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

Tuesday, July 31, 2012

Impact of Deductibles on Initiation and Continuation of Psychotherapy for Treatment of Depression

Objective. To estimate the impact of deductibles on the initiation and continuation of psychotherapy for depression.

Data Source/Study Setting. Data from health care encounters and claims from Group Health Cooperative, a large integrated health care system in Washington State, was merged with information from a centralized behavioral health triage call center to conduct study analyses.

Study Design. A retrospective observational design using a hierarchical logistic regression model was used to estimate initiation and continuation probabilities for use of psychotherapy, adjusting for key sociodemographic/economic factors and prior use of behavioral health services relevant to individual decisions to seek mental health care.

Data Collection/Extraction Methods. Analyses were based on merged datasets on patient enrollment, insurance benefits, use of mental health and general medical services and information collected by a triage specialist at a centralized behavioral health call center.

Principal Findings. Among individuals with unmet deductibles between $100 and $500, we found a statistically significant lower likelihood of making an initial visit, but there was no statistically significant effect on making an initial or subsequent visit among individuals that had met their deductible.

Conclusions. Unmet deductibles appear to influence the likelihood of initiating psychotherapy for treating depression.

Monday, July 30, 2012

Healthcare Data Breaches Still Rising

By Deborah Hirsch
HealthTechZone Contributor
Originally published July 19, 2012

Here are some excepts:

The healthcare industry has the highest percentage of data breaches of any sector, according to a report by Symantec. Healthcare also had the highest number of reported breaches, at 43 percent, Patricia Resende reports.

And the costs continue to rise, with each breach costing organizations $5.5 million, and each compromised record, $194, the Symantec study reports. And even though the costs have dropped slightly from several years ago, according to a Ponemon study, healthcare is the one area where they have not. Physicians’ offices and small clinics say they have lost more than 54,000 patient records due to breaches since 2009.

And they’ve occurred all over the country, from Utah, where the files of almost 300,000 Medicaid patients were breached in March, to Boston, where the laptop of a Boston Children’s Hospital employee at a South American conference containing more than 2000 patient records was stolen.

The entire story is here.

Beth Israel Deaconess reveals health data breach

By Kyle Murphy, PhD
EHR Intelligence
Originally published July 20, 2012

The personal health information of close to 4,000 patients at Beth Israel Deaconess Medical Center (BIDMC) has been compromised after a physician’s personal laptop was stolen on May 22, says the Boston Globe. BIDMC officials could not be reached for comment.
Thanks to Ken Pope for this information.

Sunday, July 29, 2012

Hospitals Reaping Financial Benefits of Telehealth

By Karen Minich Pourshadi
Health Leaders Media
Originally published July 19, 2012

Here are some excerpts:

The passing of the years has softened resistance by patients to using this approach. Patients are now willing to forego an in-person visit with the doctor in order to get the care they need swiftly, without having to travel, and in some instances at a lower cost. Moreover, the reimbursement environment is changing. Whereas at one time payers rejected the notion of reimbursing e-health, now more are willing to pay for it. Plus, legislators nationwide are creating state laws requiring payers to reimburse for these services, though in many instances payers are doing so irrespective of mandate.

"Telemedicine can lower healthcare costs by reducing avoidable hospital visits and providing regular access to care in remote parts of the state, and it's more convenient for patients," says Georgia Partnership for TeleHealth CEO Paula Guy. The nonprofit telehealth provider works with more than 350 partners and 175 specialists and other healthcare providers and has handled some 40,000 patient encounters as of 2011.


GPT has also placed telehealth into nursing homes. In 2011, using telehealth resulted in 160 ED visits being avoided, saving approximately $480,000 in ED cost, Guy says, "In the past, these older patients may have just called for an ambulance when they had a problem. But now patients can be seen by a doctor without an expensive ambulance trip to the ED. Plus they can use it for routine access to care, and by getting that they're less likely to end up in the hospital as frequently," Guy says.

Telehealth visits saved 310 miles and nearly six hours of traveling on average, according to a study by Children's Healthcare of Atlanta, a three-hospital system for children and teens. CHA reviewed 609 appointments over a nine-month period and noted that approximately 86% of patients would have missed school and more than 80% of parents would have missed a full day of work to go to the city for an in-office visit, according to data published in the Atlanta Journal-Constitution. Additionally, Guy explains that out of the 40,009 telehealth visits GPT tracked, a random sample showed an average savings of patient travel time of 124 miles per encounter and nearly $762,027 in fuel alone.

The entire article is here.

Saturday, July 28, 2012

EHR Adoption By Doctors Reaches 55 Percent

Kaiser Health News
Originally published July 19, 2012

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

More can be found here.

Friday, July 27, 2012

Actress urges action against human trafficking

By Andres Gonzalez
The Associated Press
Originally published July 17, 2012

Jada Pinkett Smith
Actress and activist Jada Pinkett Smith urged Congress on Tuesday to step up the fight against human trafficking in the U.S. and abroad.

The actress testified during a Senate Foreign Relations Committee hearing that she plans to launch a campaign to raise awareness and spur action against human trafficking and slavery. She said the "old monster" of slavery "is still with us," almost 150 years after President Abraham Lincoln issued the Emancipation Proclamation that freed slaves in the U.S.

"Fighting slavery doesn't cost a lot of money. The costs of allowing it to exist in our nation and abroad are much higher," the actress said. "It robs us of the thing we value most, our freedom."

The entire story is here.

Human trafficking: Modern day slavery

Women's Psych-E Newsletter
March 2012

On February 1, 2012, the APA Women’s Programs Office, the Graduate and Postgraduate Education and Training Office and the Neighborhood Opportunities for Volunteer Activities (NOVA) Committee hosted a brown bag lunch for APA staff in recognition of January as National Slavery and Human Trafficking Prevention Month featuring Tina Frundt, Founder and Executive Director of Courtney’s House.

