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, February 28, 2013

New VP will scrutinize Harvard’s investments

$30.7b endowment has faced calls to use its clout to do good

By Todd Wallack
The Boston Globe
Originally published February 19, 2013

Harvard University, which often faces pressure from students and alumni to shed controversial investments, has agreed to create a senior position at its investment management arm to consider the environmental, social, and corporate governance aspects of its holdings.

Harvard Management Co. recently began searching for a vice president for “sustainable investing,” a relatively novel position in the world of university endowments.

“We think this is a positive step,” said Harvard College senior Michael Danto, one of the leaders of Responsible Investment at Harvard, which has pushed Harvard to adopt policies to ensure its investments are consistent with the university’s values.

The entire story is here.

Indictment Of Manhattan Doctor Who Sold Oxycodone Prescriptions To Drug Dealers

Attorney General of New York Press Release
Originally released on February 13, 2013

Attorney General Eric T. Schneiderman today announced a 55-count indictment against Dr. David Brizer on charges he sold prescriptions for oxycodone and other powerful pain medications to drug dealers from his Rockland County and Midtown Manhattan offices. The indictment also charges Brizer with illegally possessing controlled substances and underreporting his income by at least $500,000 on his New York State personal tax returns in 2010 and 2011.

Brizer, a psychiatrist, was arraigned in Rockland County Court today on two top counts of Criminal Tax Fraud; 34 counts of Criminal Sale of a Prescription for a Controlled Substance; 15 counts of Criminal Possession of a Controlled Substance; 2 counts of Offering a False Instrument for Filing; along with Scheme to Defraud and Conspiracy charges. All are felony counts. He faces up to seven years behind bars.

“Instead of saving lives, Dr. Brizer used his position to supply drug dealers and feed a prescription drug epidemic that is devastating families across our state. The message is clear – whether you are a doctor or a criminal on the street, my office will prosecute those profiting off the cycle of abuse,” Attorney General Schneiderman said. “This office will use every tool at our disposal to bring criminal charges against those who line their own pockets by fueling dangerous addictions and illegally trafficking in prescription narcotics.”

The entire news release is here.

Wednesday, February 27, 2013

UChicago Professor Helps Uncover Lost Lectures by French Philosopher Foucault

University of Chicago News Release
Originally released on February 7, 2013

More than 30 years ago, French philosopher Michel Foucault gave a landmark series of seven lectures at the Catholic University of Louvain in Belgium In them, Foucault linked his early and late work—exploring the role of confession in the determination of truth and justice from the time of the Greeks forward to the 1970s.

While the lectures had been mythic among Foucault scholars, only a partial, poorly transcribed account had survived. Recently rediscovered, details of the lectures have been published in a new book co-edited by Prof. Bernard E. Harcourt.

“These 1981 lectures form a crucial link between Foucault’s earlier work on surveillance in society, the prison and neoliberal governmentality during the 1970s, and his later work on subjectivity and the care of the self in the 1980s,” said Harcourt, co-editor of Mal faire, dire vrai: La fonction de l’aveu en justice [Wrong-Doing, Truth-Telling: The Function of Avowal in Justice], which Louvain and the University of Chicago Press recently released in French.

“A lot of people still cling to the idea that there was a fundamental transition in his interests, but one can identify all his later themes much earlier on, as illustrated by the continuity revealed in these lectures,” added Harcourt, chair and professor of Political Science and the Julius Kreeger Professor of Law and Criminology.

Foucault particularly delved into how the process of confession affects the way we think about ourselves, and who we are, according to Arnold Davidson, renowned Foucault scholar and the Robert O. Anderson Distinguished Service Professor.

The entire story is here.

House Republican aims to repeal Medicare doctor pay cuts

Originally published on February 13, 2013

Republicans in the House of Representatives will seek a permanent solution to scheduled steep cuts in physician payments from the federal Medicare health insurance plan for retirees and disabled people, a House committee chairman said on Wednesday.

Rep. Fred Upton, chairman of the House Energy and Commerce Committee, told doctors he hopes to send so-called "Doc Fix" legislation to the House floor this summer that would repeal payment reductions enacted in 1997 as part of a law to balance the federal budget.

The 16-year-old "sustainable growth rate" (SGR) provision calls for reductions in doctor pay as a way to control spending by Medicare. Congress has prevented the SGR from taking effect through temporary measures, but that has run up the fiscal and political costs of finding a permanent solution.

The entire article is here.

Tuesday, February 26, 2013

The Shredder Ate My Culture Report: Five Questions the Barclays Board Should Have Asked

By Donna Boehme
Corporate Compliance Insights
Originally published on February 13, 2013

It’s been a terrible, horrible, no good, very bad few weeks for Barclays.   Despite tough talk last month by new CEO Antony Jenkins about “Five New Values” (inviting any of its 140,000 employees who don’t want to sign up to head for the exits), the bad news just keeps on coming for the embattled firm.  And the latest round involves a shredder.

Last week’s headlines of “Shreddergate” and “Qatargate” spelled out the bank’s latest troubles.  In the former, Andrew Tinney, the chief operating officer of the bank’s high-end investment division, commissioned a “workplace culture report” from an outside consultancy, but was so horrified by its contents that he shredded the report on the spot at his Surrey estate and then, according to media reports,  “denied all knowledge of it ever having existed.” Neat trick, until an anonymous internal whistleblower emailed Jenkins a hint about the mysterious culture report.   Add to this the latest revelations about a Qatari cash injection at the height of the financial crisis that may have been funded by the bank itself, which means the bank may have lied to UK regulators.

Mind you, this is after an annus horribilis in which Barclays was hit by a half a billion dollar fine for its part in manipulating LIBOR, lost its Chairman, CEO and COO in quick succession, and saw its credit rating lowered by Moody’s from “stable” to “negative.”  The scandal ripples from that debacle continues, as the firm has just announced the exit of two more top execs: its finance chief and general counsel.

The entire article is here.

The Ethics of Innovation

By Chris MacDonald
The Business Ethics Blog
Originally published February 21, 2013

Innovation is a hot topic these days. It’s been the subject of studies and reports and news reports. In fact, I spent the entire day this past Monday at the Conference Board of Canada’s “Business Innovation Summit,” listening to business leaders and civil servants talk about how Canada is lagging on innovation, and how much is left to be done to promote and manage innovation. And certainly technological innovations like Google’s new glasses and 3D printing make for compelling headlines.

So sure, hot topic. But how is it connected to ethics? What is an ethics professor like me doing at an event dedicated to innovation?

If you understand the domain of ethics properly, the connection is clear. In point of fact, innovation is an ethical matter through and through, because ethics is fundamentally concerned with anything that can promote or hinder human wellbeing. So ethics is relevant to assessing the goals of innovation, to the process by which it is carried out, and to evaluating its outcomes.

Let’s start with goals. Innovation is generally a good thing, ethically, because it is aimed at allowing us to do new and desirable things. Most typically, that gets expressed in the painfully vague ambition to ‘raise productivity.’ Accelerating our rate of innovation is a worthy policy objective because we want to be more productive as a society, to increase our social ‘wealth’ in the broadest sense.

The entire blog post is here.

Monday, February 25, 2013

New Federal Rule Requires Insurers to Offer Mental Health Coverage

The New York Times
Published: February 20, 2013

The Obama administration issued a final rule on Wednesday defining “essential health benefits” that must be offered by most health insurance plans next year, and it said that 32 million people would gain access to coverage of mental health care as a result.

The federal rule requires insurers to cover treatment of mental illnesses, behavioral disorders, drug addiction and alcohol abuse, and other conditions.

Kathleen Sebelius, the secretary of health and human services, said that in addition to the millions who would gain access to mental health care, 30 million people who already have some mental health coverage will see improvements in benefits.

White House officials described the rule as a major expansion of coverage. In the past, they said, nearly 20 percent of people buying insurance on their own did not have coverage for mental health services, and nearly one-third had no coverage for treatment of substance abuse.

The entire story is here.

U.S. proposes scrapping some obsolete Medicare regulations

By Reuters
Originally published February 13, 2013

The Obama administration on Monday proposed eliminating certain obsolete Medicare regulations, a move it said would save hospitals and other healthcare providers an estimated $676 million a year, or $3.4 billion over five years.

