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

Saturday, June 30, 2012

Can Doctors Learn Empathy?

By Pauline W. Chen, MD
The New York Times - Well
Originally published June 21, 2012

Empathy has always been considered an essential component of compassionate care, and recent research has shown that its benefits go far beyond the exam room. Greater physician empathy has been associated with fewer medical errors, better patient outcomes and more satisfied patients. It also results in fewer malpractice claims and happier doctors.

growing number of professional accrediting and licensing agencies have taken these findings to heart, developing requirements that make empathy a core value and an absolute “learning objective” for all doctors. But even for the most enthusiastic supporters of such initiatives, the vexing question remains: Can people learn to be empathetic?

new study reveals that they can.

Friday, June 29, 2012

More transparency into government requests

By Dorothy Chou
Google Senior Policy Analyst
Originally posted June 17, 2012

About two years ago, we launched our interactive Transparency Report. We started by disclosing data about government requests. Since then, we’ve been steadily adding new features, like graphs showing traffic patterns and disruptions to Google services from different countries. And just a couple weeks ago, we launched a new section showing the requests we get from copyright holders to remove search results.


This is the fifth data set that we’ve released. And just like every other time before, we’ve been asked to take down political speech. It’s alarming not only because free expression is at risk, but because some of these requests come from countries you might not suspect—Western democracies not typically associated with censorship.


We’ve rounded up some additional interesting facts in the annotations section of the Transparency Report. We realize that the numbers we share can only provide a small window into what’s happening on the web at large. But we do hope that by being transparent about these government requests, we can continue to contribute to the public debate about how government behaviors are shaping our web.

Thanks to Ed Zuckerman for this lead.

Thursday, June 28, 2012

Affordable Health Care's Individual Mandate ruled Constitutional

By Lynn Sweet and Dave McKinney
Chicago Sun Times

In an historic decision, the U.S. Supreme Court on Thursday upheld the individual insurance requirement at the heart of President Barack Obama’s health care overhaul.

The decision means the overhaul will continue to go into effect over the next several years, affecting the way that countless Americans receive and pay for their personal medical care. The ruling also handed Obama a campaign-season victory in rejecting arguments that Congress went too far in requiring most Americans to have health insurance or pay a penalty.

Chief Justice John Roberts announced the court’s judgment that allows the law to go forward with its aim of covering more than 30 million uninsured Americans.

The court found problems with the law’s expansion of Medicaid, but even there said the expansion could proceed as long as the federal government does not threaten to withhold states’ entire Medicaid allotment if they don’t take part in the law’s extension.

The court’s four liberal justices, Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor, joined Roberts in the outcome.

Justices Samuel Alito, Anthony Kennedy, Antonin Scalia and Clarence Thomas dissented.

Catastrophic neglect of basic sciences in medicine

The Lancet, Volume 379, Issue 9833, Pages 2239 - 2240, 16 June 2012
By Saroj Jayasinghe

Here is a portion of the correspondence.

Inappropriate attention to basic sciences could also unduly delay implementation of such simple interventions, resulting in unnecessary death and suffering. The conceit is not that “epidemiology is the basic science of clinical medicine”. The real conceit is to believe that health issues are mainly solved by basic scientists and health professionals. The truth, although unpalatable to some, is that health-related problems are mostly the result of the social and physical environment during our life course.....

The entire letter is here.

Catastrophic neglect of the basic sciences in medicine

The Lancet, Volume 379, Issue 9823, Page 1273, 7 April 2012

Talk with scientists who work in research-intensive schools of medicine and you hear a resonant message. The basic medical sciences are not only being neglected, they are being systematically eroded. This marginalisation will have damaging effects on clinical care over the next two decades. The foundations of fundamental knowledge about health will be fractured. The platform for applied research will have atrophied. Patient care will be harmed by the prevailing short-sighted and expedient approach to discovery science.


The errors seem to be multiple. Project grants—3-year investments of modest sums (£300 000) into the careers of young scientists—have withered. Scientists tell us that this dramatic shift in policy—converting our funding bodies into versions of the Howard Hughes Medical Institute—is a laudable objective, but one with unanticipated negative consequences. Not the least of which is the excision of investment into future generations of young medical researchers. Such a perilous policy, pursued by some research councils and larger charities alike, is being driven by a political environment that emphasises big science and aggresive commercial returns on research investments.

Tuesday, June 26, 2012

Carnegie Mellon Researchers Find Physicians Are Biased When Evaluating Medical Conflict of Interest Policies

Same Patterns Found in Finance Industry; Researchers Suggest Need For Third Parties in Conflict of Interest Policy-Making Process

Carnegie Mellon Press Release
Originally published on June 19, 2012

Medical institutions have been under pressure to develop and implement policies to avoid conflicts of interest between physicians and pharmaceutical companies. In most cases, medical professionals who have a stake in the issues at hand craft the conflict of interest policies.

New research from Carnegie Mellon University's George Loewenstein and Zachariah Sharek and the University of Pittsburgh's Robert Schoen investigated whether medical professionals making conflict of interest policy decisions are able to separate their policy judgments from their personal, vested interests. The research, which will be published in an upcoming issue of the Journal of Law, Medicine and Ethics, shows that physicians are subject to motivated bias when it comes to assessing the policies intended to regulate their behavior. The research team also tested financial planners and found similar stronger patterns of motivated bias.


Finally, the control group with no vested interest evaluated both policies positively, and dismissed the objections as being unreasonable.

The entire press release is here.