Frundt, also a survivor of domestic sex trafficking, discussed the importance of providing programs and services for domestic victims. “Trafficking of American children is often not heard about. The focus is often on foreign trafficking, she says. Due to a lack of funding for programs for trafficking victims, minors are all too often arrested, charged with child prostitution and placed in juvenile detention centers which are unsafe.” She is currently working to get legislation that will prevent children from being arrested and charged with child prostitution and to will allow them to receive services. Dr. Marsha Liss, PhD, member of the newly formed APA Task Force on Trafficking of Women and Girls, also in attendance, emphasized the importance of services and supports that prevent survivors from being sent into situations where they're at risk.

The entire article can be found here.

Thursday, July 26, 2012

Five Doctors Settle SEC Insider Trading Charges

Reuters Health Information
Originally published July 10, 2012

Five doctors have agreed to pay $1.9 million to settle U.S. Securities and Exchange Commission civil charges that they conducted insider trading in shares of a medical professional liability insurer that was preparing to be sold.

The SEC said Apparao Mukkamala routinely tipped the other doctors in 2010 about confidential details of the sale process for American Physicians Capital Inc ("APCapital"), where he had been chairman at the time.

It said the other doctors bought nearly $2.2 million of the East Lansing, Michigan-based company's stock between April 30 and July 7, 2010, based on the tips, and that Mukkamala himself bought shares through a charitable organization where he was president.

The entire story is here.

Wednesday, July 25, 2012

The Ethics of Influencing the Political Process

Stephen A. Ragusea, PsyD, ABPP
Chair, Florida State Psychological Association Ethics Advisory Committee

Ethics Corner
Summer 2012

In the last edition of the Florida Psychologist, I wrote an article about how psychologists often hesitate to encourage their patients to influence the political process. Psychologists frequently fear to unfairly utilize powerful relationships, somehow pushing patients into action they would not normally take. 

However, psychologists also too often personally and professionally avoid being involved with the political process.  To some, this avoidance is incomprehensible and frustrating.  Based on my experience, psychologists usually stay out of the political process for the most common of reasons, they just feel too busy in their daily lives to take the time to participate in the fray.  And, some psychologists seem to feel as if they would be sullied somehow by wrestling in the mud of the political arena.  Of course, some folks are just plain lazy and engage is what some writers have called, “social loafing.”   My ethics chair colleague in Pennsylvania, Dr. John Gavazzi, once wrote, “Social loafing is the tendency for people to expend less effort on a given task when working in groups than when working alone.  It is easier to loaf when individual contributions are not evaluated and when the individual can rationalize that someone else will ‘pull the weight.’”

In any case, because of social loafing and a variety of other reasons, psychologists seem to avoid involvement in the political process more often that do some other professionals.   For example, based on data from a variety of sources nurses are much more involved in political and legislative matters than are we.  Nurses and physicians also contribute substantially more money to lobbying efforts than do psychologists.  These tendencies of ours endure despite the fact that we are acting against our own best interests.  We need to do much better or, very soon I fear, we risk professional oblivion.

From my perspective in the catbird’s seat, I also think there are more lofty reasons for psychologists to be actively involved in the democratic process.  I believe psychologists have an ethical responsibility to be involved with influencing the political and legal process of our society.  It is what we owe in service to our culture and our patients.

The APA Ethical Standards actually address this topic in the preamble.  Specifically, the preamble declares the following.  (Italics are added by this writer for emphasis.)

“Psychologists are committed to increasing scientific and professional knowledge of behavior and people’s understanding of themselves and others and to the use of such knowledge to improve the condition of individuals, organizations, and society…. They strive to help the public in developing informed judgments and choices concerning human behavior.  In doing so, they perform many roles, such as researcher, educator, diagnostician, therapist, supervisor, consultant, administrator, social interventionist….”

Therefore, beyond our own self-interest, based on our ethical standards, we are not only free to participate in the political process through political giving and social activism, but we actually have an affirmative ethical responsibility to do so.  Again, quoting John Gavazzi’s article, “Although no law, statute, or ethical code mandates ‘Thou shall participate in the political process,’ psychologists are responsible to promote our patients’ welfare.  Enhancing patient welfare can occur at the community and systems level, not just within the confines of our offices.  The goals of political advocacy are noble and worthy.”

Amen, brother John.  Is anybody out there listening?  Is anybody out there acting?

American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist,Vol. 57, 1060-1073. 

Gavazzi, J. D. (2006). Legislative Efforts and Positive Ethics: Say what? The Pennsylvania Psychologist, February Quarterly, 2, 6.

If you have specific suggestions for topics to be covered in The Ethics Corner, please e-mail me with your suggestions.  My e-mail address is ragusea@aol.com

Tuesday, July 24, 2012

At Trial’s End, Lawyers Say Norway Killer Is Not Insane

By Mark Lewis
The New York Times
Originally published on June 22, 2012

The trial of Anders Behring Breivik ended on Friday with an unusual reversal of roles, as defense lawyers insisted that he was sane when he killed 77 people last year and should be sentenced to prison, and prosecutors arguing that he was mentally ill and thus not criminally responsible, and should be hospitalized instead.


Members of the defense team, in tears themselves as parents spoke about their slain children, evoked Mr. Breivik’s human rights in their conclusion that he should be held accountable for his crimes. Mr. Breivik has admitted to the killings but said they were committed in self-defense to combat what he has called the “Islamic colonization” of Europe. He has argued that an insanity judgment would detract from his cause.
“The defendant has a radical political project,” Mr. Lippestad said. “To make his acts something pathological and sick deprives him of his right to take responsibility for his own actions.”

Monday, July 23, 2012

Uncertainty shrouds psychologist's resignation

Lawrence Sanna departed University of Michigan amid questions over his work from ‘data detective’ Uri Simonsohn.

By Ed Yong
Originally published July 12, 2012

Uri Simonsohn, the researcher who flagged up questionable data in studies by social psychologist Dirk Smeesters, has revealed the name of a second social psychologist whose data he believes to be suspiciously perfect.

That researcher is Lawrence Sanna, whose former employer, the University of Michigan in Ann Arbor, tells Simonsohn that he resigned his professorship there at the end of May. The reasons for Sanna's resignation are not known, but it followed questions from Simonsohn and a review by Sanna’s previous institution, the University of North Carolina in Chapel Hill (UNC). According to the editor of the Journal of Experimental Social Psychology, Sanna has also asked that three of his papers be retracted from the journal.