The Department of Health and Human Services described the targeted regulations as unnecessary or excessively burdensome and said their proposed elimination would allow greater efficiency without jeopardizing safety for the Medicare program's elderly and disabled beneficiaries.

"We are committed to cutting the red tape for healthcare facilities, including rural providers," Health and Human Services Secretary Kathleen Sebelius said in a statement.

"By eliminating outdated or overly burdensome requirements, hospitals and health care professionals can focus on treating patients," she added.

Industry representatives largely welcomed the changes, saying the proposed rule would help hospitals free up more resources for patient care.

"There are a number of particularly meaningful provisions in the proposed rule," said Chip Kahn of the Federation of American Hospitals.

The American Hospital Association, though, said it was disappointed the administration did not allow "hospitals in multi-hospital systems" to have single integrated medical staff structures.

"Hospitals are delivering more coordinated, patient-centered care and (the administration) should not let antiquated organizational structures stand in the way," AHA President Rich Umbdenstock said in a statement.

The entire article is here.

Sunday, February 24, 2013

Situationism and Confucian Virtue Ethics

By Deborah S. Mower

Ethical Theory and Moral Practice
February 2013, Volume 16, Issue 1, pp 113-137


Situationist research in social psychology focuses on the situational factors that influence behavior. Doris and Harman argue that this research has powerful implications for ethics, and virtue ethics in particular. First, they claim that situationist research presents an empirical challenge to the moral psychology presumed within virtue ethics. Second, they argue that situationist research supports a theoretical challenge to virtue ethics as a foundation for ethical behavior and moral development. I offer a response from moral psychology using an interpretation of Xunzi—a Confucian virtue ethicist from the Classical period. This Confucian account serves as a foil to the situationist critique in that it uncovers many problematic ontological and normative assumptions at work in this debate regarding the prediction and explanation of behavior, psychological posits, moral development, and moral education. Xunzi’s account of virtue ethics not only responds to the situationist empirical challenge by uncovering problematic assumptions about moral psychology, but also demonstrates that it is not a separate empirical hypothesis. Further, Xunzi’s virtue ethic responds to the theoretical challenge by offering a new account of moral development and a ground for ethical norms that fully attends to situational features while upholding robust character traits.

The entire article is here.

The Ethics of Admissions, Part I: Graduate and Professional School

By Jane Robbings
Inside HigherEd - Sounding Board Blog
Originally posted February 13, 2013

I’ve been wanting to write a series of posts on the ethics of admissions and its connection to operating models since I began this blog a few months ago.  While there is lots of talk about one or the other, they are rarely brought together in the sense of recognizing how embedded the ethical choices of institutions—and their consequences—are in the construction of their program and college business models. Acknowledging the ethics of a business model—yes, business models are ethics-laden—implies a stakeholder, or corporate social responsibility (CSR) view.

For a long time, though, institutions of higher education have made their operational decisions largely on the basis of internal interests. We could argue about whether what is going on now in terms of business model collapse is essentially chickens coming home to roost—the inevitable outcome of blindedness and self-interest.  And maybe warn about what is yet to come in other areas such as medical research. But for now I’m most interested in looking at recent movements—some coerced, some bravely self-initiated, to consider the ethical connection between admissions and business models. So far, the most explicit has been going on in graduate and professional education.

In the “coerced” category, the poster child is law schools. One could say this is a case of the market, and in response the government, saying “enough” and forcing change. While it can seem sudden, like most sources of change the problems did not arise overnight, but are the cumulative effect of a gradual process. Law schools, like business schools, underwent a “Flexnorization”—a specific effort to become more scientific and empirical as a strategy to drive out lower, practitioner-driven forms—in the late 60s on; the reports from the middle decades of the 20th century, such as the 1968 Rutgers “Law School of Tomorrow,” reflect contentious debate and an awareness of what might be the negative outcomes; by the time of the 2007 Carnegie report with its meaningful title (Educating Lawyers: Preparation for the Practice), many concerns had become a reality. And a funny thing happened along the way: the lower-tier schools were not driven out—indeed, like their business school counterparts they thrived by the promise of credentials and high earnings—and the upper tier schools have lost much of their market in the recession—a market that may never return, in part because the narrow tasks performed by even highly paid associates can be performed more cheaply overseas or through an agency (and, increasingly, by a computer), and because firms themselves are restructuring the way they practice.

The entire blog post is here.

Saturday, February 23, 2013

MU halts administrator search after torture controversy

By Catherine Martin
The Columbia Daily Tribune
Originally posted on February 15, 2013

The University of Missouri is holding off on filling an administrative position that attracted a controversial candidate.

Larry James, who served as the director of behavioral science division at Guantanamo Bay and Abu Ghraib, was one of two finalists being considered for the job of division executive director at the MU College of Education.

His past experiences, including allegations of involvement in torture, drew criticism from staff and sparked a protest on campus. An on-campus interview last week was open to the public, and questions from community members centered on James' alleged connections to torture.

The entire story is here.

From Guantanamo to Mizzou?

By Colleen Flaherty
Inside HigherEd
Originally published February 12, 2013

Retired Col. Larry James, a former Army psychologist, went into both Abu Ghraib prison in Iraq and the military detention center at Guantanamo Bay, Cuba, to address and correct known human rights violations – hence the name of his 2008 book, Fixing Hell: An Army Psychologist Confronts Abu Ghraib.

“This is very, very important conversation to have in a variety of venues, and it’s very important to understand what went wrong at these awful places,” said James – now dean of the School of Professional Psychology at Wright State University – of why he wrote the memoir. “If we keep things in secret we’re destined to repeat it again.”

But some of the revelations in Fixing Hell are being levied against him as he tries to secure an administrative post at at the University of Missouri at Columbia. An on-campus protest was held earlier this month as James’s name surfaced as one of two finalists for the position, division executive director in the College of Education. As such, he’d oversee 60 faculty and 29 staff members in three units, including the Department of Educational, School and Counseling Psychology.

Aamer Trambu, a business graduate student and member of the Muslim Student Organization, attended the protest, along with members of the St. Louis Chapter of the Council on American-Islamic Relations and the Mid-Missouri Fellowship of Reconciliation, an interfaith peace group. He also attended a Mizzou forum last week at which James answered questions for more than an hour. A petition against James’s candidacy with at least 60 names was turned over to university administrators. (The American-Islamic relations council chapter also launched an online petition. Leaders did not respond to requests for comment.)

The entire article is here.

Friday, February 22, 2013

To Reduce Suicide Rates, New Focus Turns to Guns

The New York Times
Published: February 13, 2013

Craig Reichert found his son’s body on a winter morning, lying on the floor as if he were napping with his great-uncle’s pistol under his knee. The 911 dispatcher told him to administer CPR, but Mr. Reichert, who has had emergency training, told her it was too late. His son, Kameron, 17, was already cold to the touch.

Guns are like a grandmother’s diamonds in the Reichert family, heirlooms that carry memory and tradition. They are used on the occasional hunting trip, but most days they are stored, forgotten, under a bed. So when Kameron used one on himself, his parents were as shocked as they were heartbroken.

“I beat myself up quite a bit over not having a gun safe or something to put them in,” Mr. Reichert said. But he said even if he had had one, “There would have been two people in the house with the combination, him and me.”

The gun debate has focused on mass shootings and assault weapons since the schoolhouse massacre in Newtown, Conn., but far more Americans die by turning guns on themselves. Nearly 20,000 of the 30,000 deaths from guns in the United States in 2010 were suicides, according to the most recent figures from the Centers for Disease Control and Prevention. The national suicide rate has climbed by 12 percent since 2003, and suicide is the third-leading cause of death for teenagers.

Guns are particularly lethal. Suicidal acts with guns are fatal in 85 percent of cases, while those with pills are fatal in just 2 percent of cases, according to the Harvard Injury Control Research Center.

The entire story is here.