Monday, June 25, 2012

Why (Almost) All of Us Cheat and Steal

Behavioral economist Dan Ariely talks about why everyone's willing to cheat a little, why you'll steal a staple from work but not petty cash and whether punishments for cheating actually work

By Gary Belsky
Time Magazine - Business
Originally published June 18, 2012

Behavioral economist Dan Ariely, who teaches at Duke University, is known as one of the most original designers of experiments in social science. Not surprisingly, the best-selling author’s creativity is evident throughout his latest book, The (Honest) Truth About Dishonesty. A lively tour through the impulses that cause many of us to cheat, the book offers especially keen insights into the ways in which we cut corners while still thinking of ourselves as moral people. Here, in Ariely’s own words, are seven lessons you didn’t learn in school about dishonesty. (Interview edited and condensed by Gary Belsky.)

1. Most of us are 98-percenters.

“A student told me a story about a locksmith he met when he locked himself out of the house. This student was amazed at how easily the locksmith picked his lock, but the locksmith explained that locks were really there to keep honest people from stealing. His view was that 1% of people would never steal, another 1% would always try to steal, and the rest of us are honest as long as we’re not easily tempted. Locks remove temptation for most people. And that’s good, because in our research over many years, we’ve found that everybody has the capacity to be dishonest and almost everybody is at some point or another.”

The entire story is here.

Sunday, June 24, 2012

Mapping Your End-of-Life Choices

By Jane E. Brody
The New York Times - Well
Originally published June 18, 2012

Here is an excerpt:

“People need to sit down and decide what kind of care makes sense to them and what doesn’t make sense, and who would be the best person to represent them if they became very ill and couldn’t make medical decisions for themselves,” Dr. Hammes said.

“If, for example, you had a sudden and permanent brain injury, how bad would that injury have to be for you to say that you would not want to be kept alive? What strongly held beliefs and values would influence your choice of medical treatment?”

Divisive family conflicts and unwanted medical interventions can be avoided when people specify their wishes, he said. His own mother “told us that if she had severe dementia, it would be a total waste of her life savings to keep her alive. She would rather that her children got the money.”

“We help people work through the decision process and involve those close to them so that the family shares in their goals,” Dr. Hammes said. “When patients have a care plan, the moral dilemmas doctors face can be prevented.”

At Good Medicine in San Francisco, Dr. Brokaw and her colleagues have thus far helped about two dozen people explain their goals and preferences, at a cost of $1,500 for each person.

The entire article is here.

Saturday, June 23, 2012

Getting Fat and Fatter

By Kim McPherson
The Lancet

Book Review
Fat Fate and Disease: Why Exercise and Diet Are Not Enough
By Peter Gluckman and Mark Hanson
Oxford University Press

"We need a public debate about what it means to keep markets in their place. And to have this debate, we have to think through the moral limits of markets. We need to recognise that there are some things that money can't buy and other things that money can buy but shouldn't."

Michael Sandel, “Market and Morals”

We live in a world where it is increasingly apparent that markets have all sorts of unwanted consequences, but they remain the bedrock of our civilisation. That we should relentlessly pursue economic growth is unquestioned, while the planet is drying up and we are becoming increasingly obese. And by a dominant political account the way to grow is to liberate the markets wherever we can. Thus the planet nears extinction more quickly and the prevalence of type 2 diabetes increases alarmingly across the globe. So is some kind of consensual good will required, as Michael Sandel suggested in his 2009 Reith Lecture?


We have yet to discover an acceptable way to make markets properly balance all the pay-offs caused by unhealthy production, one of which is to suffer loss at the point of production commensurate with the harm of causing bad health in the longer term. We are not even close. Good will and responsible citizenship are not, I suspect, going to solve this problem simply because profit and growth trump everything.

The entire review and commentary are here.

Friday, June 22, 2012

As records go online, clash over mental care privacy

By Liz Kowalczyk
The Boston Globe - Health and Wellness
Originally published June 21, 2012

At her weekly therapy sessions, Julie revealed her most uncomfortable secrets: depression, debt, childhood sexual abuse. Her psychiatrist at Massachusetts General Hospital would then type a summary into Julie’s computerized medical record.

With that, more than 200 pages of sensitive notes became available to any doctor who cared for her within the sprawling Partners HealthCare system. She discovered this only when one doctor later referenced the notes.

Julie, a 43-year-old lawyer, was unnerved, then angry. “The details are really nobody’s business,” she said.

But Partners disagrees. Doctors must have a complete picture to make accurate diagnoses, the organization argues. And having different rules for psychiatric records contributes to the stigma of mental illness.

The entire story is here.

Rates of Nonsuicidal Self-Injury in Youth: Age, Sex, and Behavioral Methods in a Community Sample


Andrea L. Barrocas, MA, Benjamin L. Hankin, PhD, Jami F. Young, PhD, and John R. Z. Abela, PhD

The goal was to assess the rate and behavioral methods of nonsuicidal self-injury (NSSI) in a community sample of youth and examine effects of age and sex.


Youth in the third, sixth, and ninth grades (ages 7–16) at schools in the community were invited to participate in a laboratory study. A total of 665 youth (of 1108 contacted; 60% participation rate) were interviewed about NSSI over their lifetime via the Self-Injurious Thoughts and Behaviors Interview.


