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

Thursday, January 31, 2013

Doctor Tells U.S. Judge He Created Fake L.I.R.R. Injury Claims

Published: January 18, 2013

An orthopedist who was accused of taking cash payments for fake diagnoses and billing health insurance companies for unnecessary medical treatment in widespread disability fraud involving Long Island Rail Road workers pleaded guilty on Friday to conspiracy charges.

The doctor, Peter J. Ajemian, admitted that between the late 1990s and 2008 he invented “narratives” to justify illness and injury claims for hundreds of workers seeking to retire on disability.

The employees “were not in fact disabled and could have continued working in their railroad jobs, as they had no complaint right up to the time of their retirement date,” Dr. Ajemian told a judge in Federal District Court in Manhattan.

Prosecutors said that Dr. Ajemian, 63, received up to $1,200 for each of the fake assessments, as well as millions of dollars in health insurance payments. His patients received more than $90 million in disability benefits.

Dr. Ajemian was among 32 defendants who have been arrested in the past two years.

Three other retirees also pleaded guilty this week, bringing the number of guilty pleas in the case to 21.

Sentencing for Dr. Ajemian was set for May 24.

The story is here.

Accused gunman's doctor, university face lawsuits

By Jim Spellman,
Originally published January 17, 2013

The university psychiatrist who treated the accused gunman in last year's deadly Colorado theater rampage could face more than a dozen lawsuits that blame her and the school for not properly handling James Holmes' treatment.

At least 14 people have filed legal documents indicating they are planning to sue the University of Colorado Denver and Dr. Lynne Fenton for negligence.

Holmes, 25, was a doctoral student in neuroscience at the university.

Fenton has testified that her contact with Holmes ended on June 11, more than a month before he allegedly walked into a crowded movie theater in Aurora, Colorado, and opened fire, killing 12 people and wounding 58 others during a screening of the new Batman film.

She said she later contacted campus police because she was "so concerned" about what happened during her last meeting with him, but she declined to detail what bothered her.

The entire story is here.

Wednesday, January 30, 2013

Recovery from autism spectrum disorder (ASD) and the science of hope

Editorial in The Journal of Child Psychology and Psychiatry
Sally Ozonoff JCPP Joint Editor
Originally published January 16, 2013
DOI: 10.1111/jcpp.12045

The Journal of Child Psychology and Psychiatry, and the field of developmental psychopathology in general, is keenly interested in stability and change, continuities and discontinuities, and prediction of outcome. This issue of the journal presents several articles that examine influences and predictors of child difficulties, such as avoidant behavior (Aktar et al., 2012†) and antisocial behavior (Rhee et al., 2012). The effects of maternal depression and parental anxiety on child outcomes are also explored in this issue (Aktar et al., 2012; Hughes et al., 2012), as are the stability of symptoms in autism spectrum disorders (Corsello et al., 2012; Simonoff et al., 2012). All add to our understanding of the basic mechanisms and developmental pathways that underlie atypical child development. I call your attention to one article in particular that explores these concepts from a different angle and brings solid science to an understudied topic with a very controversial and contentious history, namely recovery from autism spectrum disorder (ASD).

Fein et al. (2012) recruited 34 children with clearly documented early histories of ASD who no longer met criteria for any autism spectrum diagnosis and, even further, had lost all symptoms of ASD. They compared these children to a group of typically developing participants and found no differences on multiple measures independent of the group classification process. They conclude, rather modestly, that these results “substantiate the possibility of optimal outcome,” demonstrating that some children with a clear early history and accurate diagnosis of ASD do indeed move into the entirely normal range of social and communication development later in childhood. Fein et al. use the word “recovery” only once in their paper, in reference to the findings and claims of another study. Their avoidance of the word is likely intentional. In fact, scientific papers have largely steered clear of this word, although it is alive and well on the Web. Why has recovery been such a provocative concept?

Lovaas (1987) was the first to use the term “recovery” in relation to ASD, describing the outcomes of children he had treated using the methods of applied behavior analysis. He did not provide an explicit definition of recovery, but described this group of children as having normal educational and intellectual functioning. His interpretation of this outcome as “recovery” was embraced wholeheartedly by some and scrutinized skeptically by others. It was pointed out that many children who meet criteria for ASD attain this level of functioning, but continue to display significant symptoms. Whether they had achieved “recovery” that fit with the Merriam-Webster definition of “regaining or returning to a normal or healthy state” was disputed. Researchers have generally avoided the term for fear of being viewed as naïve, idealistic, political, or simply just not good scientists. But recovery has remained a very powerful construct, one that many parents talk about and that has been the subject of much media and internet attention.

The entire article and issue can be found here.

Pa. sends mental health data for gun checks

By Moriah Balingit / Pittsburgh Post-Gazette
Originally published January 19, 2013

After facing legal and technical challenges for more than two years, the Pennsylvania State Police this week began transmitting hundreds of thousands of mental health records to a federal database used to conduct background checks for potential gun buyers.

On Tuesday, 643,167 mental health records were sent to the FBI-run National Instant Check System (NICS), according to the state police. The records represent people who are prohibited from buying guns because of involuntary mental health commitments.

"It's been an objective of ours for close to two years, so I think it's an important accomplishment that these records were able to be uploaded to NICS," said Lt. Col. Scott Snyder, deputy commissioner for the state police. The state police are working to fix a program that will upload the records automatically as they're created.

Strengthening the national database and universal background checks have been pillars of President Barack Obama's gun control agenda. On Wednesday, when he unfurled a massive gun control package, some executive orders were intended to make it easier for states to transmit mental health records to NICS.

Despite the state's achieving that goal, a disagreement between the state police and the Bureau of Alcohol, Tobacco, Firearms and Explosives over interpretation of federal gun law throws into question how the records will be used. At issue is the 302, the shortest and most common type of involuntary mental health commitment.

On Friday, a spokeswoman for the ATF said the bureau was still reviewing whether a 302 should preclude someone under federal law from buying a gun.

The entire story is here.

Tuesday, January 29, 2013

Hickenlooper's Gun Control

The Colorado Governor's plan to fix mental health, not firearms alone.
Review and Outlook - The Wall Street Journal
Originally published January 15, 2013

Gun control has been the exclusive political fixation of President Obama's Washington after Newtown, so perhaps readers will be surprised to learn that some states are being more constructive. One of them is Colorado, where Governor John Hickenlooper is promoting an innovative overhaul of his state's mental health-care system.

In his State of the State address last week, the Democrat said that "our democracy demands" a debate over guns, violence and mental illness—not least in the aftermath of James Holmes's attack on an Aurora movie theater that killed 12 and wounded 58 in July. "Let me prime the pump," Mr. Hickenlooper said. "Why not have universal background checks for all gun sales?"

There was a lot of media attention for that line, but much less for what followed. As Mr. Hickenlooper continued, "It's not enough to prevent dangerous people from getting weapons. We have to do a better job identifying and helping people who are a threat to themselves and others." His office spent the last five months developing a detailed $18.5 million plan to modernize civil commitment laws while expanding community-based mental health treatment.

The rest of the story is here.

Warning Signs of Violent Acts Often Unclear

The New York Times
Published: January 15, 2013

No one but a deeply disturbed individual marches into an elementary school or a movie theater and guns down random, innocent people.

That hard fact drives the public longing for a mental health system that produces clear warning signals and can somehow stop the violence. And it is now fueling a surge in legislative activity, in Washington and New York.

But these proposed changes and others like them may backfire and only reveal how broken the system is, experts said.

