How Could the CDC Make That Mistake?

Alexis C. Madrigal & Robinson Meyer
The Atlantic
Originally posted 21 May 20

The Centers for Disease Control and Prevention is conflating the results of two different types of coronavirus tests, distorting several important metrics and providing the country with an inaccurate picture of the state of the pandemic. We’ve learned that the CDC is making, at best, a debilitating mistake: combining test results that diagnose current coronavirus infections with test results that measure whether someone has ever had the virus. The upshot is that the government’s disease-fighting agency is overstating the country’s ability to test people who are sick with COVID-19. The agency confirmed to The Atlantic on Wednesday that it is mixing the results of viral and antibody tests, even though the two tests reveal different information and are used for different reasons.

This is not merely a technical error. States have set quantitative guidelines for reopening their economies based on these flawed data points.

Several states—including Pennsylvania, the site of one of the country’s largest outbreaks, as well as Texas, Georgia, and Vermont—are blending the data in the same way. Virginia likewise mixed viral and antibody test results until last week, but it reversed course and the governor apologized for the practice after it was covered by the Richmond Times-Dispatch and The Atlantic. Maine similarly separated its data on Wednesday; Vermont authorities claimed they didn’t even know they were doing this.

The widespread use of the practice means that it remains difficult to know exactly how much the country’s ability to test people who are actively sick with COVID-19 has improved.

The info is here.

Reviving the US CDC

Editorial
The Lancet
Volume 395, 10236
Originally published 16 May 20

The COVID-19 pandemic continues to worsen in the USA with 1·3 million cases and an estimated death toll of 80 684 as of May 12. States that were initially the hardest hit, such as New York and New Jersey, have decelerated the rate of infections and deaths after the implementation of 2 months of lockdown. However, the emergence of new outbreaks in Minnesota, where the stay-at-home order is set to lift in mid-May, and Iowa, which did not enact any restrictions on movement or commerce, has prompted pointed new questions about the inconsistent and incoherent national response to the COVID-19 crisis.

The US Centers for Disease Control and Prevention (CDC), the flagship agency for the nation's public health, has seen its role minimised and become an ineffective and nominal adviser in the response to contain the spread of the virus. The strained relationship between the CDC and the federal government was further laid bare when, according to The Washington Post, Deborah Birx, the head of the US COVID-19 Task Force and a former director of the CDC's Global HIV/AIDS Division, cast doubt on the CDC's COVID-19 mortality and case data by reportedly saying: “There is nothing from the CDC that I can trust”. This is an unhelpful statement, but also a shocking indictment of an agency that was once regarded as the gold standard for global disease detection and control. How did an agency that was the first point of contact for many national health authorities facing a public health threat become so ill-prepared to protect the public's health?

The article is here.

Suicide rates at a record high, yet insurers still deny care

Patrick Kennedy and Jim Ramstad
thehill.com
Originally posted February 15, 2019

Here is an excerpt:

A recent report from the Centers for Disease Control and Prevention (CDC) reinforces the seriousness of our nation’s mental health crisis. Life expectancy is declining in a way we haven’t seen since World War. With more than 70,000 drug overdose deaths in 2017 and suicides increasing by 33 percent since 1999, the message is clear: People are not getting the care they need. And for many, it’s a simple matter of access.

When the Mental Health Parity and Addiction Equity Act, also known as the Federal Parity Law, passed in 2008, those of us who drafted and championed the bill knew that talking about mental health wasn’t enough — we needed to ensure access to care as well. Hence, the Federal Parity Law requires most insurers to cover illnesses of the brain, such as depression or addiction, no more restrictively than illnesses of the body, such as diabetes or cancer. We hoped it would remove the barriers that families like Sylvia’s often face when trying to get help.

It has been 10 years since the law passed and, unfortunately, too many Americans are still being denied coverage for mental health and addiction treatment. The reason? A lack of enforcement.

As things stand, the responsibility to challenge inadequate systems of care and illegal denials falls on patients, who are typically unaware of the law or are in the middle of a personal crisis. This isn’t right. Or sustainable. The responsibility for mental health equity should lie with insurers, not with patients or their providers. Insurers should be held accountable for parity before plans are sold.

The info is here.

