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, April 30, 2012

Paul F. Tompkins on Ethics and Rationalizations

Some comic relief about ethics, stealing, lying, and rationalizations.

All three of these videos are connected as part of the stand-up routine.


 Gentleman Bandit: A great rationalization

Expected to Steal and Guilt


Confession, Rationalization, and Existential Crisis

Sunday, April 29, 2012

On campus, debate over civil rights and rape

USA Today
Originally Published April 21, 2012

For months after Kristina Ponischil was raped at a party in her off-campus apartment, her life at Western Washington University was hell.

Police wouldn't act, as often happens in college towns with "he said, she said" accounts of alcohol-influenced student encounters behind closed doors. Despite a restraining order, she kept running into her assailant on campus, prompting panic attacks.
Once, the man who'd raped her brushed up against Ponischil in the bookstore, then smirked.

"I was just constantly worried that I would run into him again," Ponischil said.
But if the criminal justice system let Ponischil down,Western Washington did not. When she finally told an administrator what happened, the school sprang to action, offering her the support she needed. Perhaps most importantly, the campus judicial system, using a lower standard of proof than criminal courts, suspended her assailant, removing him from campus until she graduated in 2009.


The college's response wasn't just a moral obligation; it was also a legal one.

June marks the 40th anniversary of Title IX, the federal gender-equity law that has made headlines mostly on the sports pages. But over the last decade or so, through a series of court rulings and more recently controversial guidance published by Obama administration, Title IX has shifted onto a different patch of contentious terrain — sexual assault on college campuses. It is transforming how colleges must respond to allegations of sexual violence.

Catholic nuns group 'stunned' by Vatican scolding for 'radical feminist' ideas

By Reuters
Originally published April 20, 2012

The Vatican
A prominent U.S. Catholic nuns group said it was "stunned" that the Vatican reprimanded it for spending too much time on poverty and social justice concerns and not enough on abortion and gay marriage.

In a stinging report on Wednesday, the Vatican said the Leadership Conference of Women Religious had been "silent on the right to life" and had failed to make the "Biblical view of family life and human sexuality" a central plank in its agenda. It accused the group of promoting "certain radical feminist themes incompatible with the Catholic faith."

It also reprimanded American nuns for expressing positions on political issues that differed, at times, from views held by American bishops. Public disagreement with the bishops -- "who are the church's authentic teachers of faith and morals" -- is unacceptable, the report said.

The entire story is here.

Saturday, April 28, 2012

The New Science of Morality - Jonathan Haidt: Edge Video

From Edge Video

"University of Virginia psychologist Jonathan Haidt's research indicates that morality is a social construction which has evolved out of raw materials provided by five (or more) innate "psychological" foundations: Harm, Fairness, Ingroup, Authority, and Purity. Highly educated liberals generally rely upon and endorse only the first two foundations, whereas people who are more conservative, more religious, or of lower social class usually rely upon and endorse all five foundations."

Part 1

Part 2

Part 3

Part 4

Friday, April 27, 2012

Jonathan Alpert's Mis-Statements, And Possible Misconduct

By Todd Essig
Forbes: Leadership
Originally published April 23, 2012

An intentionally provocative opinion piece about psychotherapy was just published in the NY Times by Jonathan Alpert. Well, it worked. I’ve been provoked. Alpert is an apparently proud fellow who uses his web-site to trumpet being called “Manhattan’s most media-friendly psychotherapist.” In the article he lays claim to a style of psychotherapy that is a unique advance because unlike others he actually helps patients change. Other people, people like me, what we do is waste our patients lives so we can get paid. According to him relaxing “spa appointments” rather than anything useful are what people get from me and my kind.

How did this get past the Times editors? It is so clearly designed as an infomercial for selling the author’s go-for-the-gusto change-your-life in 28 days book. Plus the article is dangerous. It perpetuates the myth that psychotherapy is inefficient, ineffective snake oil, relaxing to be sure but snake oil nonetheless. In so doing it erects an unnecessary conceptual obstacle to getting help that someone might need.

The entire response to Mr. Alpert's article is here.

Thanks to Richard Ievoli for this article.  He could have been a contender.

In Therapy Forever? Enough Already

By Jonathan Alpert
The New York Times - Sunday Review - Opinion
Originally published April 22, 2012

MY therapist called me the wrong name. I poured out my heart; my doctor looked at his watch. My psychiatrist told me I had to keep seeing him or I would be lost.

New patients tell me things like this all the time. And they tell me how former therapists sat, listened, nodded and offered little or no advice, for weeks, months, sometimes years. A patient recently told me that, after seeing her therapist for several years, she asked if he had any advice for her. The therapist said, “See you next week.”

When I started practicing as a therapist 15 years ago, I thought complaints like this were anomalous. But I have come to a sobering conclusion over the years: ineffective therapy is disturbingly common.

The entire story is here.

Jonathan Alpert is a Licensed Professional Counselor in Pennsylvania.

Thursday, April 26, 2012

A Sharp Rise in Retractions Prompts Calls for Reform

By Carl Zimmer
The New York Times
Originally published April 16, 2012

In the fall of 2010, Dr. Ferric C. Fang made an unsettling discovery. Dr. Fang, who is editor in chief of the journal Infection and Immunity, found that one of his authors had doctored several papers.