“Anytime you have one of these tragic cases like Newtown, it’s going to expose deficiencies in the mental health system, and provide some opportunity for reform,” said Richard J. Bonnie, a professor of public policy at the University of Virginia’s law school who led a state commission that overhauled policies after the 2007 Virginia Tech shootings that left 33 people dead. “But you have to be very careful not to overreact.”

The entire story is here.

Monday, January 28, 2013

In Second Look, Few Savings From Digital Health Records

The New York Times
Published: January 10, 2013

The conversion to electronic health records has failed so far to produce the hoped-for savings in health care costs and has had mixed results, at best, in improving efficiency and patient care, according to a new analysis by the influential RAND Corporation.

Optimistic predictions by RAND in 2005 helped drive explosive growth in the electronic records industry and encouraged the federal government to give billions of dollars in financial incentives to hospitals and doctors that put the systems in place.

“We’ve not achieved the productivity and quality benefits that are unquestionably there for the taking,” said Dr. Arthur L. Kellermann, one of the authors of a reassessment by RAND that was published in this month’s edition of Health Affairs, an academic journal.

RAND’s 2005 report was paid for by a group of companies, including General Electric and Cerner Corporation, that have profited by developing and selling electronic records systems to hospitals and physician practices. Cerner’s revenue has nearly tripled since the report was released, to a projected $3 billion in 2013, from $1 billion in 2005.

The entire story is here.

New designs to make health records easier for patients to use

U.S. Department of Health & Human Services
January 15, 2013

Winning designs of printed health records to help patients better understand and use their electronic health records (EHRs) were announced today by Farzad Mostashari, M.D., the national coordinator for health information technology. The designs, created through a HHS Office of the National Coordinator for Health Information Technology (ONC) challenge contest, all met the goal of making EHRs valuable to patients and their family members.

“Patients that are engaged in their health care treatments have better outcomes in their health,” said Farzad Mostashari, M.D., national coordinator for Health Information Technology.  “The design challenge winners all proposed patient-friendly designs that will help to translate technical health information into easy-to-understand information that will help patients work closely with their doctors to manage their care.”
More than 230 submissions to the design challenge were submitted. Winners of the Health Design Challenge include:

  • Best Overall Design – “Nightingale” - Amy Guterman, Stephen Menton, Defne Civelekoglu, Kunal Bhat, Amy Seng, and Justin Rheinfrank from gravitytank in Chicago, Ill.
  • Best Medication Section – “M.ed” - Josh Hemsley from Orange County, Calif., presented a modern and intuitive design to help patients better understand how to properly adhere to their medication
  • Best Medical/Problem History – “Grouping by Time” – Mathew Sanders from Brooklyn, N.Y., aimed to provide more context by listing items in chronological order instead of grouping by functional type so cause and effect can be seen
  • Best Lab Summaries – “Health Summary” – Mike Parker, Dan McGorry, and Kel Smith from HealthEd in Clark, N.J., brought life to lab summaries through an aggregate health score and rich graphs of lab values
  • The Best Overall Design winner will receive $16,000, while the winners in the remaining categories will each receive $5,000.

The Health Design Challenge supports ONC’s efforts to engage consumers in their health through the use of technology, including the Blue Button, and is part of ONC’s Investing in Innovation (i2) Initiative. The i2 Initiative holds competitions to accelerate development and adoption of technology solutions that enhance quality and outcomes.

"This challenge was unique because it engaged professionals and students inside and outside of the health care industry to participate and propose real solutions," said Ryan Panchadsaram, presidential innovation fellow for ONC." We’ve assembled a showcase of top entries that challenged the status quo and inspired the health community."

More information about the winning submissions and other top entries can be viewed in the online gallery at http://healthdesignchallenge.com . For more information about health information technology, visit:  www.healthit.gov.

The release was posted here.

Sunday, January 27, 2013

Details on suicide among US physicians: data from the National Violent Death Reporting System

By Karen Gold, Ananda Sen, and Thomas Schwenk
General Hospital Psychiatry
Volume 35, Issue 1 , Pages 45-49, January 2013

Physician suicide is an important public health problem as the rate of suicide is higher among physicians than the general population. Unfortunately, few studies have evaluated information about mental health comorbidities and psychosocial stressors which may contribute to physician suicide. We sought to evaluate these factors among physicians versus non-physician suicide victims.

We used data from the United States National Violent Death Reporting System to evaluate demographics, mental health variables, recent stressors and suicide methods among physician versus non-physician suicide victims in 17 states.

The data set included 31,636 suicide victims of whom 203 were identified as physicians. Multivariable logistic regression found that having a known mental health disorder or a job problem which contributed to the suicide significantly predicted being a physician. Physicians were significantly more likely than non-physicians to have antipsychotics, benzodiazepines and barbiturates present on toxicology testing but not antidepressants.

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

The entire article is here.

Thanks to Ed Zuckerman for this article.

Saturday, January 26, 2013

Who Knew? Patients’ Share Of Health Spending Is Shrinking

By Jay Hancock
KHN Staff Writer
Originally published January 13, 2013

Consumer-driven medical spending may be the second-biggest story in health care, after the Affordable Care Act. As employers give workers more "skin in the game" through higher costs from purse and paycheck, the thinking goes, they'll seek more efficient treatment and hold down overall spending.

But consumers may not have as much skin in the game as experts thought, new government figures show.

Despite rapid growth in high-deductible health plans and rising employee contributions for insurance premiums, consumers' share of national health spending continued to fall in 2011, slipping to its lowest level in decades.

"I'm surprised," says Jonathan Gruber, a health economist at the Massachusetts Institute of Technology. "All the news is about the move to high-deductible health plans. Based on that logic … I would have expected it to go up."

True, medical costs are still pressuring families. Household health expense has outpaced sluggish income growth in recent years, says Micah Hartman, a statistician with the Department of Health and Human Services, which calculates the spending data.

But from a wider perspective, consumer health costs continued a trend of at least a quarter-century of taking up smaller and smaller parts of the health-spending pie. Household expense did go up. But other medical spending rose faster, especially for the government Medicare and Medicaid programs.

The entire article is here.

Friday, January 25, 2013

Contracts Awarded Despite Inquiry

By Colleen Heild
Journal Investigative Reporter
Originally published on Jan 13, 2013
First of two parts

A Roswell, N.M.-based psychiatric services firm landed state Department of Health contracts that allow charges of up to $2,000 a day, even though it was under investigation for alleged Medicaid fraud at another state agency.

The contracts between the Department of Health and New Mexico Psychiatric Services signed last summer permit the company to bill up to $623,900 to provide on-call or temporary services to state-run health facilities.

They include the Sequoyah Adolescent Treatment Center in Albuquerque, a 36-bed residential treatment center for violent and mentally ill youth.

At the time the contacts were awarded last year, the company was facing allegations of Medicaid billing fraud at the state Human Services Department. Its payments for services for HSD have been suspended pending the outcome of the inquiry.

A top health department official said in an interview last month that he didn’t know New Mexico Psychiatric Services was under investigation at the time he helped evaluate proposals for the so-called “locum tenens” psychiatric services last April.

But in a follow-up response last week, the agency’s spokesman said others in the agency did know and the inquiry by the state Attorney General’s Office wasn’t a “determinative” factor.

DOH spokesman Kenny C. Vigil told the Journal that the president of New Mexico Psychiatric Services, Dr. Babak Mirin, made a “self disclosure” about the investigation before any contracts were signed last year.

