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

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

Monday, December 31, 2012

Moral Identity versus Moral Reasoning in Religious Conservatives

Do Christian Evangelical Leaders Really Lack Moral Maturity?

By Judith Needham-Penrose and Harris L. Friedman
The Humanistic Psychologist
Volume 40, Issue 4, 2012


Research using moral dilemmas has consistently found religious conservatives make poorer moral decisions than liberals. A sample of 104 Evangelical Christians leaders were found to score poorly in moral reasoning using this approach, but were also found to have high moral identity. Their moral identity correlated highly with self-reported moral behavior, yet their moral decision-making did not, suggesting moral identity is more salient than decision-making in their moral development. A subsample of 10 who scored low on moral decision-making but high on other moral indicators was qualitatively found to have a sophisticated morality based on different assumptions than used in past research. These findings are discussed in terms of bias in past research using moral dilemmas that denigrate religious conservatives.

The article can be found here.

Sunday, December 30, 2012

Amgen Agrees to Pay $762 Million for Marketing Anemia Drug for Off-Label Use

The New York Times
Published: December 18, 2012

The biotechnology giant Amgen marketed its anemia drug Aranesp for unapproved uses even after the Food and Drug Administration explicitly ruled them out, federal prosecutors said on Tuesday.

The federal charges were made public as Amgen pleaded guilty to illegally marketing the drug and agreed to pay $762 million in criminal penalties and settlements of whistle-blower lawsuits.

Amgen was “pursuing profits at the risk of patient safety,” Marshall L. Miller, acting United States attorneyin Brooklyn, said in a telephone news briefing on Tuesday.

David J. Scott, Amgen’s general counsel, entered the guilty plea at the United States District Court in Brooklyn to a single misdemeanor count of misbranding the drug, Aranesp, meaning selling it for uses not approved by the F.D.A.

Amgen agreed to pay $136 million in criminal fines and forfeit $14 million, with about $612 million going to settle civil litigation.

The entire article is here.

Saturday, December 29, 2012

'Not One Successful EHR System In Whole World'

Longtime advocate of computerizing healthcare C. Peter Waegemann calls current health IT policy 'misguided.'

By Neil Versel
Originally posted on December 17, 2012

While federal health IT officials were touting the perceived successes of their efforts to increase physician usage of electronic health records (EHRs), one longtime advocate of EHRs was criticizing the whole direction of health IT policy.

"In my opinion, there is not one successful EHR system in the whole world," said C. Peter Waegemann, who founded and ran the Boston-based Medical Records Institute from 1984 to 2009. "User friendliness, usability, and interoperability are not there," he added in an interview with InformationWeek Healthcare.

He defined a successful EHR as one that is fully interoperable. "We have been focusing too much on documentation [for the purpose of reimbursement]," he said. This point has not been lost on the Obama administration, which has warned providers about using EHRs to "game the system."

Still, Waegemann believes the administration has not been aggressive enough with its $27 billion federal Meaningful Use EHR incentive program, based on published rules for Stage 2 and early recommendations for Stage 3. "MU2 and MU3 are just small steps. They rely on old technology," Waegemann said.

He noted that a number of leading EHR systems are written in the MUMPS programming language that originated at Massachusetts General Hospital in the late 1960s. Meaningful Use also relies on outdated standards such as version 2.x of Health Level Seven International's messaging standards rather than the more recent version 3.

The entire story is here.

Friday, December 28, 2012

Top 10 myths about mass shootings

By James Alan Fox
Originally published on December 19, 2012

Myth: Mass shootings are on the rise.

Reality: Over the past three decades, there has been an average of 20 mass shootings a year in the United States, each with at least four victims killed by gunfire. Occasionally, and mostly by sheer coincidence, several episodes have been clustered closely in time. Over all, however, there has not been an upward trajectory. To the contrary, the real growth has been in the style and pervasiveness of news-media coverage, thanks in large part to technological advances in reporting.

Myth: Mass murderers snap and kill indiscriminately.

Reality: Mass murderers typically plan their assaults for days, weeks, or months. They are deliberate in preparing their missions and determined to follow through, no matter what impediments are placed in their path.

Myth: Enhanced background checks will keep dangerous weapons out of the hands of these madmen.

Reality: Most mass murderers do not have criminal records or a history of psychiatric hospitalization. They would not be disqualified from purchasing their weapons legally. Certainly, people cannot be denied their Second Amendment rights just because they look strange or act in an odd manner. Besides, mass killers could always find an alternative way of securing the needed weaponry, even if they had to steal from family members or friends.

Myth: Restoring the federal ban on assault weapons will prevent these horrible crimes.

Reality: The overwhelming majority of mass murderers use firearms that would not be restricted by an assault-weapons ban. In fact, semiautomatic handguns are far more prevalent in mass shootings. Of course, limiting the size of ammunition clips would at least force a gunman to pause to reload or switch weapons.

Myth: Greater attention and response to the telltale warning signs will allow us to identify would-be mass killers before they act.

Reality: While there are some common features in the profile of a mass murderer (depression, resentment, social isolation, tendency to blame others for their misfortunes, fascination with violence, and interest in weaponry), those characteristics are all fairly prevalent in the general population. Any attempt to predict would produce many false positives. Actually, the telltale warning signs come into clear focus only after the deadly deed.

Myth: Widening the availability of mental-health services and reducing the stigma associated with mental illness will allow unstable individuals to get the treatment they need.

Reality: With their tendency to externalize blame and see themselves as victims of mistreatment, mass murderers perceive the problem to be in others, not themselves. They would generally resist attempts to encourage them to seek help. And, besides, our constant references to mass murderers as “wackos” or “sickos” don’t do much to destigmatize the mentally ill.

Myth: Increasing security in schools and other places will deter mass murder.

Reality: Most security measures will serve only as a minor inconvenience for those who are dead set on mass murder. If anything, excessive security and a fortress-like environment serve as a constant reminder of danger and vulnerability.

Myth: Students need to be prepared for the worst by participating in lockdown drills.

Reality: Lockdown drills can be very traumatizing, especially for young children. Also, it is questionable whether they would recall those lessons amid the hysteria associated with an actual shooting. The faculty and staff need to be adequately trained, and the kids just advised to listen to instructions. Schools should take the same low-key approach to the unlikely event of a shooting as the airlines do to the unlikely event of a crash. Passengers aren’t drilled in evacuation procedures but can assume the crew is sufficiently trained.

Myth: Expanding “right to carry” provisions will deter mass killers or at least stop them in their tracks and reduce the body counts.

Reality: Mass killers are often described by surviving witnesses as being relaxed and calm during their rampages, owing to their level of planning. In contrast, the rest of us are taken by surprise and respond frantically. A sudden and wild shootout involving the assailant and citizens armed with concealed weapons would potentially catch countless innocent victims in the crossfire.

Myth: We just need to enforce existing gun laws as well as increase the threat of the death penalty.

Reality: Mass killers typically expect to die, usually by their own hand or else by first responders. Nothing in the way of prosecution or punishment would divert them from their missions. They are ready to leave their miserable existence, but want some payback first.

The entire story is here.

Thursday, December 27, 2012

Court Upholds Firing of College Official Over Op-Ed Against Gay Rights

By Peter Schmidt
The Chronicle of Higher Education
Originally published December 17, 2012

A federal appeals court has upheld the University of Toledo's decision to fire a high-level human-resources administrator who wrote a newspaper opinion column challenging the idea that gay people deserve the same civil-rights protections as members of racial minority groups.

In a ruling handed down on Monday, a three-judge panel of the U.S. Court of Appeals for the Sixth Circuit held that the administrator's column "contradicted the very policies she was charged with creating, promoting, and enforcing," and cannot be excused as merely a statement of her own views as a private citizen. The panel affirmed a lower court's decision to dismiss the administrator's lawsuit accusing the public university of violating her constitutional rights by firing her.

At the center of the case was an opinion essay that Crystal Dixon, who had been the university's interim associate vice president for human resources, published in the Toledo Free Press in April 2008. In it, she wrote that she takes "great umbrage at the notion that those choosing the homosexual lifestyle are 'civil-rights victims.'" She argued that she "cannot wake up tomorrow and not be a black woman" because she is biologically and genetically such "as my creator intended." But, she said, "daily, thousands of homosexuals make a life decision to leave the gay lifestyle" with the help of groups such as Exodus International, which claim to be able to help people overcome homosexual desires.

The entire article is here.

No Longer a Silent Minority

By Libby A. Nelson
Inside Higher Ed
Originally published December 17, 2012

The six-month lifespan of Queer at Patrick Henry College, a blog focusing on the struggles of gay students at the evangelical Christian college in Virginia, has been turbulent, to say the least.

