working in the mental health field.

A few numbers from the statistics page.....

The Ethics Education and Psychology site is a little over 2 years old

Over 250,000 page views

47% of page views come from beyond the US

139 countries have visited the site

252 follow by email

24 follow by Twitter

13 follow by Google+

Over 1,100 stories about ethics linked to this site

55 articles and professional papers related to ethics and ethics education are housed on the site

43 PowerPoint presentations available (over 19,000 SlideShare views & 169 downloads)

25 real life ethical vignettes for educational purposes

25 audio/video resources for teaching ethics

17 links to blogs of interest

The hope is to continue to broaden and build this site for educational purposes.

Thank you for your continued support!!

If you like what you have seen, then feel free to spread the word.




Bioethicists must not allow themselves to become a 'priestly caste'

The increasing use of expert bioethicists has profound anti-democratic implications

By Nathan Emmerich
The Guardian - Political Science Blog
Originally published May 18, 2013

In a secular age it might seem that the time for moral authorities has passed. However, research in the life sciences and biomedicine has produced a range of moral concerns and prompted the emergence of bioethics; an area of study that specialises in the ethical analysis of these issues. The result has been the emergence of what we might call expert bioethicists, a cadre of professionals who, while logical and friendly, have, nevertheless, been ordained as secular priests.

This suggestion – that there are expert bioethicists – might appear to have profoundly anti-democratic implications. Indeed handling expertise, including scientific expertise, is a central difficulty for democratic societies and its extension into the realm of moral values seems, on the face of it, to compound the problem. Nevertheless the Human Fertilisation and Embryology Authority (HFEA) has constantly made use of expert bioethicists and two members of the recently convened Emerging Science and Bioethics Advisory Committee (ESBAC) are listed as "bioethics specialists".

If we are to govern the biosciences and medical practice effectively there seems to be increasing need for expert bioethicists. Nevertheless, there is a different dynamic to the politics of bioethical expertise precisely because the opinions of bioethical experts cannot be used to obviate those of other moral agents.

This might seem like an odd claim. If there are expert bioethicists surely we should prefer their opinions to those of non-experts? However this is to assume bioethical expertise is modelled on scientific expertise. The idea of the scientist as expert is so strong we often forget that there are other forms of expertise.

The entire post is here.

Say twenty hail Autonomy’s and reflect on what you have done – bioethicists as having some, but not priestly authority

By David Hunter
BMJ Group Blogs
Originally published May 17, 2013

Nathan Emmerich, occasional commentator here at the JME blog has recently published an interesting piece in the Guardian which argues against us taking bioethicists as having a particular type of expertise. While I enjoyed and agree with much of what he argues I do have a couple of quibbles – in particular I worry that the emphasis on inclusiveness and democracy could in effect lead to the exclusion of the bioethicist, which I think would be a mistake.

The type of expertise he argues against bioethicists having is basically what I will refer to as authoritative expertise – someone who has authoritative expertise in a particular field ought to be deferred to when there is a disagreement – their opinion is “better” than ours as lay decision makers. So for example when deciding how long an object is, and whether it will fit in the boot of our car, we ought to defer to the chap with the tape measure, since their measured judgement is better than ours.

I use this example for a reason – Emmerich focuses on knowledge based expertise (no doubt because it is easier to explain to the lay public…) but this isn’t the only form of expertise that warrants some deference there is also expertise which is performative (in this case the act of measuring well). I’m inclined to think that if bioethicists deserve any deference it will be due to their performative expertise, rather than their knowledge.

Emmerich suggests however that bioethicists should not be taken as having authoratative expertise because he thinks knowledge about morality is more like knowledge about aesthetics than knowledge about facts. Hence we ought to give no more weight to the bioethicists opinion about an ethical issue, than we do someone heavily steeped in the Art’s worlds opinion about a piece of modern art – they have a “sophisticated” view but that doesn’t tell me what I should think about the piece.

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I think the bioethicist is in a position to contribute something useful to such deliberation, debate and discussion in two ways, both of which require some expertise – even if it is not totally authorative expertise. The first way is this, the bioethicist I assume will have access to more knowledge both about what has been argued in regards to ethical theory and in regards to moves in applied ethics. Knowing these moves can short-cut some discussion and debate by showing paths that will lead nowhere – the implications and consequences of particular arguments.

The entire response is here.

Wednesday, May 29, 2013

The SUPPORT Study and the Standard of Care Read

By Lois Shepherd
The Hastings Center Bioethics Forum
Originally posted May 17, 2013

The clinical research community and a number of prominent bioethicists have swiftly come to the defense of investigators conducting the SUPPORT study, in which approximately 1,300 premature infants were randomly assigned to be maintained at higher or lower levels of oxygen saturation. The study took place between 2005 and 2009, involved 22 sites and was reviewed by at least as many institutional review boards. In March, the Office of Human Research Protection (OHRP) concluded that investigators had violated the informed consent provisions of the federal regulations governing research by failing to inform parents of infants enrolled in the study about risks of retinopathy, neurological injury, and death. Results from the study revealed that infants assigned to receive the lower range of oxygen suffered higher rates of death than infants assigned to the upper range, while the latter suffered higher rates of retinopathy than the former.  Defenders accuse OHRP of faulting the investigators for failing to inform parents of risks they learned about only through the study.

The central point of disagreement between defenders and critics of the study appears to be whether participants in the study were receiving medical care that was different from the care they would have received outside the study and whether participation in research therefore carried any medical risks that required risk/benefit scrutiny by IRBs or disclosure to parents of the infants enrolled.  This would appear to be a factual matter about which one could obtain some clarity, but discussions of this issue have been somewhat opaque.

Part of the reason for this may be different, but unacknowledged, understandings of the concept of “standard of care,” a term used – both in the informed consent forms and the commentary about them – but rarely defined in this debate.

The entire article is here.

Physician Congressman Fined for Having Sex With 2 Patients

By Robert Lowes
Medscape Medical News
Originally published on May 24, 2014

Rep. Scott DesJarlais, MD (R-TN), was fined $500 by the state medical board in Tennessee for having sexual relationships with 2 female patients in 2000, according to a consent order approved by the board on May 22.

The Board of Medical Examiners of Tennessee also reprimanded Dr. DesJarlais, characterizing his behavior as "unprofessional conduct."

Dr. DesJarlais, a general practitioner who was first elected to represent Tennessee's Fourth Congressional District in 2010, signed the consent order on May 20.

The consent order describes in bare-bones fashion what was laid out in voluminous detail about Dr. DesJarlais' personal life during and after his 2012 reelection campaign. From roughly January 2000 to May 2000, Dr. DesJarlais "had a sexual relationship with 2 female patients," the order states. "No documentation exists to show whether or not the physician-patient relationship was severed prior to the commencement of a romantic relationship with either female patient."

The board fined Dr. DesJarlais $250 for each patient. He also is responsible for the state's cost of prosecuting the case, up to $1000.

The rest of the story is here.

Tuesday, May 28, 2013

VA tries quality improvement approach to medical ethics

Tools to evaluate how health care facilities perform ethically are in their infancy. The VA Health Care System hopes others can benefit from its experience.

By Tanya Albert Henry
amednews.com
Originally posted May 20, 2013

How often does a physician have enough time to discuss a treatment recommendation with a patient?

Would a doctor be reluctant to raise concerns if he or she believes a colleague's clinical abilities are impaired?

How often are notes or papers with identifiable patient information left in areas where other patients, relatives or staff members might view the sensitive material?

These are just a few of the questions the National Center for Ethics in Health Care at the U.S. Dept. of Veterans Affairs is using to query its staff at the VA Health Care System. The goal is to help facilities see what they are doing well in terms of ethics and point out areas where they could be doing more.

The concept is similar to the recent push to evaluate quality of care by asking about procedural issues such as how well physicians are helping patients control hypertension or whether hospitals are keeping infection rates low.

Ethics evaluations, though, are not so common, and surveys do not tie payment to how well facilities score. However, the idea of measuring ethics as a component of quality of care is gaining momentum, and leaders in the field say its time has come.