Asked whom Mirin had informed at the DOH and when, Vigil responded: “I don’t have that information.”

The Department of Health and the Human Services Department are separate state agencies, albeit with some overlapping missions involving assistance to New Mexicans.

The Human Services Department, which administers behavioral health services, notified New Mexico Psychiatric Services nearly a year ago of the billing fraud inquiry by the AG’s Medicaid Fraud Control Unit.

Mirin’s attorney, David H. Johnson, told the Journal in an email last week that the company has been cooperating with the AG’s investigation “and is committed to the repayment of any overpayments that it may have received.

“At this point there has only been an allegation of billing fraud,” Johnson’s email stated. “Fraud has not been established.”

The entire story is here.

Thursday, January 24, 2013

New Israeli law banning underweight models goes into effect, aims to prevent eating disorders

The Associated Press
Originally published January 11, 2013

When Margaux Stelman began modeling a few months ago, she always had her sister Aline in mind.

Aline was an ex-model who died three years ago after a long battle with anorexia, a common affliction of models trying to look thinner and thinner — and girls trying to look like them.

Now, thanks to a new Israeli law that prohibits the employment of underweight fashion models, Stelman says she feels protected from the traditional pressures of an industry notorious for encouraging extremes in thinness. The law sets weight minimums with the aim of discouraging anorexia and bulimia, eating disorders that affect mostly young women, who go on extreme diets and are unable to eat normally.

"This disease is something that's very close to me," the 21-year-old university student from Belgium said at a recent photo shoot, the country's first since the law took effect last week. "Doing the exact opposite, showing girls that (they) can be healthy and be a model anyway, it's really something I want to show."

The Israeli law, passed by parliament last year, is the first of its kind. The United States and England have guidelines, but their fashion industry is self-regulated. Other governments have taken steps to prevent "size zero" medical problems but have shied away from legislation.

Israel, like other countries, is obsessed by models. International supermodel Bar Refaeli is considered a national hero. Refaeli, an Israeli who has graced the cover of the Sports Illustrated swimsuit edition, among others, is not unnaturally thin.

The entire story is here.

Wednesday, January 23, 2013

Tending to Veterans’ Afflictions of the Soul

By Samuel J. Freedman
The New York Times
Originally published January 13, 2013

Here are some excerpts:

Moral injury might best be defined as an affliction of the soul, as distinct from a specific mental health condition like post-traumatic stress disorder. It arises, to speak in a very broad way, from the way a combatant’s actions in war seem to violate and thus undermine the most deeply held moral beliefs.

Ms. Brock did not formulate the concept of moral injury, which is attributed to the clinical psychiatrist Jonathan Shay. In books like “Achilles in Vietnam,” Dr. Shay has traced moral injury back as far as the Trojan War. But for Ms. Brock and her colleagues, the kind of counterinsurgency wars America has fought in Iraq and Afghanistan has left soldiers uniquely vulnerable to moral injury.

“There’s no good choice,” she said. “If you’re looking at a kid on the side of the road with something in his hand, if it’s a grenade and he throws it and kills someone in your unit, you’ve failed your comrade. But if it’s a rock, you’ve just shot a kid with a rock.
“If you’re praying that your company gets out or that your best friend isn’t shot, and it doesn’t turn out that way, it can collapse your whole moral system. It feels like God abandoned you.”

Her description closely matched that of Michael Yandell, 28, a student at the Brite seminary who worked on a bomb disposal team during the Iraq war. “Most deeply, it’s a loss of confidence in one’s own ability to make a moral judgment with any certainty,” he said. “It’s not that you lose your ability to tell right from wrong, but things don’t seem so clear any more. For me, it’s whether or not what I did, did any good.”

Ms. Brock’s affinity for veterans, and her knowledge of their suffering, has long, deep roots. Her father, Roy Brock, was taken prisoner during World War II and underwent electroshock treatments after liberation for his psychological distress. He later served two tours in Vietnam as a medic, enduring the deaths not only of countless soldiers but the local translator he had befriended.

The entire story is here.

Tuesday, January 22, 2013

Building a Space for Calm

The New York Times
Published: January 11, 2013

Here are some excerprts:

Efforts to reduce violence in psychiatric hospitals have focused on identifying potentially aggressive patients through clinical histories and improving staff training and care procedures. But these approaches, while worthy, are clearly not enough. While definitive numbers are hard to come by, the incidence of violence in care facilities appears to be going up.

Research suggests, however, that there’s an effective solution that has largely been overlooked: designing hospital spaces that can reduce human aggression — to calm emotionally troubled patients through architecture.

Currently, questions about design at psychiatric care facilities are viewed through the prism of security. How many guard and isolation rooms are needed? Where should we put locked doors and alarms? But architecture can — and should — play a much larger role in patient safety and care.

One prominent goal of facility design, for example, should be to reduce stress, which often leads to aggression.

For patients, the stress of mental illness itself can be intensified by the trauma of being confined for weeks in a locked ward. A care facility that’s also noisy, lacks privacy and hinders communication between staff and patients is sure to increase that trauma. Likewise, architectural designs that minimize noise and crowding, enhance patients’ coping and sense of control, and offer calming distractions can reduce trauma.

Thanks to decades of study on the design of apartments, prisons, cardiac intensive care units and offices, environmental psychologists now have a clear understanding of the architectural features that can achieve the latter — and few of these elements, if incorporated into a hospital design from the outset, significantly raise the cost of construction.

Providing day rooms and other shared spaces with movable seating, for example, gives patients the ability to control their personal space and interactions with others. Sound-absorbing surfaces reduce noise (and stress), as do designs that offer more natural light.
Some features, like single-patient bedrooms with private toilets, do increase the building cost — but that is arguably offset by the reduced trauma for patients and hospital workers. Violence, after all, isn’t just a danger to well-being, its effects — from medical care to lawsuits — are frequently expensive, too.

The entire story is here.

Thanks to Gary Schoener for this story.

There is more to end-of-life practices than euthanasia — Authors' reply

The Lancet
Volume 381, Issue 9862, Pages 202-203

Bregje Onwuteaka-Philipsen, Arianne Brinkman-Stoppelenburg, Hans van Delden, Anges van der Heide

We agree with Jan Schildmann and Eva Schildmann that the debate on end-of-life practices should not be limited to euthanasia. We also agree that increased attention to palliative care does not necessarily result in good quality end-of-life care. Our study gives an insight into end-of-life decision making and end-of-life acts, but not into the quality of end-of-life care. Additionally, what good quality end-of-life care consists of is not that straightforward. This is certainly true for palliative sedation. Although there is an increasing body of published studies on this subject, there are controversies on terminology and ethical acceptability of the practice. Guidelines are a way to try to overcome this and to improve quality of care. Yet there are many different guidelines—eg, at the institutional level and in different countries—and the premises of national guidelines can be the subject of debate. In our opinion, the role of empirical studies such as ours is to underpin the ongoing debate with information about what occurs in practice.

We declare that we have no conflicts of interest.


Monday, January 21, 2013

U.S. could save $2 trillion on health costs - study

By David Morgan
Originally published January 10, 2012

The United States could save $2 trillion in healthcare spending over the next decade, if the U.S. government used its influence in the public and private sectors to nudge soaring costs into line with economic growth, a study released on Thursday said.

Compiled by the nonpartisan Commonwealth Fund, the study recommends holding the $2.8 trillion U.S. healthcare system to an annual spending target by having Medicare, Medicaid, other government programs and private insurers encourage providers to accelerate adoption of more cost-effective care.