In both Smeesters’ and Sanna’s work, odd statistical patterns in the data raised concerns with Simonsohn, at the University of Pennsylvania in Philadelphia. But the similarity between the cases ends there. Smeesters’ resignation was announced on 25 June by his institution, Erasmus University Rotterdam in the Netherlands, which undertook a review and concluded that two of his papers should be retracted. Sanna’s resignation, by contrast, remains mysterious: UNC did not release the results of its review, and the University of Michigan will not explain why Sanna resigned.

The entire story is here.

Sunday, July 22, 2012

Investigation Sought of Extensive F.D.A. Surveillance

By Eric Lichtblau
The New York Times
Originally published July 16, 2012

Federal health officials faced pressure from Capitol Hill and outside groups on Monday to investigate a wide-ranging surveillance program that the Food and Drug Administration mounted against a group of its scientists who raised warnings about the safety of medical imaging devices.

Representative Chris Van Hollen, a Maryland Democrat, sent a letter on Monday to Kathleen Sebelius, the secretary of health and human services, calling on her to conduct a full investigation into whether the surveillance program violated federal employee protections and whistle-blower laws.

“The tactics reportedly used by the F.D.A. send a terrible message to those who are prepared to expose waste, abuse or wrongdoing in government agencies,” wrote Mr. Van Hollen, whose staff communications were monitored by the F.D.A.

The entire story is here.

In Vast Effort, F.D.A. Spied on E-Mails of Its Own Scientists

By Eric Lichtblau and Scott Shane
The New York Times
Originally published July 15, 2012

A wide-ranging surveillance operation by the Food and Drug Administration against a group of its own scientists used an enemies list of sorts as it secretly captured thousands of e-mails that the disgruntled scientists sent privately to members of Congress, lawyers, labor officials, journalists and even President Obama, previously undisclosed records show.

What began as a narrow investigation into the possible leaking of confidential agency information by five scientists quickly grew in mid-2010 into a much broader campaign to counter outside critics of the agency’s medical review process, according to the cache of more than 80,000 pages of computer documents generated by the surveillance effort.
Moving to quell what one memorandum called the “collaboration” of the F.D.A.’s opponents, the surveillance operation identified 21 agency employees, Congressional officials, outside medical researchers and journalists thought to be working together to put out negative and “defamatory” information about the agency.

Saturday, July 21, 2012

Panel calls for annual PTSD screening

By Kevin Freking
The Associated Press
Originally published July 13, 2012

The Institute of Medicine recommended Friday that soldiers returning from Iraq and Afghanistan undergo annual screening for post-traumatic stress disorder and that federal agencies conduct more research to determine how well the various treatments for PTSD are working.

Of the 2.6 million service members deployed to Iraq and Afghanistan, it's estimated that 13 percent to 20 percent have symptoms of PTSD.

Federal agencies have increasingly dedicated more resources to screen and treat soldiers, but considerable gaps remain, according to the Institute of Medicine, an independent group of experts that advises the federal government on medical issues. Its recommendations often make their way into laws drafted by Congress and policies implemented by federal agencies.

Mental health disorders among troops increased 65 percent since 2000

By Rebecca Ruiz
Originally published July 12, 2012

Mental health disorders in active-duty troops increased 65 percent since 2000, according to a report released this week by the Armed Forces Health Surveillance Center.

The report looked at a 12-year period between 2000 and 2011 and found that more than 936,000 service members had been diagnosed with at least one mental disorder. Of those diagnoses, about 85 percent were cases of adjustment disorders, depression, alcohol abuse and anxiety, among other conditions.

Between 2003 and 2008, the rate of post-traumatic stress disorder (PTSD) increased nearly sixfold; by 2011, there were more than 100,000 diagnoses. The report, however, did not evaluate mental disorders in relationship to deployments.

The entire story is here.

Friday, July 20, 2012

Aging Boomers' Mental Health Woes Will Swamp Health System

By Amanda Gardner
HealthDay Reporter
Originally published July 10, 2012

The United States faces an unprecedented number of aging baby boomers with mental health or substance use issues, a number so great it could overwhelm the existing health care system, a new report warned Tuesday.

"The report is sufficiently alarmist," said Dr. Gary Kennedy, director of geriatric psychiatry at Montefiore Medical Center in New York City. "I think [the report authors] are right."

Kennedy was not involved with the report, The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands? It was mandated by Congress and issued by The Institute of Medicine in light of a "silver tsunami" of health care needs expected to accompany a senior population that will reach 72.1 million by 2030.

The "silver tsunami" is the result of simple supply-and-demand forces gone awry, the report authors explained.

The entire story is here.

Read the report online for free

Thursday, July 19, 2012

The Evolving State of Physician-Assisted Suicide

Massachusetts voters soon will decide whether to become the third state to legalize the contentious end-of-life care option for the terminally ill.

By Jaime Joyce
The Atlantic Monthly
Originally published July 16, 2012

Should terminally ill patients have the right to kill themselves? Voters in Massachusetts will soon decide. Last Wednesday, the Secretary of the Commonwealth announced that on November 6, 2012, when Bay State voters go to the polls to pick the next President, they will also have their say on a ballot measure called the Death with Dignity Act. If passed, the law would make Massachusetts the third state to give adults diagnosed with six months or less to live the option to end their lives using a lethal dose of doctor-prescribed medication.


A study released by the Health Research and Education Trust shows that Americans are living longer lives than ever before. As a result, more individuals and families will face difficult questions about end-of-life care. In 2011, the oldest Baby Boomers turned 65. By 2030, the number of Boomers between 66 and 84 years old will climb to 61 million, and six out of 10 will be managing chronic health conditions. For the elderly and others facing terminal illness, doctors have numerous ways to prolong life. Palliative and hospice care are available to help patients find peace and comfort in their final days. But there are some people who want another option, which is the right to end suffering by taking their own life at a time and place of their choosing.


Others posts about end of life issues and Death with Dignity can be found by using the "search" function on the right hand side of this blog.

Dutch Euthanasia Rates Unchanged After Legalization

By Robert Preidt
Originally published July 10, 2012

The rates of euthanasia and assisted suicide in the Netherlands in 2010 were comparable to the rates before the practices became legal in 2002, a new study finds.