First the chancellor and founder of the college threatened to sue the bloggers over their use of the Patrick Henry name, then withdrew the threat, all on Facebook. Then he claimed to a local newspaper that the blog had to be a hoax -- that the college’s honor code, which prohibits homosexuality, meant there were no gay students on campus.

The drama has attracted a glut of national media attention, far more than the blog’s founders expected. But their story is far less unusual than it would have seemed even a year ago. More than 50 such groups, blogs and activist alumni groups have sprung up at similar Christian colleges over the past year, making 2012 something of a watershed moment for gay students and alumni at evangelical colleges.

Just over a year ago, gay alumni of Wheaton College, the evangelical college in Illinois, formed a support group and held their own homecoming celebration. Since then, groups following their template (down to the naming conventions -- OneWheaton led to OneEastern, at Eastern University, and One George Fox, at George Fox College in Oregon) have formed even at Christian colleges that place an emphasis on Biblical inerrancy.

Now new organizations and campaigns have been formed to tie these groups together so that students can share their experiences and press for change. Their goals are often incremental; few expect that Christian colleges will follow the growing national trend of supporting gay marriage, but they hope that gay students will be treated with more sensitivity and respect.

The entire article is here.

Wednesday, December 26, 2012

New Medicare fraud detection system saves $115 million

Associated Press
Originally published December 15, 2012

A highly touted new technology system designed to stop fraudulent Medicare payments before they are paid has saved about $115 million and spurred more than 500 investigations since it was launched in the summer of 2011, according to a report released Friday.

Federal health officials said the projected savings are much higher. The savings so far, however, are minuscule compared with the estimated $60 billion lost each year to Medicare fraud. With the Obama administration and Congress desperately looking for savings to avoid a budget meltdown, denting Medicare fraud has the potential to save billions of dollars annually.

However, the Department of Health and Human Services' inspector general noted the report had some inconsistencies in its data and questioned the methodology for calculating some of the figures.

"In these cases, we could not determine the accuracy of the department's information, which impeded our ability to quantify the amount of the inaccuracies noted in this report," the inspector general's office said in a review of the report. Officials in the office said regardless of the glitches, they believe the new fraud system is a useful anti-fraud, too.

The $77 million technology system fights fraud in much the way credit card companies scan charges and can freeze accounts. It saved $32 million by kicking providers out of the program or refusing to pay suspicious claims. The report from the Centers for Medicare and Medicaid Services, obtained by The Associated Press, was unclear on how many actual providers were suspended or revoked from Medicare.

The entire story is here.

DSM-5 Could Be Hazardous to Your Mental Health

By Elayne Clift
Originally published on December 22, 2012

Here are some excerpts:

Feminist therapists are concerned for women in particular. Diagnoses such as Borderline Personality Disorder (BPD) and Sexual Dysfunction have disparaged women and compromised them in troubling ways. For example, one expert says that BPD is almost exclusively applied to women because its symptoms relate to emotion and anger.   Some women with the diagnosis have histories of abuse and may have difficulty expressing anger "appropriately."   Such vulnerable women need to have their coping styles better understood before assumptions are made about their behavior.

Similarly, "sexual dysfunction" among women is often based on assumptions about what constitutes normal sexual behavior.   "If only performance failures or lack of desire count, the entire context of sexual activity becomes invisible and of secondary importance," says one member of the Association of Women in Psychology (AWP).

Another AWP member focuses on classism in psychiatric diagnosis.   "Poor women and women of color are particularly likely to be misdiagnosed or encounter bias in treatment," she says. "Therapists may interpret chronic lateness or missed appointments as hostility or resistance to treatment rather than the outcomes of unreliable transportation, irregular shift work, and unpredictable child care arrangements."

The entire article is here.

'If I'd Had To Wait Until 67 For Medicare, I'd Be Dead'

By Russ Mitchell
Kaiser Health News
Originally published December 18, 2012

Sam Lewis turned 65 in the nick of time. For a year, he'd been broke. His Brentwood, Calif., general contracting business had gone bust. He couldn't make payments on his home, and lost it. He couldn't make payments on his health insurance, so he let it lapse.

The day after his birthday in October, when he qualified for Medicare, Lewis got a checkup. Days later, he went under the knife: open-heart surgery, a triple-bypass, three arteries blocked with plaque, one of them, 99 percent. "If I'd had to wait until 67 for Medicare," Lewis said, "I'd be dead."

A proposal to raise the Medicare eligibility age from 65 to 67 to ratchet down spending is one of the more explosive ideas in the fiscal talks between House Speaker John Boehner and the White House. The negotiations are aimed at a deficit deal to avert automatic tax increases and spending cuts slated to take effect Jan. 1.  Liberal Democrats say they loathe the Medicare proposal, but the White House has not taken a public position on it.

President Barack Obama was open to a similar proposal last year during his failed effort to reach a "grand bargain" with Republicans.  And many expect it to pop up again in next year’s discussions about curbing entitlement costs if it is not included in this year’s deal.

The entire article is here.

Tuesday, December 25, 2012

Hate crimes down in 2011, but anti-gay violence up, FBI says

More than 6,000 were reported, with nearly half of them racially motivated. Crimes targeting gays and lesbians increased about 2.6%.

Originally published December 10, 2012
More than 6,000 hate crimes were reported to U.S. law enforcement agencies in 2011 — a 6% decrease from 2010, the FBI said Monday. But crimes based on the victim's sexual orientation increased slightly.
Nearly half of the 6,222 hate crimes reported in 2011 were racially motivated, the FBI said, with nearly three-fourths directed at African Americans. More than 16% were motivated by anti-white bias.

About 59% of the known offenders for all reported hate crimes were white, and 21% were black, the agency said.

The Anti-Defamation League, which monitors and seeks to combat bigotry, welcomed the overall decrease in hate crimes but highlighted those motivated by sexual orientation.

"The increase in the number of reported hate crimes directed against gays and lesbians, now the second most frequent category of crime, is especially disturbing," the ADL said in a statement.

There were 1,508 reported sexual orientation hate crimes in 2011, up from 1,470 in 2010, an increase of about 2.6%. Overall, nearly 21% of hate crimes were motivated by sexual orientation bias, the FBI said, with men victimized the majority of the time.

Religious bigotry accounted for nearly 20% of reported hate crimes — the majority anti-Semitic, and another 13% anti-Islamic.

The entire story is here.

UK government says it will legalize gay marriage, but bar Church of England from involvement

Article by: JILL LAWLESS
Associated Press
Originally posted December 10, 2012

The British government announced Tuesday that it will introduce a bill next year legalizing gay marriage — but banning the Church of England from conducting same-sex ceremonies.

Equalities minister Maria Miller said the legislation would authorize same-sex civil marriages, as well as religious ceremonies if religions decide to "opt in."

"I feel strongly that, if a couple wish to show their love and commitment to each other, the state should not stand in their way," Miller said.

"For me, extending marriage to same-sex couples will strengthen, not weaken, this vital institution."

Some religious groups, such as Quakers and liberal Jews, say they want to conduct same-sex ceremonies. But others, including the Anglican and Roman Catholic churches, oppose gay marriage.

Miller said the legislation would make it unlawful for the Church of England — the country's official church, symbolically headed by Queen Elizabeth II — and the Anglican Church in Wales to conduct gay weddings. The government does not have the same legal authority over other churches, but hopes that the ban for the Church of England will reassure religious opponents of same-sex marriage that they will not be forced to take part.

The entire story is here.

Monday, December 24, 2012

Behavioral Ethics: Toward a Deeper Understanding of Moral Judgment and Dishonesty

Annual Review of Law and Social ScienceVol. 8: 85-104
Max H. Bazerman and Francesca Gino

What makes even good people cross ethical boundaries? Society demands that business and professional schools address ethics, but the results have been disappointing. This paper argues that a behavioral approach to ethics is essential because it leads to understanding and explaining moral and immoral behavior in systematic ways. The authors first define business ethics and provide an admittedly biased history of the attempts of professional schools to address ethics as a subject of both teaching and research. They next briefly summarize the emergence of the field of behavioral ethics over the last two decades, and turn to recent research findings in behavioral ethics that could provide helpful directions for a social science perspective to ethics. These new findings on both intentional and unintentional unethical behavior can inform new courses on ethics as well as new research investigations. Such new directions can meet the demands of society more effectively than past attempts of professional schools. They can also produce a meaningful and significant change in the behavior of both business school students and professionals. Key concepts include:

  • Shifting the modes of thought can lead to profound differences in how we make ethical decisions. This has implications at the individual and at the societal level.
  • Until recently, little empirical attention was given to how people actually behave when they face ethical dilemmas and decisions or to how their behavior can be improved.
  • A behavioral ethics approach does not teach students how they should behave when facing ethical dilemmas, nor inform them about what philosophers or ethicists would recommend. Instead it sees an opportunity in helping students and professionals better understand their own behavior in the ethics domain, and compare it to how they would ideally like to behave.
  • Behavioral ethics identifies levers at both the individual and the institutional level to change ethically questionable behaviors when individuals are acting in unethical ways that they would not endorse with greater reflection.
  • Prior to the 1990s, it was rare for professional schools to have a significant focus on the area of ethics (or business ethics more specifically) in the courses offered to students. Courses that were taught used philosophical approaches or suggested that morality is a rather stable personality trait that individuals develop by going through differences phases of development.