Such a plan would require new legislation from a bitterly divided U.S. Congress, where Republicans would likely oppose new government controls, despite claims by the study's authors that families, employers and government budgets would receive long-sought relief from their growing financial healthcare burdens if the changes were enacted.

But Commonwealth Fund President Dr. David Blumenthal, a former healthcare adviser to President Barack Obama, said the approach could find bipartisan support in upcoming deficit talks as an alternative to cutting so-called entitlement programs including Medicare, the popular healthcare program for the elderly and disabled.

"In comparison with what some of those proposals advocate, we think that some of what we're proposing will look like an escape valve," Blumenthal told reporters in a conference call.

The United States has the world's most expensive healthcare system, which government forecasters say will cost more than $9,200 this year for every man, woman and child. Spending growth has slowed in recent years, but costs continue to outpace inflation and restrain overall economic growth.

The entire article is here.

Wealth but not health in the USA

The Lancet
Volume 381, Issue 9862
Page 177

Last week, American people, health-care workers, and policy makers received shocking news. Despite spending more on health care per person than other high-income countries, Americans die sooner, are least likely to reach the age of 50 years, and have higher rates of disease or injury. When judged by health alone, Americans are less healthy from birth to 75 years of age than people in 16 other economically wealthy countries, and this health disadvantage has been getting worse for 30 years, especially among women.

In a report released on Jan 9 from the US National Research Council and Institute of Medicine, U.S. Health in International Perspective: Shorter Lives, Poorer Health, comprehensive mortality and morbidity data are presented, comparing the USA with affluent democratic countries including Australia, Canada, France, Italy, most of the Nordic countries, Spain, and the UK. Life expectancy is shorter at birth for American men than for men in any of the other 16 countries, and American women fare little better—Denmark is the only country that has a lower life expectancy for women at birth. In nine key areas of health, Americans fare least well, or are near the bottom of the tables. These areas are: infant mortality and low birthweight; injuries and homicides; teenage pregnancies and sexually transmitted infections; HIV/AIDS prevalence; drug-related deaths; obesity and diabetes; heart disease; chronic lung disease; and disability. This health disadvantage applies to those with health insurance, a college education, higher incomes, and healthy behaviours as well as to those without.

Some good news in the report is that those Americans who reach 75 years live longer than their peers in other countries, and that Americans have low death rates from stroke and cancer. Moreover, current smoking rates are low, which should lead to future health benefits, and household income is relatively high.

US health spending was US$2·7 trillion in 2011, which is $8700 for every person in the country, and represents 17·9% of the economy—far greater than any other economically advanced country. But spending on health care bears little relation to good health.

Why are Americans at a health disadvantage compared with those in other countries? The fragmented US health-care system, and, in particular, poor access to health care and to primary care, are partly to blame....

The entire story is here.

Sunday, January 20, 2013

Suspect in Killings Is Deemed Not Fit

Published: January 7, 2013

A judge ruled on Monday that a man accused of killing seven people at a small Christian college in Oakland is not mentally fit for trial.

Judge Carrie Panetta of Alameda County Superior Court temporarily suspended the case against One L. Goh after two psychiatric evaluations concluded that he had paranoid schizophrenia.

David Klaus, an Alameda County assistant public defender, said after Monday’s hearing that Mr. Goh’s condition causes him to have hallucinations and delusions and to distrust people, including those trying to help him. Mr. Goh’s lawyers have trouble talking to him, Mr. Klaus said.

The rest of the story is here.

Saturday, January 19, 2013

Prevalence, Correlates, and Treatment of Lifetime Suicidal Behavior Among Adolescents

Results From the National Comorbidity Survey

Matthew K. Nock, PhD; Jennifer Greif Green, PhD; Irving Hwang, MA; Katie A. McLaughlin, PhD; Nancy A. Sampson, BA; Alan M. Zaslavsky, PhD; Ronald C. Kessler, PhD

JAMA Psychiatry. 2013;():1-11. doi:10.1001/2013.jamapsychiatry.55.


Although suicide is the third leading cause of death among US adolescents, little is known about the prevalence, correlates, or treatment of its immediate precursors, adolescent suicidal behaviors (ie, suicide ideation, plans, and attempts).

To estimate the lifetime prevalence of suicidal behaviors among US adolescents and the associations of retrospectively reported, temporally primary DSM-IV disorders with the subsequent onset of suicidal behaviors.

Dual-frame national sample of adolescents from the National Comorbidity Survey Replication Adolescent Supplement.

Face-to-face household interviews with adolescents and questionnaires for parents.

A total of 6483 adolescents 13 to 18 years of age and their parents.

Main Outcome Measures
Lifetime suicide ideation, plans, and attempts.

The estimated lifetime prevalences of suicide ideation, plans, and attempts among the respondents are 12.1%, 4.0%, and 4.1%, respectively. The vast majority of adolescents with these behaviors meet lifetime criteria for at least one DSM-IV mental disorder assessed in the survey. Most temporally primary (based on retrospective age-of-onset reports) fear/anger, distress, disruptive behavior, and substance disorders significantly predict elevated odds of subsequent suicidal behaviors in bivariate models. The most consistently significant associations of these disorders are with suicide ideation, although a number of disorders are also predictors of plans and both planned and unplanned attempts among ideators. Most suicidal adolescents (>80%) receive some form of mental health treatment. In most cases (>55%), treatment starts prior to onset of suicidal behaviors but fails to prevent these behaviors from occurring.

Suicidal behaviors are common among US adolescents, with rates that approach those of adults. The vast majority of youth with suicidal behaviors have preexisting mental disorders. The disorders most powerfully predicting ideation, though, are different from those most powerfully predicting conditional transitions from ideation to plans and attempts. These differences suggest that distinct prediction and prevention strategies are needed for ideation, plans among ideators, planned attempts, and unplanned attempts.

The original research is here.

A Clinical Trial and Suicide Leave Many Questions: Part 4: The University of Minnesota’s Response

By Judy Stone | January 8, 2013
Scientific American

Demystifying drug development, clinical research, medicine, and the role ethics plays

In earlier posts, we’ve looked at issues of consent, investigator responsibilities, and conflicts of interest on the case of Dan Markingson’s suicide while participating in a clinical trial of anti-psychotics at the University of Minnesota. This time, we turn to the University’s response.

 Not surprisingly, the University has claimed it has no responsibility for any wrongdoing—that in fact, no wrongdoing even occurred. But there are some inconsistencies in the story and unanswered questions. There is also concern over how the University has responded to criticism. We’ll examine these issues in this post.

Background regarding the University’s response

In response to the Minnesota Board of Social Work’s “corrective action” vs. Jeanne Kenney, the social worker/study coordinator who did most of the study assessments on Markingson, the UMN’s General Counsel Mark Rotenberg stated, “As we’ve stated previously, the Markingson case has been exhaustively reviewed by federal, state and academic bodies since 2004. The FDA, the Hennepin County District Court, the Minnesota Board of Medical Practice, the Minnesota Attorney General’s Office and the University’s Institutional Review Board have all reviewed the case. None found fault with the University. None found fault with any of our faculty. Most importantly, none found any causal link between the CAFE trial and the death of Mr. Markingson.”

Yet a number of UMN faculty have remaining concerns and have requested an independent investigation. Two years ago, eight faculty members in the Bioethics Department wrote Rotenberg, citing the University’s conflicts of interest in the matter. The UMN declines to reexamine the case, saying that they have been exonerated. In October 2012, Dr. Carl Elliott, Professor in the UMN Center for Bioethics, wrote Dr. Debra DeBruin, director of the Clinical Research Ethics Consultation Service for the UMN Clinical and Translational Science Institute, again requesting a review. This time Dr. Elliott expressed concern regarding human subjects protections in other trials conducted by the psychiatry department as well. As always, Dr. Elliott’s concerns were thoroughly documented. Once again, the University has turned away.