Panetta announces benefits for military same-sex partners

By Tom Vanden Brook
USA Today
Originally published February 11, 2013

Defense Secretary Leon Panetta announced Monday that the Pentagon is extending benefits to same-sex partners of military servicemembers, including the right to visit their loved ones in military hospitals.

The announcement falls short of an extension of full benefits, many of them involving health care, because federal law prevents same-sex couples from receiving them. Among the other benefits to be extended: participation in family groups on military bases, issuing dependent identification cards and privileges in commissaries.

"It is a matter of fundamental equity that we provide similar benefits to all of those men and women in uniform who serve their country," Panetta said in a statement.

The entire story is here.

Thursday, February 21, 2013

Vermont Senate approves amended death with dignity bill

By Dave Gram
The Associated Press
Originally published February 13, 2013

The Vermont Senate on Wednesday gave preliminary approval to an amended bill allowing doctors to prescribe a lethal dose of medication to terminally ill patients.

But even some backers of the measure, which passed 21-9, called the amended version a travesty. And other long-time backers of what they call ‘‘death with dignity’’ or ‘‘end-of-life choices,’’ along with opponents of physician-assisted suicide, were so angry about the amendment that they voted against it.

‘‘I will be voting yes for this bill, as much as I detest it,’’ said Sen. Claire Ayer, D-Addison and chairwoman of the Senate Health and Welfare Committee.

She said she hoped much of the original language — which mirrored Oregon’s first-in-the-nation Death With Dignity Act — would be restored when the measure moves to the House.

‘‘I want to be on that conference committee,’’ Ayer said, referring to the six-member panel of lawmakers who work out the differences between the House and Senate bills after they have cleared both chambers.

The entire story is here.

Assisted Suicide on Legal Agenda in Several States

By Susan Haigh
Associated Press
Originally posted February 8, 2013

A push for the legalization of physician-assisted suicide is under way in a half-dozen states where proponents say they see strong support for allowing doctors to prescribe mentally competent, dying individuals with the medications needed to end their own lives.

The large number of baby boomers facing end-of-life issues themselves is seen to have made the issue more prominent in recent years. Groups such as Compassion & Choices, a national end-of-life advocacy organization, have been working to advance the cause.

Advocates received a boost from last year's ballot question in Massachusetts on whether to allow physicians to help the terminally ill die. Although the vote failed, it helped to spark a national discussion, said Mickey MacIntyre, chief program officer for Compassion & Choices.

"The Massachusetts initiative lifted the consciousness of the nation and in particular the Northeast region to this issue that there are other alternatives patients and their families should have an opportunity to access," MacIntyre said.

Bills legalizing assisted suicide are being considered in Connecticut, Vermont, New Jersey, Kansas and Hawaii — and in Massachusetts, where proponents decided to resume their efforts after the public vote, according to the National Conference of State Legislatures, which tracks legislative trends. There are also bills related to the issue under consideration in New Hampshire, New York, Arizona and Montana.

In Connecticut, which has banned the practice since 1969, a group of lawmakers said Tuesday that the legislature's first public hearing on the subject would probably be held this month. At least two bills on the issue have so far been proposed in this year's session of the Connecticut legislature.

The entire story is here.

Wednesday, February 20, 2013

The Op-Ed: Antidepressants & Controversial Studies

By Ed Silverman
Originally published February 11th, 2013

Several years ago, the Black Box warnings that were added to antidepressants over suicidal thoughts and behaviors for youngsters caused a backlash, as some suggested the language had pushed physicians and parents to avoid usage when the medications could have done some good. The debate may have slipped from view, but never really ended. A pair of papers published last year, in fact, renewed the controversy, and Glen Spielmans, an associate professor of psychology at Metropolitan State University, recounts why the issue remains fraught with challenges and a recent spat that erupted when an effort was made to critique the papers.

Antidepressants can cause suicidality – suicidal thoughts and behaviors – in children and adolescents. This message has been widely disseminated since October 2004, when the FDA placed a Black Box warning on such medications. The warning was based on findings from placebo-controlled trials, in which kids taking antidepressants had an elevated rate of suicidal thoughts and behaviors (see this). But research led by Dr. Robert Gibbons, professor of biostatistics at the University of Chicago, suggests that this warning is counterproductive, scaring parents and kids away from getting safe and effective antidepressant treatment.

Gibbons was the main author on two papers published in 2012 in psychiatry’s premier journal, Archives of General Psychiatry (which was changed to JAMA Psychiatry last month). One paper examined the potential association between antidepressants and suicidality and the other focused on the efficacy of antidepressants.

The entire op-ed is here.

Pfizer disputes claim against antidepressant

By Linda Johnson
Associated Press
Originally published January 31, 2013

The maker of Zoloft is being sued in an unusual case alleging the popular antidepressant has no more benefit than a dummy pill and that patients who took it should be reimbursed for their costs.

Zoloft's maker, Pfizer Inc., the world's biggest drugmaker by revenue, disputes the claim, telling the Associated Press Thursday that clinical studies and the experience of millions of patients and their doctors over two decades prove Zoloft is effective.

The lawsuit was described as frivolous by Pfizer and four psychiatry experts interviewed by the AP.

Not so, according to plaintiff Laura A. Plumlee, who says Zoloft didn't help her during three years of treatment. Her attorney, R. Brent Wisner of the Los Angeles firm Baum Hedlund Aristei Goldman, argues the Food and Drug Administration shouldn't have approved Zoloft because Pfizer didn't publish some clinical studies that found the drug about as effective as a placebo.


Kirsch, associate director of Harvard Medical School's Program in Placebo Studies, has published a book and several medical journal articles on the effect. With colleagues, he reviewed numerous studies of popular antidepressants, including unpublished studies obtained using the Freedom of Information Act.

"The difference between drug and placebo is very small," below the level that benefits patients, Kirsch concluded.

He said Pfizer produced two studies showing Zoloft worked better than placebo — the FDA's requirement for approval — but most Zoloft studies showed its effect was the same as a placebo.
Dr. Michael Thase, who heads the mood and anxiety disorders program at the University of Pennsylvania's medical school, said research by others using the same unpublished studies concluded antidepressants have "a modest effect over placebo," on average about 15 percentage points.

That's partly because the rate of study participants improving when they're taking a placebo has been rising, said New York University's Sussman.

The entire story is here.

Tuesday, February 19, 2013

SGR Repeal Bill Favors Primary Care

Robert Lowes
MedScape Medical News
Originally published February 06, 2013

Two members of Congress today reintroduced an ambitious bill that would repeal Medicare's sustainable growth rate (SGR) formula for setting physician pay and gradually phase out fee-for-service (FFS) reimbursement.

One major difference this time around for the bipartisan bill, originally introduced in May 2012, is that its price tag appears considerably lower, making passage more likely.

When Reps. Allyson Schwartz (D-PA) and Joe Heck, DO (R-NV), proposed this legislation last year, the Congressional Budget Office (CBO) had estimated that repealing the SGR and merely freezing current Medicare rates for 10 years would cost roughly $320 billion.

Since then, the CBO has reduced that 10-year estimate on the basis of lower than projected Medicare spending on physician services for the past 3 years. In a budget forecast released yesterday, the agency put the cost of a 10-year rate freeze at $138 billion.

The immediate effect of the bill from Schwartz and Dr. Heck, titled the Medicare Physician Payment Innovation Act, would be to avert a Medicare pay cut of roughly 25% on January 1, 2014, that is mandated by the SGR formula. Instead, the bill maintains 2013 rates through the end of 2014.

After 2014, Medicare would begin to shift from FFS to a methodology that rewards physicians for the quality and efficiency of patient care. From 2015 through 2018, the rates for primary care, preventive, and care coordination services would increase annually by 2.5% for physicians for whom 60% of Medicare allowables fall into these categories. Medicare rates for all other physician services would rise annually by 0.5%.

Meanwhile, the bill calls on the Centers for Medicare & Medicaid Services (CMS) to step up its efforts to test and evaluate new models of delivering and paying for healthcare (experiments with medical homes, accountable care organizations, and bundled payments are already underway). By October 2017, CMS must give physicians its best menu of new models to choose from. Two menu options would allow some physicians unable to fully revolutionize to participate in a modified FFS scheme.

The entire article is here.