“This is about managing ethics the same way you manage health care quality,” said Ellen Fox, MD, chief ethics in health care officer for the Veterans Health Administration. “Ethics quality is an important area that can have a dramatic effect on health care, including life-and-death decisions. … An effective ethics program promotes better patient care, better patient satisfaction, better efficiency.”

The entire story is here.

Learning From Litigation

By Joanna C. Schwartz
The New York Times - Op Ed
Originally published May 16, 2013

MUCH of the discussion over the Affordable Care Act has focused on whether it will bring down health care costs. Less attention has been paid to another goal of the act: improving patient safety. Each year tens of thousands of people die, and hundreds of thousands more are injured, as a result of medical error.

Experts agree that the best way to reduce medical error is to gather and analyze information about past errors with an eye toward improving future care. But many believe that a major barrier to doing so is the medical malpractice tort system: the threat of being sued is believed to prevent the kind of transparency necessary to identify and learn from errors when they occur.

New evidence, however, contradicts the conventional wisdom that malpractice litigation compromises the patient safety movement’s call for transparency. In fact, the opposite appears to be occurring: the openness and transparency promoted by patient safety advocates appear to be influencing hospitals’ responses to litigation risk.

I recently surveyed more than 400 people responsible for hospital risk management, claims management and quality improvement in health care centers around the country, in cooperation with the American Society of Health Care Risk Managers, and I interviewed dozens more.

The entire story is here.

Monday, May 27, 2013

Students say Swarthmore has been soft on sex crime, and they’re fed up

By Will Bunch
Philadelphia Daily News
Originally published May 10, 2013

IN THE DARKNESS of night, the complaints were etched in chalk up and down the walkways of Swarthmore College, a 399-acre oasis of green quads and liberal student activism southwest of Philadelphia.

"Welcome to Swarthmore," said one of the scribblings that recently confronted students - and administrators - when the sun rose. "Home of my rapist."

The so-called chalkings, which infuriated Swarthmore's president, were a turning point in a controversy that has rattled one of America's top-ranked liberal-arts schools. It has also placed female students there on the cutting edge of a national movement - charging that colleges and universities are systematically ignoring, downplaying and underreporting sexual assault and sexual harassment.
Hope Brinn says administrators were dismissive after a male student showed up in her room when she was unclothed and refused to leave, and Mia Ferguson says she was an assault victim. The two 19-year-old sophomores organized 20 other students and alums to complain to federal authorities that Swarthmore is violating the 1990 Clery Act that requires full reporting of campus crimes, including sexual assaults.

"Swarthmore will lead on this issue," said Ferguson, an engineering major who was born in England and grew up outside Boston. She acknowledged that their complaint that Swarthmore is soft on alleged perpetrators of sex crimes and underreporting incidents is at odds with the Delaware County school's reputation as a liberal oasis - one of many contradictions in a controversy that has now sparked campus protests and teach-ins.

The entire article is here.

Sexual Assaults Mishandled At Dartmouth, Swarthmore, USC, Complaints Say

By Tyler Kingkade
The Huffington Post
Originally published May 23, 2013

When University of Southern California student Tucker Reed was sexually assaulted in 2010, she turned to school officials. But instead of helping to bring her justice, she said, their "ignorance and indifference" further traumatized her. She said a USC official told her the goal was not to "punish" her assailant, but rather to offer an "educative" process.

"Rape is not an educative experience," Reed said. "It is a crushing, life-altering, inhuman violence."

Feeling like she had no other options, Reed on Wednesday filed a formal complaint with U.S. Department of Education, claiming USC's administration failed to respond adequately to the assault. Students and alumni who were assault victims at three other prestigious schools -- University of California, Berkeley; Dartmouth College; and Swarthmore College -- filed similar claims alleging the schools failed to properly adjudicate campus sex crimes.

The filings were coordinated through a network of campus sexual assault survivors and advocates. The complainants from the four colleges received help filing the complaints from students and alumni at the University of North Carolina and Occidental College who filed similar complaints against their schools earlier this year. Some students at Occidental and USC have retained attorneys, including Gloria Allred, for potential lawsuits against the schools.

The entire article is here.

Seven subjects off limits for teaching, Chinese universities told

Civil rights, press freedom and party's mistakes among subjects banned from teaching in order described by an academic as back-pedaling

By Raymond Li
South China Morning Post
Originally published May 11, 2013

Mainland universities have been ordered to steer clear of seven topics in their teaching, including universal values, press freedom and civil rights, two university staff said, offering an insight into ideological control under the new Communist Party leaders.

A law professor with a Shanghai-based university who requested anonymity because he feared persecution said yesterday that teaching staff at his university had been briefed about the seven taboo subjects, which also include judicial independence and the past mistakes of the Communist Party.

"Are we still a university if we are not allowed to talk about even civil rights and press freedom?" he asked.

He said he had no idea which party department had given the order, saying they were simply told that it came from the party's Central Committee.

A Beijing-based industrial relations professor said yesterday the order, in the form of a classified document, had come from the General Office of the party's Central Committee, and only a select group of teaching and administrative staff at his university had been briefed about it.

The Beijing professor, who also declined to be named, said he had not personally seen the document but had been briefed on it because he had been outspoken.

"It's apparent back-pedaling if we cannot talk about what the Communist Party did wrong in the past," he said.

The entire story is here.

Sunday, May 26, 2013

Medical ethics language doesn’t stick with students

A study finds a gap between learning ethical terms and using them in a clinical setting, which can lead to a lack of shared understanding.

By MARCIA FRELLICK
amednews correspondent — Posted May 15, 2013

Do medical school students remember ethical principles when they start practicing medicine?

Because physicians need shared language and universal terms when they discuss ethical issues with each other and with patients, researchers at the University of Iowa Carver College of Medicine examined how well terms and concepts taught in school were recalled and incorporated in the clinical years. The study asked 109 third-year medical students at the University of Iowa to recall ethics terms learned in the first two years of school.

Results were mixed, according to the study posted online April 14 in AJOB Primary Research. The students were much more likely to name the four ethical principles (beneficence, nonmaleficence, respect for patient autonomy and justice) than the six sources of ethical value or categories for justifying an ethical decision (ethical principles, rights, consequences, comparable cases, professional guidelines and conscientious practice).

Overall, 59.6% of the students remembered all four principles, but the highest number of sources of ethical value recalled was four of the six. Only 10% of students could name three or four of the six sources.

The entire article is here.

Here is the original research abstract.

Background: 
Ethics education is an established part of the medical school curriculum and typically involves preclinical instruction that includes formal ethical terminology. However, it is not clear whether the language of ethics taught in preclinical settings is applied by students during the clinical years of training.

Methods: 
We used a survey and a content analysis of written reflections to determine whether third-year (clinical) medical students were able to recall and apply ethical principles and other sources of ethical value they were taught as second-year (preclinical) students.

Results: 
The majority of clinical students were able to recall the four ethical principles, appreciated the relevance of preclinical ethics education, and had positive self-assessments of their clinical-ethical reasoning abilities. However, they were less able to recall other (nonprinciple) sources of ethical value and infrequently used ethical terms spontaneously in written reflections about ethically or professionally challenging issues.

Conclusions: 
Ethics educators should consider the extent to which preclinical ethics education depends on a formal language of ethics and should develop ways to reinforce that language meaningfully through experience-based learning opportunities during the clinical years of training, with special emphasis on the way clear ethical reasoning and communication demonstrate respect for other persons.

Owning Our Mistakes

By Nate Kreuter
Inside Higher Ed - Career Advice
Originally published May 15, 2013

Some of the columns that I write here at Inside Higher Ed arise from a really basic formula. It goes something like this: I make a mistake at work. I realize my error, or am compelled by another party to realize it, and I take corrective action. Then I write a column addressing the mistake in general terms, in hopes of perhaps removing a little of the trial and error from this whole higher education gig for a reader or two. Somewhat less frequently I simply observe the mistake of another and then write a column. I probably couldn’t keep up with this column without the steady stream of mistakes I make myself. Maybe my mistakes are job security of a strange sort.

