How An Ethically Challenged Researcher Found A Home at the University of Miami

By Paul Thacker

Forbes

Dr. Charles Nemeroff

Three weeks ago, the National Institutes of Health announced new rules to govern federally-funded researchers and their financial conflicts of interest. Three years in the making, the policy will affect over 38,000 scientists at 2000 organizations as the NIH attempts to ensure that biomedical research, paid with taxpayer dollars, remains objective.  (See our prior blog post.)

But none of these changes might have happened were it not for Dr. Charles Nemeroff.

A renowned chairman of psychiatry at Emory University, Nemeroff was a proponent for drugs sold by GlaxoSmithKline, such as the antidepressant Paxil. While earning hundreds of thousands of dollars jetting around the country and giving talks about Paxil to doctors at fancy restaurants, Nemeroff also managed a multi-million dollar grant from the NIH to research drugs under development by Glaxo.

The ensuing scandal became central to an investigation by Senator Charles Grassley into undisclosed payments from companies to prominent physicians—a practice that puts patients at risk and drives up healthcare costs. As Grassley’s lead investigator on the matter, I had a ringside seat as arguably the most powerful psychiatrist in the country was forced from prominence, eventually leaving Emory.

At my new job with the Project On Government Oversight (POGO), a government watchdog, I have continued to study the cozy relationships between physicians and corporations.  I also observed as Nemeroff left Emory for a new job at the University of Miami which has a medical school operating under financial strain. But why would this school snatch up a physician with such a history?

According to new emails and other materials shown to me, UM officials had serious concerns about Nemeroff’s history of ethical blunders. However, these emails suggest that Nemeroff’s perceived ability to raise money trumped those concerns. At one point while negotiating with UM for a job, Nemeroff even dangled the possibility of a new funder for the school if he was hired. These emails imply that, despite new federal rules, the public must remain vigilant to ensure that medicine is practiced with the highest regard for ethics and patient safety.

Officials at UM did not respond to detailed and repeated questions about the emails, which include communications by UM President Donna Shalala, who is now facing public scrutiny over a separate ethics scandal involving UM’s football program.

The entire story can be found here.

Maryland State Board of Physicians v. Eist

Patient Privacy vs. Disciplining Doctors

By Jonathan E. Montgomery

Martindale.com

Originally published June 21, 2011

This January, Maryland's highest court ruled in Board of Physicians v. Eist, that health care practitioners must timely disclose patient medical records to Maryland's Board of Physicians pursuant to a Board subpoena, or face sanctions, even if the patient involved objects to the disclosure.

In this case, Dr. Eist, a psychiatrist, became the subject of a Board investigation after the estranged husband of one of his patients accused Dr. Eist of, among other things, overmedicating the patient. The Board demanded the patient's medical records, but Dr. Eist initially withheld the records when his patient refused to give consent to the disclosure. Dr. Eist believed that he should wait until the Board and his patient settled their privacy dispute.

The entire summary of the case can be found here.

The entire opinion can be read here.

One issue from this case stems from the psychiatrist’s choice of counsel.  Apparently, though a competent attorney, Dr. Eist’s lawyer did not seem to grasp fully how to proceed when dealing with Maryland's Board of Physicians.

One major benefit to being a PPA member is to subscribe to our Legal Consultation Plan.  For $150 per year, a member has access to three hours of time from an attorney who is also a psychologist and understands the workings of the Pennsylvania State Board of Psychology.

One in 10 suicides is among people with a physical illness

By Anne Gulland
BMJ 2011; 343:d5464

A report on the link between suicide and physical ill health has found that one in 10 people who take their own life is chronically or terminally ill.

The report, by think tank Demos, is one of the first such comprehensive studies to look at the links between suicide and physical ill health. It says that the figure, which came from coroners and primary care trusts (PCTs), is likely to be a substantial underestimate because coroners do not always include the relevant health information with their inquest reports.

Demos believes that the findings provide strong evidence that people with chronic and terminal illnesses should be regarded as a high risk group for suicide and should be given better “medical, practical, and psychological support.”

Demos believes that the findings provide strong evidence that people with chronic and terminal illnesses should be regarded as a high risk group for suicide and should be given better "medical, practical, and psychological support."

<snip>

The government launched a consultation on suicide in July which identified five high risk groups for suicide: people in the care of mental health services (1200 suicides a year); people in the criminal justice system (80 suicides in prison a year); adult men aged under 50 (2000 suicides a year); people with a history of self harm (950 suicides a year), and occupational groups such as doctors, nurses, and farmers.

There were 4390 suicides in England in 2009, which, using Demos's calculation, would mean that more than 400 of these were among people with a chronic or terminal illness.

Demos believes that this group should be identified as high risk.

<snip>

Louise Bazalgette, author of the report, said it was important that doctors treating people with a chronic or terminal illness were aware of the issue.

"Doctors should be thinking about the possibility that a person with chronic health problems may be depressed and struggling. They should ask them if they ever feel suicidal," she said.