Impending rules will guide equality for mental health

By Kelly Kennedy
USA Today
Originally published February 6, 2013

Regulations to be issued this month on the type of mental health coverage insurers must provide under the 2010 health care law may elevate mental illness to the status it needs, mental health experts say.

"Mental health solutions aren't likely to have an impact on this kind of violence," said Jennifer Mathis, deputy legal director of the Bazelon Center for Mental Health Law. "But we have a broken mental health system, and this is an opportunity to rectify that. You take your opportunities where they are."

Since the shooting of 26 people at Sandy Hook Elementary School in Newtown, Conn., President Obama has signed several executive actions designed to identify and help those with mental illness.
He has called for a discussion about mental health and has vowed to issue final rules this month that extend mental health parity to everyone who has health insurance under the health care law, also known as the Affordable Care Act.

Those regulations would go into effect in January, and though the specifics of those rules are unknown, advocates have clear ideas of what they'd like to see parity look like.

"In a broad-speaking way, we want to see parity be about what outcomes are, not specific tit-for-tat," said Debbie Plotnick, senior director of state policy at Mental Health America, a non-profit group that promotes mental wellness.

The entire story is here.

Monday, February 18, 2013

Mindy McCready Dead: Country Singer Dies At 37

By Leigh Blickley
The Huffington Post
Originally published February 17, 2013

Mindy McCready was found dead in Heber Springs, Ark., on Sunday night, her brother confirms to the NY Daily News. She was 37.

A source tells E! News that neighbors reportedly heard gunshots at McCready's house and called the police. "She shot herself and the dog," the insider adds.

No other details have been released on her death, but the Daily News is reporting that it was an apparent suicide. NBC's TODAY reports, "The cause of death 'appears to be a single self-inflicted gunshot wound,' the Cleburne County (Ark.) Sheriff's Office said in a statement."

The entire story is here.

Four Common Antipsychotic Drugs Found to Lack Safety and Effectiveness in Older Adults

Science Daily
Originally published November 27, 2012

In older adults, antipsychotic drugs are commonly prescribed off-label for a number of disorders outside of their Food and Drug Administration (FDA)-approved indications -- schizophrenia and bipolar disorder. The largest number of antipsychotic prescriptions in older adults is for behavioral disturbances associated with dementia, some of which carry FDA warnings on prescription information for these drugs.

In a new study -- led by researchers at the University of California, San Diego School of Medicine, Stanford University and the University of Iowa, and funded by the National Institute of Mental Health -- four of the antipsychotics most commonly prescribed off label for use in patients over 40 were found to lack both safety and effectiveness. The results will be published November 27 in The Journal of Clinical Psychiatry.

The study looked at four atypical antipsychotics (AAPs) -- aripiprazole (Abilify), olanzapine (Zyprexa), quetiapine (Seroquel), and risperidone (Risperdal) -- in 332 patients over the age of 40 diagnosed with psychosis associated with schizophrenia, mood disorders, PTSD, or dementia.

"Our study suggests that off-label use of these drugs in older people should be short-term, and undertaken with caution," said Dilip V. Jeste, MD, Estelle and Edgar Levi Chair in Aging, Distinguished Professor of Psychiatry and Neurosciences, and director of the Stein Institute for Research on Aging at UC San Diego.

The entire story is here.

Thanks to Tom Fink for this information.

A Recent Study of Atypical Neuroleptics: “The Results of our Study are Sobering”

Sandra Steingard, M.D.
Mad In America
Originally published December 3, 2012

This week, MIA highlighted a recently published study of the four most commonly prescribed neuroleptics.  As noted in the post, the major outcome was that these drugs were not found to be effective or safe.

This important study, co-authored by Dilip Jeste the current president of the American Psychiatric Association, is worth reviewing in greater detail.

The study was modeled to capture clinical practice.  Entry to the study was broad and not limited to a specific diagnostic category.  It is characterized as a study of “older adults” and I admit to some chagrin that this meant anyone over 40.  Diagnoses included schizophrenia, schizoaffective disorder,  and psychosis associated with mood disorder, PTSD or dementia.  It was open to individuals who were either already taking an atypical neuroleptic or had a psychiatrist who was recommending this.


What was most striking to me is this line from the study: there was

“no significant change in psychopathology with any of the study atypical antipsychotics“

They did not even report the numbers in their report.

The entire information is here.

Thanks to Tom Fink for this information.

Sunday, February 17, 2013

Mislabeling Medical Illness

The Health Care Blog
Originally published on February 12, 2013

Many readers of my previous blog listing the 10 worst suggestions in DSM 5 were shocked that I failed to mention an 11th dangerous mistake — that DSM-5 will harm people who are medically ill by mislabeling their medical problems as mental disorder. They are absolutely right. I apologize for my previous failure to attend to this danger and hope it is not now too late to influence the process.

Adding to the woes of the medically ill could be one of the biggest problems caused by DSM-5. It will do this in two ways: 1) by encouraging a quick jump to the erroneous conclusion that someone’s physical symptoms are ‘all in the head’; and 2) by mislabeling as mental disorders what are really just the normal emotional reactions that people understandably have in response to a medical illness.

UK health advocate, Suzy Chapman, has closely monitored every step in the development of DSM-5. Her website is the best available resource for finding just about everything you need to know about DSM-5 and ICD-11. Ms Chapman sent me a troubling email that summarizes where DSM-5 has gone wrong and the many harmful consequences that will follow. More details are available at: ‘Somatic Symptom Disorder could capture millions more under mental health diagnosis’ (http://wp.me/pKrrB-29B )

Ms Chapman writes:
…The DSM-5 Somatic Symptom Disorders Work Group is planning to eliminate several little used DSM-IV Somatoform Disorders and replace them instead with an extremely broad new category that is likely to be wildly overused (‘Somatic Symptom Disorder’ — SSD).
A person will meet the criteria for SSD by reporting just one bodily symptom that is distressing and/or disruptive to daily life and having just one of the following three reactions to it that persist for at least six months: 1) ‘disproportionate’ thoughts about the seriousness of their symptom(s); or 2) a high level of anxiety about their health; or, 3) devoting excessive time and energy to symptoms or health concerns.
The entire blog post is here.

Focus on Mental Health Laws to Curb Violence Is Unfair, Some Say

The New York Times
Published: January 31, 2013

In their fervor to take action against gun violence after the shooting in Newtown, Conn., a growing number of state and national politicians are promoting a focus on mental illness as a way to help prevent further killings.

Legislation to revise existing mental health laws is under consideration in at least a half-dozen states, including Colorado, Oregon and Ohio. A New York bill requiring mental health practitioners to warn the authorities about potentially dangerous patients was signed into law on Jan. 15. In Washington, President Obama has ordered “a national dialogue” on mental health, and a variety of bills addressing mental health issues are percolating on Capitol Hill.

But critics say that this focus unfairly singles out people with serious mental illness, who studies indicate are involved in only about 4 percent of violent crimes and are 11 or more times as likely than the general population to be the victims of violent crime.

And many proposals — they include strengthening mental health services, lowering the threshold for involuntary commitment and increasing requirements for reporting worrisome patients to the authorities — are rushed in execution and unlikely to repair a broken mental health system, some experts say.

“Good intentions without thought make for bad laws, and I think we have a risk of that,” said J. Reid Meloy, a forensic psychologist and clinical professor at the University of California, San Diego, who has studied rampage killers.

The entire story is here.

Saturday, February 16, 2013

CMS Issues Sunshine Rule

By Joyce Frieden, News Editor, MedPage Today
Published: February 01, 2013

The Centers for Medicare and Medicaid Services issued a long-awaited rule Friday finalizing the details for a database that will list payments made to physicians by pharmaceutical and device manufacturers.

"You should know when your doctor has a financial relationship with the companies that manufacture or supply the medicines or medical devices you may need," Peter Budetti, MD, the agency's deputy administrator for program integrity, said in a statement. "Disclosure of these relationships allows patients to have more informed discussions with their doctors."