I probably could even use this venue to make a public promise regarding my mistakes to my colleagues in my department, college, university, and across my discipline. Here goes: I promise you all that I’ll screw up again one day. I don’t know exactly how and I don’t know exactly when, but I promise to bungle something. Maybe just in a small way. Maybe in a big way. Who knows?

But here’s what I also promise: I promise to own up to whatever mistakes I make as soon as I recognize them, to do everything in my power to correct them, and to do my damnedest not to repeat them. This is, I think and I hope, what it means to be a good colleague. I certainly would not ask a colleague for more, but I also expect no less.

If to err is human, then 'fessing up is humane. Humane for ourselves and humane for our fellows.

The entire post is here.

Saturday, May 25, 2013

VETS Act Expands Veterans Access to Care, Protects Patient Safety

The American Telemedicine Association strongly supports the proposed Veterans E-Health and Telemedicine Support Act (H.R. 2001,) lauding it as a key step in improving healthcare quality by minimizing regulatory barriers for interstate telemedicine.

Press Release
The American Telemedicine Association
Originally published May 16, 2013

The American Telemedicine Association voices its strong support for the new Veterans E-Health and Telemedicine Support Act (H.R. 2001) as one key step in lowering regulatory barriers to 21st century healthcare. The bi-partisan bill, introduced by Representatives Charles Rangel (D-NY) and Glenn Thompson (R-PA) and cosponsored by 21 Members of Congress, would permit U.S. Department of Veterans Affairs health professionals to treat veterans nationwide with a single state license.

This bill, known as the VETS Act, builds on the unanimous congressional enactment of the 2011 STEP Act (Servicemembers' Telemedicine and E-Health Portability Act,) which provides a similar provision for healthcare providers in the U.S. Department of Defense. A similar licensing rule for patients and providers of Medicare, Medicaid and other major federal health programs was included in a comprehensive telemedicine bill submitted by Rep. Mike Thompson (D-CA) in December 2012.

“These bills are a simple way, while preserving the states’ role to license, to address shortages of medical specialists, to improve patient access to the best qualified physicians, and to accommodate mobile Americans and multi-state health plans,” said Jonathan Linkous, Chief Executive Officer of the American Telemedicine Association. “They accommodate both patient choice and patient safety. We would like to see a similar act for all federal patients and providers.”

Presently, most providers who practice interstate telemedicine must be licensed both where the patient and provider are physically located. Such regulation increases the cost of healthcare and is an artificial barrier, favoring the business interests of local physicians over patient choice. Some state medical boards are even imposing stricter licensing requirements for telehealth providers than they do for in-person care, such as requiring a prior face-to-face examination for each and every case.

“Access to quality healthcare is, ultimately, the foremost safety issue for the patient,” concluded Linkous. “It’s time that we allow patients to make an appointment and see a qualified licensed health provider regardless of where the patient or provider is located."

About the American Telemedicine Association

The American Telemedicine Association is the leading international resource and advocate promoting the use of advanced remote medical technologies. ATA and its diverse membership, works to fully integrate telemedicine into transformed healthcare systems to improve quality, equity and affordability of healthcare throughout the world. Established in 1993, ATA is headquartered in Washington, DC.

For more information visit http://www.americantelemed.org.

Vermont Legalizes Assisted Suicide

By Wilson Ring
The Associated Press
Originally published May 20, 2013

After years of debate, Vermont became the fourth state in the country Monday to allow doctors to prescribe lethal doses of medicine to terminally ill patients seeking to end their lives.

Gov. Peter Shumlin signed the bill into law at a Statehouse ceremony even as opponents vowed to push for its repeal.

The End of Life Choices law was effective immediately, although it could be weeks before the state Health Department develops regulations in accordance with the new measure.

Vermont Health Commissioner Dr. Harry Chen said he expects doctors to write between 10 and 20 lethal prescriptions a year, with a smaller number of patients actually using the drugs.

He based his figures on the experience in Oregon, the first state to legalize assisted suicide in 1997. Washington state and Montana followed later, with Montana's coming by way of a court order.

The entire story is here.

Friday, May 24, 2013

Doctors’ Lucrative Industry Ties

By Roni Caryn Rabin
The New York Times - The Consumer Blog
Originally published May 13, 2013

Dr. Alfred J. Tria is the chief of orthopedic surgery at St. Peter’s University Hospital, a 478-bed facility in New Brunswick, N.J., and to the medical technology company Smith & Nephew, his good word is worth a million bucks. Well, $940,857, to be precise.

That’s how much the company paid Dr. Tria in fees for promoting its products and training doctors in Asia to use them from 2009 to 2011, according to disclosures required by the state of Massachusetts, where Dr. Tria is licensed. In 2010, Dr. Tria earned $421,905 from private industry — more than any other Massachusetts-licensed physician that year.

Dr. Tria may be an outlier, but gifts and payments to physicians from drug and medical device companies have been rampant in medicine for decades. Over a two-and-a-half-year period, device and drug companies shelled out over $76 million just to physicians licensed in Massachusetts, according to a study published online this month in The New England Journal of Medicine. That amount does not include outlays of less than $50, which are exempt from disclosure.

The entire story is here.

Why Groupon and other social coupons are unethical in healthcare

By Deniza Gertzberg
www.kevinmd.com
Originally published on May 16, 2013

In addition to the possible legal pitfalls of advertising on Groupon-type websites, there are also ethical and practice management concerns to be weighed by healthcare practitioners before agreeing to such arrangements. Even with the recent announcement that companies such as Groupon and LivingSocial may be offering contracts to healthcare providers that take into consideration the prohibition against fee splitting, practitioners should nonetheless proceed with caution.

The concerns about social coupons in the healthcare context extend further than what is strictly legal as doctors also face the more basic question of whether such advertising practices are appropriate. It is not surprising that we find an increasing number of professional organizations speaking out about the ethical implications of providing social discounts to consumers. Several past presidents of the British Association of Aesthetic Plastic Surgeons, for example, in 2011 spoke out strongly against the practice of advertising discounts for plastic surgeries online.

Similarly, in the United States, we are seeing professional societies discussing the legality and ethical implications of such arrangements. The American Dental Association (ADA) last year, for example, issued an advisory opinion prohibiting the use of social coupons if such an arrangement would constitute fee splitting.

The entire blog post is here.

Thanks to Ed Zuckerman for this lead.

Thursday, May 23, 2013

New Mental-Health Manual Likely to Impact HR

Making accommodations for employees with mental disabilities has never been easy, and it's about to get more difficult with the release of the American Psychiatric Association's new manual of mental disorders.

By James J. McDonald, Jr.
Human Resource Executive Online
Originally published May 22, 2013

In psychiatry, unlike other branches of medicine, there is no laboratory test that can confirm the existence of a particular mental disorder. Psychiatrists and other mental health professionals rely on the Diagnostic and Statistical Manual of Mental Disorders, known as "DSM-5" to diagnose patients. The American Psychiatric Association has just released a new fifth edition of the manual and human resources executives should take note. It contains new diagnostic categories not listed in its predecessor and loosens the criteria for some diagnoses which will likely result in more people qualifying for these diagnoses. DSM-5 is likely to impact HR by expanding the number of employees who will qualify as disabled under the Americans with Disabilities Act and be entitled to reasonable accommodation.

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New Diagnoses

DSM-5 adds several new diagnoses that employers are likely to find vexing. One is "Social (Pragmatic) Communication Disorder," which describes persons whose communication skills are impaired but who do not qualify for an autism diagnosis. It applies to persons with "persistent difficulties in the social use of verbal and nonverbal communications" that limit social relationships or occupational performance. While typically diagnosed in childhood it can continue into adulthood. Employees previously thought to be merely shy or socially awkward may qualify for this new diagnosis.