Did I just feed an addiction? Or ease a man’s pain? Welcome to modern medicine’s moral cage fight

Jay Baruch
STAT News
Originally published October 23, 2017

Here are two excerpts:

Will the opioid pills Sonny is asking for treat his pain, feed an addiction, or both? Will prescribing it fulfill my moral responsibility to alleviate his distress, contribute to the supply chain in the illicit pill economy, or both? Prescribing guidelines from the Centers for Disease Control and Prevention and recommendations from medical specialties and local hospitals are well-intentioned and necessary. But they do little to address the central anxiety that makes this decision a source of distress for physicians like me. It’s hard to evaluate pain without making some judgment about the patient and the patient’s story.

(cut)

A good story shortcuts analytical thinking. It can work its charms without our knowledge and sometimes against our better judgment. Once an emotional connection is made and the listener becomes invested in the story, the believability of the story matters less. In fact, the more extreme the story, the greater its capacity to enthrall the listener or reader.

Stories can elicit empathy and influence behavior in part by stimulating the release of the neurotransmitter oxytocin, which has ties to generosity, trustworthiness, and mother-infant bonding. I’m intrigued by the possibility that clinicians’ vulnerability to deceit is often grounded in the empathy they are reported to be lacking.

The article is here.

Middle School Suicides Reach An All-Time High

Elissa Nadworny
npr.com
Originally posted November 4, 2016

There's a perception that children don't kill themselves, but that's just not true. A new report shows that, for the first time, suicide rates for U.S. middle school students have surpassed the rate of death by car crashes.

The suicide rate among youngsters ages 10 to 14 has been steadily rising, and doubled in the U.S. from 2007 to 2014, according to the Centers for Disease Control and Prevention. In 2014, 425 young people 10 to 14 years of age died by suicide.

The article and the video are here.

National Suicide Hotline: 1-800-273-8255

Mental Health Reform Will Not Reduce US Gun Violence, Experts Say

Rita Rubin
JAMA.
Published online December 16, 2015. doi:10.1001/jama.2015.16421

Here is an excerpt:

But while few people would disagree with the need for mental health reform, scientists who study gun violence say it won’t make much of a dent in the number of homicides and attempted homicides committed with firearms. That’s because although mass shooters are likely to be mentally ill (but not necessarily diagnosed), high-profile mass shootings represent only a small fraction of US gun violence, the vast majority of which is committed by people who are not mentally ill. In addition, most people with mental illness are not violent; they are far more likely to be the victims than the perpetrators of shootings.

People should realize that “even though it feels that mass shootings happen all the time, they’re still extremely rare,” said Jeffrey Swanson, PhD, a professor of psychiatry and behavioral sciences at Duke University.

Through early December 2015, about 450 individuals died in mass shootings in the United States last year, according to Mass Shooting Tracker, a crowd-sourced website that defines a mass shooting as one in which at least 4 people have been shot but not necessarily killed (http://bit.ly/1MuHpVL). Compare that with 11 208, the number of people killed in homicides committed with firearms in 2013, the most recent year for which the Centers for Disease Control and Prevention (CDC) has US data (http://1.usa.gov/1GEJ0TN).

The entire article is here.

Sharp Rise in Drug Overdoses Among U.S. Women: CDC

By Steven Reinberg
MedicineNet.com
Originally posted July 2, 2013

The rate of fatal overdoses of prescription painkillers and other drugs among U.S. women quadrupled between 1999 and 2010, federal officials reported Tuesday.

Long thought of as primarily a male problem, drug addiction is increasingly affecting women, and the new study from the Centers for Disease Control and Prevention estimates that 42 women in the United States die each day from prescription drug overdoses.

"Prescription drug overdose deaths have skyrocketed in women," CDC Director Dr. Thomas Frieden said during a noon press conference. "Mothers, wives, sisters and daughters are dying from overdoses at rates we have never seen before."

(cut)

Other statistics, based on 2010 data:

• Suicides from these drugs accounted for 34 percent of all suicides among women, compared with 8 percent among men.
• More than 940,000 women were seen in emergency departments for drug misuse or abuse.
• More than 6,600 women, or 18 women every day, died from a prescription painkiller overdose.
• Narcotic painkillers accounted for four times more deaths among women than deaths linked to cocaine and heroin combined.
• More than 200,000 emergency department visits were for misuse or abuse of these drugs among women -- about one every three minutes.

The entire story is here.