The rule, a provision of the Affordable Care Act known as the Physician Payments Sunshine Act, "finalizes the provisions that require manufacturers of drugs, devices, biologicals, and medical supplies covered by Medicare, Medicaid, or the Children's Health Insurance Program to report payments or other transfers of value they make to physicians and teaching hospitals to CMS," the statement explained. "CMS will post that data to a public website. The final rule also requires manufacturers and group purchasing organizations (GPOs) to disclose to CMS physician ownership or investment interests."

Data collection will start on Aug. 1, CMS said, noting that "Applicable manufacturers and applicable GPOs will report the data for August through December of 2013 to CMS by March 31, 2014 and CMS will release the data on a public website by Sept. 30, 2014. CMS is developing an electronic system to facilitate the reporting process."

The rule "is intended to help reduce the potential for conflicts of interest that physicians or teaching hospitals could face as a result of their relationships with manufacturers," the statement continued.

The American Medical Association responded cautiously to the release of the final rule. "The AMA will carefully review the new Physician Payment Sunshine Act rule," AMA President Jeremy Lazarus, MD, said in a statement. "Physicians' relationships with the pharmaceutical industry should be transparent and focused on benefits to patients ... As the rule is implemented, we will work to make sure physicians have up-to-date information about the new reporting process."

The entire story is here.

Path ordered to pay $800,000 to settle FTC privacy charges

By Shawn Knight
Originally published February 1, 2013

Social networking startup Path has been ordered to pay an $800,000 fine to the Federal Trade Commission in addition to other measures to settle a controversial privacy issue. The service was accused of using deceitful tactics to collect personal information from members’ mobile device address books and storing it locally on their servers – even from children.

The FTC levied the fine against Path for collecting personal information from children without parental consent. Path allegedly collected information from around 3,000 kids under the age of 13, a move that violated the Children’s Online Privacy Protection act.

The entire article is here.

Friday, February 15, 2013

Clergy are not doctors — and the U.S. has its own Savita Halappanavars

By Irin Carmon
Originally published February 7, 2013

The death of Savita Halappanavar — the woman who died of sepsis in Ireland after being denied her request for termination of a nonviable pregnancy — drew outrage and attention in the United States late last fall, but one crucial point was often missed. Even in America, where abortion is mostly legal, cases like Halappanavar’s are a known reality in Catholic hospitals.

Take one case detailed to medical sociologist Lori Freedman by the doctor involved. A woman 16 weeks pregnant with twins was diagnosed with a molar pregnancy, which can lead to cancer, and “didn’t want to carry the pregnancy further.” She went to the hospital with vaginal bleeding, but unluckily for her, it was a Catholic one. There, the ethics committee decided that a uterine evacuation was tantamount to abortion, because there was a slim chance one of the fetuses would survive.

According to another doctor who witnessed the situation, “The clergy who made the decision Googled molar pregnancy.”

The woman was transferred out, Freedman wrote in a recent study published in the American Journal of Bioethics Primary Research, “despite the fact that terminating a bleeding molar pregnancy is safer in the hospital setting due to a high risk of hemorrhage.” What Freedman learned tracked closely with her previous studies focused on doctors’ concerns about miscarriage care in Catholic hospitals in situations very much like Halappanavar’s. Many doctors told her they preferred to send patients elsewhere rather than navigate the ethics committee.

The tension between religious beliefs and denial of medical care is currently playing out in the courtroom battles over the contraceptive coverage requirements under Obamacare, and for years, in legislative battles over “conscience clauses” that allow medical providers to opt out of some procedures. But some doctors’ consciences are being violated in the opposite fashion: Their recommendations for what is best for the women’s health and life, and often the wishes of the women themselves, are being circumvented by ethics committees at ever-expanding Catholic hospitals.

The entire story is here.

Thanks to Gary Schoener for this article.

New Report Suggests 'Moral Realism' May Lead To Better Moral Behavior

Medical News Today
Originally published February 1, 2013

Getting people to think about morality as a matter of objective facts rather than subjective preferences may lead to improved moral behavior, Boston College researchers report in the Journal of Experimental Social Psychology.

In two experiments, one conducted in-person and the other online, participants were primed to consider a belief in either moral realism (the notion that morals are like facts) or moral antirealism (the belief that morals reflect people's preferences) during a solicitation for a charitable donation. In both experiments, those primed with moral realism pledged to give more money to the charity than those primed with antirealism or those not primed at all.

"There is significant debate about whether morals are processed more like objective facts, like mathematical truths, or more like subjective preferences similar to whether vanilla or chocolate tastes better," said lead researcher Liane Young, assistant professor of psychology at Boston College. "We wanted to explore the impact of these different meta-ethical views on actual behavior."

The entire story is here.

Moral realism as moral motivation: The impact of meta-ethics on everyday decision-making can be found here.

Thursday, February 14, 2013

As Suicides Rise in U.S., Veterans Are Less of Total

The New York Times
Published: February 1, 2013

Suicides among military veterans, though up slightly in recent years, account for a shrinking percentage of the nation’s total number of suicides — a result of steadily rising numbers of suicides in the general population, according to a report released on Friday by the Department of Veterans Affairs.

The report, based on the most extensive data the department has ever collected on suicide, found that the number of suicides among veterans reached 22 a day in 2010, the most recent year available.

That was up by 22 percent from 2007, when the daily number was 18. But it is only 10 percent higher than in 1999, according to the report. Department officials described the numbers as “relatively stable” over the decade.

In the same 12-year period, the total number of suicides in the country rose steadily to an estimated 105 a day in 2010, up from 80 in 1999, a 31 percent increase.

As a result, the percentage of the nation’s daily suicides committed by veterans declined to 21 percent in 2010, from 25 percent in 1999.

The entire story is here.

VA report: 22 veterans commit suicide each day

The number of veterans who commit suicide each day is more than 20 percent higher than previously estimated
By Kevin Freking
Originally published February 1, 2013

The number of veterans who commit suicide each day is more than 20 percent higher than the Department of Veterans Affairs has previously estimated, but the problem doesn’t appear to be getting worse for veterans compared to the rest of the country, according to a VA study released Friday.

Indeed, the overall percentage of suicides by veterans has declined in recent years. VA researchers say the trend suggests that efforts to reduce suicide among veterans may be having an effect.

About 22 veterans committed suicide each day in 2010. Previous estimates from the VA put the number at 18.

While much attention has been paid to suicides by veterans of Iraq and Afghanistan, the report indicates the problem is worse among older veterans. About 70 percent of veterans who commit suicide are over age 50.

The latest projections from the VA incorporate data from about two dozen states that recorded the cause of death on death certificates. Previous estimates focused only on those getting care from the VA’s hospitals and clinics. The department described the study as the most comprehensive it has ever taken on the issue. 

“We have more work to do, and we will use this data to continue to strengthen our suicide prevention efforts and ensure all veterans receive the care they have earned and deserve,” said VA Secretary Eric K. Shinseki.

Wednesday, February 13, 2013

Easing ADHD without meds

Psychologists are using research-backed behavioral interventions that effectively treat children with ADHD.

By Rebecca A. Clay
February 2013, Vol 44, No. 2
Print version: page 44

Because of his attention-deficit/hyperactivity disorder (ADHD), the 10-year-old boy rarely even tried to answer the questions on the math and language arts worksheets his fourth-grade teacher asked students to complete during class. Not only that, he often bothered the students who did.

Then the teacher made an important change to the boy's worksheets: She wrote the correct answers on them with invisible markers so that the boy could reveal the correct answer by coloring over the space as soon as he finished a question. The teacher also randomly inserted stars he could uncover by coloring and told him he would earn a reward for collecting four stars. The strategy paid off: The boy was soon answering every question and getting 84 percent of them correct.

Giving immediate feedback is just one of many simple and effective behavioral approaches to improving children's attention, says psychologist Nancy A. Neef, PhD, who described the invisible marker experiment in a chapter on treating ADHD she co-authored in the 2012 "APA Handbook of Behavior Analysis." With ADHD affecting an estimated 7 percent of American children ages 3 to 17, psychologists are developing behavioral interventions that parents, teachers and others can use to help kids focus and control their impulses. Others are conducting research that demonstrates that more exercise and longer sleep can help.