Another new diagnosis is "Binge Eating Disorder," a condition characterized primarily by eating a large amount of food in a short time at least once per week for three months. DSM-5 notes that while most overweight persons do not engage in recurrent binge-eating, Binge Eating Disorder is "reliably associated with overweight and obesity."  Thus, this diagnosis makes it more likely that obesity (at least when precipitated by binge-eating) might finally qualify as a disability under the ADA.

Largest US Hospice Company Sued for Medicare Fraud

By Kelli Kennedy
The Associated Press/ABC News
Originally posted May 9, 2013

The Department of Justice is suing the hospice company founded by Florida's Senate president, accusing it of submitting tens of millions of dollars in fraudulent Medicare claims for more than a decade, including while Don Gaetz was vice chairman of the board.

Vitas Hospice and Vitas Healthcare submitted claims for emergency services for patients that weren't needed, weren't provided, or were provided to patients who weren't eligible under Medicare requirements, according to the DOJ. The companies set goals for the number of crisis-care days to be billed and pressured their employees to submit more claims so it would get more revenue, the lawsuit said. The agency said Medicare payments for crisis care can be hundreds of dollars greater than typical hospice care payments.

Vitas is the largest U.S. hospice care chain, and its parent company Chemed Corp. said the claims go back to 2002, two years before it acquired the company.

The entire article is here.

Doctors and nurses among nearly 100 charged in $223 million Medicare fraud busts in 8 cities

By Associated Press
Originally published May 14, 2013

Nearly 100 people, including 14 doctors and nurses, were charged for their roles in separate Medicare scams that collectively billed the taxpayer-funded program for roughly $223 million in bogus charges in a massive bust spanning eight cities, federal authorities said Tuesday.

It was the latest in a string of similar announcements by Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder as federal authorities crack down on fraud that’s believed to cost the program between $60 billion and $90 billion each year. Stopping Medicare’s budget from hemorrhaging that money will be key to paying for President Barack Obama’s health care overhaul. Sebelius and Holder partnered in 2009 to increase enforcement by allocating more money and staff and creating strike forces in fraud hot spots around the country.

The entire story is here.

Wednesday, May 22, 2013

Doctors Protest Psychiatric Manual Revision in Global Petition

By Natasha Khan
Bloomberg News
May 15, 2013

Doctors are protesting new guidance for the diagnosis of some mental disorders, including autism, contained in the revised edition of a professional manual to be released in coming days.

The so-called “psychiatric bible,” whose first update in 19 years will be released at a medical meeting that opens in San Francisco on May 18, also influences the way patients are treated and reimbursed for mental disorders. A petition that raised concerns about the manual’s diagnostic categories and patient safety received more than 3,000 signatures from Paris to Montreal in recent months.

The Diagnostic and Statistical Manual of Mental Disorders is the standard used by mental-health professionals for diagnosing illness and for research. The newest edition is meant to incorporate the latest research findings and has collapsed several conditions, including Asperger’s syndrome and child disintegrative disorder, into a single autism diagnosis.

The entire article is here.

Medicine's big new battleground: does mental illness really exist?

The latest edition of DSM, the influential American dictionary of psychiatry, says that shyness in children, depression after bereavement, even internet addiction can be classified as mental disorders. It has provoked a professional backlash, with some questioning the alleged role of vested interests in diagnosis

By Jaime Doward
The Observer
Originally published May 11, 2013

It has the distinctly uncatchy, abbreviated title DSM-5, and is known to no one outside the world of mental health.

But, even before its publication a week on Wednesday, the fifth edition of the Diagnostic and Statistical Manual, psychiatry's dictionary of disorders, has triggered a bitter row that stretches across the Atlantic and has fuelled a profound debate about how modern society should treat mental disturbance.

Critics claim that the American Psychiatric Association's increasingly voluminous manual will see millions of people unnecessarily categorised as having psychiatric disorders. For example, shyness in children, temper tantrums and depression following the death of a loved one could become medical problems, treatable with drugs. So could internet addiction.

Inevitably such claims have given ammunition to psychiatry's critics, who believe that many of the conditions are simply inventions dreamed up for the benefit of pharmaceutical giants.

A disturbing picture emerges of mutual vested interests, of a psychiatric industry in cahoots with big pharma. As the writer, Jon Ronson, only half-joked in a recent TED talk: "Is it possible that the psychiatric profession has a strong desire to label things that are essential human behaviour as a disorder?"

Psychiatry's supporters retort that such suggestions are clumsy, misguided and unhelpful, and complain that the much-hyped publication of the manual has become an excuse to reheat tired arguments to attack their profession.

The entire article is here.

Tuesday, May 21, 2013

Your Privacy Online

A Project by the Markkula Center of Applied Ethics - Santa Clara University

This looks to be a great teaching tool.

Your Privacy Online

Should you care about privacy?

This group of resources addresses that question, including an exploration of what privacy has to do with ethics, threats to privacy, and steps you can take to protect your privacy.

The site has sections labeled:
*   Defining Privacy
*   A Privacy Quiz
*   Loss of Privacy: What's the Harm?
*   Information about you = $
*   Are Attitudes Changing about Privacy?
*   A Case Study on Online Privacy
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*   The Ethics of Online Privacy Protection



DSM-IV Boss Presses Attack on New Revision

By John Gever, Deputy Managing Editor
MedPage Today
Published: May 17, 2013

A new edition of psychiatry's diagnostic guide "will probably lead to substantial false-positive rates and unnecessary treatment," charged the man who led development of the last version.

To be released this weekend at the American Psychiatric Association's annual meeting, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, "introduce[s] several high-prevalence diagnoses at the fuzzy boundary with normality," according to Allen Frances, MD, who chaired the task force responsible for DSM-IV issued in 1994.

Frances, now an emeritus professor at Duke University, wrote online in Annals of Internal Medicine that changes from DSM-IV will apply disease labels to individuals who may be unhappy or offensive but still normal. Such individuals would include those experiencing "the forgetfulness of old age" as well as children with severe, chronic temper tantrums and individuals with physical symptoms with no medical explanation.

He also worried about new marketing pushes from the pharmaceutical industry seeking to exploit what he believes are "loose" diagnostic criteria in the new edition. "Drug companies take marketing advantage of the loose DSM definitions by promoting the misleading idea that everyday life problems are actually undiagnosed psychiatric illness caused by a chemical imbalance and requiring a solution in pill form," he wrote.

The entire article is here.

Monday, May 20, 2013

Did Mormon Morality Teachings Really Make it Harder for Elizabeth Smart to Run?

By Joanna Brooks
Religion Dispatches
Joanna Brooks Blog post
Originally published May 8, 2013

Elizabeth Smart made big news this week—from Associated Press headlines to feminist blogs like Wonkette and Jezebel to the Mormon bloggernacle—when she connected her inability to run from her kidnappers to feelings of worthlessness stemming from harsh sexual morality lessons traditional to Mormon culture.

Speaking to a human trafficking forum at Johns Hopkins University last week, Smart recalled that it was not only fear for the safety of her family that kept her from running but also a sense that rape had ruined her:
“It goes beyond fear. It’s feelings of self worth. Who would ever want me now? I’m worthless. That is what it was for me the first time I was raped. I was raised in a very religious household, one that taught that sex was something very special that only happened between a husband and a wife who loved each other... For that first rape, I felt crushed. ‘Who could want me now?’ I felt so dirty and so filthy. I understand all too well why someone wouldn’t run because of that alone. If you can imagine the most special thing being taken away from you? And feeling not that that was your only value in life, but that devalued you? I remember in school one time I had a teacher who was talking about abstinence, and she said, imagine, you’re a stick of gum and when you engage in sex, that’s like getting chewed, and if you do that lots of times, you’re going to be an old piece of gum, and who’s going to want you after that? And that’s terrible, but nobody should ever say that, but for me, I thought, I’m that chewed up piece of gum. Nobody ever rechews a piece of gum.  …That’s how easy it is to feel that you no longer have worth, you no longer have value. Why would you even bother screaming out?”


The entire blog post is here.

See Elizabeth Smart speak here.