The entire story is here.

Thanks to Tom Fink for this story.

Military suicides hit record in 2012, outpace combat deaths

Originally published January 14, 2013

The number of U.S. troops committing suicide set a record in 2012, exceeding the number of combat deaths, the Pentagon said on Monday.

The Pentagon said 349 active-duty troops killed themselves in 2012, up more than 15 percent from 2011 despite renewed efforts by the military to stem the suicide rate.

"This is an epidemic that cannot be ignored," said Senator Patty Murray, who championed legislation last year to improve suicide prevention efforts and mental health care for troops and veterans.

"As our newest generation of servicemembers and veterans face unprecedented challenges, today's news shows we must be doing more to ensure they are not slipping through the cracks."

The Army, as the largest service, counted the biggest number of suicides, with 182 soldiers killing themselves in 2012, according to preliminary figures. The Navy had 60 suicides, the Air Force had 59 and the Marines had 48.

The figures were first reported by the Associated Press.

The Pentagon pointed to steps to bolster suicide prevention efforts, including expanding a suicide prevention hotline. Still, Defense Secretary Leon Panetta last year acknowledged that the suicides were the most frustrating issue he had faced since taking over the Pentagon in 2011.

"Despite the increased efforts, the increased attention, the trends continue to move in a troubling and tragic direction," Panetta told at a joint Pentagon-Department of Veterans Affairs suicide prevention conference in June.

The entire story is here.

Friday, January 18, 2013

U.S. high court won't review federal embryonic stem cell funds

By Terry Baynes
Originally posted on January 7, 2013

The U.S. Supreme Court on Monday refused to review a challenge to federal funding of human embryonic stem cell research brought by two researchers who said the U.S. National Institutes of Health rules on such studies violate federal law.

The decision brings an end to a lawsuit that had threatened to hamper stem cell research after a district court judge blocked the taxpayer funding in 2010. But some observers expected the Supreme Court would decline the take the case after an appeals court ruled that the funding could continue.

U.S. law prohibits the NIH from funding the creation of human embryos for research or research in which human embryos are destroyed, but leaves room for debate over whether that includes work with human embryonic stem cells.

Opponents of such research, including many religious conservatives, have argued that it is unacceptable because it destroys human embryos.

Scientists hope to be able to use stem cells to find treatments for spinal cord injuries, cancer, diabetes and diseases such as Alzheimer's and Parkinson's.

The entire story is here.

Thursday, January 17, 2013

'Protecting' Psychiatric Medical Records Puts Patients At Risk Of Hospitalization

Medical News Today
Originally published January 6, 2013

Medical centers that elect to keep psychiatric files private and separate from the rest of a person's medical record may be doing their patients a disservice, a Johns Hopkins study concludes.

In a survey of psychiatry departments at 18 of the top American hospitals as ranked by U.S. News & World Report's Best Hospitals in 2007, a Johns Hopkins team learned that fewer than half of the hospitals had all inpatient psychiatric records in their electronic medical record systems and that fewer than 25 percent gave non-psychiatrists full access to those records.

Strikingly, the researchers say, psychiatric patients were 40 percent less likely to be readmitted to the hospital within the first month after discharge in institutions that provided full access to those medical records.

"The big elephant in the room is the stigma," says Adam I. Kaplin, M.D., Ph.D., an assistant professor of psychiatry and behavioral sciences and neurology at the Johns Hopkins University School of Medicine and leader of the study published online in the International Journal of Medical Informatics. "But there are unintended consequences of trying to protect the medical records of psychiatric patients. When you protect psychiatric patients in this way, you're protecting them from getting better care. We're not helping anyone by not treating these diseases as we would other types of maladies. In fact, we're hurting our patients by not giving their medical doctors the full picture of their health."

The entire story is here. 

Wednesday, January 16, 2013

Disclosure and Concealment of Sexual Orientation and the Mental Health of Non-Gay-Identified, Behaviorally Bisexual Men.

Eric W. Schrimshaw, Karolynn Siegel, Martin J. Downing, Jeffrey T. Parsons.
Disclosure and Concealment of Sexual Orientation and the Mental Health of Non-Gay-Identified, Behaviorally Bisexual Men. Journal of Consulting and Clinical Psychology, 2012;
DOI: 10.1037/a0031272


Although bisexual men report lower levels of mental health relative to gay men, few studies have examined the factors that contribute to bisexual men's mental health. Bisexual men are less likely to disclose, and more likely to conceal (i.e., a desire to hide), their sexual orientation than gay men. Theory suggests that this may adversely impact their mental health. This report examined the factors associated with disclosure and with concealment of sexual orientation, the association of disclosure and concealment with mental health, and the potential mediators (i.e., internalized homophobia, social support) of this association with mental health.


An ethnically diverse sample of 203 non-gay-identified, behaviorally bisexual men who do not disclose their same-sex behavior to their female partners were recruited in New York City to complete a single set of self-report measures.


Concealment was associated with higher income, a heterosexual identification, living with a wife or girlfriend, more frequent sex with women, and less frequent sex with men. Greater concealment, but not disclosure to friends and family, was significantly associated with lower levels of mental health. Multiple mediation analyses revealed that both internalized homophobia and general emotional support significantly mediated the association between concealment and mental health.


The findings demonstrate that concealment and disclosure are independent constructs among bisexual men. Further, they suggest that interventions addressing concerns about concealment, emotional support, and internalized homophobia may be more beneficial for increasing the mental health of bisexual men than those focused on promoting disclosure.

Tuesday, January 15, 2013

Guilt and Moral Character

Academic Minute
Inside Higher Ed
Originally published January 4, 2012

In today’s Academic Minute, Carnegie Mellon University's Taya Cohen analyzes why our moral nature may depend on our response to guilt. Cohen is an assistant professor of organizational behavior and theory in the Tepper School of Business at Carnegie Mellon. Find out more about her here.

Access To Electroconvulsive Therapy In Decline: A Clinical Choice Or An Economic One?

Originally published January 12, 2013

Here are some excerpts:

A new study in Biological Psychiatry suggests that reductions in ECT treatment have an economic basis. From 1993 - 2009, there was a progressive decline in the number of hospitals offering ECT treatment, resulting in an approximately 43% drop in the number of psychiatric inpatients receiving ECT.

Using diagnostic and discharge codes from survey data compiled annually from US hospitals, researchers calculated the annual number of inpatient stays involving ECT and the annual number of hospitals performing the procedure.

Lead author Dr. Brady Case, from Bradley Hospital and Brown University, said, "Our findings document a clear decline in the capacity of US general hospitals - which provide the majority of inpatient mental health care in this country - to deliver an important treatment for some of their most seriously ill patients. Most Americans admitted to general hospitals for severe recurrent major depression are now being treated in facilities which do not conduct ECT."

This is the consequence of an approximately 15 year trend in which psychiatric units appear to be discontinuing use of the procedure. The percentage of hospitals with psychiatric units which conduct ECT dropped from about 55% in 1993 to 35% in 2009, which has led to large reductions in the number of inpatients receiving ECT.

The entire story is here.