That's good news for kids, says Neef, who believes that parents, teachers and pediatricians are sometimes too quick to jump to prescribing medication for ADHD.

"Particularly in the case of stimulant medications, which are the most common treatment for ADHD, we don't know an awful lot about the long-term side effects," says Neef, a professor of special education at The Ohio State University.

And medication doesn't address problems related to children's academic performance and relationships with family members, peers and others. "Even though medication can be effective and very helpful, it's not a panacea," Neef says.

Behavioral interventions

Surprisingly, nonpharmacological approaches are also controversial, especially among the medical community.

"If you read the professional guidelines for psychiatrists or sometimes pediatricians, the treatment that is emphasized for kids with ADHD is a pharmacological one," says Gregory A. Fabiano, PhD, an associate professor of counseling, school and educational psychology at the State University of New York at Buffalo.

The entire story is here.

If Medications Don’t Work, Why Do I Prescribe Them Anyway?

By Steve Balt, Psychiatrist
Thought Broadcast Blog
Originally posted January 4, 2013

I have a confession to make.  I don’t think what I do each day makes any sense.

Perhaps I should explain myself.  Six months ago, I started my own private psychiatry practice.  I made this decision after working for several years in various community clinics, county mental health systems, and three academic institutions.  I figured that an independent practice would permit me to be a more effective psychiatrist, as I wouldn’t be encumbered by the restrictions and regulations of most of today’s practice settings.

My experience has strengthened my long-held belief that people are far more complicated than diagnoses or “chemical imbalances”—something I’ve written about on this blog and with which most psychiatrists would agree.  But I’ve also made an observation that seems incompatible with one of the central dogmas of psychiatry.  To put it bluntly, I’m not sure that psychiatric medications work.

Before you jump to the conclusion that I’m just another disgruntled, anti-medication psychiatrist who thinks we’ve all been bought and misled by the pharmaceutical industry, please wait.  The issue here is, to me, a deeper one than saying that we drug people who request a pill for every ill.  In fact, it might even be a stretch to say that medications never work.  I’ve seen antidepressants, antipsychotics, mood stabilizers, and even interventions like ECT give results that are actually quite miraculous.

But here’s my concern: For the vast majority of my patients, when a medication “works,” there are numerous other potential explanations, and a simple discussion may reveal multiple other hypotheses for the clinical response.  And when you consider the fact that no two people “benefit” in quite the same way from the same drug, it becomes even harder to say what’s really going on. There’s nothing scientific about this process whatsoever.

And then, of course, there are the patients who just don’t respond at all.  This happens so frequently I sometimes wonder whether I’m practicing psychiatry wrong, or whether my patients are playing a joke on me.  But no, as far as I can tell, I’m doing things right: I prescribe appropriately, I use proper doses, and I wait long enough to see a response.  My training is up-to-date; I’ve even been invited to lecture at national conferences about psychiatric meds.  I can’t be that bad at psychiatry, can I?

The entire blog post is here.

Tuesday, February 12, 2013

Heart risk link to SSRI antidepressants confirmed

BBC Health News
Originally posted January 30, 2013

Some but not all antidepressant drugs known as SSRIs pose a very small but serious heart risk, say researchers.

Citalopram and escitalopram, which fall into this drug group, can trigger a heart rhythm disturbance, a new study in the British Medical Journal shows.

UK and US regulators have already warned doctors to be extra careful about which patients they prescribe these medicines to.

And they have lowered the maximum recommended dose.

The UK's Medicines and Healthcare products Regulatory Agency (MHRA) says people with pre-existing heart conditions should have a heart trace before going on these drugs, to check for a rhythm disturbance known as long QT interval.

Experts reassure that complications are very rare and that in most cases the benefits for the patient taking the drug will outweigh the risks.

The entire story is here.

Thanks to Tom Fink for this story.

Measure would strengthen mental health-care system

By Brady Dennis and Paul Kane,
The bill would put in place standards for about 2,000 “federally qualified” community behavioral health centers, requiring them to provide such services as substance abuse treatment and 24-hour crisis care.

In return, facilities meeting criteria would be able to bill Medicaid for their services — a change intended to open the door to treatment for many more people and one that is estimated to cost about $1 billion over the next decade.

“There is an important gap here,” said Sen. Debbie Stabenow (D-Mich.), one of the bill’s main sponsors. She warned that too many people receive inadequate or no treatment and are at risk of their problems becoming more dangerous.

Sen. Roy Blunt (Mo.), the lead GOP sponsor of the measure, cited his state’s work in providing community health centers but also said that the recent shootings in Newtown, Conn., spotlighted shortcomings in mental health care that demand attention.

“We have a moment that works, and we have a model that works,” he said.

Additional Republican co-sponsors include Sens. Marco Rubio (Fla.) and Susan Collins (Maine). Other Democrats backing the legislation include Sens. Jack Reed (R.I.), Patrick J. Leahy (Vt.) and Barbara Boxer (Calif.).

The entire article is here.

Drowned in a Stream of Prescriptions

The New York Times
Published: February 2, 2013

Every morning on her way to work, Kathy Fee holds her breath as she drives past the squat brick building that houses Dominion Psychiatric Associates.

It was there that her son, Richard, visited a doctor and received prescriptions for Adderall, an amphetamine-based medication for attention deficit hyperactivity disorder. It was in the parking lot that she insisted to Richard that he did not have A.D.H.D., not as a child and not now as a 24-year-old college graduate, and that he was getting dangerously addicted to the medication. It was inside the building that her husband, Rick, implored Richard’s doctor to stop prescribing him Adderall, warning, “You’re going to kill him.”

It was where, after becoming violently delusional and spending a week in a psychiatric hospital in 2011, Richard met with his doctor and received prescriptions for 90 more days of Adderall. He hanged himself in his bedroom closet two weeks after they expired.

The story of Richard Fee, an athletic, personable college class president and aspiring medical student, highlights widespread failings in the system through which five million Americans take medication for A.D.H.D., doctors and other experts said.

Medications like Adderall can markedly improve the lives of children and others with the disorder. But the tunnel-like focus the medicines provide has led growing numbers of teenagers and young adults to fake symptoms to obtain steady prescriptions for highly addictive medications that carry serious psychological dangers. These efforts are facilitated by a segment of doctors who skip established diagnostic procedures, renew prescriptions reflexively and spend too little time with patients to accurately monitor side effects.

Richard Fee’s experience included it all. Conversations with friends and family members and a review of detailed medical records depict an intelligent and articulate young man lying to doctor after doctor, physicians issuing hasty diagnoses, and psychiatrists continuing to prescribe medication — even increasing dosages — despite evidence of his growing addiction and psychiatric breakdown.

The entire story is here.

Monday, February 11, 2013

Vignette 22: A Duty to Report?

Dr. Tell worked with a woman for several months on issues related to depression, anxiety, and relationship issues. During one session, the patient indicated that her boyfriend has lost interest in sex and became more involved with online pornography. While discussing these issues, the patient suddenly stopped talking. Dr. Tell allowed several moments to pass before asking the patient what was happening. 

The client indicated that she was hesitant to speak about the issue for fear of a breach of confidentiality. Dr. Tell reminded her about confidentiality and the laws in Pennsylvania that would override it. The client continued to struggle. She eventually blurted out that, during a heated discussion, her boyfriend indicated that looking at online pornography was not as bad as what his uncle did. She went on to detail how her boyfriend described how his uncle was involved in collecting and distributing child pornography but remained faithful to his aunt. The client's boyfriend expressed that she should never discuss this with anyone. The client asked if she could just give Dr. Tell the information about the uncle so that she could report it to the authorities and leave her out of the situation. The client is feeling very helpless and vulnerable about this bind. 

Dr. Tell explained that the alleged perpetrator was several times removed from their sessions and she did not believe that she had the obligation to report it. The client then asked if she could invite her boyfriend to the next session so that they could all discuss the information and the best way to handle the situation. 
Dr. Tell focused the client on her dilemma as well as the relationship issues with her boyfriend. Dr. Tell agreed to contact someone to discuss whether Dr. Tell had to report this information to the police or Child Protective Services. And, Dr. Tell agreed to determine whether or not reporting this information would put her client’s confidentiality at risk. She also agreed to think about the need to bring in the boyfriend, because inviting him to therapy will not necessarily help the situation.
Dr. Tell contacts you with the above scenario.
1. How would you feel if you were Dr. Tell?
2. How would you feel if you were the consultant?