Mental Evaluations Endorse Insanity Plea in Colorado Shootings, Defense Says

By Jack Healy
The New York Times
Published May 13, 2013

Mental health experts who evaluated the man accused of killing 12 people in a Colorado movie theater last year have offered a diagnosis that bolsters an insanity plea in the case, his lawyers said at a hearing here on Monday.

“We now have a diagnosis that’s complete,” Daniel King, a defense lawyer for the suspect, James E. Holmes, said in court. “We now have an opinion by qualified professionals.”

Mr. Holmes, 25, a former graduate student in neuroscience, faces 166 counts of murder, attempted murder and weapons charges in the July 20 shooting during a midnight premiere of the Batman movie “The Dark Knight Rises” at an Aurora movie theater. Officials say he slipped out of an emergency exit shortly after the movie began, sheathed himself in commando-style gear and then returned through the same door to spray the sold-out crowd with gunfire.

Mr. Holmes’s lawyers made a long-expected move on Monday to change his plea to not guilty by reason of insanity. At an arraignment in March, a judge entered a straightforward not guilty plea on Mr. Holmes’s behalf after his lawyers said they were not ready to enter a plea.

The entire story is here.

Sunday, May 19, 2013

California Senate leader proposes mental health program expansions

By Patrick McGreevy
The Los Angeles Times
Originally posted May 7, 2013

State Senate leader Darrell Steinberg (D-Sacramento) on Tuesday proposed a plan to significantly increase mental health services in California with the goal of reducing the number of people ending up in prison, jail and emergency rooms.

Steinberg said the plan is in response to the Newtown, Conn., school massacre, in which a gunman killed 20 students and six adults, as well as a scandal involving a Nevada hospital dumping patients in other states, and the recent order by a federal court to further cut the number of inmates in California prisons

“It’s time for action,” he told reporters at the Capitol. Steinberg proposed expanding a program providing mental health services to prison parolees with mental illness from 1,500 to 5,000 people. Those in the program have a recidivism rate of 24%, nearly a third of the rate for those not in the program.

“While the governor appeals a federal court order to release thousands of state prison inmates, we also need to be smarter about crime by putting more resources into ensuring people who leave incarceration don’t commit new crimes and go back in,’’ Steinberg said.

The entire story is here.

Dangers found in lack of safety oversight for Medicare drug benefit

By Tracy Weber, Charles Ornstein and Jennifer LaFleur
ProPublica
Originally published: May 11, 2013

Here is an excerpt:

But an investigation by ProPublica has found the program, in its drive to get drugs into patients’ hands, has failed to properly monitor safety. An analysis of four years of Medicare prescription records shows that some doctors and other health professionals across the country prescribe large quantities of drugs that are potentially harmful, disorienting or addictive for their patients. Federal officials have done little to detect or deter these hazardous prescribing patterns.

Searches through hundreds of millions of records turned up physicians such as the Miami psychiatrist who has given hundreds of elderly dementia patients the same antipsychotic, despite the government’s most serious “black box” warning that it increases the risk of death. He believes he has no other options.

Some doctors are using drugs in unapproved ways that may be unsafe or ineffective, records showed. An Oklahoma psychiatrist regularly prescribes the Alzheimer’s drug Namenda for autism patients as young as 12; he says he thinks it calms them. Autism experts said there is scant scientific support for this practice.

The entire article is here.

Saturday, May 18, 2013

New Efforts to Overhaul Psychiatric Diagnoses Spurred by DSM Turmoil

By Greg Miller
Wired Science
Originally posted May 17, 2013

Thousands of psychiatrists will descend on San Francisco this weekend for a meeting that will mark the release of the latest edition of the profession’s diagnostic guide, the Diagnostic and Statistical Manual of Mental Disorders, or DSM for short. This hugely influential book has been 14 years in the making, and it’s been dogged by controversies every step of the way.

To name just a few, there have been allegations of financial conflicts of interest, debates over whether internet addiction is really a thing (it is not, but “disordered gambling” is), arguments that the new diagnostic criteria will medicalize normal grief and temper tantrums, and lead to millions of people being falsely diagnosed with mental disorders.

With the new manual on the eve of its official debut, many experts are already looking beyond it. Some envision a future in which psychiatric diagnoses are based on the underlying biological causes instead of a description of a patient’s symptoms. Others caution that such a single-minded focus on biology ignores important social factors that contribute to mental illness. If there’s any area of agreement it’s this: There has to be a better way.


The DSM is used by doctors to diagnose patients, by insurance companies to decide what treatments to pay for, and by pharmaceutical companies and government funding agencies to set research priorities. The new edition, DSM-5, defines hundreds of mental disorders.

The fundamental problem, according to many of DSM’s critics, is that these definitions don’t carve nature at its joints.

“An obvious, easy example is schizophrenia,” said Peter Kinderman, a clinical psychologist at the University of Liverpool. “If you’re a 52-year-old man who hears voices, you’ll receive a diagnosis of schizophrenia. If you’re a 27-year-old woman with delusional beliefs, you’ll also receive a diagnosis of schizophrenia,” Kinderman said. “Two people can receive the same diagnosis and not have a single thing in common. That’s ludicrous scientifically.”

In most areas of medicine, diagnoses are based on the cause of illness. Heartburn and heart attacks both cause chest pain, but they’re different diagnoses because they have different underlying causes.

The entire story is here.

Psychiatry’s Guide Is Out of Touch With Science, Experts Say

By PAM BELLUCK and BENEDICT CAREY
The New York Times
Published: May 6, 2013

Just weeks before the long-awaited publication of a new edition of the so-called bible of mental disorders, the federal government’s most prominent psychiatric expert has said the book suffers from a scientific “lack of validity.”

The expert, Dr. Thomas R. Insel, director of the National Institute of Mental Health, said in an interview Monday that his goal was to reshape the direction of psychiatric research to focus on biology, genetics and neuroscience so that scientists can define disorders by their causes, rather than their symptoms.

While the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., is the best tool now available for clinicians treating patients and should not be tossed out, he said, it does not reflect the complexity of many disorders, and its way of categorizing mental illnesses should not guide research.

“As long as the research community takes the D.S.M. to be a bible, we’ll never make progress,” Dr. Insel said, adding, “People think that everything has to match D.S.M. criteria, but you know what? Biology never read that book.”

The entire story is here.

Why the Fuss Over the D.S.M.-5?

By Sally Satel
The New York Times - Opinion
Originally published on May 11, 2013

LATER this month, the American Psychiatric Association will unveil the fifth edition of its handbook of diagnoses, the Diagnostic and Statistical Manual of Mental Disorders. Fourteen years in the making, the D.S.M.-5 has been the subject of seemingly endless discussion.
      
The charges are familiar: the manual medicalizes garden-variety distress, leads doctors to prescribe unnecessary medications, serves as a cash cow for the association, and so forth.
      
But many critics overlook a surprising fact about the new D.S.M.: how little attention practicing psychiatrists will give to it.
      
There are dozens of revisions in the D.S.M. — among them, the elimination of a “bereavement exclusion” from major depressive disorder and the creation of binge eating disorder — but they won’t alter clinical practice much, if at all.
      
This is because psychiatrists tend to treat according to symptoms.
      
So why the fuss over D.S.M.-5? Because of the unwarranted clout that its diagnoses carry with the rest of society: They are the passports to insurance coverage, the keys to special educational and behavioral services in school and the tickets to disability benefits.
      
This is a problem because the D.S.M. is an imperfect guide to predicting what treatments will benefit patients most — a reality tied to the fact that psychiatric diagnoses are based on clinical appearances that tend to cluster, not on the mechanism behind the illness, as is the case with, say, bacterial pneumonia.

Friday, May 17, 2013

Reconsidering the Declaration of Helsinki

By Ezekiel J. Emanuel
The Lancet, Volume 381, Issue 9877, 
Pages 1532 - 1533, 4 May 2013
doi:10.1016/S0140-6736(13)60970-8

Next year will mark the 50th anniversary of the Declaration of Helsinki. Consequently, the World Medical Association (WMA) is developing its eighth version of the Declaration. This anniversary presents an excellent opportunity to reconsider the problems of the Declaration and how they can be remedied to ensure the document retains its prominent status.