It was a new experience for him. “Prior to that time,” he said in an interview, “Infection and Immunity had only retracted nine articles over a 40-year period.”

The journal wound up retracting six of the papers from the author, Naoki Mori of the University of the Ryukyus in Japan. And it soon became clear that Infection and Immunity was hardly the only victim of Dr. Mori’s misconduct. Since then, other scientific journals have retracted two dozen of his papers, according to the watchdog blog Retraction Watch.

The Flight From Conversation

By Sherry Turkle
The New York Times - Opinion
The Sunday Review
Originally published April 21, 2012

WE live in a technological universe in which we are always communicating. And yet we have sacrificed conversation for mere connection.

At home, families sit together, texting and reading e-mail. At work executives text during board meetings. We text (and shop and go on Facebook) during classes and when we’re on dates. My students tell me about an important new skill: it involves maintaining eye contact with someone while you text someone else; it’s hard, but it can be done.

Over the past 15 years, I’ve studied technologies of mobile connection and talked to hundreds of people of all ages and circumstances about their plugged-in lives. I’ve learned that the little devices most of us carry around are so powerful that they change not only what we do, but also who we are.

We’ve become accustomed to a new way of being “alone together.” Technology-enabled, we are able to be with one another, and also elsewhere, connected to wherever we want to be. We want to customize our lives. We want to move in and out of where we are because the thing we value most is control over where we focus our attention. We have gotten used to the idea of being in a tribe of one, loyal to our own party.

Thanks to Lou Moskowitz for this story.

This story has implications for face-to-face psychotherapy as well as online therapy.

Wednesday, April 25, 2012

As Beef Cattle Become Behemoths, Who Are Animal Scientists Serving?

By Melody Petersen
The Chronicle of Higher Education
Originally published on April 15, 2012

Here are some exerpts:

Scores of animal scientists employed by public universities have helped pharmaceutical companies persuade farmers and ranchers to use antibiotics, hormones, and drugs like Zilmax to make their cattle grow bigger ever faster. With the use of these products, the average weight of a fattened steer sold to a packing plant is now roughly 1,300 pounds—up from 1,000 pounds in 1975.

It's been a profitable venture for the drug companies, as well as for the professors and their universities. Agriculture schools increasingly depend on the industry for research grants, a sizable portion of which cover overhead and administrative costs. And many professors now add to their personal bank accounts by working for the companies as consultants and speakers. More than two-thirds of animal scientists reported in a 2005 survey that they had received money from industry in the previous five years.

Yet unlike a growing number of medical schools around the country, where administrators have recently tightened rules to better police their faculty's ties to pharmaceutical companies, the schools of agriculture have largely rejected critics' concerns about industry cash. Administrators have set few limits on how much corporate money agricultural professors can accept. Faculty work with industry is governed by confidentiality rules that veil it from public view.

The entire story is here.

Tuesday, April 24, 2012

Should 'Mental Health Checkups' Be Made Part Of Health Care In Schools?

Medical News Today
Originally published April 16, 2012

"The early detection of children who are showing psychiatric symptoms or are at the risk of a mental disorder is crucial, but introducing "mental health checkups" as part of health care in schools is not altogether simple," says David Gyllenberg, MD, whose doctoral dissertation "Childhood Predictors of Later Psychotropic Medication Use and Psychiatric Hospital Treatment - Findings from the Finnish Nationwide 1981 Birth Cohort Study" was publically examined at the University of Helsinki on 13 April 2012.

In Gyllenberg's study, the mental wellbeing of nearly 6,000 Finnish children of the age of eight was charted through a survey carried out in 1989. After this, the use of psychotropic medication and psychiatric hospital periods of the same children from the age of 12 to 25 was followed up.

The entire story is here.

A Spate of Teenage Suicides Alarms Russians

By Glenn Kates
The New York Times
Originally published April 19, 2012

Russia has been hit with a wave of copycat teenage suicides so pronounced that President Dmitri A. Medvedev felt compelled on Thursday to warn news media outlets against making too much of the deaths, for fear of attracting more imitators.

“It is indeed very alarming and serious, but it does not mean that it is a snowball that will become bigger and bigger every year,” Mr. Medvedev said. “This must be treated extremely gently.”

The spike in teenage suicides began in February, when two 14-year-old girls jumped hand in hand from the 16th-floor roof of an apartment building in suburban Moscow. Afterward, a series of apartment jumps attracted national attention.

Over 24 hours starting on April 9, there were at least six deaths. A girl, 16, jumped from an unfinished hospital in Siberia, while five others hanged themselves: a boy, 15, who died in the city of Perm two days after his mother found him hanging; another 15-year-old, who killed himself on his birthday, in Nizhny Novgorod, a city on the Volga River; teenagers in the northern city of Lomonosov and in Samara; and a 16-year-old murder suspect who used his prison bedsheet to kill himself in Krasnoyarsk.

Monday, April 23, 2012

Do Bioethics Really Matter?