Monday, January 14, 2013

Vignette 21: A Phone Call from a Friend

Dr. Goodfriend receives a call from Buddy, his very close high school friend. Dr. Goodfriend speaks with Buddy about once every six to nine months. During those calls, the conversations typically focus on careers, family members, and the whereabouts about other classmates.

Buddy phoned Dr. Goodfriend in an apparent emotional anguish by the tone of his voice.  Buddy states that he has been feeling "stressed" over the last month. He explains that he recently lost his job and has been worrying about the financial impact that this is having on his family. Buddy adds that he has had trouble sleeping, has stopped exercising, has little energy, and fleeting thoughts of hurting himself.  Buddy also shares that he has been short tempered with his wife and kids.

During the 90-minute call, Dr. Goodfriend tries to be a good listener, empathizes with Buddy's difficult situation, offers advice on ways that Buddy can better manage his stress, provides him with general encouragement, and suggests a book that outlines stress management and anxiety reduction strategies.

At the end of the call, Buddy tells Dr. Goodfriend that he is feeling much better. Just as he is about to hang up, Buddy says, "Thanks. My wife told me that I should see a therapist but I told her that I could talk with you and that it would be much cheaper."

Dr. Goodfriend is unclear whether Buddy is serious or joking.

If you were Dr. Goodfriend, how do you feel about the phone call?

Does Dr. Goodfriend need to phone his high school friend to clarify his last comment?

Does Dr. Goodfriend need to encourage Buddy to become involved in therapy if symptoms persist?

Should Dr. Goodfriend call Buddy and offer a few referrals?

What factors influence this decision?

Is college football doing enough about head injuries to protect players?

By Jon Solomon | jsolomon@al.com
on January 03, 2013

Some chilling images of head injuries loom over this college football season.

There was the huge hit USC wide receiver Robert Woods took against Utah while blocking for a teammate. Woods got up, staggered around and fell to the ground. He was checked on the sideline and returned after missing one play.

There were two hits to the head Arizona quarterback Matt Scott received on one play against USC. He vomited on the field as the television announcers almost pleaded for Scott to be taken out. Scott stayed in the game to throw the winning touchdown.

There was the hit Connecticut quarterback Chandler Whitmer sustained against Cincinnati that he would later describe as a "bullet to the head." Whitmer, who had suffered a concussion the previous week, missed one play. He soon took another hit, needed help getting to the Connecticut sideline, and this time his day was over.

As college football reaches its national championship game Monday night, a question is being asked publicly with more frequency: Is college football doing enough to keep players safe?

The entire article is here.

Sunday, January 13, 2013

Aaron Swartz, Reddit Co-founder, commits suicide

By Anne Cai
The Tech, Online Edition
Originally posted January 12, 2013

Computer activist Aaron H. Swartz committed suicide in New York City yesterday, Jan. 11, according to his uncle, Michael Wolf, in a comment to The Tech. Swartz was 26.

“The tragic and heartbreaking information you received is, regrettably, true,” confirmed Swartz’ attorney, Elliot R. Peters of Kecker and Van Nest, in an email to The Tech.

Swartz was indicted in July 2011 by a federal grand jury for allegedly downloading millions of documents from JSTOR through the MIT network — using a laptop hidden in a basement network closet in MIT’s Building 16 — with the intent to distribute them. Swartz subsequently moved to Brooklyn, New York, where he then worked for Avaaz Foundation, a nonprofit “global web movement to bring people-powered politics to decision-making everywhere.” Swartz appeared in court on Sept. 24, 2012 and pleaded not guilty.

The story is here.

Intellectual property law and the psychology of creativity

By Jessica Bregant, JD, and Jennifer K. Robbennolt, JD, PhD, University of Illinois
The Monitor on Psychology - The Judicial Notebook
January 2013, Vol 44, No. 1
Print version: page 21

Creativity and the process of innovation are fertile grounds for psychological research, with applications spanning education, the arts, business and science. Last year, the U.S. Supreme Court took up the topic of creativity in the context of patent law. The case, Mayo Collaborative Services v. Prometheus Laboratories, Inc., revisited a long-observed legal prohibition on patenting the "laws of nature" and illustrates one of the many ways in which law, particularly intellectual property law, can be informed and shaped by psychological principles.


The court, in Mayo, identified the competing incentives created by the availability of patents: The rights granted by patents are intended to provide an economic incentive for innovation but may also restrict the flow of information and cross-fertilization of ideas among inventors. To balance these interests, patents are generally issued only for inventions that are novel, not obvious and useful. The court also recognized the breadth of the fields to which patent law (and, more broadly, intellectual property law) applies. Different types of creative activities may involve different aspects of creativity.

Psychologists have much to contribute to an understanding of the cognitive processes by which people engage in creative activity, how those processes are similar and different across substantively different fields, what motivates creative activity, whether and how the rules of intellectual property can encourage or stifle innovation, and what else might be done to cultivate innovation.

The entire article is here.

Saturday, January 12, 2013

State reprimands psychologist David T. Bice over "touch"

Psychiatric Crimes Database
Originally posted January 3, 2012

On October 8, 2012, the Oregon Board of Psychologist Examiners reprimanded David T. Bice, Ph.D. for unprofessional conduct; failure to avoid harm; failure to obtain informed consent and exceeding the boundaries of competence with regard to a teenage female patient.

According to the Board’s document, Bice engaged in “comforting touch” with the patient, which made her uncomfortable to the extent that “she will never see a male counselor again.” Bice additionally failed to make entries in the patient’s chart when he touched her, the rationale for touching, how the patient reacted, etc.; failed to get the patient’s full informed consent, relative to the use of touch in that the did not address the use of touch with the patient nor did he address it in his informed consent documents or the patient’s chart notes; exceeding the boundaries of competence by engaging in touch with the patient “without first establishing a strong therapeutic alliance and [failing] to monitor [the patient’s] reactions…and to make a corresponding chart note.”

In addition to the reprimand, Bice must successfully complete coursework in the areas of informed consent, patient charting and the use of touch during therapy and is also required to practice for a minimum of one year under the supervision of a licensed psychologist, among other things.

Friday, January 11, 2013

State of Pennsylvania suspends psychologists

Psychiatric Crimes Database
Originally published January 2, 2013

On July 31, the Pennsylvania Department of State (DoS) suspended psychologist John H. Edgette, pursuant to the Order of the Court of Common Pleas of York County dated July 17, 2012, which the court issued under section 4355 of the Domestic Relations Code, which regards issues of custody, visitation and support.

On November 5, 2012, the DoS suspended psychologist Scott Adam Merritt for a period of no less than one year and placed a public reprimand in his permanent disciplinary record with the board because he is unable to practice psychology with reasonable skill and safety by reason of illness or as a result of mental or physical condition.

On November 13, 2012, the DoS ordered psychologist Jennifer Hope Bullock to pay a civil penalty of $500 because she practiced as a licensed professional counselor while her license was lapsed.

Thursday, January 10, 2013

The year of the suicide

Suicide rates among Americans are steadily rising and have been for years. Why are we killing ourselves?

Originally published Decemeber 31, 2012

Let’s call 2012 the year of the suicide: On Friday, the Department of the Army released a report revealing that suicides continue to outnumber combat-related deaths among American soldiers —an average of one suicide a day— a number that’s increasing despite the fact that the armed forces have installed new training and awareness programs over the past few years. Stateside, suicide has become the leading cause of death by injury, and is the 10th leading cause of death overall. According to a CDC report released over the summer, suicide attempts by high-school students has risen to from 6.3 percent in 2009 to 7.8 percent in 2011, and accounts for 13 percent of all deaths among people between the ages of 10 and 24 — the third leading cause of death in that age group.