In 1964 when the Declaration of Helsinki was initially enacted, it contained 11 articles and 713 words. At that time, the Declaration was unique. Over the years, ethical guidance on research involving human participants has proliferated substantially to encompass the Belmont Report by the US National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research; the International Ethical Guidelines for Biomedical Research Involving Human Subjects of the Council for International Organizations of Medical Sciences; multiple laws and regulations, such as the US Federal Policy for the Protection of Human Subjects (known as the “Common Rule”, 45 CFR part 46) and the European Union's Clinical Trials Directive; and the eight principles of What Makes Research Ethical?. Simultaneously, the Declaration of Helsinki has been revised six times and tripled in size with its 35 articles and 2045 words. The revisions have often been extensive. For instance, the distinction between “clinical research combined with professional care” and “non-therapeutic clinical research” was eliminated after much withering criticism. The article that relates to use of placebos was revised and scaled back multiple times between 2000 and 2008.

Over the years problems with, and objections to, the document have accumulated. I propose that there are nine distinct problems with the current version of the Declaration of Helsinki: it has an incoherent structure; it confuses medical care and research; it addresses the wrong audience; it makes extraneous ethical provisions; it includes contradictions; it contains unnecessary repetitions; it uses multiple and poor phrasings; it includes excessive details; and it makes unjustified, unethical recommendations. For instance, the Declaration reads like a haphazard list of articles without an overall logical framework. The topics of articles 21 to 24 are literally a jumble: they cover the importance of the research outweighing research risks, the requirement for voluntary consent, the need to protect participants' privacy, and informed consent requirements for competent individuals, respectively.

The entire article is here.

Michael Shermer - The Moral Arc of Science

Thursday, May 16, 2013

One Fifth Of Suicidal Teens Have Access To Guns At Home

By Joseph Nordqvist
Medical News Today
Originally published May 6, 2013

Around twenty percent of adolescents in the U.S. who are considered "suicidal" have guns in their homes, according to a recent study published at the Pediatric Academic Societies (PAS) annual meeting in Washington, DC.

In addition, the researchers revealed that 15 percent of those at risk of suicide know how to use the guns and the ammunition and have access to both.

According to data from the Centers for Disease Control and Prevention data, among young people between the ages of 10 and 24, suicide is the second leading cause of death.

Around half of teenage suicides are carried out using a firearm.

Suicide is a serious public health issue worldwide. It is the most prevalent cause of death in female teenagers and the second most common among male teenagers after road traffic accidents. Official estimates reveal that suicide causes close to 164,000 deaths every year.

The researchers carried out the study to create and develop a new tool for doctors to use which can help identify teenagers and young adults who require some form of intervention to prevent them from harming themselves. They asked the youths about their access to firearms as well as ammunition.

The entire story is here.

Minnesota now 12th state to approve gay marriage

By Sofia Perpetua
NBCNews.com
Originally published May 15, 2013

As thousands cheered outside the state Capitol with rainbow and American flags, Governor Mark Dayton signed a bill on Tuesday that makes it possible for same-sex couples to get married.

Minnesota is the 12th state to pass a gay marriage bill and the first Midwestern state to do so through a legislative vote.

"What a day for Minnesota!" Dayton, a Democrat, declared moments before putting his signature on a bill. "And what a difference a year and an election can make in our state."

The bill was signed a day after it was approved by the Senate in a 37-30 vote.

"It is an overwhelming joyful day, the culmination of years of work. Two years ago it would have been unimaginable to be here," said Jake Loesch, communications director with Minnesotans United, a LGBT group. "It was incredible, we had 7,000 people cheering as the bill as signed, it was probably the biggest crowd the Capitol has ever seen."

The entire story is here.

Wednesday, May 15, 2013

One Step Forward On Mental Health Parity

The American Psychiatric Association
Press release on May 1, 2013

Yesterday, the United States District Court for the District of Vermont became the first court in the country to interpret the Mental Health Parity and Addiction Equity Act of 2008—and that decision is favorable to mental health patients.

In C. M. v. Fletcher Allen Health Care, Inc., plaintiff C. M. challenges her health plan’s administration of mental health benefits. Specifically, she alleges that the Plan violates MHPAEA by: (1) requiring pre-approval for routine mental health services but not for medical-surgical services; (2) conducting concurrent reviews of mental health services but not requiring such reviews for medical-surgical services; and (3) initiating automatic review processes triggered by a fixed number of visits for mental health services but not for medical-surgical services.

The defendant argued that the Interim Final Regulations under MHPEA require that, in addition to demonstrating that mental health services were treated in a different manner than medical-surgical services, patients have to demonstrate that “no clinically appropriate standard of care would permit a difference,” to prove violation of MHPAEA. The Court disagreed, finding that “the Parity Act was promulgated to eliminate impermissible disparity in the benefits afforded for mental health and substance abuse disorders when compared to those afforded medical/surgical conditions. ...  It stands to reason that plan administrators would also bear the burden of establishing, under the Parity Act, why mental health and medical benefits are treated differently based upon divergent clinical standards.”

According to Colleen Coyle, General Counsel of the American Psychiatric Association, “this is significant because it clearly puts the burden on the insurance industry to provide clinically appropriate standards of care to justify treating mental health claims differently than medical-surgical claims. Mental health and substance disorder patients have a right to know whether they are being treated differently than patients with other physical or surgical issues, and if so, on what clinical grounds the insurance companies justify that difference.”  The APA assisted the plaintiff’s counsel in briefing the MHPAEA arguments in this case, has filed another lawsuit against insurers Anthem and WellPoint, and is in the process of challenging several other insurance carriers it believes are violating mental health parity.

Lead attorney representing C.M., Alison J. Bell, partner at Langrock Sperry & Wool, LLP, said, “Mental health parity is an important lifeline for my client, who was denied benefits for medical care desperately needed in order to live a healthy life.  We are grateful for the APA’s assistance with MHPAEA issues.”

Meiram Bendat, founder of Psych-Appeal, which assists mental health professionals and their patients in challenging insurance denials for mental health treatment, added “Psych-Appeal has worked hard to bring the parity issues to the forefront in this case and proudly hails its collaboration with plaintiff's counsel and the American Psychiatric Association."

Last weekend, former Congressman Patrick Kennedy held a round table discussion with psychiatrists, patients, mental health advocates, and political leaders about mental health parity, and the need for patients to speak out publicly about disparate treatment of mental health claims in order to ensure that the full vision of MHPAEA is realized. (Read one of the patient stories as previously provided in hearings held by the Connecticut Health Care Advocate’s office.)  James Scully, CEO and Medical Director of the APA stated, “The APA applauds plaintiff C.M. and others who spoke at the round table last week for having the courage to stand up for the right to care. We look forward to the day when parity is fully realized and those with a mental illness and/or substance use disorders can expend their energy and resources conquering the illness, rather than battling the insurance companies for the coverage to which they are entitled and for which they and their employer have paid.”

The American Psychiatric Association is a national medical specialty society whose physician members specialize in the diagnosis, treatment, prevention and research of mental illnesses, including substance use disorders. Visit the APA at www.psychiatry.org.

Parity Laws: Powerful Weapon--or Pipe Dream?

By Heidi Anne Duerr, MPH
Psychiatric Times
Originally published May 6, 2013

Is true mental health parity really possible, even with the Mental Health Parity and Addiction Equity Act (MHPAEA)? It’s beginning to look like the answer is maybe–but only with a fight.

Across the US, the war for parity is being fought, with numerous law suits asking courts to help ensure the law has real bite. In the meantime, does this mean patients without legal support and know-how are going without proper care—or that real parity is just a pipe dream?