Early research and teaching on ethics focused on either a moral development perspective or philosophical approaches, and used a normative approach by focusing on the question of how people should act when resolving ethical dilemmas. In this paper, we briefly describe the traditional approach to ethics and then present a (biased) review on the behavioral approach to ethics. We define behavioral ethics as the study of systematic and predictable ways in which individuals make ethical decisions and judge the ethical decisions of others that are at odds with intuition and the benefits of the broader society. By focusing on a descriptive rather than a normative approach to ethics, behavioral ethics is better suited than traditional approaches to address the increasing demand from society for a deeper understanding of what causes even good people to cross ethical boundaries.

A version of the paper is here.

Sunday, December 23, 2012

Is Psychotherapy Too Expensive?

By Pauline Wallin, Ph.D.
Guest Blogger

The cost of a typical course of psychotherapy (12 sessions or fewer) is generally under $2000. That’s certainly more than pocket change. But is it too much? Well, it depends on how you figure it.

If you use your health insurance, you’ll be paying only a fraction of that cost. But even if you pay completely out of pocket, $2000 for psychotherapy could turn out to be a bargain.

First, we know that emotional problems and stress can make you more vulnerable to serious medical illness – which can lead to additional medical bills, time lost from work and higher health insurance premiums. These factors can add up to well over $2000.

Next, consider how depression and anxiety affect your day-to-day quality of life. You not only feel sub-par; you may also have trouble with focus and concentration – which can lead to costly mistakes, omissions and accidents.

When you feel miserable, the people around you are also affected. You cannot be the parent or spouse or friend that you want to be. And if you let things go too far, you may even lose your will to live. That’s pretty scary!

The good news is that psychotherapy helps the majority of people who enter into treatment. Psychologists are trained to help you discover better ways to deal with what life throws at you.

“$2000 is way out of my budget. What are my options?”

If you have health insurance there’s a good chance that it covers psychotherapy by a licensed mental health professional. You’ll probably need to pay a copay, which will be higher for out-of-network therapists.

But don’t decide on the basis of cost alone. Get recommendations from family members, friends or your physician. It’s very important that you have confidence in your therapist and that you feel comfortable with him or her.

Keep in mind that you don’t need to come up with the entire therapy fee all at once. You’ll be paying by the session. Many therapists accept credit card payments. You may also consider taking out a loan. After all, psychotherapy is an investment in yourself (similar to education) where you anticipate a brighter future as a result of the time and money you spend.

Don’t put it off

Although it’s never to late to get help, the longer you wait, the more time is wasted.  Investing in your own psychological well-being is a good plan for both yourself and for your loved ones.

Saturday, December 22, 2012

Conflict of Interest: Disclosure to Whom? And How?

By Jane Robbins
Inside Higher Ed - Sounding Board
December 11, 2012

Conflict of interest in academic science is a controversial, but most of all a highly emotional, issue in the academy. Scientists and administrators disagree vehemently about whether it is a good or bad thing, and many aver that it has no impact on research—or that it is no one’s business. The thing is that the term conflict of interest is descriptive of a state, not a quality, and its effects or impacts can only be known, sometimes tragically and always far beyond the individual involved, after-the-fact. This is why disclosure is generally considered to be a poor means of avoiding bias or harm—it is too little, too late, and we are left with not knowing who or what to trust, and may need to run around retracting articles, shutting down trials, imposing sanctions, firing people, or engaging in yet another political effort to rein in a growing ill. Physician, heal thyself: an ounce of prevention is worth a pound of cure.

At the moment, though, disclosure is the modus operandi. Even that took decades to put in place, and efforts to make disclosure, let alone enforcement, more robust have been disappointing exercises in which the whole point—the integrity of science and scientific institutions—bows to external pressure and resistance. One of the many disappointments in the recent (2009-2011), largely failed effort to strengthen conflict of interest rules and enforcement was the rejection of additional reporting to the federal government. In making my public comments at the time, I for one had called for reporting of all disclosures, patent/royalty data, equity values, contract terms, management plans, and other conflict-specific data to a central website created and maintained by the Public Health Service (HHS/PHS), the funding agent soliciting comments on proposed new rules. Some others made similar recommendations, as discussed below. In a rationalized interpretation of lessening the administrative and financial burden to institutions, the final rules instead called for each institution to create its own site and/or respond to requests for information on a case-by-case basis.  Appeasement often yields the irrational.

The entire story is here.

Friday, December 21, 2012

Drug Executive Faces Manslaughter Charges

The New York Times
Published: December 11, 2012

A French court brought manslaughter and injury charges on Tuesday against a drug executive and six companies in a case involving a diabetes and weight-loss drug that caused cardiovascular damage, the Paris public prosecutor’s office said.

The executive, Jacques Servier, 90, and six companies of the Servier group are accused of having known the risks associated with the drug, Mediator, which they produced and marketed until French authorities ordered it withdrawn in 2009, the spokeswoman, Agnès Thibault-Lecuivre, said.

The entire article is here.

Supreme Court slates generic drug 'pay-for-delay' case

By Joe Carlson
Posted: December 8, 2012

The U.S. Supreme Court has agreed to hear arguments in a "pay-for-delay" case that has the Federal Trade Commission accusing generic drugmakers of violating competition laws by agreeing to accept $42 million in annual payments in exchange for not selling generic versions of a more-expensive brand-name testosterone gel.

The FTC says (PDF) the companies—lead respondent Watson Pharmaceuticals, along with Paddock Laboratories, Par Pharmaceutical Cos. and Abbott Laboratories subsidiary Solvay Pharmaceuticals—conspired illegally to keep cheaper drugs off the market, to the detriment of consumers of the brand-name drug.

The companies, meanwhile, say their actions were legal and immune from FTC scrutiny (PDF). However, they did not oppose a hearing before the U.S. Supreme Court, because they said differing interpretations of federal law had led to split legal reasoning in various U.S. circuits on a controversy of national significance.

The entire story is here.

Thursday, December 20, 2012

Violent Video Games: More Playing Time Equals More Aggression

Ohio State University
News Release
Originally released on December 10, 2012

A new study provides the first experimental evidence that the negative effects of playing violent video games can accumulate over time.

Researchers found that people who played a violent video game for three consecutive days showed increases in aggressive behavior and hostile expectations each day they played. Meanwhile, those who played nonviolent games showed no meaningful changes in aggression or hostile expectations over that period.

Although other experimental studies have shown that a single session of playing a violent video game increased short-term aggression, this is the first to show longer-term effects, said Brad Bushman, co-author of the study and professor of communication and psychology at Ohio State University.

“It’s important to know the long-term causal effects of violent video games, because so many young people regularly play these games,” Bushman said.

“Playing video games could be compared to smoking cigarettes. A single cigarette won’t cause lung cancer, but smoking over weeks or months or years greatly increases the risk. In the same way, repeated exposure to violent video games may have a cumulative effect on aggression.”

Bushman conducted the study with Youssef Hasan and Laurent Bègue of the University Pierre Mendès-France, in Grenoble, France, and Michael Scharkow of the University of Hohenheim in Germany.

Their results are published online in the Journal of Experimental Social Psychology and will appear in a future print edition.

The study involved 70 French university students who were told they would be participating in a three-day study of the effects of brightness of video games on visual perception.

They were then assigned to play a violent or nonviolent video game for 20 minutes on each of three consecutive days.

Those assigned the violent games played Condemned 2, Call of Duty 4 and then The Club on consecutive days (in a random order). Those assigned the nonviolent games played S3K Superbike, Dirt2 and Pure (in a random order).