Bullying and suicide among youth is a public health problem

Press Release
Contact: Eileen Leahy
e.leahy@elsevier.com
732-238-3628
Elsevier Health Sciences

Recent studies linking bullying and depression, coupled with extensive media coverage of bullying-related suicide among young people, led the Centers for Disease Control and Prevention (CDC) to assemble an expert panel to focus on these issues. This panel synthesized the latest research about the complex relationship between youth involvement in bullying and suicide-related behaviors. Three themes emerged:

1) Bullying among youth is a significant public health problem, with widespread and often harmful results;
2) There is a strong association between bullying and suicide-related behaviors; and
3) Public health strategies can be applied to prevent bullying and suicide.

A special supplement of the Journal of Adolescent Health presents the panel's findings, introduced by an insightful editorial by Marci Feldman Hertz, MS, Centers for Disease Control and Prevention, Atlanta, Georgia, and Ingrid Donato and James Wright, MS, LCPC, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Between 20 and 56 percent of young people are involved in bullying annually, as either a victim or perpetrator, or both. While bullying situations vary by type, age, and duration, middle school-aged children are more likely to be involved in bullying than those in high school. Verbal bullying occurs more frequently than physical or cyber-bullying and is more likely to happen over a longer time period. Further, lesbian and gay youth are more likely to be victimized than heterosexuals.

Poor mental and physical health among the victims and perpetrators of bullying, and those who experience both victimization and perpetration, investigators say, contribute to the problem. Further, involvement in bullying can have long-lasting, harmful effects, such as depression, anxiety, abdominal pain, and tension, months or even years later, as reported by two studies in this special supplement.

Researchers demonstrate a strong link between involvement in bullying and suicide. Dorothy Espelage and Melissa K. Holt, authors of "Suicidal Ideation and School Bullying Experiences After Controlling for Depression and Delinquency," show that the idea of suicide and attempts at suicide among middle school students were three-to-five times greater than among uninvolved students.

By applying public health strategies, researchers assert that bullying can be prevented, improving health and mental outcomes for many youth. Articles such as "Suicidal Thinking and Behavior Among Youth Involved in Verbal and Social Bullying: Risk and Protective Factors," by Iris Wagman Borowsky, Lindsay A. Taliaferro, and Barbara J. McMorris, reinforce the call for an integrated approach of multiple strategies to prevent suicide by focusing on shared risk and protective factors, including individual coping skills, family and school social support, and supportive school environments.

Notes the supplement's guest editor, Marci Feldman Hertz, "Given the prevalence and impact of bullying, it is important to move forward while public health strategies are still being developed. We can begin by implementing and evaluating strategies that have demonstrated effectiveness at increasing protective factors and decreasing risk factors associated with both bullying and suicide." Education and health stakeholders, she adds, should consider broadening their focus beyond just providing services to those already involved in bullying or suicide-related behaviors. They should also implement strategies to prevent bullying and suicide behavior from occurring in the first place.

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.

Prescription drug-related deaths continue to rise in U.S.

By Scott Glover and Lisa Girion
The Los Angeles Times
March 29, 2013

Despite efforts by law enforcement and public health officials to curb prescription drug abuse, drug-related deaths in the United States have continued to rise, the latest data show.

Figures from the U.S. Centers for Disease Control and Prevention reveal that drug fatalities increased 3% in 2010, the most recent year for which complete data are available. Preliminary data for 2011 indicate the trend has continued.

The figures reflect all drug deaths, but the increase was propelled largely by prescription painkillers such as OxyContin and Vicodin, according to just-released analyses by CDC researchers.

The numbers were a disappointment for public health officials, who had expressed hope that educational and enforcement programs would stem the rise in fatal overdoses.

“While most things are getting better in the health world, this isn’t,” CDC director Tom Frieden said in an interview. “It’s a big problem, and it’s getting worse.”

Drugs overtook traffic accidents as a cause of death in the country in 2009, and the gap has continued to widen. (Italics and color added).

The entire story is here.

A.D.H.D. Seen in 11% of U.S. Children as Diagnoses Rise

By ALAN SCHWARZ and SARAH COHEN
The New York Times
Published: March 31, 2013

Nearly one in five high school age boys in the United States and 11 percent of school-age children over all have received a medical diagnosis of attention deficit hyperactivity disorder, according to new data from the federal Centers for Disease Control and Prevention.