Just recently, the US District Court for the District of Vermont was the first court to interpret and support the MHPAEA.1 In this case, the plaintiff alleged Fletcher Allen Health Care Inc, the plaintiff’s health plan administrator, violated the parity law “by imposing, both in writing and in practice, more stringent reviews for mental health benefits than are imposed for medical benefits.”

Specifically, the complaint noted the insurer “conducts prospective and concurrent medical necessity reviews of routine, outpatient, out-of-network mental health office visits while … [the plan] conducts no such reviews for comparable medical office visits.” In addition, the plaintiff alleged that the plan “imposes a numeric cap on the number of routine outpatient visits participants may request before pre-approval is required for all subsequent medical necessity reviews.”

Meanwhile, the New York State Psychiatric Association filed a class-action suit against UnitedHealth Group for violating both federal and state antidiscrimination laws. Among other complaints, the suit noted UnitedHealth Group denied or delayed access to care and required continuing authorizations for psychotherapy, intensive outpatient treatment, and partial hospitalization.

The entire story is here.

Tuesday, May 14, 2013

Ethics of Erasing Memory

By David Levin
NOVA Science Now
pbs.org
Originally posted January 13, 2011

Neuroscientists have identified a chemical that can erase the connections between brain cells, essentially wiping out memories. Although it can't target specific experiences, like a traumatic event, its existence raises a lot of big ethical issues. In this interview, we asked Art Caplan to help us sort them out. He's the director of the Center for Bioethics at the University of Pennsylvania.

The podcast and transcript are here.

Kierkegaard at 200

By Gordon Marino
The New York Times - Op Ed
Originally published May 3, 2013

THE intellectual immortal Soren Kierkegaard turns 200 on Sunday. The lyrical Danish philosopher is widely regarded as the father of existentialism, a philosophical and literary movement that emphasizes the category of the individual and meditates on such gauzy questions as, Is there a meaning to life?
      
Not surprisingly, existentialism hit its zenith after humanity got a good look at itself in the mirror of the Holocaust, but then memories faded and economies boomed and existentialism began to seem a little overwrought.

(cut)

In one of his books Kierkegaard moans, “The present age is an age of publicity, the age of miscellaneous announcements: Nothing happens but still there is instant publicity.” In the end, Kierkegaard was concerned about the power of the press to foment and form public opinion and in the process relieve of us of the need to think matters through on our own.
      
Over a 17-year span, Kierkegaard published a score of books and compiled thousand of pages of journal entries. Like Nietzsche and other geniuses who were more than less immolated by the fiery force of their own ideas, Kierkegaard sacrificed his body to dance out the riches of his thoughts. Self-conscious of his own preternatural powers, he wrote, “Geniuses are like thunderstorms. They go against the wind, terrify people, cleanse the air.”

Monday, May 13, 2013

Vignette 25: A Questionable Letter

Dr. Betty Frances has been treating Peggy Olson for anxiety and depression related to job stress and intermittent spousal bullying.  During their course of treatment, Mr. Olson physically abused Mrs. Olson to the point where the police arrested him on charges of domestic violence and terroristic threats.  Because of the seriousness of his threats and prior criminal behavior, Mr. Olson’s family could not bail him out of prison.

After this event, Mrs. Olson became more forthcoming with Dr. Frances.  His behavioral history includes stalking, assault, battery, public disturbance, public intoxication, and other out of control behaviors.  Dr. Frances continues to treat Mrs. Olson for anxiety and depression on a weekly basis.

Dr. Frances arrived at her office one day and found a letter with the return address of Mr. Olson at the local detention facility.  Dr. Frances feels an anxiety reaction in her body.  Trying to calm down, Dr. Frances writes out a list of questions.

1.      Should I open the letter now (as it is addressed to me)?
2.      Should I tell the patient about the letter before I open it?
3.      What are the benefits of telling the patient about the letter?
4.      What are the drawbacks of telling the patient about the letter?
5.      If the letter contains threatening information toward Mrs. Olson, or me, am I able to turn the letter over to the District Attorney?
6.      Am I required to turn the letter over to the DA if there is threatening information in it?
7.      How much control does the patient have over the letter and its contents?
8.      Is the letter automatically part of the treatment record or does it depend on the contents of the letter?
9.      Do I need a self-care plan as I am stressed out about this situation?

Having calmed down and written out these questions, Dr. Frances calls you for an ethics consultation about the letter.

What are your responses to her questions about the letter?

Sunday, May 12, 2013

Capitalism is killing our morals, our future

By Paul B. Farrell
The Wall Street Journal
Originally published April 29, 2013


Yes, capitalism is working ... for the Forbes 1,000 Global Billionaires whose ranks swelled from 322 in 2000 to 1,426 recently. Billionaires control the vast majority of the world’s wealth, while the income of American workers stagnated.

For the rest of the world, capitalism is not working: A billion live on less than two dollars a day. With global population exploding to 10 billion by 2050, that inequality gap will grow, fueling revolutions, wars, adding more billionaires and more folks surviving on two bucks a day.

Over the years we’ve explored the reasons capitalism blindly continues on its self-destructive path. Recently we found someone who brilliantly explains why free-market capitalism is destined to destroy the world, absent a historic paradigm shift: That is Harvard philosopher Michael Sandel, author of the new best-seller, “What Money Can’t Buy: The Moral Limits of Markets,” and his earlier classic, “Justice: What’s the Right Thing to Do?”

For more than three decades Sandel’s been explaining how capitalism is undermining America’s moral values and why most people are in denial of the impact. His classes are larger than a thousand although you can take his Harvard “Justice” course online. Sandel recently summarized his ideas about capitalism in the Atlantic. In “What Isn’t for Sale?” he writes:

“Without being fully aware of the shift, Americans have drifted from having a market economy to becoming a market society ... where almost everything is up for sale ... a way of life where market values seep into almost every sphere of life and sometimes crowd out or corrode important values, non-market values.”

Sandel should be required reading for all Wall Street insiders as well as America’s 95 million Main Street investors. Here’s a condensed version:

In one generation, market ideology consumed America’s collective spirit

“The years leading up to the financial crisis of 2008 were a heady time of market faith and deregulation — an era of market triumphalism,” says Sandel. “The era began in the early 1980s, when Ronald Reagan and Margaret Thatcher proclaimed their conviction that markets, not government, held the key to prosperity and freedom.”

And in the 1990s with the “market-friendly liberalism of Bill Clinton and Tony Blair, who moderated but consolidated the faith that markets are the primary means for achieving the public good.”

Today “almost everything can be bought and sold.” Today “markets, and market values, have come to govern our lives as never before. We did not arrive at this condition through any deliberate choice. It is almost as if it came upon us,” says Sandel.

The entire article is here.

You can find Harvard University's Justice with Michael Sandel here.

Schools drop Mellow’s name

By Andrew Seder
The Times Leader
Originally published April 25, 2013

The name of disgraced ex-state Sen. Robert J. Mellow has been removed from two buildings, a portion of one local college campus and one park.

On Thursday, Marywood University issued a statement saying, “After thoughtful consideration, The Marywood University Board of Trustees made the decision this past Saturday at their spring meeting to rename the university’s athletic center. The center originally named for Senator Robert J. Mellow, will for the foreseeable future be referred to as The Marywood University Center for Athletics and Wellness.”

Also, Lackawanna College President Mark Volk sent an email to all college staff members Thursday informing them that the campus’ Mellow Theater has been renamed.

“The college’s board of trustees met recently and after a serious discussion decided to name the college’s theater. Effective immediately, it is officially The Theater at Lackawanna College,” Volk wrote in the email obtained by The Times Leader.

The entire story is here.

Saturday, May 11, 2013

Physicians build less rapport with obese patients

By K.A. Gudzune, M.C. Beach, D.L. Roter, & L.A. Cooper
Obesity (Silver Spring). 2013 Mar 20. doi: 10.1002/oby.20384.

Abstract

Objective: 
Physicians' negative attitudes towards patients with obesity are well documented. Whether or how these beliefs may affect patient-physician communication is unknown. We aimed to describe the relationship between patient BMI and physician communication behaviors (biomedical, psychosocial/lifestyle, and rapport building) during typical outpatient primary care visits.