Researchers analyzed the Netherlands' death-registry data and found that the total number of euthanasia and assisted-suicide deaths in 2010 was 4,050, slightly less than 3 percent of all deaths.

The rates of euthanasia and assisted suicide in the Netherlands decreased between 2002 and 2005, but increased between 2005 and 2010. The increase was due largely to a rise in the number of patients requesting to end their lives, the researchers said.

The entire story is here.

The research from The Lancet is here.

Wednesday, July 18, 2012

Free access to British scientific research to be available within two years

Radical shakeup of academic publishing will allow papers to be put online and be accessed by universities, firms and individuals

By Ian Sample
The Guardian
Originally published July 15, 2012

The government is to unveil controversial plans to make publicly funded scientific research immediately available for anyone to read for free by 2014, in the most radical shakeup of academic publishing since the invention of the internet.

Under the scheme, research papers that describe work paid for by the British taxpayer will be free online for universities, companies and individuals to use for any purpose, wherever they are in the world.

In an interview with the Guardian before Monday's announcement David Willetts, the universities and science minister, said he expected a full transformation to the open approach over the next two years.

The move reflects a groundswell of support for "open access" publishing among academics who have long protested that journal publishers make large profits by locking research behind online paywalls. "If the taxpayer has paid for this research to happen, that work shouldn't be put behind a paywall before a British citizen can read it," Willetts said.

Treatment of Gender Identity Disorder: Guidelines from the ApA

by Mary Elizabeth Dallas
Originally published on July 6, 2012

Psychiatrists who see transgender patients need specific guidelines to help determine the best course of treatment, according to new report from the American Psychiatric Association.

The American Psychiatric Association Task Force on Treatment of Gender Identity Disorder also calls for the psychiatrists' group to clarify its position on the health care and civil rights of people who are transgender or transitioning gender, meaning they are in the process of changing their gender through hormones and surgery.

The entire story is here.

The guidelines from the American Psychiatric Association are here.

Tuesday, July 17, 2012

Appeals Court Rejects Student's Lawsuit Over Alleged Harassment by Professor

By Libby Sander
The Chronicle of Higher Education
Originally published July 10, 2012

Student workers who are sexually harassed on the job do not enjoy a higher standard of protection under federal employment law than do workers in other employment settings, a federal appeals court ruled on Tuesday.

The case involves Southern Illinois University at Carbondale, which the U.S. Court of Appeals for the Seventh Circuit concluded is not liable for an undergraduate student's claims of sexual harassment by a prominent emeritus faculty member who was also a major donor.

In a 2-to-1 opinion, a three-judge panel of the appeals court rejected claims by the student, Samuel Milligan, under federal employment law that Southern Illinois created a hostile work and educational environment.

The entire story is here.

Monday, July 16, 2012

Identifying Perceived Personal Barriers to Public Policy Advocacy Within Psychology

The authors are Amy E. Heinowitz, Kelly R. Brown, Leah C. Langsam, Steven J. Arcidiacono, Paige L. Baker, Nadimeh H. Badaan, Nancy I. Zlatkin, & Ralph E. (Gene) Cash.
Professional Psychology: Research & Practice

There is an urgent and growing need for professional and social justice advocacy within the psychological community (Ratts & Hutchins, 2009; Kiselica & Robinson, 2001; Ratts, D'Andrea, & Arredondo, 2004; Toporek, Gerstein, Fouad, Roysircar, & Israel, 2006).  Psychology, as a field as well as a profession, aims to reduce negative treatment outcomes and to enhance personal wellbeing through research and practice (Council of Specialties in Professional Psychology, 2009; American Psychological Association, 2010b).  The viability of the profession and its capacity to provide fundamental and essential services are directly affected by legislation and regulations (Barnett, 2004).  As a result, advocacy is integral to the roles of all psychologists, with the future and success of their profession and careers depending on their incorporation of advocacy into their professional identity (Burney et al., 2009).


The findings presented in this study carry valuable implications for efforts aimed at enhancing participation in advocacy. Lating et al. (2009) suggest that the continued separation of professional and educational agendas in the training of psychologists may contribute to the profession's deficient involvement in advocacy. Specifically, psychology is the only major health profession to maintain an academic training model despite the creation of professional training programs. The lack of advocacy training appears to contribute to the development and maintenance of barriers such as lack of awareness of and lack of perceived competence in discussing public policy issues.

Efforts to increase psychologists' participation in public policy advocacy must begin early on and be integrated throughout their curricula. Pertinent public policy issues fit well into courses on ethics, diversity, assessment, and even intervention. Similarly, discussion about and training in the advocacy role may be reinforced through clinical training and supervision. In addition to incorporated teaching lessons, specific coursework in public policy advocacy might aid students in developing skills used to advocate, while increasing comfort, enhancing familiarity, and expanding knowledge of current issues.

Thanks to Ken Pope for this information.

Sunday, July 15, 2012

Good News for Mental Illness in Health Law

By Richard A. Friedman, MD
The New York Times
Originally published July 9, 2012

Americans with mental illness had good reason to celebrate when the Supreme Court upheld President Obama’s Affordable Care Act. The law promises to give them something they have never had before: near-universal health insurance, not just for their medical problems but for psychiatric disorders as well.

Until now, people with mental illness and substance disorders have faced stingy annual and lifetime caps on coverage, higher deductibles or simply no coverage at all.

This was supposed to be fixed in part by the Mental Health Parity and Addiction Equity Act of 2008, which mandated that psychiatric illness be covered just the same as other medical illnesses. But the law applied only to larger employers (50 or more workers) that offered a health plan with benefits for mental health and substance abuse. Since it did not mandate universal psychiatric benefits, it had a limited effect on the disparity between the treatment of psychiatric and nonpsychiatric medical diseases.