By Arthur Kaplan
Book Review published in The Lancet
Malignant: Medical Ethicists Confront Cancer by Rebecca Dresser
Originally published April 14, 2012

Malignant is a book that I am sure will catch the eye of many readers of this journal. Not because it is a collection of essays by people who have either had cancer or who cared for loved ones who did. Many books cover that ground. Not because it is a collection of essays by distinguished American bioethicists, including Norman Fost, Leon Kass, Daniel W Brock, and Rebecca Dresser. There are lots of bioethics collections authored by eminent scholars around too. This book will command attention because the bioethicists writing the essays are also the very same people who had the cancer or helped loved ones who did.

The book thus raises the obvious question—in facing cancer, did the contributors fare any better for all their scholarly expertise in bioethics? Or, did cancer prove to be the great leveller, leaving all who talk for a living about moral theory and normative argument tongue-tied as each learned what the real world of serious sickness is all about? Did careers of offering opinions to others in and out of health care about how to behave, speak, and respond make a whit of difference to the personal experience each of the contributors had in their own intimate struggles with cancer?

Sunday, April 22, 2012

J.&J. Fined $1.2 Billion in Drug Case

By Katie Thomas
The New York Times
Originally published April 11, 2012

A judge in Arkansas ordered Johnson & Johnson and a subsidiary to pay more than $1.2 billion in fines on Wednesday, a day after a jury found that the companies had minimized or concealed the dangers associated with an antipsychotic drug.

The fine, which experts said ranked among the largest on record for a state fraud case involving a drug company, is the most recent in a string of legal losses for Johnson & Johnson related to its marketing of the drug, Risperdal.

In January, Texas settled a similar case with the subsidiary, Janssen Pharmaceuticals, for $158 million. Last year, a South Carolina judge levied civil penalties of $327 million against Janssen, and in 2010, a Louisiana jury awarded nearly $258 million in damages.

Here is a prior story about Johnson and Johnson with Risperdal.

Saturday, April 21, 2012

Turning Good Intentions into Good Behavior: Self-perception, Self-care, and Social Influences

Samuel Knapp, EdD, ABPP
Director of Professional Affairs

John D. Gavazzi, PsyD, ABPP
Chair, PPA Ethics Committee

Originally published in The Pennsylvania Psychologist

            Most of us want to fulfill our ethical mandate to help our clients as best as we can. However, non-rational factors, such as faulty thinking habits, situational pressures, or fatigue can overpower our good intentions and lead to less-than-optimal ethical behaviors. We are not just referring to flagrant misconduct that would leave us vulnerable to a licensing board complaint or lawsuit. Instead, this less-than-optimal behavior is more subtle, such as delivering acceptable (but not top quality) professional services.
Traditional approaches to improve ethical conduct and clinical skills involve attending didactic lectures. As helpful as these lectures may be, behavioral change is more likely to occur when we take a more active role in exploring how important variables such as self-perception, self-care, and social factors influence clinical performance (Tjeltveit & Gottlieb, 2010). Reducing our blind spots, increasing our self-knowledge, and enhancing our awareness of work pressures and organizational cultures are worthwhile processes to explore in order to investigate our basic ethical obligations (Bazerman & Tenbrunsel, 2011).
Professional narcissism,” or an “overestimation of one’s abilities” (Younggren, 2007, p. 515) represents one such blind spot. For example, Davis et al. (2006) asked physicians to perform a standardized patient procedure, and then estimate their competence at that procedure. Most physicians rated themselves higher than justified, including a few who performed incompetently but nonetheless rated themselves very high. While a modest amount of overconfidence may be harmless (or perhaps even healthy), we need to guard against the tendency to see ourselves as much better than we really are. We can avoid professional narcissism through activities that promote self-reflection, such as keeping a journal geared toward clinical experiences and contemplating ethical nuances of practice. We can also establish routines to ensure regular feedback about our behavior, such as asking patients questions at the end of sessions. We can ask how the session went or how we could have been more helpful. Some psychologists have adopted a productive philosophy of admitting mistakes, apologizing for them (when appropriate), learning from them, and then moving on (show self-compassion). “People can learn to see mistakes not as terrible personal failings to be denied or justified, but as inevitable aspects of life that help us grow” (Tavris & Aronson, 2007, p. 235).
Medical residents who are fatigued make more errors as their fatigue increases (Harvard Work Group, 2004). Similarly, we are less able to focus on our professional obligations and we can become more prone to errors when we are fatigued. Highly competent psychologists engage in positive self-care activities, such as regular exercise, good sleep hygiene, healthy eating, and other activities that promote health and wellness. Part of self-care means accepting our limitations in terms of time, energy, and resources. Healthy psychologists acknowledge that they cannot help everyone and cannot master every facet in the psychology domain.
Some practices, agencies, or organizations may not value ethical behavior, even though they may have an ethics policy, an ethics code, mandatory ethics education, or other formal structures designed to promote ethics. However, the “hidden culture” of the organization often has more influence then formal guidelines when framing ethical dilemmas and determining ethical behavior. “Formal systems are the weakest link in an organization’s ethical infrastructure” (Bazerman & Tenbrunsel, 2011, p. 118). That is, the interactions and comments that occur among members of the organization create the day-to-day ethical tone of an organization. The informal ethical culture of an organization courses through the stories that employees tell, the euphemisms that they use to describe issues, or the socialization rituals that employees undergo. In many cases, the cultural influences on practitioners remain unseen, especially to those who remain frame-dependent.
 Here are some strategies, activities, or routines that some psychologists have used to reduce the gap between good intentions and good behavior.