Overall, 53 (8.0%) of the 665 youth reported engaging in NSSI; 9.0% of girls and 6.7% of boys reported NSSI engagement; 7.6% of third graders, 4.0% of sixth-graders, and 12.7% of ninth-graders reported NSSI engagement. There was a significant grade by gender interaction; girls in the ninth grade (19%) reported significantly greater rates of NSSI than ninth-grade boys (5%). Behavioral methods of NSSI differed by gender. Girls reported cutting and carving skin most often, whereas boys reported hitting themselves most often. Finally, 1.5% of youth met some criteria for the proposed fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnosis of NSSI.


Children and adolescents engage in NSSI. Ninth-grade girls seem most at risk, as they engage in NSSI at 3 times the rate of boys. Behavioral methods of NSSI also vary by grade and gender. As possible inclusion of an NSSI diagnosis in the fifth edition of the DSM-5 draws near, it is essential to better understand NSSI engagement across development and gender. 

Pediatrics 2012;130:39–45 

Thursday, June 21, 2012

Editors With Ethics

By Scott Jaschik
Inside Higher Ed
Originally published June 12, 2012

Many of the public debates over ethics in scholarly journals focus on such questions as conflict of interest by biomedical researchers. And various federal regulations (and journal codes of conduct) attempt to prevent conflicts.

Now some journal editors -- primarily in the social sciences but extending to other fields -- are trying to use a new code of conduct to address ethical issues that arise in fields beyond the biological sciences (though there, too), but that also have the potential to tarnish the image of the research enterprise. In the past few months, 88 journal editors have signed on to the principles outlined by 5 other journal editors, and 71 associate editors have signed on.

The entire article is here.

Wednesday, June 20, 2012

Putting dignity to work

By Charles Foster
The Lancet
Originally published June 2, 2012

A profoundly brain-damaged teenage girl is brought to hospital. The nurses undress her and leave her, uncovered, on a trolley in front of some lascivious youths who are waiting in the Accident and Emergency Department. She seems to enjoy receiving their attention; they enjoy giving it. Is this wrong? Yes it is. But what language describes the wrongness? Certainly the four principles laid out by Tom Beauchamp and James Childress in their classic Principles of Biomedical Ethics (autonomy, beneficence, non-maleficence, and justice) can't really help, or can't help without straining uncomfortably. Autonomy isn't offended. Insofar as the girl is capable of exercising autonomous thought, she's all for it, and so are the boys. And there's no real harm here, as harm would conventionally be described. One might say that the maxim “Do good” has been violated, but what does “good” mean?


In answering that question, and in saying what is meant by “good”, it is hard to avoid using words like dignity. And that, for many, is rather embarrassing. Dignity has a bad reputation among some philosophers. It tends to be thought of as feel-good philosophical window-dressing—the name you give to whatever principle gives you the answer you think is right; as a substitute for hard thinking; as impossibly amorphous or (because of its historical association with the notion of the Imago Dei), as incurably theological. Dignity-peddlers, it tends to be thought, are selling metaphysical snake oil.


Beauchamp and Childress sometimes falter because their principles are second-order principles, derived ultimately from dignity. Sometimes, to get the right ethical answer, you've got to go to the source. Burrow down deep enough into any bioethical conundrum, and you'll eventually hit dignity.

The entire article is here.

Psychologist D. Laurence More surrenders license on charges of sex with two patients

Psychiatric Crimes Database
Originally published on June 11, 2012

On November 16, 2011, D. Laurence More, M.Ed. permanently surrendered his psychologist’s license to the Pennsylvania State Board of Psychology.


More admitted that, approximately one month following termination, he commenced a personal relationship with the wife and further admitted that approximately two to three months later, he commenced a sexual relationship with her.


More engaged in a sexual relationship with a different patient without first waiting two years after terminating professional services, as required by Board regulations.

The entire story is here.

Tuesday, June 19, 2012

Secrets And Electronic Health Records: A Privacy Concern

By David Schultz
The KNH Blog
Originally published on June 11, 2012

Does your orthodontist or opthamologist need to know what you tell your psychotherapist in order to provide you with quality care? In the age of electronic medical records, a whole range of health care providers may have access to this information whether you want them to or not.


Here’s what many say is the problem: If a mental health specialist types up his or her notes from a therapy session and puts them into a patient’s electronic medical record, that file can be shared with any doctor the patient sees within their health system. And, because of a loophole in the Health Insurance Portability and Accountability Act, or HIPAA, there’s nothing a patient can do to stop this from happening.

Many mental health professionals, who consider their patients’ privacy and confidentiality to be sacrosanct, find this appalling. But often times, the decision of how they file their patients’ records is not up to them.

The entire blog post is here.

Monday, June 18, 2012

UConn Researchers Voice Concern Over Proposed Addiction Guideline Changes

By Lisa Catanese
Originally published June 2, 2012

Two prominent University of Connecticut Health Center researchers are adding their voices to a chorus of other national experts who are questioning proposed changes regarding substance abuse guidelines in a manual used internationally in the diagnosis and treatment of mental illnesses.


Babor’s reservations about the proposed changes concern the broadening of language defining addiction and the lowering of the threshold of what counts as a substance use disorder. The revisions would expand the number of symptoms of addiction, reduce the number required for a diagnosis, and introduce a “behavioral addiction” category – all of which could lead to millions more people being categorized as addicts when they in fact are simply unhealthy users. This could put a strain on already-limited resources in schools, prisons, and hospitals, he says.


Kaminer is concerned about the impact of the proposed DSM changes from two perspectives – classifying too many people as having a problem while deterring adolescents from seeking treatment. “There are not enough resources right now,” he says. “This country is collapsing under the burden of health care. Is it necessary to expand diagnosis to include mild cases and yet push away prospective clients by calling them addicts?”