Saturday, July 14, 2012

Rift Forms in Movement as Belief in Gay 'Cure' Is Renounced

By Erik Eckholm
The New York Times
Originally published on July 7, 2012

Here are some exerpts:

Alan Chambers, 40, the president, declared that there was no cure for homosexuality and that “reparative therapy” offered false hopes to gays and could even be harmful. His statements have led to charges of heresy and a growing schism within the network.
“For the last 37 years, Exodus has been a bright light, arguably the brightest one for those with same-sex attraction seeking an authentically Christian hope,” said Andrew Comiskey, founder and director of Desert Stream Ministries, based in Kansas City, Mo., one of 11 ministries that defected. His group left Exodus in May, Mr. Comiskey said in an e-mail, “due to leader Alan Chambers’s appeasement of practicing homosexuals who claim to be Christian” as well as his questioning of the reality of “sexual orientation change.”


“I believe that any sexual expression outside of heterosexual, monogamous marriage is sinful according to the Bible,” Mr. Chambers emphasized. “But we’ve been asking people with same-sex attractions to overcome something in a way that we don’t ask of anyone else,” he said, noting that Christians with other sins, whether heterosexual lust, pornography, pride or gluttony, do not receive the same blanket condemnations.


Mr. Pickup, an officer of the National Association for Research and Therapy of Homosexuality, composed of like-minded therapists, said reparative therapy had achieved profound changes for thousands of people, including himself. The therapy, he said, had helped him confront emotional wounds and “my homosexual feelings began to dissipate and attractions for women grew.”
Some in the ex-gay world are more scathing about Mr. Chambers.

Google wants the world to "Legalize Love"

By Anna Peirano
Originally published July 8, 2012

Google is launching a new campaign called "Legalize Love" with the intention of inspiring countries to legalize marriage for lesbian, gay, and bisexual people around the world.

The "Legalize Love" campaign officially launches in Poland and Singapore on Saturday, July 7th. Google intends to eventually expand the initiative to every country where the company has an office, and will focus on places with homophobic cultures, where anti-gay laws exist.

Friday, July 13, 2012

ASPPB Receives Licensure Portability Grant from Federal Government

Any questions can be directed to Alex Siegel, JD, PhD, Director of Professional Affairs of ASPPB

ASPPB Receives Grant

California places psychologist David Van Zak's license on probation

Psychiatric Crimes Database
Originally published July 5, 2012

On January 26, 2012, the California Board of Psychology placed DAVID VAN ZAK, Ph.D.’s license on probation for five years. According to the Board’s Accusation, Van Zak committed, among other things, repeated acts of negligence by accepting financial gifts from a patient, as well as the patient’s invitation to join her and her husband on a Mexican cruise.

The entire story is here.

Thursday, July 12, 2012

Child Abuse Reporting: Rethinking Child Protection

By Susan C. Kim, JD, MPH; Lawrence O. Gostin, JD; & Thomas B. Cole, MD, MPH.
Journal of the American Medical Association
JAMA. 2012;308(1):37-38. doi:10.1001/jama.2012.6414
Originally published July 4, 2012

The general public has been bewildered by the magnitude of sex abuse cases and the widespread failure by pillars of the community to notify appropriate authorities. The crime of sexually abusing children is punishable in all jurisdictions. However, what is the duty to report suspected cases by individuals in positions of trust over young people, such as in the church or university sports?

Since the mid-1980s, law enforcement has been investigating allegations of sexual crimes committed by Catholic priests against young boys and girls. These sexual abuse scandals and lawsuits have cost the Church an estimated $2 billion in settlements. A 2004 US Conference of Catholic Bishops report found that law enforcement was contacted in only 24% of cases of suspected abuse. In other cases, the church hierarchy responded internally or not at all: priests may have been counseled, evaluated, provided treatment, suspended, or limited in their priestly duties.

The entire article is here.

Thanks to Ken Pope for this lead.

Wednesday, July 11, 2012

Fraud-Detection Tool Could Shake Up Psychology

By Martin Enserink
Originally published July 3, 2012

The most startling thing about the latest scandal to hit social psychology isn’t the alleged violation of scientific ethics itself, scientists say, or the fact that it happened in the Netherlands, the home of fallen research star and serial fraudster Diederik Stapel, whose case shook the field to its core less than a year ago. Instead, what fascinates them most is how the new case, which led to the resignation of psychologist Dirk Smeesters of Erasmus University Rotterdam and the requested retraction of two of his papers by his school, came to light: through an unpublished statistical method to detect data fraud.

The technique was developed by Uri Simonsohn, a social psychologist at the Wharton School of the University of Pennsylvania, who tells Science that he has also notified a U.S. university of a psychology paper his method flagged.

That paper’s main author, too, has been investigated and has resigned, he says. As Science went to press, Simonsohn said he planned to reveal details about his method, and both cases, as early as this week.

If it proves valid, Simonsohn’s technique might find other possible cases of misconduct lurking in the vast body of scientific literature. “There’s a lot of interest in this,” says Brian Nosek of the University of Virginia in Charlottesville, who recently launched an examination of replicability in social psychology findings.

There are other stories about Diederik Stapel on this site.

A New Record for Retractions? (Part 2)

By Dennis Normile
Originally published on July 2, 2012

An investigating committee in Japan has concluded that a Japanese anesthesiologist, Yoshitaka Fujii, fabricated a whopping 172 papers over the past 19 years. Among other problems, the panel, set up by the Japanese Society of Anesthesiologists, could find no records of patients and no evidence medication was ever administered.

"It is as if someone sat at a desk and wrote a novel about a research idea," the committee wrote in a 29 June summary report posted in Japanese on the society's Web site.

The fabrications could produce a record number of retractions by a single author if the journals, as seems likely, decide to retract the papers. ScienceInsider was unable to reach Fujii, who had asked the society not to provide the media with his contact information.

The entire story is here.

Tuesday, July 10, 2012

Justice for Injured Research Subjects

By Carl Elliott, MD, PhD
The New England Journal of Medicine-Perspective
Originally published July 5, 2012

Critics have long argued that U.S. ethics guidelines protect researchers more than they protect research subjects. The U.S. system of oversight, writes Laura Stark, was developed as a “technique for promoting research and preventing lawsuits.” Consider, for example, the obligations of U.S. research sponsors when a study goes wrong. If a research subject is seriously injured, neither the researcher nor the sponsor has any legal obligation to pay for that subject's medical care. In fact, only 16% of academic medical centers in the United States make it a policy to pay for the care of injured subjects. If a subject is permanently disabled and unable to work, sponsors have no obligation to pay compensation for his or her lost income. If a subject dies, sponsors have no financial obligations to his or her family. Not a single academic medical center in the United States makes it a policy to compensate injured subjects or their families for lost wages or suffering. These policies do not change even if a subject is injured in a study that is scientifically worthless, deceptive, or exploitative.