After playing the game each day, participants took part in an exercise that measured their hostile expectations. They were given the beginning of a story, and then asked to list 20 things that the main character will do or say as the story unfolds. For example, in one story another driver crashes into the back of the main character’s car, causing significant damage. The researchers counted how many times the participants listed violent or aggressive actions and words that might occur.

The press release is here.

Most Professors Say They've Considered Quitting Over Work-Life Conflicts

by Audrey Williams June
The Chronicle of Higher Education
Originally published December 10, 2012

Work-life conflicts have caused roughly three out of every four assistant professors to think about leaving their institution, according to the results of a new survey.

For some assistant professors, leaving their institution isn't enough to solve their work-life problems.

Almost 45 percent of those surveyed said they could see themselves leaving academe altogether.

Meanwhile, 65 percent of full professors surveyed said that they had considered leaving their university in the last year.


The survey found that nearly 80 percent of faculty members would consider leaving their institution in search of a more-supportive work environment.

About 60 percent would consider leaving where they now work to spend more time with their families.

About 35 percent of respondents would think about leaving to deal with elder care, while about one-fourth would consider leaving their institution because of problems related to child care.

The entire story is here.

Thanks to Ken Pope for this information.

Wednesday, December 19, 2012

Aging Doctors Face Greater Scrutiny

By Sandra G. Boodman
Originally published on December 10, 2012
Kaiser Health News in collaboration with The Washington Post

A distinguished vascular specialist in his 80s performs surgery, then goes on vacation, forgetting he has patients in the hospital; one subsequently dies because no doctor was overseeing his care. An internist who suffered a stroke gets lost going from one exam room to another in his own office. A beloved general surgeon with Alzheimer's disease continues to assist in operations because hospital officials don't have the heart to tell him to retire.

These real-life examples, provided by an expert who evaluates impaired physicians, exemplify an emotionally charged issue that is attracting the attention of patient safety experts and hospital administrators: how to ensure that older doctors are competent to treat patients.

About 42 percent of the nation's 1 million physicians are older than 55 and 21 percent are older than 65, according to the American Medical Association, up from 35 percent and 18 percent, respectively, in 2006. Their ranks are expected to increase as many work past the traditional retirement age of 65, for reasons both personal and financial.

Many older doctors remain sharp, their skills up-to-date and their judgment honed by years of experience. Peter Carmel, the AMA's immediate past president, a 75-year-old pediatric neurosurgeon in New Jersey, recently wrote about "going full tilt."

Unlike commercial airline pilots, who by law must undergo regular health screenings starting at age 40 and must retire at 65 -- or FBI agents, whose mandatory retirement age is 57 -- there are no such rules for doctors. Nor are any formal evaluations required to ensure the continued competence of physicians, many of whom trained decades ago. Most states require continuing education credits to retain a medical license, but, as Ann Weinacker, chief of the medical staff at Stanford Hospital and Clinics in California, observed, "you can sleep through a session, and if you sign your name, you'll get credit."

The entire article is here.

New Taxes to Take Effect to Fund Health Care Law

The New York Times
Originally Published: December 8, 2012

For more than a year, politicians have been fighting over whether to raise taxes on high-income people. They rarely mention that affluent Americans will soon be hit with new taxes adopted as part of the 2010 health care law.

The new levies, which take effect in January, include an increase in the payroll tax on wages and a tax on investment income, including interest, dividends and capital gains. The Obama administration proposed rules to enforce both last week.

Affluent people are much more likely than low-income people to have health insurance, and now they will, in effect, help pay for coverage for many lower-income families. Among the most affluent fifth of households, those affected will see tax increases averaging $6,000 next year, economists estimate.

To help finance Medicare, employees and employers each now pay a hospital insurance tax equal to 1.45 percent on all wages. Starting in January, the health care law will require workers to pay an additional tax equal to 0.9 percent of any wages over $200,000 for single taxpayers and $250,000 for married couples filing jointly.

The new taxes on wages and investment income are expected to raise $318 billion over 10 years, or about half of all the new revenue collected under the health care law.

The entire article is here.

Tuesday, December 18, 2012

The Violence Carousel Has Gone Around Again

By Stephen A. Ragusea

This time the violence involves semi-automatic weapons and scores of elementary school children.  There are also dead teachers, a dead principal and a dead school psychologist.   All seven adults were women and my bet is that, as we learn more about the psychodynamics of the disturbed young man who was the shooter, we will find that the gender of the victims was not a coincidence, but part of his thought disturbance.

We all want to know why this thing happened and we would prefer that there be one single, clear reason.  But, as a clinical psychologist, I can assure you that there were several contributing factors, because human beings rarely do anything for one simple reason.   We are complex creatures, we humans.  Why did this happen?   Part of the answer is that we live in a culture that encourages violence and that culture is held up for worship on the altars of television screens and movie theatres each and every day.  It’s in our lust for blood in boxing matches and our appreciation of helmet cracking tackles in football and ice hockey.  It’s in movies from “Rambo (I through V)” to Brad Pitt’s “Killing Them Softly.”  It’s on television via movie reruns and shows like “The Sopranos” and your favorite version of “CSI.” We are a culture that embraces violence.

And, don’t forget our love of guns.  ABC News recently reported that during the three day Thanksgiving holiday weekend alone, over 250,000 guns were sold in the United States.

Over the next couple of weeks, you’ll hear the same question over and over in the news media: does violence in the media increase violent behavior?  For nearly fifty years the American Psychological Association has issued a variety of reports answering that critical question with an emphatic “Yes!”  In psychological research, the viewing of large amounts of violence on television by young children has been correlated with increases in violent behavior into adulthood.  Well, if TV viewing can impact our aggressive tendencies, what about the music we listen to?

One 2003 study published in the Journal of Personality and Social Psychology suggested that listening to songs that contain violent lyrics results in an increase in aggressive thoughts and emotions.  Some think that listening to powerful, violent, angry, songs can provide a “venting” of these powerful feelings, but this research provides evidence that just the opposite is true.

Of course, we must also ask ourselves “How much violence do we expose our children to?”  One 2007 study found that “By the time the average U. S. child starts elementary school, he or she will have seen 8,000 murders and 100,000 acts of violence on TV.”  And, that doesn’t include exposure via music and movies.

Add into that mix the fact that a small percentage our population suffers from various forms of severe mental illness and that we perpetually underfund treatment for psychological disorders.  Make semi-automatic weapons available to that group and sooner or later, we will see an explosive incident such as that which occurred in Newtown, Connecticut.  If we don’t do something to influence this course of events, we’ll see these incidents occur again and again.

Violence directly and negatively impacts our physical and mental health. Because violent content in movies, television, and songs has so consistently been shown to increase violent behavior, these characteristics should be diminished in our entertainment products.  Psychologists have been giving that research-based advice to American society for almost 50 years.  Quite frankly, nobody seems to be listening.

We can do better.  Each one of us can decide to stop consuming these products.  When enough people boycott media violence, producers will stop creating these violence-encouraging forms of “entertainment.”  We can do better and we’d better do that.

Stephen A. Ragusea, Psy D, is a clinical psychologist in Key West and on the medical staff of The Lower Keys Medical Center.

Monday, December 17, 2012

The Ratings Game

Online physician-review sites pose legal challenges

By Andis Robeznieks
Originally Posted: November 10, 2012

People who sue people may receive more undesired attention than anyone else in the world.

That is the general idea behind the “Streisand Effect,” a phenomenon that occurs when an attempt to stifle publicity creates more publicity for something that might never have received much attention in the first place.

According to legend, the term was coined when singer Barbra Streisand tried to have a photo of her home—one among thousands of pictures that were part of an online display showing coastline erosion in California—deleted from that site. The ensuing publicity essentially guaranteed the image will never disappear from the Internet.

It could be unlikely that combative efforts to counter negative profiles on physician review websites will lead to a similar occurrence known as a the “Dr. McKee Effect,” but no one can predict how these things turn out.

Dr. David McKee, a neurologist from Duluth, Minn., is suing a patient's family member for defamation after the man posted negative reviews of him online. The case was argued in September before the Minnesota Supreme Court and, while its legal precedent-setting impact might not extend beyond the state's boundaries, attorneys for both sides say it could serve as a guide in future legal proceedings—wherever the jurisdiction may be.

The entire article is here.

Sunday, December 16, 2012

Mental health and disadvantage in Indigenous Australians

The Lancet
Volume 380, Issue 9858, Page 1968

Last week, Australia's National Mental Health Commission released A Contributing Life: the 2012 National Report Card on Mental Health and Suicide Prevention, its first such publication. The report card takes a whole-of-life approach, recognising that, like everyone else, people who have a mental illness need a stable home, a decent education, a job, good physical health, and a support network, as well as access to high-quality treatment and services.