The entire story is here.

The D.S.M. Gets Addiction Right

By Howard Markel
The New York Times - Opinion
Orignally published June 5, 2012

WHEN we say that someone is “addicted” to a behavior like gambling or eating or playing video games, what does that mean? Are such compulsions really akin to dependencies like drug and alcohol addiction — or is that just loose talk?

This question arose recently after the committee writing the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (D.S.M.), the standard reference work for psychiatric illnesses, announced updated definitions of substance abuse and addiction, including a new category of “behavioral addictions.” At the moment, the only disorder featured in this new category is pathological gambling, but the suggestion is that other behavioral disorders will be added in due course. Internet addiction, for instance, was initially considered for inclusion but was relegated to an appendix (as was sex addiction) pending further research.


Disease definitions change over time because of new scientific evidence. This is what has happened with addiction. We should embrace the new D.S.M. criteria and attack all the substances and behaviors that inspire addiction with effective therapies and support.

Sunday, June 17, 2012

Same-sex couples raising children on the rise

By Elaine Quijano
CBS Evening News
Originally published June 16, 2012

On this Father's Day Eve, we take notice of a sea change. The Census Bureau estimates that the percentage of same-sex couples raising children has more than doubled in just 10 years, from 8 percent in 2000, to 19 percent in 2010. We visit one of the couples behind the numbers.

As a same-sex couple, Sean McGill and Luigi Caiola say they never contemplated fatherhood.

"We never imagined or never thought that children would be an option for us," said McGill.

But after almost 10 years together, they were drawn to the idea of parenting.

The entire story is here.

Suicides Outpacing War Deaths for Troops

by Timothy Williams
The New York Times
Originally published on June 8, 2012

The suicide rate among the nation’s active-duty military personnel has spiked this year, eclipsing the number of troops dying in battle and on pace to set a record annual high since the start of the wars in Iraq and Afghanistan more than a decade ago, the Pentagon said Friday.

Suicides have increased even as the United States military has withdrawn from Iraq and stepped up efforts to provide mental health, drug and alcohol, and financial counseling services.
The military said Friday that there had been 154 suicides among active-duty troops through Thursday, a rate of nearly one each day this year. The figures were first reported this week by The Associated Press.


Mr. Rieckhoff attributed the rise in military suicides to too few qualified mental health professionals, aggravated by the stigma of receiving counseling and further compounded by family stresses and financial problems. The unemployment rate among military families is a particular problem, he said.

Pentagon Chief Orders Review of Mental Diagnoses

By Donna Cassata
Originally published June 13, 2012

Under questioning from a Senate panel on Wednesday, Panetta disclosed that he had asked the Air Force and Navy, which includes the Marine Corps, to follow the lead of the Army in launching an independent study of how it evaluates soldiers with possible post-traumatic stress disorder. Panetta's answer marked the first time that the Pentagon chief had said publicly that he had requested the review by all the services.
Defense Secretary Leon Panetta

The Army review was prompted in part by reports that the forensic psychiatry unit at Madigan Army Medical Center at Joint Base Lewis-McChord in Washington state may have reversed PTSD diagnoses based on the expense of providing care and benefits to members of the military. In recent years, the number of PTSD and traumatic brain injury cases has increased significantly as the Iraq war drew to a close after nearly a decade and the Afghanistan conflict enters its second decade.

Th entire story is here.

Saturday, June 16, 2012

Study Compares Effectiveness of Telephone-Administered vs. Face-to-Face Cognitive Behavioral Therapy for Depression

The JAMA Network
Originally published June 5, 2012

Patients with major depression who received telephone-administered cognitive behavioral therapy (T-CBT) had lower rates of discontinuing treatment compared to patients who received face-to-face CBT, and telephone administered treatment was not inferior to face-to-face treatment in terms of improvement in symptoms by the end of treatment; however, at 6-month follow-up, patients receiving face-to-face CBT were less depressed than those receiving telephone administered CBT, according to a study in the June 6 issue of JAMA.


“The findings of this study suggest that telephone-delivered care has both advantages and disadvantages. The acceptability of delivering care over the telephone is growing, increasing the potential for individuals to continue with treatment,” the authors write. “The telephone offers the opportunity to extend care to populations that are difficult to reach, such as rural populations, patients with chronic illnesses and disabilities, and individuals who otherwise have barriers to treatment.

Thanks to Tom Fink for this information.

Friday, June 15, 2012

Verification of Postdoctoral Experience: Pitfalls for Students

By Rachael Baturin, MPH, JD
The Pennsylvania Psychologist
June 2012

One of the requirements for students interested in becoming licensed in Pennsylvania is to complete one year of postdoctoral experience. It is very important for potential supervisees to review the postdoctoral experience requirements before they start this experience as there are a lot of nuances to the law, and the postdoctoral experience requirements vary from state to state. There have been cases where supervisees did not review the requirements before starting their experience, their experience did not qualify for the postdoctoral year, and they needed to repeat it.

This article will discuss some of the pitfalls that supervisees and supervisors have faced when trying to complete the verification of postdoctoral experience form, which must be sent to the State Board of Psychology upon completion of postdoctoral requirements. If readers would like to review all postdoctoral requirements in Pennsylvania, they can be found in the Pennsylvania State Board of Psychology’s regulations, Section 41.32 and Section 41.33, available on the State Board’s website: http://www.pacode.com/secure/data/049/chapter41/chap41toc.html.