Thanks to Gary Schoener for this information.

Monday, July 9, 2012

Data breach leads to $1.7M fine for Alaska DHSS

By Erin McCann
Healthcare Finance News
Originally published June 27, 2012

The Alaska Department of Health and Social Services (DHSS) – the state’s Medicaid agency – has agreed to pay $1.7 million to the U.S. Department of Health and Human Services (HHS) to settle possible violations of the HIPAA Security Rule, making it the second largest settlement for HIPAA violations to date.

As part of the settlement, the state has also agreed to take corrective action to properly safeguard the electronic personal health information (PHI) of their Medicaid beneficiaries.

The HHS Office for Civil Rights (OCR) began its investigation following a breach report submitted by Alaska DHSS as required by the Health Information Technology for Economic and Clinical Health (HITECH) Act. The report indicated that a portable electronic storage device (USB hard drive) possibly containing PHI was stolen from the vehicle of a DHSS employee. PHI from an estimated 2,000 individuals was stored on the device.

The entire story is here.

Editorial Note: Please do not tranfer large amounts of personal data from a secure data bank to a jump drive, lap top or other portable storage device.

MD Anderson suffers data breach via stolen computer

By Beth Walsh
CMIO - Industry News
Originally published July 2, 2012

The University of Texas MD Anderson Cancer Center announced that a computer containing patient and research information was stolen from a physician’s home on April 30. The physician notified the local police department.

After learning of the theft on May 1, MD Anderson immediately began a thorough investigation, including working with outside forensics experts, to determine the information contained on the computer.

The entire story is here.

Sunday, July 8, 2012

Coalition Responds to Invitation from APA's "PENS II" Task Force

The Coalition for an Ethical Psychology has been invited to nominate a consultant to “review materials” for the American Psychological Association’s so-called “member-initiated task force.” This task force purports to “reconcile policies related to psychologists’ involvement in national security settings.” We have declined the invitation because we reject both the aims and the legitimacy of this task force (hereafter referred to as “PENS II”) – and we discourage others from participating.

The entire response is here.

Others posts about the PENS report can be found by searching this blog via the "search" function.

Here is a portion of the response:

"Since the PENS Report became APA policy in 2005, subsequent APA policies related to interrogations (with the exception of the Referendum) have been framed in ways largely consistent with the PENS Report. As such, they are all “fruit of a poisoned tree.” Any constructive attempt to consolidate national security policies must therefore begin with annulment of the PENS Report in order to remove its corrosive influence on the profession of psychology and on the unexamined proliferation of operational psychology in coercive contexts.

The Coalition for an Ethical Psychology unequivocally rejects collaboration with the illegitimate PENS II “task force” and calls for its dissolution. We further encourage others to refuse to collaborate with this effort aimed at undermining true reform. PENS II is built upon faulty premises. If successful, it would enshrine one of the darkest initiatives in APA policy-making."

Saturday, July 7, 2012

Psychiatry's identity crisis - A Response

The Lancet, Volume 379, Issue 9835, Page 2428, 30 June 2012
By Andres Barkil-Oteo

Psychiatry has attempted to cope with its identity problem (April 7, p 1274) mainly by assuming an evidence-based approach, favoured throughout medicine. Evidence-based, however, became largely synonymous with psychopharmacological approaches, with relative disregard for other evidence-based modalities.

This situation has created a dilemma since the evidence for many common medication-prescribing practices is being challenged, whereas many of the psychological approaches have very solid evidence but are underused (eg, family psychoeducation). A good example is the extensive use of second-generation antipsychotic drugs, despite evidence of their lack of superiority over first-generation medication, as well as additional economic cost and the added burden of medical complications.

The entire response is here.

Psychiatry's identity crisis - Original letter

The Lancet, Volume 379, Issue 9823, Page 1274, 7 April 2012

Last week, the American Psychiatric Association issued a press release highlighting an ongoing decline in the recruitment of medical students into the specialty—at a time when the numbers of practising psychiatric professionals in the USA is falling. Various reasons are proposed, including the short-term nature of placements (usually just 4 weeks); the sheer breadth of an evolving specialty, which is drawing students towards newer areas such as clinical neuroscience; and concerns that psychiatry is not as lucrative as other specialties.


Psychiatrists, first and foremost, are clinicians. Evidence-based approaches should be at the core of the psychiatrist and non-clinical members of any mental health team.

The entire piece is here.

Friday, July 6, 2012

To Evaluate or Not To Evaluate

Dr. Joey Bishop has been conducting pre-ordination evaluations for a religious institution for many years. The purpose of these psychological evaluations is to identify individuals who have gross psychopathology, strong personality disorders, or other characteristics that would make them incapable of performing their religious duties adequately. Dr. Bishop developed a strong relationship with this institution and they have been quite satisfied with his work.

One day, Dr. Bishop receives a phone call from his contact at the institution.  The contact is now requesting that Dr. Bishop begin to screen individuals for "homosexual tendencies" because, according to the doctrines of the denomination, such individuals are not eligible to become clergy.

Dr. Bishop feels uneasy about this situation, as “homosexuality” has not been considered a mental illness since the 1970s.  Simultaneously, the religious institution is adamant about this requirement. 

Dr. Bishop calls you for a consult about this situation.

What are the ethical issues involved in this scenario?

If you were the psychologist, what would be your emotion response to this situation?

What are some potential responses that you could offer Dr. Bishop?

Thursday, July 5, 2012

Court Upholds Counseling Program's Requirement That Students Accept Gay Clients

By Peter Schmidt
Chronicle of Higher Education
Originally published June 26, 2012

Jennifer Keeton
A federal district court has thrown out a civil-rights lawsuit challenging the Augusta State University school-counseling program's dismissal of a student who said her Christian beliefs preclude her from affirmatively counseling homosexual students.