Self-Directed Activities to Enhance Ethical Practice

Encourage self-reflection (to reduce or to avoid professional narcissism)

Keep a journal or a diary to focus on therapy and possible ethical issues in daily practice, engage in therapy, try to be more open-minded, listen to feelings.
Routinely ask patients for feedback at the end of each session (what did I do that was helpful today? Not helpful?). Routinely gather outcome data. Re-read therapy notes to become aware of any unproductive emotions or countertransference.
Think in terms of ethical issues when facing clinical problems.
            Have a productive philosophy concerning mistakes: Admit them, apologize (if helpful), learn from them, and move on (show self-compassion).
Attend to environmental influences

Encourage friends or colleagues to tell me when they think I am doing something wrong.
Develop schedules – although not too rigidly—and think about time management.
Attend to environmental circumstances that might influence me to engage in less than optimal ethical behavior.
Be aware of temptations to minimize the worth or individuality of clients or other people (e.g., interpret troublesome behaviors as barriers, not manifestations of evil).

Establish Healthy Routines

Make checklists or schedule healthy activities.
Make learning a habit. Attend CE programs (especially programs on ethics), read journals, get advanced training or certification in an area of psychology.
Keep the APA Ethics Code or the Pennsylvania licensing law and regulations close by.
Get in the habit of using an ethical decision-making model.
Belong to and participate in a professional association  (or present at a CE program, join a listserv, start a blog, or participate in student groups, committees).
Uphold ideals without being sanctimonious.
Prevent problems ahead of time

Practice self-care: e.g., pay attention to exercise, sleep hygiene, and diet.
Maintain a good work-life balance.
Reduce dysfunctional emotions through meditation, mindfulness exercises, therapy, or recreational activities unrelated to school or work.
Manage time and tasks carefully (breaking big tasks into smaller ones).
Accept my limitations in terms of time, energy, and resources. (I can’t help
            everyone; I can’t do everything). Balance compassion and altruism with my own needs.[1]
Show concern for others, including your fellow psychologists (help them out if
            I can); commit random acts of kindness; express appreciation (say “thank you”).

Bazerman, M., & Tenbrunsel, A. (2011). Blind spots. Princeton, NJ: Princeton University Press.
Davis, D., Mazmanian, P. E., Fordis, M., Van Harrison, R., Thorpe, K. E., & Perrier, L. (2006). Accuracy of physician self-assessment compared with observed measures of competence: A systematic review. Journal of the American Medical Association, 296, 1137-1139.
Harvard Work Hours Health and Safety Group. (2004). New England Journal of Medicine, 351, 1838-1848.
Ross, W. D. (1998). What makes right act right? In J. Rachaels (Ed.). Ethical theory (pp. 265-285). New York: Oxford University Press. (Original work published 1930).
Tavris, C., & Aronson, E. (2007). Mistakes were made. Orlando, FL: Harcourt.
Tjeltveit, A., & Gottlieb, M. (2010). Avoiding the road to ethical disaster: Overcoming vulnerabilities and developing resilience. Psychotherapy: Theory, Research, Practice, Training, 47, 98-110.
Younggren, J. (2007). Competence as a process of self-appraisal. Professional Psychology: Research and Practice, 38, 515-516.

[1] W.D. Ross (1998) says that supererogatory obligations should not distract us from our primary obligations to family, close friends, and ourselves.

Friday, April 20, 2012

Happy Birthday to Our Blog

Hi Folks!!

Happy Birthday seems appropriate.

As I stated on the very first post, this blog was an outgrowth from the Pennsylvania Psychological Association's decision to change their web site and scrap our bulletin board.

The overarching goals of the prior bulletin board and this blog are to raise awareness about ethics and to help students and professionals become better psychologists.  The blog has greatly expanded our ability to provide multi-media content to viewers.

Since this blog was an experiment of sorts, I had some minor goals in mind whether to keep this going after one year.

One goal was to have 150 individuals follow by email.  I wanted to be able to reach 150 people per day so that there would be critical mass of individuals who were reading the content.  Put differently, I did not want to spend a great deal of time and energy for minimal gain.  Currently, there are 170 individual who follow the blog via email.

I also hoped that the blog had about 20,000 page hits at the one year mark.  Again, my thinking was that others who did not subscribe to the email service would visit this site occasionally (if not regularly).  Perhaps professors would have students check out the site.  Perhaps supervision groups would use some of the material, such as the vignettes.  And, I had no idea that there would be any international interest whatsoever.  The current page view count is well over 64,000.

Aside from these numbers, I have had quite a few surprises.

First, there have been some psychologists and students reaching out for support.  Whether it was an ethics question or the internship match day, we have responded in ways that have been helpful.  I appreciate that students and psychologists felt comfortable to ask questions.  I also appreciate those who were willing to pitch in and write responses or answer questions.