These rates reflect a marked rise over the last decade and could fuel growing concern among many doctors that the A.D.H.D. diagnosis and its medication are overused in American children.

The figures showed that an estimated 6.4 million children ages 4 through 17 had received an A.D.H.D. diagnosis at some point in their lives, a 16 percent increase since 2007 and a 41 percent rise in the past decade. About two-thirds of those with a current diagnosis receive prescriptions for stimulants like Ritalin or Adderall, which can drastically improve the lives of those with A.D.H.D. but can also lead to addiction, anxiety and occasionally psychosis.

“Those are astronomical numbers. I’m floored,” said Dr. William Graf, a pediatric neurologist in New Haven and a professor at the Yale School of Medicine. He added, “Mild symptoms are being diagnosed so readily, which goes well beyond the disorder and beyond the zone of ambiguity to pure enhancement of children who are otherwise healthy.”

The entire story is here.

Suicide Outbreak Prompts CDC Assessment

Community education and availability of mental health resources are called essential in efforts to limit suicidal behavior.

By Christopher White
Psychiatric News
Originally published September 21, 2012

In the first five months of this year, 11 young people completed suicide in Kent and Sussex counties in Delaware, an increase from the yearly average of four in those aged 12 to 21 from 2009 to 2011.

Reflecting the state’s concern about this troubling development, the Delaware Department of Health and Human Services asked the federal Centers for Disease Control and Prevention (CDC) to conduct an epidemiological study to determine the rates of fatal and nonfatal suicide behaviors in the area, analyze risk factors, and recommend strategies to prevent future suicides.

Of the 11 decedents, four were students at the same high school, two were students at other local high schools, one was a student at a middle school, one had dropped out of high school, two had graduated from area high schools and were still living in Sussex County, and one was an adult with unknown education history.


The entire story is here.

Doctors target gun violence as a social disease

By Marilynn Marchione
Seattle Post-Intelligencer
Originally published on August 13, 2012

Is a gun like a virus, a car, tobacco or alcohol? Yes say public health experts, who in the wake of recent mass shootings are calling for a fresh look at gun violence as a social disease.

What we need, they say, is a public health approach to the problem, like the highway safety measures, product changes and driving laws that slashed deaths from car crashes decades ago, even as the number of vehicles on the road rose.

One example: Guardrails are now curved to the ground instead of having sharp metal ends that stick out and pose a hazard in a crash.

"People used to spear themselves and we blamed the drivers for that," said Dr. Garen Wintemute, an emergency medicine professor who directs the Violence Prevention Research Program at the University of California, Davis.

It wasn't enough back then to curb deaths just by trying to make people better drivers, and it isn't enough now to tackle gun violence by focusing solely on the people doing the shooting, he and other doctors say.

They want a science-based, pragmatic approach based on the reality of a society saturated with guns and seek better ways of preventing harm from them.

The entire story is here.

EHR Adoption By Doctors Reaches 55 Percent

Kaiser Health News
Originally published July 19, 2012

Physician adoption of the electronic health record (EHR) may be at — or even past — the proverbial tipping point, or so suggests a government study released yesterday that is a litany of progress. In 2011, 55% of physicians reported having adopted an EHR, and of those, 85% said they were either somewhat or very satisfied with the technology, according to the report from the US Centers for Disease Control and Prevention (CDC). Roughly 3 in 4 physicians using EHRs said the software enhanced overall patient care. And 71% of digital physicians would buy their EHR program again.

More can be found here.

CDC Social Media Tools, Guidelines & Best Practices

"The use of social media tools is a powerful channel to reach target audiences with strategic, effective and user-centric health interventions. To assist in the planning, development and implementation of social media activities, the following guidelines have been developed to provide critical information on lessons learned, best practices, clearance information and security requirements. Although these guidelines have been developed for the use of these channels at the Centers for Disease Control and Prevention (CDC), they may be useful materials for other federal, state and local agencies as well as private organizations to reference when developing social media tools."

The site can be found here.

The site includes a Social Media Toolkit, a Guide to Writing for Social Media, and Twitter Guidelines and Best Practices, to name a few.

Thanks to Pauline Wallin for this information.

Another link to these resources can be found on our Resources, Guides, and Guidelines page.