3. Is Dr. Tell a mandated reporter in this situation?

4. As a mandated reporter, would Dr. Tell report place her client's confidentiality be at risk?
5. If Dr. Tell is not a mandated reporter, should Dr. Tell bring in the boyfriend gather more facts so that Dr. Tell can report the alleged crime?
6. Is the goal of therapy to help the client manage the situation or is the responsibility now on the psychologist to gather more information about the possible crimes committed with children?
7. Can the client contact Child Protective Services anonymously in this case?

8. Can the psychologist contact Child Protective Services anonymously, provided that the client supply the name and address of the uncle?

9.What should the psychologist do?

Does an 'A' in Ethics Have Any Value?

B-Schools Step Up Efforts to Tie Moral Principles to Their Business Programs, but Quantifying Those Virtues Is Tough

The Wall Street Journal
Originally published on February 6, 2013

Business-school professors are making a morality play.

Four years after the scandals of the financial crisis prompted deans and faculty to re-examine how they teach ethics, some academics say they still haven't gotten it right.

Hoping to prevent another Bernard L. Madoff-like scandal or insider-trading debacle, a group of schools, led by University of Colorado's Leeds School of Business in Boulder, is trying to generate support for more ethics teaching in business programs.

"Business schools have been giving students some education in ethics for at least the past 25 or 30 years, and we still have these problems," such as irresponsibly risky bets or manipulation of the London interbank offered rate, says John Delaney, dean of University of Pittsburgh's College of Business Administration and Katz Graduate School of Business.

He joined faculty and administrators from Massachusetts' Babson College, Michigan State University and other schools in Colorado last summer in what he says is an effort to move schools from talk to action. The Colorado consortium is holding conference calls and is exploring another meeting later this year as it exchanges ideas on program design, course content and how to build support among other faculty members.

But some efforts are at risk of stalling at the discussion stage, since teaching business ethics faces roadblocks from faculty and recruiters alike. Some professors see ethics as separate from their own subjects, such as accounting or marketing, and companies have their own training programs for new hires.

The entire story is here.

Sunday, February 10, 2013

iDoctor: Could a Smartphone be the future of Medicine?

Ethical Framework for the Use of Technology in Supervision

By LoriAnn S. Stretch, DeeAnna Nagel and Kate Anthony

Ethical and Statutory Considerations

Supervisors must demonstrate and promote good practice by the supervisee to ensure supervisees acquire the attitudes, skills, and knowledge necessary to protect clients. Supervisors and supervisees must research and abide by all applicable legal, ethical, and customary requirements of the jurisdiction in which the supervisor and supervisee practice.   The supervisor and supervisee must document relevant requirements in the respective record(s).  Supervisors and supervisees need to review and abide by requirements and restrictions of liability insurance and accrediting bodies as well.

Informed Consent

Supervisors will review the purposes, goals, procedures, limitations, potential risks, and benefits of distance services and techniques. All policies and procedures will be provided in writing and reviewed verbally before or during the initial session. Documentation of understanding by all parties will be maintained in the respective record(s).

Supervisor Qualifications

Supervisors will only provide services for which the supervisor is qualified.  The supervisor will provide copies of licensure, credentialing, and training upon request.  The supervisor will have a minimum of 15 hours of training in distance clinical supervision as well as an active license and authorization to provide supervision within the jurisdiction for which supervision will be provided. Supervisors providing distance supervision should participate in professional organizations related to distance services and develop a network of professional colleagues for peer and supervisory support.

Supervisee and Client Considerations

Supervisors will screen supervisees for appropriateness to receive services via distance methods. The supervisor will document objective reasons for the supervisee’s appropriateness in the respective record(s).  Supervisors will ensure that supervisees screen clients seeking distance services for appropriateness to receive services via distance methods. Supervisors will ensure that the supervisee utilizes objective methods for screening clients and maintains appropriate documentation in the respective record(s).

Supervisors will ensure that supervisees inform clients of the supervisory relationship and that all clients have written information on how to contact the supervisor.  Written documentation of the client acknowledging the supervisory relationship and receipt of the supervisor’s contact information should be maintained in the respective record(s). Supervisors will only advise the supervisee to provide services for which the supervisee is qualified to provide.
Clients and supervisees must be informed of potential hazards of distance communications, including warnings about sharing private information when using a public access or computer that is on a shared network.  Clients and supervisees should be discouraged, in writing, from saving passwords and user names when prompted by the computer.  Clients and supervisees should be encouraged to review employer’s policies regarding using work computers for distance services.

The entire story is here.

Saturday, February 9, 2013

Successful and Schizophrenic

The New York Times - Opinion
Published: January 25, 2013

THIRTY years ago, I was given a diagnosis of schizophrenia. My prognosis was “grave”: I would never live independently, hold a job, find a loving partner, get married. My home would be a board-and-care facility, my days spent watching TV in a day room with other people debilitated by mental illness. I would work at menial jobs when my symptoms were quiet. Following my last psychiatric hospitalization at the age of 28, I was encouraged by a doctor to work as a cashier making change. If I could handle that, I was told, we would reassess my ability to hold a more demanding position, perhaps even something full-time.

Then I made a decision. I would write the narrative of my life. Today I am a chaired professor at the University of Southern California Gould School of Law. I have an adjunct appointment in the department of psychiatry at the medical school of the University of California, San Diego, and am on the faculty of the New Center for Psychoanalysis. The MacArthur Foundation gave me a genius grant.

Although I fought my diagnosis for many years, I came to accept that I have schizophrenia and will be in treatment the rest of my life. Indeed, excellent psychoanalytic treatment and medication have been critical to my success. What I refused to accept was my prognosis.

The entire article is here.

Budding designer from Paramus left "suicide diary," according to newspaper report.

Englewood-Englewood Cliffs Patch
Originally posted February 7, 2013

A 22-year-old aspiring fashion designer originally from Paramus jumped off the George Washington Bridge Wednesday and left behind a list of five girls she did not want at her funeral, the New York Post reported.

Riders on a jitney bus saw Ashley A. Riggitano plunge from the New Jersey-bound lanes at around 4:40 p.m., the report said. She reportedly left a Louis Vuitton bag containing pages of notes in a "suicide diary" on the bridge walkway.

Riggitano was apparently bullied by friends in the fashion industry, according to the Post report. The girls banned from her funeral were reportedly from work and college.

“All my other ‘friends’ are in it for gossip,” she wrote in the letter, the Post reported. “Never there.”

Riggitano had attempted to commit suicide before, the newspaper reported.

The entire story is here.

Friday, February 8, 2013

Physicians and Malpractice Data

On Average, Physicians Spend Nearly 11 Percent Of Their 40-Year Careers With An Open, Unresolved Malpractice Claim

By Seth A. Seabury, Amitabh Chandra, Darius N. Lakdawalla, and Anupam B. Jena


The US malpractice system is widely regarded as inefficient, in part because of the time required to resolve malpractice cases. Analyzing data from 40,916 physicians covered by a nationwide insurer, we found that the average physician spends 50.7 months—or almost 11 percent—of an assumed forty-year career with an unresolved, open malpractice claim. Although damages are a factor in how doctors perceive medical malpractice, even more distressing for the doctor and the patient may be the amount of time these claims take to be adjudicated. We conclude that this fact makes it important to assess malpractice reforms by how well they are able to reduce the time of malpractice litigation without undermining the needs of the affected patient.

The research can be found here.

Thanks to Ken Pope for this information.

Medical malpractice: Why is it so hard for doctors to apologize?

Fixing a system built on blame and revenge will require bold ways of analyzing mistakes and a radical embrace of openness.