Judge J. Randal Hall of the U.S. District Court in Augusta, Ga., dismissed the lawsuit last week, rejecting its claims that the graduate counseling program had violated the student's rights under the U.S. Constitution by demanding that she demonstrate a willingness to counsel homosexual students in a nonjudgmental manner.

In upholding the counseling program's decision to kick out the student, Jennifer Keeton, for refusing to complete a remediation plan intended to change her position, Judge Hall said the plan was based on a "a legitimate pedagogical interest in cultivating a professional demeanor" and concern that Ms. Keeton "might prove unreceptive to certain issues and openly judge her clients."

Ms. Keeton was motivated by her religious beliefs, but those she sued were not, Judge Hall concluded in rejecting her claims that professors and administrators at Augusta State, and officials of the University System of Georgia, had violated her rights under the Constitution's First Amendment and Equal Protection Clause.

Rejecting the idea that the case represented "a public contest of values," Judge Hall said the facts it had presented "amount to no more than this: a student enrolled in a professional graduate program was required to complete a course of remediation after being cited for purported professional deficiencies by educators in her chosen field of study; she refused to do so and was dismissed from the program."

The entire story is here.

Thanks to Ken Pope for this story.

Christian Group Backs Away from Ex-Gay Therapy

By Patrick Condon
The Associated Press
Originally published June 26, 2012

Alan Chambers
The president of the country's best-known Christian ministry dedicated to helping people repress same-sex attraction through prayer is trying to distance the group from the idea that gay people's sexual orientation can be permanently changed or "cured."

That's a significant shift for Exodus International, the 36-year-old Orlando-based group that boasts 260 member ministries around the U.S. and world. For decades, it has offered to help conflicted Christians rid themselves of unwanted homosexual inclinations through counseling and prayer, infuriating gay rights activists in the process.

This week, 600 Exodus ministers and followers are gathering for the group's annual conference, held this year in a Minneapolis suburb. The group's president, Alan Chambers, told The Associated Press on Tuesday that the conference would highlight his efforts to dissociate the group from the controversial practice usually called ex-gay, reparative or conversion therapy.

The entire story is here.

Wednesday, July 4, 2012

Parity for Patriots: The mental health needs or military personnel, veterans and their families

The National Alliance on Mental Illness released a report entitled Parity for Patriots: The Mental Health Needs of Military Personnel, Veterans and their Families.  Here is a section of the report that is particularly important.

"The U.S. Department of Defense must move more forcibly to end discrimination associated with invisible wounds of war. Reducing the stigma of mental illness will enhance opportunities to deliver prompt, effective treatment to military service members and families who live with PTSD, depression and other mental health conditions. Examples of immediate steps that can be taken to eliminate stigma and barriers to seeking help include:

  • Military leader accountability for stigma and suicide: Military leaders throughout the chain of command should be required to focus on preventable psychological injuries and deaths, which should be part of their efficiency reporting process. Suicides are preventable just as are the heat and cold injuries of service members for which leaders are routinely relieved of command.
  • Purple Heart for psychological wounds: Posttraumatic stress and other mental health injuries, that are the result of hostile action, including terrorism, should be eligible for award of the Purple Heart with the same level of appreciation and recognition as those awarded to warriors with visible wounds.

The Veterans Health Administration must increase service capacity by expanding provider networks to include community mental health agencies and private practitioners. The VHA should monitor the degree to which contract providers accept veterans and families as clients and should adjust networks to make care available when and where it is needed. Ongoing training in military-informed mental health treatment should be a basic requirement for contract providers. Improved distance delivery through technology should be implemented to remove the travel burden from veterans and improve the use of professional care giver time."

Please remember our military service personnel on this holiday.

The Fiduciary Heart of Ethics

By Ed Zuckerman, PhD

We have all heard the word “fiduciary”bandied about during the ongoing mortgage and banking crisis and probably thought it meant something about money. Not true.

In your first day in professional school, when they talked about the helping relationship, you were probably told something like, always put your client’s needs ahead of your own. As soon as you nodded to that you became a fiduciary.

The fiduciary duty then is an obligation to act in the best interests of another party. In any relationship it is imposed upon the stronger (more knowledgeable, richer, smarter, whatever) as a duty to the weaker. Stealing candy from a baby is a breach of this duty and so is insider trading–using non-public information gained because of one’s special position to buy stock for a gain not available to the public. In one sense being a good parent is fulfilling a fiduciary obligation to a child - doing what is in the child’s best long-term interest instead of what is convenient for the parent. 

However, stockbrokers only have to offer what is suitable - likely to be beneficial -  to the client. They do not have to offer what might be in the clients best interest or what is less profitable for the broker. Similarly, and closer to therapy relationships, a lawyer cannot represent both plaintiff and defendant in a dispute - the lawyer cannot act for two principals and be loyal to both.

A “fiduciary is, in law, a person who is obliged to discharge faithfully a responsibility of trust toward another. Among the common fiduciary relationships are guardian to ward, parent to child, lawyer to client, corporate director to corporation, trustee to trust, and business partner to business partner.” 
The Columbia Electronic Encyclopedia Copyright © 2004.

And psychologist to client. A cornerstone of counseling is the moral principle of trust, the client’s belief that the clinician will be honest and tell the whole truth, will not conceal any important relevant information, and will maintain the confidentiality of what is entrusted to the clinician. Underlying all of these is the principle of fiduciary responsibility - to not take advantage of the client for the benefit of the clinician. Although it may not always be apparent, concealing some facts, inadequate documentation, or breaching confidentiality would only be done for some advantage to the clinician. The promise of non-exploitation provides the safety to reveal and explore thoughts, feelings, history, plans or anything else which would have to be concealed out of fear of the consequences to the client.

“In a fiduciary relation one person justifiably reposes confidence, good faith, reliance and trust in another whose aid, advice or protection is sought in some matter. In such a relation good conscience requires one to act at all times for the sole benefit and interests of another, with loyalty to those interests.” Wikipedia, accessed December 17, 2009.

Respect and autonomy

While such efforts are legally and ethically imposed they also can be empowering of the client and clinically useful in the therapy.