There is a special focus on the first Australians, the Aboriginal and Torres Strait Islanders, who still face enormous disadvantages when compared with the general population. This disadvantage starts before birth. For example, three in ten Aboriginal and Torres Strait Islanders, including pregnant women, report barriers to accessing health services. 50% of pregnant Aboriginal and Torres Strait Islander women smoke. And one in seven new Indigenous mothers have postnatal depression. As the report notes, a child born into these circumstances does not have an auspicious start in life. Furthermore, an Indigenous child is two and a half times more likely to be born into the lowest income group, and has a one in two chance of living in a one-parent household when compared with the general population. All these factors play into adolescence and adulthood, and increase the risk of mental health problems and associated issues such as substance misuse in the Indigenous population. Up to 15% of the 10-year life expectancy gap compared with non-Indigenous Australians has been attributed to mental health disorders.

The report recommends the development and implementation of an Aboriginal and Torres Strait Islander Mental Health and Social and Emotional Wellbeing Plan to commence in 2013 as well as training and employment of more Indigenous people in mental health services. This must be a national government priority, as should addressing the deep health and social inequalities faced by Aboriginal and Torres Strait Islanders. Australia's Indigenous population should have the opportunity to thrive, not just survive.


Saturday, December 15, 2012

Court: Off-Label Drug Marketing Is 'Free Speech'

By John Fauber, Reporter
Milwaukee Journal Sentinel/MedPage Today
Originally Published: December 04, 2012

A decision by a federal appeals court this week could have a dramatic impact on the marketing of prescription drugs in America, potentially affecting patient care and everything from TV advertising to future government prosecutions which, in the past, had yielded billions of dollars in settlements, doctors and attorneys said Tuesday.

"This risks taking us back to an era when people could promote snake oil without restrictions – a situation I would hate to see," said Richard Deyo, MD, a professor of family medicine at Oregon Health and Science University.

Citizens United Redux

However, others say the ruling by a three-judge panel of the Court of Appeals for the Second Circuit in Manhattan is a victory for free speech, one that could become the drug industry equivalent of Citizens United, the 2010 U.S. Supreme Court decision that gave corporations and unions the right to spend unlimited sums on political ads.

Like the Citizens United case, the ruling Tuesday by the prestigious U.S. Court of Appeals for the Second Circuit in New York, involved the right of commercial free speech, applying it to the complicated world of pharmaceutical industry promotion of prescription drugs.

How wide-ranging the decision becomes likely will depend on whether it gets to the U.S. Supreme Court, attorneys said.

Once the Food and Drug Administration approves a drug, physicians are free to prescribe that drug as they wish -- but the drug makers can only market the drug for the FDA-approved marketing indication.

The case involves Alfred Caronia, a sales representative with Orphan Medical who was criminally prosecuted for making off-label promotional statements about Xyrem, a drug approved in 2002 to treat narcolepsy patients with a condition known as cataplexy. Cataplexy involves weak or paralyzed muscles.

The FDA required a black box warning on the drug stating that its safety and effectiveness had not been established in people under the age of 16. The active ingredient in Xyrem is GHB, is a powerful medication that acts on the central nervous system and also is known as the "date rape" drug.

The entire story is here.

Friday, December 14, 2012

48 countries join forces against online child abuse

By Associated Press
Originally Published: December 5

Forty-eight countries united Wednesday in a global alliance to fight child sexual abuse online, a cross-border crime that experts say is increasing at alarming rates.

By conservative estimates, 1 million photographs of child pornography are on the Internet, with an additional 50,000 being posted every year, said Cecilia Malmstrom, the European Union’s commissioner for home affairs who was one of sponsors of the conference in Brussels.

“Behind each of these images there is an abused child, an exploited and helpless victim,” Malmstrom said at a news conference. “And every time someone looks at these pictures, that child is exploited and violated again and again and again.”

The alliance will focus on identifying and helping victims, prosecuting offenders, increasing public awareness and reducing the availability of child pornography online, according to a joint declaration.

The entire story is here.

Greater awareness and funding approved to address internship imbalance

APA Access | December 11, 2012

The Education Directorate and the American Psychological Association of Graduate Students worked to raise awareness of and make strides toward solving the internship imbalance.

The Education Directorate and the American Psychological Association of Graduate Students (APAGS) worked extensively over the past year to promote more quality internship positions for psychology graduate students. The effort paid off when the APA Council of Representatives approved the allocation of up to $3 million over three years for a small grant program to assist internship sites with the accreditation process. This program will potentially add up to 500 APA-accredited slots to promote quality assurance in training.

Thursday, December 13, 2012

Justice Dept. recovers record $5 billion under False Claims Act

By Peter Finn
The Washington Post
Originally published: December 4, 2012

The Justice Department’s civil division recovered a record $5 billion in the past fiscal year from companies that defrauded taxpayers, with much of the abuse occurring in the health-care and mortgage industries.

The department pursued settlements and judgments under the False Claims Act, which Acting Associate Attorney General Tony West described Tuesday as “quite simply, the most powerful tool we have to deter and redress fraud.”

“Vigorous enforcement of the act allows us to protect not only taxpayer dollars but also the integrity of important government programs on which so many Americans rely,” West said.

The amount of money recovered in 2012 is up from $3.2 billion last year, and two-thirds of it was secured through the act’s whistleblower provisions.

“Many of these cases would not be possible without the whistleblowers . . . who have come forward to report fraud, often at great personal risk,” said Stuart Delery, the principal deputy assistant attorney general for the civil division.

The entire story is here.

APA Practice Organization safeguards Medicare reimbursements for psychologists

APA Access | December 11, 2012

Editorial note: APAPO dollars working for you!

Advocates also targeted managed care rate cuts as a violation of federal parity rules.

APAPO made ensuring appropriate Medicare reimbursement for psychologists its top legislative advocacy priority in 2012. Along with grassroots psychologists, APAPO lobbyists called for alteration of the Medicare payment formula with letters and visits to officials in the Centers for Medicare and Medicaid Services and members of key health-related congressional committees. The current flawed formula reimburses expensive technology-based specialty services at a higher rate than lower-cost mental health and primary care services.

APA’s Practice Directorate continued its multi-year initiative to evaluate the psychotherapy billing codes and recommend “work relative value units” for the new set of psychotherapy codes that take effect Jan. 1, 2013.

The entire story is here.

Wednesday, December 12, 2012

Parity for Behavioral Health Coverage Delayed by Lack of Federal Rules

By Michael Ollove
Stateline/Kaiser Health News
Originally published on December 2, 2012

Here are some excerpts:

A Law but No Rules

Congress recognized that equivalence in 2008 when it passed the Mental Health Parity and Addiction Act, which requires insurers to cover mental illness and substance abuse treatment on an equal basis with physical ailments. The law, which passed with substantial bipartisan support, was supposed to eliminate two-tiered systems for co-pays, deductibles or treatment limitations.

The Obama administration's Affordable Care Act will vastly extend the reach of the 2008 law. The older law does not require health insurance plans to offer behavioral health coverage, although if they do it must be on par with benefits provided for medical and surgical care. But the ACA does require that all health plans sold on the soon-to-be-created state health insurance exchanges eventually offer mental health coverage. Those plans, then, will all be required to observe the federal parity act.

The problem, behavioral health advocates say, is that more than four years after President George W. Bush signed the parity bill into law, the Obama administration has yet to complete the federal rules that would enable states to enforce it.

As a result, behavioral health may actually have fallen further behind since passage of the law. In May, the U.S. Government Accountability Office released a report showing that health insurance plans have actually increased the number of exclusions for mental health and addiction treatments since the law was enacted. In 2010 and 2011, for example, 15 percent of the plans surveyed by the GAO were excluding residential mental health, a significant increase from 2008.

"Hundreds of thousands of Americans are being denied their rights under the federal parity law," says James Ramstad, a former Republican congressman who originally introduced the House version of the bill in 1996 at the request of his friend and fellow Minnesotan, the late Democratic Senator Paul Wellstone, whose name is memorialized on the law. Wellstone was killed in a plane crash in 2002. "It took 12 years to pass that parity act and four years later, we still have no rules and therefore no enforcement," says Ramstad. "It’s unconscionable."

The entire article is here.

Tuesday, December 11, 2012

Gay 'Conversion Therapy' Faces Test in Courts

by Erik Eckholm
The New York Times
Originally published November 27, 2012

Gay "conversion therapy," which claims to help men overcome unwanted same-sex attractions but has been widely attacked as unscientific and harmful, is facing its first tests in the courtroom.