By Dr. Darshak Sanghavi
The Boston Globe
Originally posted on January 27, 2013

DANIELLE BELLEROSE WENT THROUGH HELL for two years trying to conceive, undergoing nine rounds of fertility treatments before she finally got pregnant with twins in late 2003. Shortly thereafter, the then 28-year-old nurse and Massachusetts native developed a complication that required months of bed rest at home. Suddenly, on a June night nearly three months before her due date, Danielle’s uterus began bleeding profusely. At 4:56 a.m. she had an emergency caesarean section at Beth Israel Deaconess Medical Center. Her daughters, Katherine and Alexis, entered the world weighing only about 3 pounds each.

Everything seemed to go well until the end of the first week. When Danielle and her husband, John, visited the unit, Alexis looked fine, but Katherine appeared mottled and pale. Panicked, Danielle found a nurse, and testing confirmed that Katherine was in profound shock due to necrotizing enterocolitis, a devastating intestinal complication that affects premature babies. The infant’s blood had turned acidic. An X-ray indicated a tear in her bowel. Just after midnight, Katherine was taken by ambulance to Children’s Hospital Boston.

Extremely premature infants such as Katherine and Alexis are entirely unprepared to live outside their mother’s womb. After only 30 weeks of gestation, the newborn heart isn’t fully developed, and the intestines can’t easily digest breast milk or formula. At that age, a baby’s brain often doesn’t remember to breathe. In 1963, when President John F. Kennedy’s son, Patrick, was born prematurely, the only thing to do was “monitor the infant’s blood chemistry,” as a newspaper of the day put it. Patrick Kennedy died after two days. By the time Katherine Bellerose was being cared for in the same hospital, however, new treatments had increased survival rates in very low birth weight infants to 96 percent.

Still, at Children’s Hospital, Katherine struggled to survive. Surgeons made a last-ditch effort to save her life by removing her colon, in the hope that this would halt further damage. She failed to improve. Multiple rounds of CPR were performed.

The rest of the story is here.

Thursday, February 7, 2013

Grief Over New Depression Diagnosis

By Paula Span
The New York Time Blog - The New Old Age
Originally published January 24, 2013

When the American Psychiatric Association unveils a proposed new version of its Diagnostic and Statistical Manual of Mental Disorders, the bible of psychiatric diagnoses, it expects controversy. Illnesses get added or deleted, acquire new definitions or lists of symptoms. Everyone from advocacy groups to insurance companies to litigators — all have an interest in what’s defined as mental illness — pays close attention. Invariably, complaints ensue.

“We asked for commentary,” said David Kupfer, the University of Pittsburgh psychiatrist who has spent six years as chairman of the task force that is updating the handbook. He sounded unruffled. “We asked for it and we got it. This was not going to be done in a dark room somewhere.”

But the D.S.M. 5, to be published in May, has generated an unusual amount of heat. Two changes, in particular, could have considerable impact on older people and their families.

First, the new volume revises some of the criteria for major depressive disorder. The D.S.M. IV (among other changes, the new manual swaps Roman numerals for Arabic ones) set out a list of symptoms that over a two-week period would trigger a diagnosis of major depression: either feelings of sadness or emptiness, or a loss of interest or pleasure in most daily activities, plus sleep disturbances, weight loss, fatigue, distraction or other problems, to the extent that they impair someone’s functioning.

The entire blog post is here.

Proposed DSM-5 Changes To Assessment Of Alcohol Problems

Medical News Today
Originally posted January 24, 2013

Proposed changes to the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will affect the criteria used to assess alcohol problems. One change would collapse the two diagnoses of alcohol abuse (AA) and alcohol dependence (AD) into a single diagnosis called alcohol use disorder (AUD). A second change would remove "legal problems," and a third would add a criterion of "craving." A study of the potential consequences of these changes has found they are unlikely to significantly change the prevalence of diagnoses.

Results will be published in the March 2013 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

"Updating the DSM could be advantageous if changes are made based on improvements in our understanding of a disorder's etiology, and/or if changes improve the accuracy of the diagnosis," said Alexis C. Edwards, assistant professor in the Department of Psychiatry at Virginia Commonwealth University School of Medicine as well as corresponding author for the study. "It would probably be a little disappointing if no changes were ever made, because that might suggest that we haven't made much headway in understanding and accurately diagnosing psychiatric disorders, despite all our efforts."

Wednesday, February 6, 2013

Legal showdown over gay conversion therapy waged in 2 states

At issue is whether states can ban the therapy on minors and whether counselors who conduct the therapy can be held liable for consumer fraud.

Posted Jan. 21, 2013

The patient’s anguish was clearly visible to psychiatrist Jack Drescher, MD, as the man spoke about his experience undergoing so-called gay conversion therapy.

Such therapy often is rooted in the claim that poor parenting is the cause of same-sex attractions, and that patients can change if they truly wish to be heterosexual. Methods of “repairing” patients can include instructing them to beat effigies of their mothers, touch themselves while naked in front of counselors and be subjected to mock locker room scenarios in which therapists scream anti-gay epithets at them.

After attending a religious-based therapy six times a week and experiencing no change in his sexuality, the patient was left feeling ashamed, depressed and suicidal, Dr. Drescher said.

“I felt sad[ness] and also anger, because sometimes a therapist would say things that were very hurtful to the patient,” said Dr. Drescher, an author and medical expert on gay conversion therapy. He also is president of the Group for the Advancement of Psychiatry, a think tank that analyzes issues in the field of psychiatry. “It’s distressing when you see professionals, regardless if they are well-meaning or otherwise, deliver intentional or inadvertent harm to a patient.”

Physicians and health professionals across the country have reported treating patients for the problems they have after conversion therapy. In recent years, physician organizations including the American Medical Association have developed policy opposing the use of “reparative” or “conversion” therapy that the AMA describes as “based upon the assumption that homosexuality per se is a mental disorder or … that the patient should change his/her homosexual orientation.” The potential serious risks of reparative therapy include depression, anxiety and self-destructive behavior, said an American Psychiatric Assn. position statement.

The entire story is here.

Tuesday, February 5, 2013

Why We Should Talk About the Football Coach's Salary When Faculty are Let Go Read

by John Warner
Inside HigherEd - Blog - Just Visiting
Originally published January 23, 2013

Bowling Green State University recently announced that it would be cutting 100 faculty positions for next fall, more than 10% of the total number of full-time faculty.

I found out this news via Facebook, which really does seem to be the source (along with Twitter) of the majority of news and information that crosses my mental desk on any given day. A debate/discussion cropped up underneath the posting, and as happens someone invoked the salaries of football coaches, and how it seems unfair that 100 teachers will lose their jobs when coaches are making so much.

There was a debate/discussion about this, and it was generally agreed that maybe it was too simplistic or counterproductive to lament these imbalances as they are a fact of the way universities operate. Academics and athletics are separate, football programs bring in money that they get to use for themselves, and in the end, these realities are just a reflection of society’s values.

I agree that the situation at BGSU is a reflection of society’s values, which is why I think we need to bring up football and athletic departments every time faculty are cut, or furloughed, or denied raises for years on end, or we’re told that the treatment of adjunct faculty is “unlikely to change.”

The entire story is here.

Monday, February 4, 2013

Physician Study Finds Similar Outcomes From In-Person, Telehealth Consultations

By Jonathan Field
Managing Editor - The Institute for HealthCare Consumerism

Thanks to health care reform and technological innovations in the private sector, the telehealth market is booming. And it is having a direct impact on the physician-patient relationship and on the health costs associated with an employer-sponsored health plan.

The industry predicts continued, strong growth. According to a recent market analysis by IMS Research, the telehealth market will grow by 55 percent in 2013 after growing only 5 percent from 2010 to 2011 and 18 percent from 2011 to 2012. And a 2012 report by BCC Research, the Wellesley, Mass.-based market research firm, predicted that the global telehealth market was expected to double from $11.6 billion in 2011 to over $27 billion in 2016.

InMedica, leading independent provider of market research and consultancy to the global medical electronics industry, predicts that in by 2017 the telehealth market will reach 1.8 million patients -- up from 300,000 in last year. The research firm attributes growth to four sectors of demand: federal, provider, payer and patient. For more details on the projected growth of telehealth market, view InMedica's new report The World Market for Telehealth – An Analysis of Demand Dynamics – 2012.

The entire article is here.