Design and Methods: 
Using audio-recorded outpatient encounters from 39 urban PCPs and 208 of their patients, we examined the frequency of communication behaviors using the Roter Interaction Analysis System. The independent variable was measured patient BMI and dependent variables were communication behaviors by the PCP within the biomedical, psychosocial/lifestyle, and rapport building domains. We performed a cross-sectional analysis using multilevel Poisson regression models to evaluate the association between BMI and physician communication.

Results: 
PCPs demonstrated less emotional rapport with overweight and obese patients (IRR 0.65, 95%CI 0.48-0.88, p=0.01; IRR 0.69, 95%CI 0.58-0.82, p<0.01, respectively) than for normal weight patients. We found no differences in PCPs' biomedical or psychosocial/lifestyle communication by patient BMI.

Conclusions:
Our findings raise the concern that low levels of emotional rapport in primary care visits with overweight and obese patients may weaken the patient-physician relationship, diminish patients' adherence to recommendations, and decrease the effectiveness of behavior change counseling.

And, click here for a blog post on this article, with the excerpt below:

Are Doctors Nicer to Thinner Patients?

By TARA PARKER-POPE
The New York Times - Well Column
Originally published April 29, 2013

Here is an excerpt:

“When there is increased empathy by the doctor, patients are more likely to report they are satisfied with their care, and they are more likely to adhere to recommendations of physicians,” Dr. Gudzune said. “There is evidence to show that after visits with more empathy, patients have improved clinical outcomes, so patients with diabetes have better blood sugar control or cholesterol is better controlled.”

Dr. David L. Katz, director of the Yale-Griffin University Prevention Research Center, says that overweight patients often complain to him that doctors appear judgmental about their weight, at the expense of other health concerns.

“You come in with a headache, and the doctors say, ‘You really need to lose weight.’ You have a sore throat, and the doctor says, ‘You really need to lose weight,’ ” he said. “These patients feel like the doctor doesn’t help them and they insult them, and so they stop going.”

In dealing with patients who are overweight, Dr. Katz added, doctors often show the same biases and prejudices as the culture at large. The problem may be compounded by the fact that doctors are trained to deal with immediate medical problems that have specific solutions, like a pill to lower blood pressure or emergency treatment for a heart attack. But obesity is a far more complex problem that isn’t easy to solve, and that can be frustrating to doctors.

“When we can’t fix what is broken we tend to behave badly,” he said.


Genetic Testing Recommendations Contradict Professional Ethics, Experts Say

By Rebecca Voelker
News@JAMA
Originally posted May 9, 2013

Recent recommendations that advise laboratories and physicians how to tell patients about incidental findings in genetic tests contradict ethical clinical practice, according to bioethicists at Stanford University’s Center for Biomedical Ethics in California.

A working group convened by the American College of Medical Genetics and Genomics (ACMG) released recommendations in March saying that clinical DNA sequencing laboratories should test for a list of specific genetic abnormalities regardless of the clinical reason for testing and report the results to the patient’s physician. In turn, the recommendations say physicians have a responsibility to give patients all the findings, even if patients don’t want results that aren’t relevant to the condition for which they were tested.

The ACMG recommends that patients who undergo genome sequencing be tested for conditions including various forms of cancer, cardiomyopathy, and familial hypercholesterolemia in addition to their primary medical condition.

Recommending that patients not be able to choose whether they want to receive incidental findings, even when test results suggest adult-onset conditions in children, “contradicts ethical clinical practice in general,” wrote bioethicists Megan Allyse, PhD, and Marsha Michie, PhD, in the journal Trends in Biotechnology.

The entire article is here.

The ACMG recommendations are here.

Friday, May 10, 2013

The Mind of a Con Man

By YUDHIJIT BHATTACHARJEE
The New York Times
Published: April 26, 2013

Here are some excerpts:

Stapel was an academic star in the Netherlands and abroad, the author of several well-regarded studies on human attitudes and behavior. That spring, he published a widely publicized study in Science about an experiment done at the Utrecht train station showing that a trash-filled environment tended to bring out racist tendencies in individuals. And just days earlier, he received more media attention for a study indicating that eating meat made people selfish and less social.

His enemies were targeting him because of changes he initiated as dean, Stapel replied, quoting a Dutch proverb about high trees catching a lot of wind. When Zeelenberg challenged him with specifics — to explain why certain facts and figures he reported in different studies appeared to be identical — Stapel promised to be more careful in the future. As Zeelenberg pressed him, Stapel grew increasingly agitated.

Finally, Zeelenberg said: “I have to ask you if you’re faking data.”

“No, that’s ridiculous,” Stapel replied. “Of course not.”

That weekend, Zeelenberg relayed the allegations to the university rector, a law professor named Philip Eijlander, who often played tennis with Stapel. After a brief meeting on Sunday, Eijlander invited Stapel to come by his house on Tuesday morning. Sitting in Eijlander’s living room, Stapel mounted what Eijlander described to me as a spirited defense, highlighting his work as dean and characterizing his research methods as unusual. The conversation lasted about five hours. Then Eijlander politely escorted Stapel to the door but made it plain that he was not convinced of Stapel’s innocence.

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And yet as part of a graduate seminar he taught on research ethics, Stapel would ask his students to dig back into their own research and look for things that might have been unethical. “They got back with terrible lapses­,” he told me. “No informed consent, no debriefing of subjects, then of course in data analysis, looking only at some data and not all the data.” He didn’t see the same problems in his own work, he said, because there were no real data to contend with.

The entire story is here.

Conversion therapy advocate issues formal apology, renounces “ex-gay” past

John Paulk says in a statement that he was never "cured" of being gay and apologizes for harming the LGBT community

BY KATIE MCDONOUGH
Salon.com
Originally posted April 25, 2013

Former Exodus International chairman and conversion therapy “success story” John Paulk has written a formal statement of apology for his role in promoting Focus on the Family’s “ex-gay” ministry and for any harm his actions may have done to other gays and lesbians.

In the letter, Paulk admits that “many things” in his life changed during his time at Focus on the Family, though his sexual orientation did not.

The entire letter of apology can be found here.

Here are some excerpts:

"So in 2003, I left the public ministry and gave up my role as a spokesman for the “ex-gay movement.” I began a new journey. In the decade since, my beliefs have changed. Today, I do not consider myself “ex-gay” and I no longer support or promote the movement. Please allow me to be clear: I do not believe that reparative therapy changes sexual orientation; in fact, it does great harm to many people.

I  know that countless people were harmed by things I said and did in the past.

Parents, families, and their loved ones were negatively impacted by the notion of reparative therapy and the message of change. I am truly, truly sorry for the pain I have caused."

The Salon story is here.

Thursday, May 9, 2013

Poor Prognosis for Privacy

By Melinda Beck
The Wall Street Journal
Originally published May 1, 2013

The sharing of Americans' health information is set to explode in coming years, with millions of patients' medical records converted to electronic form and analyzed by health-care providers, insurers, regulators and researchers.

That has prompted concerns over privacy—and now, new federal rules that aim to give patients more control over their information are posing technical and administrative problems for the doctors and hospitals that have to implement them.

Information-technology experts say the challenges illustrate how difficult it may be to protect sensitive patient information as digitization of the health-care industry expands.

"The reality is, our ability to exchange electronic information is already well beyond our ability to control it," says John Leipold, CEO of Valley Hope Technology in Norton, Kan., which makes electronic record systems for behavioral-health providers.

The new rules are part of a revision of the 1996 Health Insurance Portability and Accountability Act, known as HIPAA. They went into effect in March, but providers have until Sept. 23 to comply.

One key new provision requires doctors and hospitals not to disclose medical information to a patient's insurer if the patient requests it and pays for the services out-of-pocket. The information can be noted in the patient's medical file, but stopping it being revealed to insurers inadvertently may be difficult, some health-care providers say.

The entire story is here.

You will likely hit a pay-wall for this story.