Practical Issues

First, the supervisee should check to see whether the supervisor has been subject to any disciplinary actions by the State Board of Psychology. If they are currently being disciplined, they may not qualify as a supervisor. After December 1, 2015, postdoctoral supervisors must have completed either a course in supervision or 3 hours of continuing education in supervision.

Second, supervisees are required to have at least half of their training in diagnosis, assessment, therapy, other interventions, consultation, and individual supervision received as a supervisee, and the other half may be in teaching in association with either an organized psychology program preparing practicing psychologists and/or a postdoctoral training program, supervision provided as a supervisor, professional development, or research. For example, if a supervisee is doing 40 hours per week of research and 20 hours per week of direct services, the student should count 20 hours of research and 20 hours of direct services per week because at least half must be in direct services. There have been cases where the supervisee submitted a verification form on which it appeared as though 50% of the time was not in providing direct services because the supervisee was submitting too many research hours.

An hour of diagnosis, assessment, or therapy does not necessarily have to be an hour of direct patient contact. For example, a supervisee could spend an hour in therapy with a child and then spend another hour talking to the pediatrician and the school. Both of those hours should be counted toward fulfilling the 1,750-hour requirement for the postdoctoral year.

As another example, if the supervisee is just starting supervision and is seeing clients fewer than 15 hours per week, the supervisee could ask the supervisor for a research project to undertake in order to obtain additional hours, as long as they do not exceed 50% of the postdoctoral hours.

Next, supervisees are required to have 2 hours of face-to-face meetings with their supervisors per week. If you need to complete your experience in two different settings, you are still required to have 2 hours of face-to-face meetings with your supervisor at each site unless the sites are interrelated. For example, if one site is owned by ABC Corporation and the other is owned by XYZ Corporation, then the supervisee is required to get 2 hours of supervision at each site. However, if both sites were owned by ABC Corporation and one was the main office and the other a satellite office then the supervisee would be required to obtain only 2 hours of supervision for both sites. Also, supervisees must be present at each site for at least 6 consecutive months for the experience to count. There have been cases where students failed to meet this requirement and had to repeat the experience.

Last, the supervisor is required to maintain records or notes of the scheduled supervisory sessions, observe client/patient sessions of the supervisee or review verbatim recordings of these sessions on a regular basis and must prepare written evaluations or reports which are discussed with the supervisee. Once again, cases exist in which the supervisor failed to produce the written evaluations and the experience did not count.

Dual Relationships

The supervisor and supervisee must not be in a dual relationship. The supervisor cannot be related to the supervisee by blood or marriage, nor can the supervisor have a therapeutic relationship with the supervisee. In addition, supervisees are not allowed to pay supervisors for supervision (although supervision may be paid by a third party). The supervisor must be free from the supervisee’s control or influence and must be allowed to stop the supervisory relationship if necessary.

CU regent candidate raps "minutiae" amid false-degree claims

By Lynn Bartels
The Denver Post
Originally published June 8, 2012

A Republican running to sit on the governing board at the University of Colorado has erroneously told voters he has a master's degree in international economics from a prestigious East Coast university.

Matt Arnold
Called on it by critics, Matt Arnold mocked advanced degrees Thursday, explaining he completed the coursework but not his thesis.

"I was more interested in getting on with my life than trying to, quite frankly, waste more time in pursuit of academic BS that no one cares about," he said.

"I think that's one of the big problems, quite frankly, with education these days. We're graduating a bunch of people who hang letters after their names, but they have no useful skills."

The entire story is here.

Thursday, June 14, 2012

Examination of the Effectiveness of the Mental Health Environment of Care Checklist in Reducing Suicide on Inpatient Mental Health Units

Archives of General Psychiatry
Bradley V. Watts, MD, MPH; Yinong Young-Xu, ScD, MA, MS; Peter D. Mills, PhD, MS; Joseph M. DeRosier, PE, CSP; Jan Kemp, RN, PhD; Brian Shiner, MD, MPH; William E. Duncan, MD, PhD
Arch Gen Psychiatry. 2012;69(6):588-592. doi:10.1001/archgenpsychiatry.2011.1514


Objective  To evaluate the effect of identification and abatement of hazards on inpatient suicides in the Veterans Health Administration (VHA).

Design, Setting, and Patients  The effect of implementation of a checklist (the Mental Health Environment of Care Checklist) and abatement process designed to remove suicide hazards from inpatient mental health units in all VHA hospitals was examined by measuring change in the rate of suicides before and after the intervention.

Intervention  Implementation of the Mental Health Environment of Care Checklist.

Results  Implementation of the Mental Health Environment of Care Checklist was associated with a reduction in the rate of completed inpatient suicide in VHA hospitals nationally.

Conclusions  Use of the Mental Health Environment of Care Checklist was associated with a substantial reduction in the inpatient suicide rate occurring on VHA mental health units. Use of the checklist in non-VHA hospitals may be warranted.

The entire article is free here.

Thanks to Ken Pope for this information.

An article about psychologists using checklists to reduce treatment  failure is here.

Wednesday, June 13, 2012

A Chance to Walk the Talk at the Ethics Educators Conference

By Jeff Sternlieb, PhD
The Pennsylvania Psychologist
June 2012

During the 2011 annual PPA Ethics Educators Conference, an exchange occurred that could, met with the right attitude, guide our organization in creating safe learning spaces. Here’s what happened:

The exchange

The chair of the Ethics Committee began by identifying the content of the program for the day and then introduced the “luminaries” present: past presidents of PPA and significant contributors to ethics education. He ended with a specific request to be respectful of each other in our exchange of ideas and then introduced the morning’s presenters.