These are sobering statistics. And with the statistics comes more data to explain them: The Washington Post reported that “the stress on the force after more than a decade of lengthy and multiple deployments for many troops in support of the wars in Iraq and Afghanistan,” while Defense Secretary Leon Panetta attributed the high rate to “substance abuse, financial distress and relationship problems … that will endure beyond war.” Among civilians, the number of suicides have been attributed to the recession — historically, there is a spike with every economic downturn. And 20 percent of high-school teenagers say they are being bullied — 16 percent say they’ve been cyber-bullied through texting, IM-ing, email, and Facebook or other social media.

The entire story is here.

Wednesday, January 9, 2013

Employers Must Offer Family Care, Affordable or Not

The New York Times
Originally published: December 31, 2012

In a long-awaited interpretation of the new health care law, the Obama administration said Monday that employers must offer health insurance to employees and their children, but will not be subject to any penalties if family coverage is unaffordable to workers.

The requirement for employers to provide health benefits to employees is a cornerstone of the new law, but the new rules proposed by the Internal Revenue Service said that employers’ obligation was to provide affordable insurance to cover their full-time employees. The rules offer no guarantee of affordable insurance for a worker’s children or spouse. To avoid a possible tax penalty, the government said, employers with 50 or more full-time employees must offer affordable coverage to those employees. But, it said, the meaning of “affordable” depends entirely on the cost of individual coverage for the employee, what the worker would pay for “self-only coverage.”

The new rules, to be published in the Federal Register, create a strong incentive for employers to put money into insurance for their employees rather than dependents. It is unclear whether the spouse and children of an employee will be able to obtain federal subsidies to help them buy coverage — separate from the employee — through insurance exchanges being established in every state. The administration explicitly reserved judgment on that question, which could affect millions of people in families with low and moderate incomes.

The entire story is here.

Tuesday, January 8, 2013

OSU prof falsified research results, probes find

Elton hit with work restrictions; he must seek retractions from journals

By  Ben Sutherly
The Columbus Dispatch
Originally published December 22, 2012

An Ohio State University pharmacy professor has agreed to request retractions of much of his research after university and government officials found that he falsified data in six journal articles.

As part of an agreement disclosed yesterday, Terry S. Elton said he will avoid contracting or subcontracting with any agency of the federal government for three years, or serving in any advisory capacity to the U.S. Public Health Service for three years. He will request that five of his scientific publications be retracted.

Federal and university investigations found that Elton falsified data from Western blots, a standard laboratory technique used to detect proteins. Some of Elton’s research explored the brain functions of people with Down syndrome.

The entire story is here.

Monday, January 7, 2013

Doctors Warned on ‘Divided Loyalty’

The New York Times
Published: December 26, 2012

With hospitals buying up medical practices around the country and seeking to make the most of their investment, the American Medical Association reached out to doctors this week to remind them that patient welfare must always come first and not be overridden by the economic interests of hospitals that now employ doctors in ever-growing numbers.

“In any situation where the economic or other interests of the employer are in conflict with patient welfare, patient welfare must take priority,” says a policy statement adopted by the association.

“A physician’s paramount responsibility is to his or her patients,” the association said. At the same time, it added, a doctor “owes a duty of loyalty to his or her employer,” and “this divided loyalty can create conflicts of interest, such as financial incentives to over- or under-treat patients.”

The association is disseminating its policy to doctors at a time when more of them are becoming hospital employees. About one-third of new doctors say they would prefer to be employed by hospitals, rather than practice on their own. The association is urging hospitals and medical groups to adopt similar policies.

A major goal of the guidelines is to protect the professional autonomy of doctors. Hospital employment agreements often include provisions that discourage doctors from sending patients to providers of services that are not affiliated with the hospital.

The guidelines say that “physicians should always make treatment and referral decisions based on the best interests of their patients.” Moreover, the association says, patients should be told whenever a hospital provides financial incentives that encourage, discourage or restrict referrals or treatment options.  

Sunday, January 6, 2013

State report blasts FAMU's effort to fight hazing before Champion's death

By Denise-Marie Ordway
Orlando Sentinel
Originally published December 28, 2012

FAMU lacked the internal controls needed to identify and fight hazing before the beating death of drum major Robert Champion in Orlando a year ago, according to a long-awaited investigative report released Friday afternoon.

The sharply critical report lays out a host of problems that the State University System found during its year-long investigation focusing on the university's failure to deter hazing in the years before Champion's death.

It comes just weeks after Florida A&M University's accrediting agency placed the school on probation for a year because of problems in areas such as student safety and school finances.

Derry Harper, the Inspector General for the university system's Board of Governors, reviewed hazing reports and FAMU's regulations between 2007 and 2011 to reach his conclusions. He discovered numerous failings, including poor communication between two key university departments and a lack of clear rules on how to handle hazing complaints.

Many of the hazing allegations investigated by campus police were never shared with the office that handles student discipline, even though some complaints might have prompted student disciplinary action. And nobody was tracking hazing on a campus that had been wrestling with the violent practice for decades.

The entire story is here.

Saturday, January 5, 2013

New tools to help providers protect patient data in mobile devices

U.S. Department of Health & Human Services
Press Release
December 12, 2012

Launched by the U.S. Department of Health and Human Services (HHS) today, a new education initiative and set of online tools provide health care providers and organizations practical tips on ways to protect their patients’ protected health information when using mobile devices such as laptops, tablets, and smartphones.

The initiative is called Mobile Devices: Know the RISKS. Take the STEPS. PROTECT and SECURE Health Information and is available at www.HealthIT.gov/mobiledevices.  It offers educational resources such as videos, easy-to-download fact sheets, and posters to promote best ways to safeguard patient health information.

“The use of mobile health technology holds great promise in improving health and health care, but the loss of health information can have a devastating impact on the trust that patients have in their providers.  It’s important that these tools are used correctly,” said Joy Pritts, HHS’ Office of the National Coordinator for Health Information Technology (ONC) chief privacy officer. “Health care providers, administrators and their staffs must create a culture of privacy and security across their organizations to ensure the privacy and security of their patients’ protected health information.”

Despite providers’ increasing use of using mobile technology for clinical use, research has shown  that only 44 percent of survey respondents encrypt their mobile devices.  Mobile device benefits—portability, size, and convenience—present a challenge when it comes to protecting and securing health information.

Along with theft and loss of devices, other risks, such as the inadvertent download of viruses or other malware, are top among reasons for unintentional disclosure of patient data to unauthorized users.

“We know that health care providers care deeply about patient trust and the importance of keeping health information secure and confidential,” said Leon Rodriguez, director of the HHS Office for Civil Rights. “This education effort and new online resource give health care providers common sense tools to help prevent their patients’ health information from falling into the wrong hands.”

For more information, tips, and steps on protecting and securing health information when using a mobile device visit www.HealthIT.gov/mobiledevices.

Friday, January 4, 2013

War Tragedies Strike Families Twice

The Wall Street Journal
Originally published on December 20, 2012

One night in March 2008, William and Christine Koch opened their front door to see two soldiers in green dress uniforms bearing news that their son, Army Cpl. Steven Koch, had been killed by a suicide bomber in Afghanistan.

Two years later, Mr. and Mrs. Koch opened the door to see two police officers in blue. This time, they learned their daughter, Lynne, brokenhearted over her brother's death, had killed herself with an overdose of prescription drugs.