Next, the number of international viewers has been truly staggering.  As of today, people from 101 countries have read material from the blog.  Readers from the United Kingdom, the Ukraine, and Germany  have over 2,000 page views.  Canada, Russia, China, and Australia have over 1,000 page views.  International readers have accounted for 35% of the total page views.  Please keep reading, and spread the word.

Third, the vignettes have been high volume reads.  My hope is that readers are using these dilemmas as teaching tools or ways to start discussions about ethics with colleagues or during presentations.

The blog has been a success by most measures. 

To that end, I want to thank Ken Pope and Gary Schoener for providing information that did not pop up on my feedreader.  Sam Knapp's contributions have also been a huge part of blog articles.  I also want to thank everyone who has contributed powerpoint presentations, papers, articles, or other information to make the blog this successful.

Having been able to find so many articles and stories about ethics, new material has popped up on a daily basis.  So, we will continue to forge ahead for another year.  I cannot promise daily content as life continues to be hectic.  However, I will try to continue to post high quality stories, vignettes, and articles.

Thank you for reading.  Thank you for enjoying and promoting ethics.

John Gavazzi
Blog Founder
Ethics Educator

Cardiologists fined $100,000 for Internet privacy violations

By Ken Alltucker
The Republic - azcentral.com
Originally published April 17, 2012

The federal government has fined a Phoenix and Prescott cardiac surgeon medical practice $100,000 for posting patients' clinical and surgical appointment information on an Internet calendar that was available to the public.

The entire story is here.

Thursday, April 19, 2012

Two Healthcare Data Breaches Show Importance Of Encryption

Patient data from Howard University Hospital and California Department of Child Support Services wasn't fully encrypted, and one security expert wants to know why.

By Neil Versel
Originally published April 5, 2012

The theft of a laptop containing more than 34,000 unencrypted records from Howard University Hospital in Washington, D.C., and the loss of backup tapes containing records of 800,000 people enrolled in California Department of Child Support Services programs are just the latest in a string of healthcare data breaches that could have and should have been prevented, a data protection expert contends.

Last week, Howard University Hospital disclosed that it had notified 34,503 patients that a personal laptop of a former contractor was stolen in January from that individual's car. The laptop, according to the hospital, was password-protected, but the actual data was not encrypted.

That is disturbing to Mark Bower, data protection expert and VP at Voltage Security, based in Cupertino, Calif. "Why was their contractor allowed to use their own laptop, connect to the network, and download this data?" Bower wondered. "Why was that information not encrypted on the back end?"

The entire story is here.

Patient ID information stolen at Memorial hospitals

by Bob LaMendola and Donna Gehrke-White
Florida Sun-Sentinel
Originally published on April 13, 2012

Patients of Memorial hospitals in south Broward County had their identities stolen by employees who wanted to use the information to make money filing phony tax returns, Memorial officials said Thursday.

Two employees have been fired and are under criminal investigation by federal agents for improperly gaining access to the patients' information, said Kerting Baldwin, a spokeswoman for tax-assisted Memorial Healthcare System, parent of five Memorial hospitals.

Memorial sent letters Thursday to about 9,500 patients whose identities may have been exposed by the two employees.

The entire story is here.

Thanks to Ken Pope for this information.

Security breach at North Shore Univ. Hospital

By Sarah Wallace
WABC-TV New York
Originally published on April 11, 2012

Eyewitness News has an exclusive investigation into a major security breach at one of the area's largest hospitals.

Eyewitness News has learned that patients at North Shore University Hospital have been notified that their private health records, including social security numbers and insurance information, have been stolen.
New York State Police are saying this is an ongoing and widespread probe.

The entire story is here.

Thanks to Ken Pope for this information.

Wednesday, April 18, 2012

Protecting Psychologists Who Harm: The APA's Latest Wrong Turn

By Roy Eidelson

Shortly after learning about the American Psychological Association's (APA) late February announcement of its new Member-Initiated Task Force to Reconcile Policies Related to Psychologists' Involvement in National Security Settings, I found my thoughts turning to the School of the Americas, Blackwater and perhaps even more surprisingly, the Patagonian toothfish. Those may seem like a strange threesome, but they share one important thing in common. All have undergone a thorough repackaging and renaming in a marketing effort aimed at obscuring - but not altering - some ugly truth.


What can annulment of the PENS Report accomplish? First, annulment will serve to indisputably repudiate the illegitimate process by which the military-intelligence establishment took control over the core ethics of psychology as a profession. Second, annulment will set the stage for a long-overdue transparent, broad-based and independent examination - by psychologists, by human rights advocates, by national security experts and by ethicists - of whether or not it is ethical for psychologists to serve in aggressive operational roles in national security settings. More than a decade has passed since the attacks of 9/11, yet this fundamental question has never been honestly and openly addressed. Indeed, the PENS Report was strategically designed to take this question off the table - by offering the mere pretense of meaningful discussion and debate.

A blog post referencing the member-initiated task force is here.

A blog post referencing the PENS report is here.