When the first pair of presenters described their roles, the second made a comment about being a longtime sidekick – Robin to the first one’s Batman. Immediately, someone in the audience remarked, “Oh, I guess that means you’re gay,” chuckling as though it were a joke. A ripple of laughter from the audience quickly subsided as the presenters moved on without any comment about the “joke,” even though it occurred minutes after the Ethics chair requested sensitivity.

My thoughts

Immediately I struggled. I wondered whether anyone would respond to the remark. I believed we were all, through our silence, colluding with the “joke” and placing in an unfair position anyone who was gay or simply cognizant of the impact of such comments on any minority member.

I shared my concern with a colleague next to me, who did not seem to consider it nearly as significant. I was considering what I should do, but doing or saying nothing was not an option. Two choices occurred to me: say something to the entire group, potentially embarrassing the person who made the remark, or say something to him at the break. The former had the potential to interfere with the ethics program; the latter might determine the speaker’s awareness of the remark’s impact and intent to address it in the larger group. I chose the latter.

The conversation

When I asked the quipster whether he was aware of the possible impact of his comment, he indicated that not only was he aware, but that he had already addressed it during a small-group discussion. He said he regretted it the minute it came out of his mouth, and that he worked with a number of gay clients in a setting in which his comment would have been heard differently. It struck me as a justification rather than an understanding of its potentially negative impact in the current context. He said he appreciated that I brought the concern to him but made no offer to discuss it with the larger group. He had not heard the term “microaggression” when I used it. Included in his small discussion group had been the Ethics chair, who approached while we were talking and asked whether I would be willing to share my experience with the larger group. I agreed.

The organic process

After the morning break, one psychologist, new to the Ethics Educators Conference, questioned how the earlier comment had impacted the learning, sharing environment. This opened the opportunity to share these issues in a natural way, and the Ethics chair publicly invited me to share what we discussed during break. This person’s independent concern supported my belief that such comments have an impact. Save for those who speak out, we cannot know how many others have been affected.

I shared my reaction, thought process, and conversation. I then invited the quipster to share his perspective, and he did, explaining that he worked with a largely gay clientele, apologizing to anyone he might have offended, and repeating that he had regretted his remark immediately after making it.

Audience reactions

Some participants thanked the new attendee for her courage in raising this issue, while others commended the quipster for his apology. One asked what the fuss was about, saying she did not recall hearing any offensive remarks. One person rejected the idea that he was collusive, having heard the remark less negatively. Another asked how this had become Jeff Sternlieb’s issue. Others expressed discomfort at censoring comments that might be seen as offensive to any one person, resisting “political correctness.” One participant noted a significant bias toward calling on male participants to the exclusion of women.


All comments struck me as introductory and reactive. No one sought clarification. We did not converse. While no time was scheduled to explore these issues, I was surprised at the lack of informal discussion during lunch or break. These issues seemed too hot to handle and we seemed too uncomfortable to talk about them. Though the exchange introduced the opportunity to learn, our inability to talk effectively stopped us from naming our experience and the concepts involved, including:

·         Privilege. Those of us with privilege – especially we who are white, male, heterosexual, and relatively financially secure ­– tend to minimize the perspectives of those who are marginalized. While none of us want an environment in which we cannot talk about race, sexual orientation, or gender because we are afraid of offending others, we seem to do the opposite: fail to take others seriously when insensitivity is identified. Just because clients or friends are gay does not give us the freedom to make jokes about being gay, particularly among those we may not know well. When any group is singled out, it impacts all groups who have been marginalized.
·         Collusion can be active or passive. Active collusion involves direct participation in the offense, and might involve adding to an initial insult or joke, thus amplifying the impact. This “joining in” sanctions the remark, making it easier for others to “pile on” with similar comments and more difficult for anyone to object. Passive collusion consists of saying or doing nothing, thereby lending tacit support to an unacceptable statement. To object may be seen as a personal affront, discomfiting, or unnecessarily confrontational.
·         Microaggressions are comments that may seem innocent, harmless, or even complimentary but contain demeaning implications or hidden messages. They “...are the brief and everyday slights, insults, indignities and denigrating messages” sent to minorities in subtle, unintended discrimination (Sue, 2010). Sue describes three types: micro-assaults, micro-insults, and micro-invalidations. A useful website, http://microaggressions.com, lists many examples of such comments.
·         Political correctness. The primary reason we should not joke about people’s race, gender, or sexual orientation is that these characteristics are personal. In the context of a professional exploration of issues, a reference might not be microaggressive, but a joke about a minority made as an aside is a personal affront, and to not recognize it as such IS to collude.
·         Misapplication of Golden Rule. The Golden Rule, “Do unto others as you would have others do unto you,” does not address individual and group preferences; we cannot assume that because a remark might not offend us that it won’t offend others. An alternate rule, the “Platinum Rule,” can be helpful: “Treat others as they want to be treated,” which would require asking rather than assuming.

The fact that one seemingly simple comment raises so many questions, issues, and reactions suggests we in PPA have a lot more to learn. Having a Committee on Multiculturalism and a host of resources (including a CE program) is not a guarantee of progress. Having this experience in vivo can teach more than any didactic exercise.

The comment one person made could have been made by any of us. The real challenge, in my view, is how we respond.

Sue, D. W. (2010). Microaggressions in everyday life:  Race, gender and sexual orientation. New York, NY: John Wiley and Sons.