In New Jersey on Tuesday, four gay men who tried the therapy filed a civil suit against a prominent counseling group, charging it with deceptive practices under the state's Consumer Fraud Act.

The former clients said they were emotionally scarred by false promises of inner transformation and humiliating techniques that included stripping naked in front of the counselor and beating effigies of their mothers.

They paid thousands of dollars in fees over time, they said, only to be told that the lack of change in their sexual feelings was their own fault.

In California, so-called ex-gay therapists have gone to court to argue for the other side.

They are seeking to block a new state law, signed by Gov. Jerry Brown in September and celebrated as a milestone by advocates for gay rights, that bans conversion therapy for minors.

In Sacramento on Friday, a federal judge will hear the first of two legal challenges brought by conservative law groups claiming that the ban is an unconstitutional infringement on speech, religion and privacy.

Since the 1970s, when mainstream mental health associations stopped branding homosexuality as a disorder, a small network of renegade therapists, conservative religious leaders and self-identified "life coaches" has continued to argue that it is not inborn, but an aberration rooted in childhood trauma.

The entire article is here.

SPLC files groundbreaking lawsuit accusing conversion therapy organization of fraud

Press Release
November 27, 2012

The Southern Poverty Law Center filed a first-of-its-kind lawsuit today accusing a New Jersey organization of consumer fraud for offering conversion therapy services – a dangerous and discredited practice that claims to convert people from gay to straight.

The lawsuit, filed in the Superior Court of New Jersey, charges that Jews Offering New Alternatives for Healing (JONAH), its founder, Arthur Goldberg, and counselor Alan Downing violated New Jersey’s Consumer Fraud Act by providing conversion therapy claiming to cure clients of being gay.

It is the first time a conversion therapy provider has been sued for fraudulent business practices. The lawsuit describes how the plaintiffs – four young men and two of their parents – were lured into JONAH’s services through deceptive practices.

“JONAH profits off of shameful and dangerous attempts to fix something that isn’t broken,” said Christine P. Sun, deputy legal director for the SPLC. “Despite the consensus of mainstream professional organizations that conversion therapy doesn’t work, this racket continues to scam vulnerable gay men and lesbians out of thousands of dollars and inflicts significant harm on them.”

The lawsuit describes how the underlying premise of conversion therapy – that a person can “convert” to heterosexuality – has no basis in scientific fact. Conversion therapy has been discredited or highly criticized by all major American medical, psychiatric, psychological and professional counseling organizations. It is the longstanding consensus of the behavioral and social sciences that homosexuality is a normal and positive variation of human sexual orientation.

Customers of JONAH’s services typically pay a minimum of $100 for weekly individual counseling sessions and another $60 for group therapy sessions. The lawsuit describes sessions that involved clients undressing in front of a mirror and even a group session where young men were instructed to remove their clothing and stand naked in a circle with the counselor, Downing, who was also undressed. Another session involved a subject attempting to wrest away two oranges, which were used to represent testicles, from another individual.

“Sadly, there is no accountability for those who practice conversion therapy,” said Michael Ferguson, a conversion therapy survivor and plaintiff in the lawsuit. “They play blindly with deep emotions and create an immense amount of self-doubt for the client. They seize on your personal vulnerability, and tell you that being gay is synonymous with being less of a man. They further misrepresent themselves as having the key to your new orientation.”

Thanks to Gary Schoener for this information.

Monday, December 10, 2012

Report Urges ‘Cultural Shift’ as Hockey Coaches Defy Concussion Specialists

The New York Times
Originally Published: November 30, 2012

Despite several years of intensive research, coverage and discussion about the dangers of concussions, the idea of playing through head injuries is so deeply rooted in hockey culture that two university teams kept concussed players on the ice even though they were taking part in a major concussion study.

The study, which was published Friday in a series of articles in the journal Neurosurgical Focus, was conducted during the 2011-12 hockey season by researchers from the University of Western Ontario, the University of Montreal, Harvard and other institutions.

“This culture is entrenched at all levels of hockey, from peewee to university,” said Dr. Paul S. Echlin, a concussion specialist and researcher in Burlington, Ontario, and the lead author of the study. “Concussion is a significant public health issue that requires a generational shift. As with smoking or seat belts, it doesn’t just happen overnight — it takes a massive effort and collective movement.”

The study is believed to be among the most comprehensive analyses of concussions in hockey, which has a rate of head trauma approaching that of football. Researchers followed two Canadian university teams — a men’s team and a women’s team — and scanned every player’s brain before and after the season. Players who sustained head injuries also received scans at three intervals after the injuries, with researchers using advanced magnetic resonance imaging techniques.

The entire article is here.

Sunday, December 9, 2012


One Case at a Time Blog
observations from an anesthesiologist and mother of two
Originally published January 2012
The anesthesia scheduling office accidentally placed me in an operating room tomorrow with a patient who is a Jehovah’s Witness. It was a paperwork slip-up; I am new and someone forgot to put my name on the “never” list. There are three options for anesthesiologists at my hospital: You will provide anesthesia for Jehovah’s Witnesses

  1. For all operations
  2. Only for operations that are not expected to involve great blood loss
  3. Never
Of course, all anesthesiologists agree to care for Jehovah’s Witnesses who have a life-threatening emergency if we are the only one available.

I had chosen number three: never. I called the scheduling office and they apologized and switched me to a different operating room.

My lack of faith in any nameable higher being is so firm that I can not reconcile it with what Jehovah’s Witnesses would ask me to do. Their practice comes, of course, from the bible. According to watchtower.org, the official website of the Jehovah’s Witnesses, the belief that “Taking blood into body through mouth or veins violates God's laws” comes from three biblical passages: Gen. 9:3, 4; Lev. 17:14; Acts 15:28, 29.
I am morally incapable of letting someone bleed to death. In my operating room, when I am delivering anesthesia, I am responsible completely for that person’s life. This responsibility weighs heavily on me until each patient is safely out of the operating room. I welcome the weight. I care for each person deeply.
Thanks to Ed Zuckerman for this information.

Saturday, December 8, 2012

Psychologist surrenders license over custody evaluation

Psychiatric Crimes Database
Published on November 29, 2012

On July 20, 2012, psychologist Charlotte Higgins-Lee surrendered her license to practice to the Oregon Board of Psychologist Examiners According to the Board’s document, in late 2010, Higgins-Lee received a referral to conducted a psychological evaluation of a father and his nine-year-old daughter and to testify in a January 2011 hearing concerning custody and parenting time. Though the custody matter concerned the father, daughter and father’s ex-spouse (the daughter’s mother), Higgins-Lee did not interview the mother (though she interviewed the father, daughter and others). Nonetheless, she concluded that the father should have sole custody and that “more information should be obtained on the mother’s alcohol use/abuse and violence,” among other statements critical of the mother, whom she had never met or interviewed. The Board proposed a reprimand, civil fine of $7,500 and requirement to practice under supervision for a minimum of six months. However, Higgins-Lee later agreed to a new stipulated agreement to surrender her license to the Board.

The board order is here.

Friday, December 7, 2012

Arizona studies envision telemedicine on smartphones

By: Lorri Allen
Cronkite News Service
Originally published: Nov 21, 2012

Until now, telemedicine has largely involved capital-intensive studios and cameras isolated to one area of a hospital. But the Mayo Clinic and a University of Arizona center dedicated to telemedicine are pioneering work aimed at moving care to smartphones.

That means practicing medicine in remote and underserved communities will become cheaper, quicker and more effective, according to Dr. Bart Demaerschalk, a neurologist at Mayo Clinic Hospital.

"What we're attempting to do is to make it even easier for the clinical specialist to insert themselves in a virtual manner for the patient in the remote environment," he said. "A mobile device should fulfill that goal."

Dr. Ronald Weinstein, director of the Arizona Telemedicine Program, sees it as a natural progression.

"Telemedicine is rapidly evolving into being next-generation or even a generation beyond by going to mobile health or e-health, and the concept du jour is that the smartphone is the telemedicine workstation," he said.

That's happening at Benson Hospital, where health care workers use Skype on iPads to save time.

"It's very low-cost and it's to facilitate communication between our ER docs and admissions," said John Roberts, information technology director.

The entire story is here.

Thursday, December 6, 2012

Vignette 20: Has the Psychologist Done too Much?

Dr. Plenty lives and practices psychology in a rural area.  She began to provide psychotherapy to Mr. DiMencha, a 52-year-old, who suffered with depression.  After six sessions, Mr. DiMencha suffered a significant concussion while at work.  His impairment is noticeable by Dr. Plenty without any type of testing.  He struggles with understanding concepts and becomes tangential during the next two sessions.