Baptist Blogger Accuses SBC Ethics Agency Head of Plagiarism

By Greg Horton
Originally published April 16, 2012

Richard Land, president of the Ethics and Religious Liberty Commission of the Southern Baptist Convention, has been accused of plagiarism by a Baptist blogger.

Aaron Weaver, a doctoral student at Baylor University, posted a partial transcript of Land's March 31 radio show in which Land quoted liberally from a March 29 Washington Times column written by Jeffrey Kuhner without attributing the quotes to him.

Land used Kuhner's material about Trayvon Martin, the media and racism on his radio show – Richard Land Live! – often quoting entire paragraphs without attribution.

The entire post is here.

Tuesday, April 17, 2012

Growing up drugged

For the first time ever, millions of today's adults were raised on psychotropic medications. What does that mean?

By Kaitlin Bell Barnett
Originally published April 7, 2012

Here are some exerpts:
For the first time in history, millions of young Americans are in a position not unlike Andrew’s: they have grown up taking psychotropic medications that have shaped their experiences and relationships, their emotions and personalities and, perhaps most fundamentally, their very sense of themselves. In “Listening to Prozac,” psychiatrist Peter Kramer’s best-selling meditation on the drug’s wide-ranging impact on personality, Kramer said that “medication rewrites history.” He was referring to the way people interpret their personal histories once they have begun medication; what they thought was set in stone was now open to reevaluation. What, then, is medication’s effect on young people, for whom there is much less history to rewrite? Kramer published his book in 1993, at a time of feverish — and, I think, somewhat excessive — excitement about Prozac and the other selective serotonin reuptake inhibitor antidepressants, or SSRIs, that quickly followed on its heels and were heralded as revolutionary treatments for a variety of psychiatric problems.

For most people, I suspect, medications are perhaps less like a total rewriting of the past than a palimpsest. They reshape some of one’s interpretations about oneself and one’s life but allow traces of experience and markers of identity to remain. The earlier in life the drugs are begun, the fewer and fainter those traces and markers are likely to be. All told, the psychopharmacological revolution of the last quarter century has had a vast impact on the lives and outlook of my generation — the first generation to grow up taking psychotropic medications. It is therefore vital for us to look at how medication has changed what it feels like to grow up and to become an adult.

The entire story is here.

Thanks to Tom Fink for this information.

Military's increased use of medications under fire

Army has seen eightfold increase since 2005
by Kim Murphy
The Los Angeles Times
Originally published April 8, 2012

U.S. Air Force pilot Patrick Burke’s day started in the cockpit of a B-1B bomber near the Persian Gulf and proceeded across nine time zones as he ferried the aircraft home to South Dakota.

Every four hours during the 19-hour flight, Burke swallowed a tablet of Dexedrine, the prescribed amphetamine known as “go pills.” After landing, he went out for dinner and drinks with a fellow crewman. They were driving back to Ellsworth Air Force Base when Burke began striking his friend in the head.

“Jack Bauer told me this was going to happen – you guys are trying to kidnap me!” he yelled, as if he were a character in the TV show “24.”

When the woman giving them a lift pulled the car over, Burke leaped on her and wrestled her to the ground. “Me and my platoon are looking for terrorists,” he told her before grabbing her keys, driving away and crashing into a guardrail.

Burke was charged with auto theft, drunken driving and two counts of assault. But in October, a court-martial judge found the young lieutenant not guilty “by reason of lack of mental responsibility” – the almost unprecedented equivalent, at least in modern-day military courts, of an insanity acquittal.

The entire story is here.

Monday, April 16, 2012

Court Upends 9-Year Fight on Housing Mentally Ill

By Mosi Secret
The New York Times
Originally published April 6, 2012

A federal appeals court, ruling on procedural grounds, struck down on Friday a judge’s order that New York State transfer thousands of mentally ill adults in New York City from institutional group homes into their own homes and apartments. In doing so, the court brought a nine-year legal battle to an abrupt end without resolving the underlying issues of how the state cares for such patients.

Though the lower court judge had ruled the current system violated federal law by warehousing people with mental illness in far more restrictive conditions than necessary, the appellate panel said the nonprofit organization that began the litigation, Disability Advocates, did not have legal standing to sue.

The panel, comprising three judges of the United States Court of Appeals for the Second Circuit, acknowledged that its decision essentially reset the long-running battle to its starting point.

Sunday, April 15, 2012

2 Former Kaplan Employees Settle Lawsuit and Withdraw Whistle-Blower Case

By Goldie Blumenstyk
The Chronicle of Higher Education
Originally published on April 11, 2012

Two former employees of a Kaplan-owned college in Pennsylvania who alleged in a 2006 federal whistle-blower lawsuit that the company had falsified graduation and job-placement rates and had paid illegal bonuses to student recruiters have withdrawn their suit. The two also reached a settlement with Kaplan on an employment-discrimination claim alleging that the company had fired them in retaliation for saying they would report wrongdoing.

The terms of the settlement are confidential.

The entire story is here.

WellCare Health Plans whistle-blower to receive about $21 million

By Jeff Harrington
Tampa Bay Times
Originally published on April 4, 2012

Whistle-blower Sean Hellein will receive nearly $21 million for triggering a successful federal inquiry into Medicare and Medicaid fraud at his former Tampa employer, WellCare Health Plans.