Tuesday, June 12, 2012

Two South Florida doctors, 3 others convicted on Medicare fraud charges

A Miami federal jury convicted five people of Medicare-related fraud in a case involving the nation’s biggest mental-health racket.

By Jay Weaver
The Miami Herald
Originally published on June 1, 2012

Two South Florida doctors stared in disbelief — then teared up as they turned to relatives for comfort — after a federal jury found them guilty Friday of conspiring to defraud Medicare through the nation’s biggest mental-health racket.

The 12-person Miami jury convicted psychiatrists Mark Willner of Weston and Alberto Ayala of Coral Gables, the medical directors for American Therapeutic Corp., for their roles in a $205 million scheme to fleece the taxpayer-funded program for the elderly and disabled. The jurors found them not guilty on other healthcare fraud offenses.

In addition, the jury convicted Vanja Abreu, Ph.D, program director for American Therapeutic in Miami-Dade, of the same healthcare-fraud conspiracy offense, and two other defendants, Hilario Morris and Curtis Gates, of paying kickbacks to residential home operators in exchange for providing patients.

The entire story is here.

Thanks to Steve Ragusea for this story.

Judge sends suspended Doc back to work

By Andy Fox
Originally published on June 7, 2012

A local psychologist who is often called on by local courts to give advice on child custody decisions is back in business.

WAVY.com first told you earlier this week the Virginia Psychology Board indefinitely suspended Dr. Brian Wald for inappropriate relations with a client.

But a trip to court changed that. The Judge basically overruled the Psychology Board, allowing Dr. Wald to go back to work until the matter is settled in court in September. The Judge set several conditions: Wald must take an ethics course, he must continue his own therapy, he must have supervision during clinical cases and he is prohibited from participating in parental custody cases in Norfolk.

Here is a video of the local newscast.

The entire article is here. A prior blog entry can be found here.

Monday, June 11, 2012

Our moral motivations

Humans have evolved from being driven by self-interest to being team players who want their lives to count for something, argues University of Virginia psychologist Jonathan Haidt.

By Kirsten Weir
The Monitor on Psychology
June 2012, Vol 43, No. 6
Print version: page 24

In the midst of a superheated election, in which truth is hard to come by and personal attacks are commonplace, it's hard to imagine politics having much to do with morality. However, in his new book, "The Righteous Mind," positive psychology pioneer Jonathan Haidt, PhD, argues that even our divisive political system arose from a deep-seated human need to work toward a greater good.

In his search for the roots of morality, he explores our species' evolution from our individualistic primate ancestors to deeply cooperative human beings, and describes how religious and political institutions helped enable that transformation.

The Monitor spoke with Haidt about his research and how we might bring politics — and psychology — back to their moral roots.

The entire article is here.

Sunday, June 10, 2012

Senator questions $2m NIH grant to disgraced psychiatric researcher

By Bob Roehr
British Medical Journal
Originally published June 1, 2012

Dr. Nemeroff
The US senator Charles Grassley has called on the National Institutes of Health to justify its decision to award a five year $2,000,000 grant to the prominent but disgraced psychiatric researcher Charles Nemeroff, "despite past ethical problems."

"It is troubling that NIH continues to provide limited federal dollars to individuals who have previously had grant funding suspended for failure to disclose conflicts of interest," Grassley wrote in a 29 May letter to the director of the NIH, Francis Collins.

He asked Collins to provide full documentation of communications concerning Nemeroff and the grant within two weeks.

The information is here.

Thanks to Ken Pope for this information.

There are other blog entries here and here about Dr. Nemeroff.

Alzheimer's research fraud case set for trial

By Toni Clarke
Reuters Health News
Last updated May 11, 2012

Two Harvard teaching hospitals and a prominent Alzheimer's disease researcher accused of using falsified data to obtain a government research grant are set to stand trial after a federal appeals court said this week that a lower court erred when it dismissed the case.

The lawsuit accuses Marilyn Albert, a former professor of psychiatry at Harvard Medical School, and Massachusetts General Hospital (MGH), where she was conducting research, of submitting a grant application based on manipulated data.

The data showed results from a trial were scientifically significant when in fact they were not, according to the lawsuit.

Brigham and Women's Hospital, which collaborated on the research, is also a defendant in the case. The lawsuit was brought in 2006 under the False Claims Act, a 150-year-old federal law designed to recover government funds appropriated through fraud.

This is the first time a lawsuit dealing with alleged scientific fraud has been allowed to progress to trial under the False Claims Act, according to Michael Kohn, a lawyer with Kohn, Kohn & Colapinto in Washington, D.C.

The entire story is here.

Saturday, June 9, 2012

Clinical Considerations When Working With Lesbian Clients

By Jeanne L. Stanley, PhD
The Pennsylvania Psychologist
June 2012

One challenge of working with lesbian clients lies in never assuming all concerns relate to sexual identity issues, while also acknowledging the potential impact of sexual identity. Also important is understanding the intersection of our clients’ sexual orientation with other socio-cultural identities, including age, citizenship status, ability, ethnicity, gender, race, religion, and socioeconomic status. A client’s socio-cultural identities are at times independent, interdependent, and multiplicative, and are best understood individual by individual (Stanley, 2004).