Mr. DiMencha’s co-worker, Janet, helped him find an attorney so that his rights are protected.  Dr. Plenty had Mr. DiMencha sign a release to talk with the attorney as well as Janet.  From a phone call with the attorney, Workers Compensation wants to work out a settlement. However, the attorney has little awareness about how impaired Mr. DiMencha is.  The patient has never met the attorney face-to-face, just by email and phone contacts.

Mr. DiMencha demonstrates a variety of cognitive deficits.  He needs assistance and monitoring with daily tasks, such as home care, shopping, transportation, understanding the settlement process, reading his mail, and paying his bills. He will likely need to go into an assisted living facility. His family lives at a distance and provides minimal help. Workers Compensation refuses to pay for the case management services of an independent social worker. Attempts to find social service agencies able to help him have not been successful. Mr. DiMencha doesn't appear to understand his legal rights or the settlement process.

Prior to providing extra-therapy support, Dr. Plenty had Mr. DiMencha sign a document explaining her fees for the additional services.  She is not sure that he completely understands what is happening or her version of informed consent for the additional services.  The psychologist has been doing much of the case management work, e.g. locating a long-time friend who is willing to help him at home, referring him to a neuropsychologist for testing, engaging in lengthy discussions with his primary care physician and neurologist, participating in multiple conversations with the attorney, and trying to find a guardian or power of attorney.

In the midst of all of this activity, the psychologist contacts you for an ethics consultation.

What are the potential ethical issues with this case?

What are the competing ethical principles?

Is Dr. Plenty acting beyond the limits of her competency?

Is she practicing outside of her scope of her license?

What problems may occur as a function of Dr. Plenty engaging in a multiple relationship role in Mr. DiMencha’s care?

What suggestions would you make to Dr. Plenty?

Wednesday, December 5, 2012

The Psych Approach

The New York Times
Originally Published: September 27, 2012

Here are some excerpts:

Tough’s book is part of what you might call the psychologizing of domestic policy. In the past several decades, policy makers have focused on the material and bureaucratic things that correlate to school failure, like poor neighborhoods, bad nutrition, schools that are too big or too small. But, more recently, attention has shifted to the psychological reactions that impede learning — the ones that flow from insecure relationships, constant movement and economic anxiety.

Attention has shifted toward the psychological for several reasons. First, it’s become increasingly clear that social and emotional deficits can trump material or even intellectual progress. Schools in the Knowledge Is Power Program, or KIPP, are among the best college prep academies for disadvantaged kids. But, in its first survey a few years ago, KIPP discovered that three-quarters of its graduates were not making it through college. It wasn’t the students with the lower high school grades that were dropping out most. It was the ones with the weakest resilience and social skills. It was the pessimists.

Second, over the past few years, an array of psychological researchers have taught us that motivation, self-control and resilience are together as important as raw I.Q. and are probably more malleable.

Finally, pop culture has been far out front of policy makers in showing how social dysfunction can ruin lives. You can turn on an episode of “Here Comes Honey Boo Boo,” about a train wreck working-class family. You can turn on “Alaska State Troopers” and see trailer parks filled with drugged-up basket cases. You can listen to rappers like Tyler, The Creator whose songs are angry howls from fatherless men.

The entire article is here.

Gay Conversion Therapy Law Temporarily Blocked By Federal Judge

The Huffington Post
Originally published December 4, 2012

A federal judge on Monday temporarily blocked California from enforcing a first-of-its-kind law that bars licensed psychotherapists from working to change the sexual orientations of gay minors, but he limited the scope of his order to just the three providers who have appealed to him to overturn the measure.

U.S. District Court Judge William Shubb made a decision just hours after a hearing on the issue, ruling that the First Amendment rights of psychiatrists, psychologists and other mental health professionals who engage in "reparative" or "conversion" therapy outweigh concern that the practice poses a danger to young people.

"Even if SB 1172 is characterized as primarily aimed at regulating conduct, it also extends to forms of (conversion therapy) that utilize speech and, at a minimum, regulates conduct that has an incidental effect on speech," Shubb wrote.

The judge also disputed the California Legislature's finding that trying to change young people's sexual orientation puts them at risk for suicide or depression, saying it was based on "questionable and scientifically incomplete studies."

The law, which was passed by the Legislature and signed by Gov. Jerry Brown in October, states that therapists and counselors who use "sexual orientation change efforts" on clients under 18 would be engaging in unprofessional conduct and subject to discipline by state licensing boards. It is set to take effect on Jan. 1.

The entire story is here.

Tuesday, December 4, 2012

Human Enhancements at Work Pose Ethical Dilemmas

By Kate Holland
Reuters Health Information
Originally published November 8, 2012

Retinal implants to help pilots see at night, stimulant drugs to keep surgeons alert and steady handed, cognitive enhancers to focus the minds of executives for a big speech or presentation.

Medical and scientific advances are bringing human enhancements into work but with them, according to a report by British experts, come not only the potential to help society and boost productivity, but also a range of ethical dilemmas.

"We're not talking science fiction here, we're talking about advances that could impact significantly on the way we work...in the near future," said Genevra Richardson, a professor of law at Kings College London and one of the authors of the report.

The report was published after a joint workshop involving four major British scientific institutions which looked at emerging technologies like cognitive enhancing drugs, bionic limbs and retinal implants that have the potential to change workplaces dramatically in future.

Richardson said while such developments may benefit society in important ways, such as by boosting workforce productivity, their use also had "significant policy implications" to be considered by governments, employers, workers and trades unions.

The entire article is here.

DSM-5 Wins APA Board Approval

By John Gever, Senior Editor
MedPage Today
Originally published December 1, 2012

The American Psychiatric Association's board of trustees has approved the fifth edition of its influential diagnostic manual, dubbed DSM-5, the group announced Saturday.

The board vote is the last step before the manual is formally released at the APA's annual meeting next May. The association's Diagnostic and Statistical Manual of Mental Disorders was last revised in 1994; that edition is known colloquially as DSM-IV.

According to an APA statement, changes include an end to the system of "axes" used to class diagnoses into broad groups, and an associated restructuring of diagnostic groups to bring disorders thought to be biologically related under the same headings.

Also, many of the diagnostic criteria will now include so-called dimensional assessments to indicate severity of symptoms.

Specific language in DSM-5 was not immediately released, and probably won't be until the formal unveiling in May. Detailed criteria that had been published on the APA's DSM5.org website for public review and comment have now been removed.

However, the statement released Saturday indicated that the manual will include many of the most controversial of the proposed changes from DSM-IV.

The entire article is here.

Monday, December 3, 2012

When Is It Okay to Date a Patient?

By Shelly Reese
Medscape Ethics Report 2012
Originally published November 15, 2012


To the besotted poet, love is intoxicating, exasperating, invigorating. To the doctor -- if the would-be paramour is a patient -- it's also unethical.

But physician responses to Medscape's 2012 ethics survey clearly indicate that many physicians aren't willing to condemn every romance. When asked, "Is it ever acceptable to become involved a romantic or sexual relationship with a patient?" more than two thirds (68%) of the 24,000 doctors who responded resoundingly say "no."

In contrast, nearly one third are more nuanced in their view. Only a tiny minority (1%) give romance with current patients a green light, but a sizable share (22%) say that a romantic relationship with a former patient may be acceptable, as long as at least 6 months have passed since the professional relationship was terminated. Another 9% say the ethics depend on the situation.

Whereas the American Medical Association (AMA) clearly states that sexual contact that is concurrent with the doctor/patient relationship constitutes sexual misconduct, it takes a fuzzier position on relationships that might develop later. The AMA notes that the prior doctor/patient relationship may unduly influence the patient and that such a relationship is unethical if the doctor "uses or exploits trust, knowledge, emotions or influence derived from the previous professional relationship."

Ethicists, such as Dr. Richard Martinez, director of forensic psychiatry services at Denver Health Medical Center and the author of several articles on ethical decision-making and the patient/physician relationship, says the AMA was wise to leave a little wiggle room in its opinion.

"Relationships are complicated," he says. "Every ethical dilemma has to be evaluated and considered on a case-by-case basis."

The entire story is here.

Thanks to Gary Schoener for this information.

Dealing With Doctors Who Take Only Cash

The New York Times
Originally published: November 23, 2012

Here is an excerpt:

The next day, he drove an hour from Brooklyn to our house. He then spent an hour and a half talking to us and examining our daughter in her nursery. He prescribed some medicine for her and suggested some changes to my wife’s diet. Within two days, our baby was sleeping through the night and we were all feeling better.