She is a casualty of this war, and I don't care what anybody says," Mrs. Koch said. "If my son was not killed, my daughter would be here."

The military tracks suicides among the troops. The Department of Veterans Affairs studies self-inflicted deaths among people who have left the service. Nobody collects data on suicides among the parents, siblings and spouses of the more than 6,500 Americans killed in Afghanistan and Iraq.

But anecdotal evidence from military families, support groups and suicide survivors suggests that over the past 11 years of war, the U.S. has experienced a little-recognized suicide outbreak among the bereaved. This second round of tragedy often takes place years after a loved one's death, when the finality of the loss becomes inescapable.

"We've all had the idea of suicide at one time or another," said Nadia McCaffrey of Tracy, Calif., whose son Patrick died in an ambush in Iraq in 2004. She said she personally knows a half dozen military parents who have killed themselves.

To learn more about war grief, researchers at the Uniformed Services University of the Health Sciences, a federal institution in Bethesda, Md., are recruiting 3,000 people to participate in a first-ever U.S. study of bereavement among families of those killed on active duty.

"We don't know whether or in what ways military-service deaths—combat-related, accidents or suicides—differ from similarly sudden or violent civilian deaths in their impact on bereaved family members," said Stephen Cozza, a psychiatrist involved in the research.

The violent and faraway nature of combat death—often following months of dread—may make it harder to accept for those left behind, said Bonnie Carroll. She founded the Tragedy Assistance Program for Survivors, or TAPS, after her husband, an Army general, died in a 1992 plane crash.

"To have someone come to the house and deliver this devastating information that you'd never see them again is impossible to absorb," Mrs. Carroll said. In her grief after her husband's death, she found herself taking high-speed, late-night drives along the Alaska coast, as if daring herself to join him.

The entire story is here.

Thursday, January 3, 2013

Reported sex assaults spike at military academies

Associated Press
Originally published Dec 19, 2012

Reported sexual assaults at the nation's three military academies jumped by 23 percent overall this year, but the data signaled a continued reluctance by victims to seek criminal investigations.

According to a report obtained by The Associated Press, the number of assaults rose from 65 in the 2011 academic year to 80 in 2012. However, nearly half the assaults involved victims who sought confidential medical or other care and did not trigger an investigation. There were 41 assaults reported in 2010.

Reported sexual assaults have climbed steadily since the 2009 academic year. The Defense Department has urged the academies to take steps to encourage cadets and midshipmen at the Army, Navy and Air Force academies to report sexual harassment and assaults in order to get care to everyone and hold aggressors accountable. The number of assaults reported by the U.S. Military Academy at West Point, N.Y., and the U.S. Air Force Academy in Colorado Springs, Colo., increased, while reports at the U.S. Naval Academy in Annapolis, Md., declined.

The entire story is here.

Wednesday, January 2, 2013

Mobile medical apps & FDA regulation

The Growth of the Health IT Sector and the Need for More Robust FDA Regulation

By Adam
Originally posted on December 21, 2012

Over the last six years, there has been significant growth in the health technology sector (e.g. mobile medical apps), driven by advances in technology and an increase in venture capital (VC) funding. VCs have been lured into the space due to the perception of high returns on investment within shorter timeframes versus their traditional life science funds. The significant growth in this market has driven the need for increased scrutiny from the FDA in how these products should be regulated.

The FDA has the authority to regulate software if it falls within the broad definition of a “device”. It has further segmented medical devices into three classes; Class I, Class II and Class III. Class I devices don’t require FDA regulatory filing (i.e., 510(K), Premarket Approval Application (PMA)) whereas Class II requires 510(K) and Class III devices require a PMA. The class to which a device is assigned determines the type of premarketing submission/application required for FDA clearance, prior to product launch.

While the FDA has had policies in place for many years regarding the regulation of software/computer products, it has historically taken the position not to enforce the regulation unless the product interfaces directly with a medical device. In cases such as these, products have then been subjected to regulation as if they were a medical device. This caused problems for the manufacturers of these devices as there was no structured classification system based on a risk assessment, making it difficult to predict whether a device would end up being a Class I, II or III medical device. Furthermore, the rapid adoption of mobile technology within healthcare meant that there was a pressing need to develop specific guidelines around the regulation of these products also (out of the 14,558 medical apps currently available, only 75 have received clearance from the FDA).

The entire article is here.

Effective and Ineffective Supervision

Nicholas Ladany, Yoko Mori, and Kristin E. Mehr
The Counseling Psychologist
January 2013 41: 28-47
First published on May 23, 2012


Although supervision is recognized as a significant tenant of professional growth for counseling and psychotherapy students, the variability of the effectiveness, or ineffectiveness, of supervision has come under scrutiny in recent times. Our sample of 128 participants shed light on the most effective (e.g., encouraged autonomy, strengthened the supervisory relationship, and facilitated open discussion) and most ineffective (e.g., depreciated supervision, performed ineffective client conceptualization and treatment, and weakened the supervisory relationship) supervisor skills, techniques, and behaviors. Moreover, effective and ineffective behaviors, along with best and worst supervisors, were significantly differentiated based on the supervisory working alliance, supervisor style, supervisor self-disclosure, supervisee nondisclosure, and supervisee evaluation. Implications for supervision competencies and supervisor accountability are discussed.

The entire article can be found here.

A presentation by Nicholas Ladany on effective supervision can be found in the PowerPoint Vault on this blog.

Tuesday, January 1, 2013


The New Yorker
Originally published December 24, 2012

A lot of scientists have been busted recently for making up data and fudging statistics. One case involves a Harvard professor who I once knew and worked with; another a Dutch social psychologist who made up results by the bushel. Medicine, too, has seen a rash of scientific foul play; perhaps most notably, the dubious idea that vaccines could cause autism appears to have been a hoax perpetrated by a scientific cheat. A blog called RetractionWatch publishes depressing notices, almost daily. One recent post mentioned that a peer-review site had been hacked; others detail misconduct in dentistry, cancer research, and neuroscience. And that’s just in the last week.

Even if cases of scientific fraud and misconduct were simply ignored, my field (and several other fields of science, including medicine) would still be in turmoil. One recent examination of fifty-three medical studies found that further research was unable to replicate forty-seven of them. All too often, scientists muck about with pilot studies, and keep tweaking something until they get the result they were hoping to achieve. Unfortunately, each fresh effort increases the risk of getting the right result for the wrong reason, and winding up with a spurious vision of something that doesn’t turn out to be scientifically robust, like a cancer drug that seems to work in trials but fails to work in the real world
How on Earth are we going to do better? Here are six suggestions, drawn mainly from a just-published special issue of the journal Perspectives on Psychological Science. Two dozen articles offer valuable lessons not only for psychology, but for all consumers and producers of experimental science, from physics to neuroscience to medicine.

Restructure the incentives in science. For many reasons, science has become a race for the swift, but not necessarily the careful. Grants, tenure, and publishing all depend on flashy, surprising results. It is difficult to publish a study that merely replicates a predecessor, and it’s difficult to get tenure (or grants, or a first faculty jobs) without publications in elite journals. From the time a young scientist starts a Ph. D. to the time they’re up for tenure is typically thirteen years (or more), at the end of which the no-longer young apprentice might find him or herself out of a job. It is perhaps, in hindsight, no small wonder that some wind up cutting corners. Instead of, for example, rewarding scientists largely for the number of papers they publish—which credits quick, sloppy results that might not be reliable—we might reward scientists to a greater degree for producing solid, trustworthy research that other people are able to successfully replicate and then extend.

The entire article is here.