Hellein in late February withdrew his objections to a pending $137.5 million civil settlement with WellCare. But the size of his payout was unclear until Tuesday, when U.S. Attorney Robert O'Neill announced the settlement of all four lawsuits initiated by whistle-blowers.

Tenet to pay almost $43 million to settle false claims

Originally published April 10, 2012

Tenet Healthcare Corp has agreed to pay almost $43 million to settle allegations that it overbilled the federal Medicare healthcare program for treating patients at certain rehabilitation facilities, the Justice Department said on Tuesday.

The entire story is here.

Saturday, April 14, 2012

Medical Boards Discipline Physicians for Online Behavior

By Jenni Laidman
Medscape Medical News
Originally published March 20, 2012

Most medical licensing boards have received at least 1 complaint about unprofessional online behavior by physicians, and many of these complaints resulted in serious disciplinary actions, including license revocation, according to a research letter published in the March 21 issue of JAMA.

S. Ryan Greysen, MD, from the Division of Hospital Medicine, University of California, San Francisco, and colleagues report that 48 (71%) of the 68 executive directors of medical licensing boards responded to the study survey. Of those, 44 (92%; 95% confidence interval [CI], 86% - 98%) indicated receiving at least 1 complaint about an online professional breach.


"We've just found a new way to violate our own standards," Jason Jent, PhD, assistant professor of clinical pediatrics, Division of Clinical Psychology, Department of Pediatrics, University of Miami Miller School of Medicine, Florida, said to Medscape Medical News.

The entire story is here.

Friday, April 13, 2012

Can Checklists Help Reduce Treatment Failures?

Samuel Knapp, EdD, ABPP
Director of Professional Affairs

John Gavazzi, PhD, ABPP
Chair, PPA Ethics Committee

Originally Published in The Pennsylvania Psychologist

Checklists have become a stable feature of safety science. Airline pilots, for example, will meet with other members of the airline crew and go through a checklist before they fly a plane. Checklists have been proposed for surgeons (Gawande, 2009) and other physicians (Ely et al., 2010). Could checklists be useful for psychologists? If so, when could they be useful?
Using checklists for complex procedures such as general medicine, surgery, or psychological services may seem overly simplistic. However, proponents argue that checklists have value because of the complexity of these processes. Although the items in the checklist may seem basic, the risk that decision makers will make “dumb” mistakes increases when they are confronted with large amounts of complex information, much of which may be contradictory or ambiguous. Checklists can help health care professionals in difficult situations by reducing reliance on memory alone and, more importantly, by allowing them to step back, reflect on, and rethink their initial decisions (Ely et al., 2010).
For most patients, checklists would be unnecessary. Most patients do well in therapy, and 50% of patients terminate therapy in 10 sessions or fewer. Nonetheless, a few patients have more complicated problems, take more time to report therapeutic benefits, drop out of treatment unexpectedly, or otherwise fail in therapy. Checklists may be especially helpful with these difficult patients.
Knapp and Gavazzi (2012) proposed that treatment outcomes can be improved by using the “four-session rule.” According to this rule, if a patient is not making gains at the end of four sessions or does not have a good working relationship with the psychologist (in the absence of an obvious reason), the psychologist should reassess the treatment with this patient. The four-session rule does not require transferring the patient. Instead, the rule requires psychologists to reconsider the case, perhaps using the checklist provided at the end of this article.
Often, the reasons for a lack of improvement in psychotherapy may be obvious. For example, a patient enters therapy with a minor depression, but then gets worse because of a sudden and unanticipated layoff from work. The reason for the deterioration is clear and the psychologist has almost automatically talked to the patient about new modifications to treatment in light of the new life circumstances. However, the mere deterioration in the patient’s condition in this situation does not appear predictive of a treatment failure.
We consider the “four-session rule” as a useful heuristic because it helps control for over-optimism on the part of the psychologists. Evidence suggests that many psychologists are overly optimistic about their ability to help patients. For example, Stewart and Chambliss (2008) found that psychologists worked with patients for a median of 12 sessions before concluding that treatment was not working and considering alternative steps. Nonetheless, Lambert (2007) claims that his algorithm can predict risk for treatment failure by the fourth session with a high degree of accuracy. These two sources suggest that psychologists should adopt a lower threshold for considering a case at risk of failure.
            We suggest using a checklist when treating a patient who falls into the “four-session rule.” After identifying an area of concern from the checklist, the psychologist can follow up in more detail, such as by answering some of the questions footnoted.
            We know of no empirical studies to validate the use of the checklist for those patients at risk of treatment failure. Nonetheless, it does represent an effort of self-reflection that is needed in difficult cases. Readers may send any feedback or comments on this checklist to Drs. Sam Knapp or John Gavazzi.

Four-Session Checklist

Patient Collaboration (What does the patient say?)

YES ___ NO ___ 1 Does the patient think you have a good working relationship?