A difference exists between a lesbian’s self-identification and behavior. For example a female client married to a man may not be heterosexual. A recent study found that 67% of “exclusively straight” women had questioned or were questioning their sexual orientation (Morgan & Thompson, 2011). Conversely, a client who identifies as lesbian may never have had a same-sex experience. Fifty percent of self-identified lesbian adolescents had not had same-sex contacts (Savin-Williams, 2005). It is therefore better to ask a client, “With what gender or genders are you sexually active, if you are so?” as well as how they identify themselves, rather than to focus solely on labels. For some women, sexual behavior or attraction is not the basis for their identification as lesbian. In this context, Klein, Sepekoff and Wolf (1990) were instrumental in helping psychologists broaden their understanding of sexual identity to include other factors, such as attraction, emotional connection, and community affiliation.

Coming out to oneself about one’s sexual identity can happen at any age. Sexual orientation may be static over a lifetime or more fluid (Diamond, 2008). I recently met with a 71-year-old client who described experiencing sexual attraction toward women for the first time. Assuming that sexual identity is static may lead mental health professionals to miss subtle comments by clients who may be reaching out for support regarding their orientation.

As they consider coming out for the first time, clients benefit from thorough exploration of the “why” and “how” of their communication. It is useful for clients to choose carefully whom to tell first, in order to identify those with whom they are likely to have a positive experience. Reviewing how particular people have handled potentially disconcerting information in the past may prepare the client.

Coming out is an ongoing, lifelong process. While clients may focus on the major coming-out events, such as telling parents, spouses, friends, and work colleagues about their sexual identity, the decision of whether to come out and the possible consequences may arise daily.  Checking into a hotel as a same-sex couple and assuring the clerk that indeed you would like one queen-sized bed rather than two double beds, or receiving an invitation for one to a cousin’s wedding, even though you have been with your spouse for fifteen years, can take a toll on even the most “out” and empowered individuals. A high school reunion full of questions about relationship status may lead an otherwise “out” lesbian to retreat back into the closet for the night. It is especially important for mental health professionals to be able to normalize for clients the process of “recycling” through the coming-out process based upon life circumstances and to give them a place to discuss their present contexts without pathologizing their needs and decisions. 

Facing subtle and more overt forms of discrimination leads lesbian, gay, bisexual, and transgender (LGBT) individuals to seek mental health support services on a higher average than their heterosexual counterparts (Israel, Grocheva, Burnes, & Walther, 2008). Lesbian clients are not more emotionally “flawed” than their heterosexual counterparts; rather the chronic, overt discrimination and prejudice they experience can lead to higher rates of depression, anxiety, and substance abuse. The importance of screening for depression, anxiety, addictions, self-harming behaviors, and suicidality is therefore essential in our initial and continued work with lesbian clients. 

Support from family of origin and/or family of choice (i.e., friends and mentors) plays a crucial role for many lesbians. Therefore, it may be useful to connect lesbian clients to affinity groups related to their interests and their work, whether through local or national venues. LGBT psychologists may find support and recognition through membership in APA’s Division 44. Clients in non-urban areas may benefit from online support groups and other social networking sites. Support for lesbians is often found in their friendships, which may differ in important ways from heterosexual friendships. It is not uncommon for lesbians to work to maintain friendships with their ex-partners (Weinstock & Rothblum, 2004; Stanley, 1996).

Psychologists who see lesbian couples need to consider some of the unique aspects of working with them. If one member of the couple is out to family and friends but the other partner is not because of fear of losing her job or being rejected by her parents or siblings, the disparity may strongly impact their relationship. Domestic violence in lesbian couples may also manifest in unique ways: An angry member of the relationship might threaten to “out” the closeted partner, thereby using the knowledge of her sexual identity to exert control. Working with lesbians who are married to men may involve conflicted feelings about coming out to their husbands and/or children. Their own mixed feelings such as excitement, shame, joy, and fear may interact with the reactions of friends, parents, and neighbors. Support groups are often useful for married or recently divorced lesbians to gain affirmation in their lives.

Unique issues for lesbians considering children range from legal issues (some states do not allow same-sex couple adoptions), to refusals by hospitals to recognize the non-pregnant female partner, to deciding which partner will be the biological mother. Today’s psychologist needs to have at least a basic understanding of fertility, adoption, and donor options for lesbian clients. Lesbian parents may also experience homophobia from teachers, school districts, Boy Scout troops, and others. Psychologists must be aware of local, state, and national laws regarding the protection of LGBT clients in order to best meet their needs. For up-to-date resources for such information in Pennsylvania, see http://www.hrc.org/laws-and-legislation/state/c/pennsylvania.

Lesbian psychologists are also affected by the interconnected nature of the lesbian community (Kessler & Waehler 2005; Brown, 1988).  It is not unusual for lesbians to recommend their own mental health provider to friends and colleagues or for a lesbian psychologist to become well known in the community. Given the limited number of lesbian gatherings, a lesbian psychologist may run into clients socially. Consequently, early in therapy a discussion of professional boundaries may be particularly useful.

Finally, all psychologists benefit from ongoing self-introspection and awareness in regard to their own internalized homophobia. None of us, regardless of orientation, are immune from it. Riddle’s (1990) scale, which ranges from repulsion to nurturance, is a useful measure to assess one’s level of personal comfort regarding sexual orientation. We are ethically bound to recognize our limitations and to refer lesbian clients or consult if our biases or ignorance of a culture may be barriers to treatment. PPA’s Multicultural Resource Guide as well as other online resources may assist you in finding LGBT-affirmative therapists in your area for your client and continuing education trainings for yourself. Since we never know whether we may be working with lesbian clients, we must ensure we are providing a supportive and affirming environment for clients of all sexual orientations. 

References are available from the author at jstanley@gradschoolcoaching.com or on the PPA website, www.PaPsy.org.