The only catch was this pediatrician did not accept insurance. He had taken our credit card information before his visit and given us a form to submit to our insurance company as he left, saying insurance usually paid a portion of his fee, which was $650.

A couple of weeks later, our insurance company said it wouldn’t pay anything. Here’s how the company figured it: First, it said a fair price for our doctor’s fee was $285, about 60 percent less, because that was the going rate for our town. Then, it said the lower fee was not enough to meet our out-of-network deductible.

While we were none too happy with the insurance company, we remained impressed by the doctor: he had made our baby better and was compensated for it, all the while avoiding the hassle of dealing with insurance.

Last year, I wrote about doctors who catered only to the richest of the rich and charged accordingly. But after my experience, I became interested in doctors for the average person who take only cash. What pushes a doctor to go this route, often called concierge medicine? And how hard is it to make a living?

The entire story is here.

Sunday, December 2, 2012

Hanging Suicides Up in United States

By Steven Reinberg
HealthDay Reporter
Originally published November 20, 2012

A surge in hanging deaths among middle-aged adults appears to be responsible for the notable increase in U.S. suicides between 2000 and 2010, a new study finds.

Hangings accounted for 26 percent of suicides in 2010, up from 19 percent at the start of the decade. Among those aged 45 to 59, suicide by hanging increased 104 percent in that time period, according to the report documenting changing suicide patterns.

Overall, 16 percent more Americans took their own lives in 2010 than in 2000. That's equivalent to 12.1 suicides per 100,000 people compared to 10.4 per 100,000 previously.

"It is important that the huge increase in suicide by hanging be recognized," said lead researcher Susan Baker, founding director of the Johns Hopkins Center for Injury Research and Policy at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

The entire story is here.

Saturday, December 1, 2012

Online Patient Access to Records May Boost Visits

By John Gever, Senior Editor
MedPage Today
Published: November 20, 2012

Patients with access to their physicians' electronic health record systems had more office visits, hospital admissions, and emergency room encounters than those without such access, researchers said.

Participants in a Kaiser Permanente program giving them access to their electronic records, including a secure email system for communicating with clinicians, showed significant increases in nearly all measures of healthcare utilization, relative to the period before they joined the program, Ted E. Palen, MD, PhD, MSPH, of Kaiser Permanente Colorado in Denver, and colleagues reported in the Nov. 20 issue of the Journal of the American Medical Association.


In an accompanying editorial, two researchers at Brigham and Women's Hospital in Boston noted that the study findings stood in contrast to Kaiser investigations in other regions, which had found reductions in utilization associated with so-called patient portals to electronic health records.

The entire story is here.

Medicare Is Faulted on Shift to Electronic Records

The New York Times
Originally Published: November 29, 2012

The conversion to electronic medical records — a critical piece of the Obama administration’s plan for health care reform — is “vulnerable” to fraud and abuse because of the failure of Medicare officials to develop appropriate safeguards, according to a sharply critical report to be issued Thursday by federal investigators.

The use of electronic medical records has been central to the aim of overhauling health care in America. Advocates contend that electronic records systems will improve patient care and lower costs through better coordination of medical services, and the Obama administration is spending billions of dollars to encourage doctors and hospitals to switch to electronic records to track patient care.

But the report says Medicare, which is charged with managing the incentive program that encourages the adoption of electronic records, has failed to put in place adequate safeguards to ensure that information being provided by hospitals and doctors about their electronic records systems is accurate. To qualify for the incentive payments, doctors and hospitals must demonstrate that the systems lead to better patient care, meeting a so-called meaningful use standard by, for example, checking for harmful drug interactions.

The entire article is here.

Friday, November 30, 2012

MaleSurvivor Conference Examines Sexual Abuse in Sports

By Eric V. Copage
The New York Times
Originally published November 18, 2012

Here are some excerpts:

A dour procession of stories about sexual misconduct by coaches toward their male charges has come to light in recent months. Jerry Sandusky, a former assistant football coach at Penn State, was sentenced in October to 30 to 60 years in prison on 45 counts of child molesting. Sugar Ray Leonard wrote in his autobiography last year that he was sexually molested by an Olympic boxing coach. The N.H.L. players Theo Fleury and Sheldon Kennedy were sexually abused as teenagers by their hockey coach Graham James.
The prevalence of sexual abuse among all boys 17 and under has been variously estimated to be as low as 5 percent and as high as 16 percent. For some of the millions of children who participate in sports nationwide, and their parents, sexual assault in a sports context has its own dynamic.
“Sports is a place where parents send their boys to learn skills, to learn how to be teammates and how to work together — to make boys stronger and healthier,” said Dr. Howard Fradkin, author of “Joining Forces,” a book about how men can heal from sexual abuse. “It’s the place where we send our boys to grow up. The betrayal that occurs when abuse occurs in sports is damaging because it destroys the whole intent of what they started out to do.”

Maine West High School Sued For Student Hazing, Sodomy 'Sanctioned By Coaches'

The Huffington Post
Originally published November 20, 2012

The family of a Illinois high school freshman is suing the Maine Township High School District 207, claiming that Maine West High School officials sanctioned hazing of the unnamed teen as part of a years-long ritual at the school.

The unidentified mother appeared at a news conference Monday wearing a baseball cap and sunglasses alongside attorney Antonio Romanucci.

"I thought my son would be safe at school," she said, according to WLS-TV. "You think when you drop off your son, it's a safe place to be. But I feel like the coaches should have kept him safe on the soccer field, and they didn't do that."

The mother adds that the acts -- and the school's failure to respond -- breaks Illinois state anti-bullying laws.

The lawsuit claims that the 14-year-old and at least two other boys were sexually assaulted during soccer practice in September -- during school hours and condoned by coaches. The complaint alleges that teammates shoved the three boys to the ground and beat them. The older players then held them down, pulled down their pants and underwear and sodomized them.

The entire story is here.

Thursday, November 29, 2012

The Role of Health Professionals in Detainee Interrogation

A teenager tortured at Guantanamo, and the stalled legislation to ensure clinicians "first, do no harm"

By Santiago Wills
The Atlantic
Originally published November 11, 2012

Here is one excerpt:

In the aftermath of the wars in Iraq and Afghanistan, ever since leaked reports and testimonies -- including that of alleged 9/11 mastermind Khalid Sheikh Mohammed, currently on trial in Guantanamo -- were published in 2004, the issue has attracted the attention of the media, health organizations, and political activists. Psychologists and doctors have clashed with their peers and with the Department of Defense over the role that health professionals should play in interrogations, given their oath to "do no harm." The Senate Judiciary Committee and numerous military investigations have confirmed that physicians and clinicians played a significant role during so-called enhanced interrogations, either through reverse engineering of the Survival, Evasion, Resistance, Escape (SERE) program, or through monitoring and assisting in CIA black sites and prisons like Bagram and Guantanamo.

Recently, that conflict reached politicians in Albany, New York. This year, State Senator Thomas Duane and Assembly Member Richard Gottfried sponsored a unique piece of legislation that establishes sanctions (including license removal) for state-licensed health professionals who participate in torture or improper treatment of prisoners.

"The bill presents an opportunity to fill a gap in state law on the regulation of health professionals that desperately needs to be filled," Leonard Rubenstein, the former president of Physicians for Human Rights -- an independent organization that fights human rights violations all around the world -- said in a public forum. "Almost everyone agrees that the idea that health professionals can participate in abuse of detainees and prisoners is indefensible. If that is the case, it is also indefensible to exclude such acts from state law on licensing and regulation of health professionals."

The entire story is here.

Wednesday, November 28, 2012

Physician Suicide Linked to Work Stress

By Crystal Phend, Senior Staff Writer
MedPage Today
Originally published November 14, 2012

Suicide among physicians appears to follow a different profile than in the general population, with a greater role played by job stress and mental health problems, a national analysis showed.

Problems with work were three times more likely to have contributed to a physician's suicide than a nonphysician's, Katherine J. Gold, MD, MSW, of the University of Michigan in Ann Arbor, and colleagues found.

Their analysis of the National Violent Death Reporting System also showed that known mental illness prior to suicide was 34% more common among physicians than nonphysicians.

"The results of this study paint a picture of the typical physician suicide victim that is substantially different from that of the nonphysician suicide victim in several important ways," the group wrote online in General Hospital Psychiatry.

The entire story is here.

The original article is here.

Here is the conclusion from the abstract:
Mental illness is an important comorbidity for physicians who complete a suicide but postmortem toxicology data shows low rates of medication treatment. Inadequate treatment and increased problems related to job stress may be potentially modifiable risk factors to reduce suicidal death among physicians.