YES ___ NO ___ 2. Do you and your patient share the same treatment goals?[1]
YES ___ NO ___ 3. Does the patient report any progress in therapy?[2]
YES ___ NO ___ 4. Does the patient want to continue in treatment? [3] If so, does the
                                    patient see a need to modify treatment?

Additional Reflections (What do you think about the patient?)

YES ___ NO ___ 5. Do you believe you have a positive working relationship with your patient? (Does he or she trust you enough to share sensitive information and collaborate?)[4]

YES ___ NO ___ 6. Is your assessment of the patient sufficiently comprehensive?[5] Do you need to obtain additional information?

YES ___ NO ___ 7. Do unresolved clinical issues of significant concern impede the course of treatment (such as Axis II issues, possible or minimization of substance abuse, or ethical concerns)?

YES ___ NO ___ 8. Does the patient need a medical examination?


YES ___ NO ___ 9. Have you documented appropriately?

Ely, J., Graber, M. L., & Croskerry, P. (2011). Checklists to reduce diagnostic errors. Academic Medicine, 86, 307-313.
Gawande, A. (2009). The checklist manifesto. NewYork: Holt.
Knapp, S., & Gavazzi, J. (2012). Ethical issues with difficult patients. In S. Knapp, M. C. Gottlieb, M. Handelsman, & L. VandeCreek, (Eds.), APA handbook of ethics in psychology. Washington, DC: American Psychological Association.
Lambert, M. (2007). Presidential address: What have we learned from a decade of research aimed at improving psychotherapy outcome in routine care? Psychotherapy Research, 17, 1-14.
Stewart, R., & Chambliss, D. (2008). Treatment failures in private practice: How do psychologists proceed? Professional Psychology: Research and Practice, 39, 176-181.

[1] Do you understand your patient’s goals and how he or she expects to achieve them? How do they correspond to your goals and preferred methods of treatment? If they differ, can you reach a compromise? Does the patient buy into treatment? Did you document the goals in your treatment notes? What did the patient say was particularly helpful or hindering about therapy? Have you incorporated your patient’s perceptions into your treatment plan?

[2] Do you agree on how to measure progress (self-report, reports of others, psychometric testing, non-reactive objective measures, etc.)? Does the patient need a medical examination?

[3] If yes, why?

[4] Can you identify what is happening in the relationship to prevent a therapeutic alliance? Does the patient identify an impasse? Do your feelings toward your patient compromise your ability to be helpful? If so, how can you change those feelings? Have you sought consultation on your relationship or feelings about the patient? If so, what did you learn?

[5] Have you reassessed the diagnosis or treatment methods using the BASIC ID, MOST CARE, or another system designed to review the presenting problem? Are you sensitive to cultural, gender-related status, sexual orientation, SES, or other factors? What input did you get from the patient, significant others of the patient, or consultants (this is especially important if there are life-endangering features)?

Thursday, April 12, 2012

Medicaid clients’ data breached at Utah Department of Health

by Meredith Forrest Kulwicki and Zach Whitney
Salt Lake City Fox 13
Originally posted on April 4, 2012

The Utah Department of Health announced a data breach on Wednesday concerning Medicaid claims.

The initial breach appears to have happened on Friday, March 30 and information from 24,000 claims was accessed according to the Utah Department of Health (UDOH).

The server that was breached contained data related to Medicare claims.  Information such client names, addresses, birth dates, Social Security numbers, physician’s names, nation provider identifiers, tax identification numbers and procedure codes may have been accessed said the UDOH.

The entire story is here.

Howard University Data Breach due to Stolen Laptop

NBC Channel 4 in Washington.
Originally published on March 28, 2012

A heads up if you have personal information on file with Howard University Hospital.

The facility sent letters to more than 34,000 patients about a laptop stolen in January.

The entire story is here.

Editorial note:
This story is yet another example of protected health information data loss due to a stolen laptop. 

A guiding principle can be derived from multiple stories like this: Prevent data breaches by not taking PHI home in a laptop or portable storage device.

Wednesday, April 11, 2012

Drug Data Shouldn’t Be Secret

By Peter Doshi and Tom Jefferson
The New York Times - Opinion
Originally published April 10, 2012

IN the fall of 2009, at the height of fears over swine flu, our research group discovered that a majority of clinical trial data for the anti-influenza drug Tamiflu — data that proved, according to its manufacturer, that the drug reduced the risk of hospitalization, serious complications and transmission — were missing, unpublished and inaccessible to the research community. From what we could tell from the limited clinical data that had been published in medical journals, the country’s most widely used and heavily stockpiled influenza drug appeared no more effective than aspirin.

After we published this finding in the British Medical Journal at the end of that year, Tamiflu’s manufacturer, Roche, announced that it would release internal reports to back up its claims that the drug was effective in reducing the complications of influenza. Roche promised access to data from 10 clinical trials, 8 of which had not been published a decade after completion, representing more than 4,000 patients from every continent except Antarctica.


In response to our conclusions, which we published in January, the C.D.C. defended its stance by once again pointing to Roche’s analyses. This is not the way medical science should progress. Data secrecy is a disservice to those who volunteer their bodies for clinical trials, and is dangerous to those being asked to swallow approved medicines. Governments need to become better stewards of the scientific process.