The fiduciary principle expands the principles of respect and trustworthiness in specific and helpfully guiding ways. It recognizes the multiple differences between the parties and extends that knowledge into ethical rules. The fiduciary duty requires one to explore, identify and recognize differences. It requires one to weigh and to adapt to these differences; to respect and dignify them. 

With respect for the other comes trust by the other in our loyalty to them. The enactment of such trust can be seen in at least  two relevant and related ethical responsibilities placed on clinicians: 
to ensure fully informed consent about all aspects of the therapeutic relationship both initially and as the relationship evolves and is extended, and 
to make every necessary effort to ensure and protect the privacy of the patient’s information.  

Multiple relationships

We have an ethical obligation to avoid harmful multiple relationships. But why? 

First, because each role has obligations and expectations and these may be in conflict. Multiple roles require choices of actions and the therapist might choose to meet his or her needs or wants before the needs of the client or just be seen by the client as putting his or her needs first. Simply put, a fiduciary may not and does not have a conflict of interests. 

A second element is that by foregoing any relationship other than client to therapist we absolutely prevent even accidental breaches of confidentiality. If we are not members of the client’s work setting or deal with relatives of the client we cannot even accidentally reveal information vouchsafed to us with the expectation of confidentiality (that we will not share it with another).

Among our responses can be a withdrawal from one role or the seeking of informed consent to allow limited role overlap. For example, we can inform about the ways a friendship would conflict with therapy and ask for consent to forego the friendship’s benefits. If we fail to resolve he conflicted interests we will breach our fiduciary duty and thus be open to both accusations of ethical failure and the possibilities of malpractice suits. 

In our work, preserving privacy, respecting differences, and supporting autonomy are aspects of our fiduciary duty. Carrying out this duty consistently and thoroughly - professionally - enables us to deserve the trust of those who seek our help.

Appreciation to Sam Knapp for his helpful comments.
December 17, 2009 and June 26, 2012.

Tuesday, July 3, 2012

Teacher: Sex with students was "casual" and "warm"

A teacher admits having sex with students but says he's "surprised they remember." An expert says that this is typical.

By Tracy Clark-Flory
Originally published June 25, 2012

More startling than the fact that he gave an interview to the media, or even that he admitted to having had sex with his underage students, was that Tek Young Lin described the many-decades-old incidents as “warm” and “casual.”

In Sunday’s New York Times, the former teacher at the elite Manhattan private school Horace Mann, which is now the focus of widespread allegations of abuse, said, “The only thing I can assure you of was that everything I did was in warmth and affection and not a power play.” Of his three former high school students who spoke with the Times about the incidents — two of whom say the sexual contact began at 14 or 15, one of whom said it began at 17 — Lin said, “I’m surprised they remember. It was all so casual and warm.”
James Cantor, a psychologist and editor in chief of the research journal Sexual Abuse, tells me this sort of rationalization is common among adults who pursue sex with minors.

The entire story is here.

Thanks to Gary Schoener for this story.

Monday, July 2, 2012

Sandusky Verdict: Will Reporting Rates For Sex Abuse Improve?

A strong set of beliefs prevents reporting, but seeing the system visibly work will encourage others to come forward

by Christopher J. Ferguson
Time Magazine - Ideas
Originally published June 25, 2012

Jerry Sandusky
With the verdict in the Jerry Sandusky trial behind us, it’s worth reconsidering one of the most troubling aspects of this case: Why do many people, including professionals such as psychologists and pediatricians, fail to report child sexual abuse? It is well-known that authorities at Penn State, including head football coach Joe Paterno, did not report what they had learned to legal authorities. The incident witnessed by Mike McQueary was passed up the chain at Penn State, but no one took that crucial step of informing law enforcement officials. This failure allowed Sandusky to remain free to continue to abuse children.

It is easy to convince ourselves that we would act more decisively if we were in the same situation, and many people indeed do. But even medical and mental health professionals with a legal duty to report abuse fail to do so.

The entire story is here.

Thanks to Gary Schoener for this story.


On a national ethics educators listserv, the following exchange took place about this article.

Sam Knapp:

This article reflects popular attitudes about mandated reporting.

However, reporting rates are highly influenced by rates of substantiation after reports of abuse are made. Pennsylvania has the lowest rate of substantiated child abuse in the country (one-seventh the national average) and a rate of substantiating child abuse, which is 14% (compared to 23% nationwide). And if you look across the country you find that the states that have low rates of child abuse reports tend to have low rates of substantiating those reports and states that have high rates of child abuse reports tend to have high rates of substantiating those reports. What happens is an informal process of education where mandated reporters learn, over time, that certain reports are not going to be founded (or even investigated), so they discontinue making those reports.

Some states have proposed legislation that would make the failure to file a mandated a report a felony (in most states it is a misdemeanor). My concern is that the fear of a felony will cause mandated reporters to adopt a very low threshold for making reports resulting in an investigation of a large number of cases where the likelihood of child abuse being founded is extremely low.

I know that we as a profession can do better at educating our own on child abuse and child abuse reporting laws. My point is that reporting rates are very much influenced by the response of the child protective system to those reports.

Gary Schoener responded:

I agree Sam that reporting is not the issue in terms of mandated reporters -- at least not the lone issue.

What was troubling about the Sandusky case was not the non-reporting as much as the inaction by the adults -- especially officials.  I have seen cases where at least there is internal disciplinary action, referral for therapy, etc.  In fact, some of the high visibility Catholic cases actually did involve taking action -- it's just that the action was ineffective.

One common problem was the failure of professionals who were sent pedophiles for treatment to know what they were doing, or to propose a return to work without any surveillance.  You may not remember, but in Boston there was a big pissing match between the Archdiocese and the Institute for Living.  The Archdiocese did not ask if the guy should be put back, and the Inst. for Living allegedly made no such warning or recommendation about safety.

Likewise, that Minnesota statute I mentioned was directed at people like us, asking that we be accountable in cases where someone has been caught and is being fired or resigning.  We have not eliminated silence agreements completely, I am sure, but they are very rare indeed here.

I certainly agree that reporting to child protection can be very ineffective, and the same can be true for reporting to the police.