<snip>

Simon Gillespie, chief executive of the Multiple Sclerosis Society, said: "There is a big difference between someone wanting to end their life having explored and received every care option, and someone giving up hope because they feel they have nothing available to them. The right care and support can make a huge difference to an individual's life."

Clare Wyllie, head of policy and research at the Samaritans, said it was important that a suicide prevention strategy was implemented locally.

"It is vital that commissioners of local NHS, social care and public health services recognise that poor physical health and poor mental health are often closely linked [and] that depression is often undiagnosed in people with poor physical health," she said.

Thanks to Ken Pope for this information.

New emotion detector can see when we're lying

By Hamish Pritchard

Science Reporter, BBC News

A sophisticated new camera system can detect lies just by watching our faces as we talk, experts say.

The computerised system uses a simple video camera, a high-resolution thermal imaging sensor and a suite of algorithms.

Researchers say the system could be a powerful aid to security services.

It successfully discriminates between truth and lies in about two-thirds of cases, said lead researcher Professor Hassan Ugail from Bradford University.

The system, developed by a team from the universities of Bradford and Aberystwyth in conjunction with the UK Border Agency, was unveiled today at the British Science Festival in Bradford.

This new approach builds on years of research into how we all unconsciously, involuntarily reveal our emotions in subtle changes of expression and the flow of blood to our skin.

We give our emotions away in our eye movements, dilated pupils, biting or pressing together our lips, wrinkling our noses, breathing heavily, swallowing, blinking and facial asymmetry. And these are just the visible signs seen by the camera.

 

The entire story can be read here.

Day Care Centers Using GPS To Track Kids On Outings, Sweden

By Catharine Paddock, PhD
Medical News Today

Some day care centers in Sweden are starting to use GPS and other electronic devices to keep track of kids when they go on supervised outings, according to an Associated Press report from Stockholm on Wednesday. Some have welcomed the idea as a practical solution, while others say it raises ethical concerns and invades children's privacy.

Par Strom, an author and commentator who specializes in the evolution of IT and its consequences for businesses, individuals and society, told Swedish news agency Tidningarnas Telegrambyrå (TT) he could see both sides of the argument about using technology to track kids, and was personally in two minds about it.

"On the one hand I can see the practical advantages in some situations. At the same time you get children used to constant surveillance at a very young age," said Strom.

The concerns are sufficient to raise the interest of Sweden's Data Inspection Board, who say they are likely to investigate the matter. The Board works to protect individual privacy in the information society. Their team leader, Eric Janzon, said the system could be "quite harmless", or it could "affect aspects of privacy".

For instance, there could be problems around storing personal data, or details of a person's whereabouts.

"It depends on what kind of information you feed into the system and the purpose of the use," said Janzon.

And even if it is initially developed for a good purpose, it could later be misused, he added.

Some parents are concerned that the technology is a means to replace staff at day care centers. Others are also worried about the ethical implications, and whether putting children under close surveillance could affect their sense of privacy as they get older.

But the day care centers appear to see it as a very useful practical device.

One day care center principal told the Associated Press they use the devices when they take the children on supervised excursions in the forest. The children wear a special vest that incorporates a transmitter, allowing staff to see where they are on a screen.

Monica Blank-Hedqvist, who runs a center in the city of Borlange, said the system is "excellent, it has been only positive for us".

She said they use it as extra security: they have three supervisors for 20 children, and the system quickly tells them when any children stray too far.

One of the companies supplying GPS devices is Purple Scout. Their spokesman said they did not store personal information, and they see the trackers as an aid to staff, not a replacement. They are currently testing their system at a day care center in the south of Sweden, but already have orders from many private centers, he said.

But some parents would prefer the money was used to pay for more staff. That was also the opinion of Malin Wollin, a columnist with the Swedish tabloid Aftonbladet. Wollin, who has three children, said it was a shame the money and energy was not going on salaries instead, noting that technology can sometimes "play up": anyone who has a cell phone or a computer knows this, she said.

The idea of tracking kids with GPS is not new, and has been raising controversy ever since the devices started appearing on websites, with benefits statements designed to bring peace of mind to anxious parents.

The entire story can be found here.

When Your Therapist Is Only a Click Away

By Jan Hoffman
The New York Times

THE event reminder on Melissa Weinblatt’s iPhone buzzed: 15 minutes till her shrink appointment.

She mixed herself a mojito, added a sprig of mint, put on her sunglasses and headed outside to her friend’s pool. Settling into a lounge chair, she tapped the Skype app on her phone. Hundreds of miles away, her face popped up on her therapist’s computer monitor; he smiled back on her phone’s screen.

She took a sip of her cocktail. The session began.

Ms. Weinblatt, a 30-year-old high school teacher in Oregon, used to be in treatment the conventional way — with face-to-face office appointments. Now, with her new doctor, she said: “I can have a Skype therapy session with my morning coffee or before a night on the town with the girls. I can take a break from shopping for a session. I took my doctor with me through three states this summer!”

And, she added, “I even e-mailed him that I was panicked about a first date, and he wrote back and said we could do a 20-minute mini-session.”

Since telepsychiatry was introduced decades ago, video conferencing has been an increasingly accepted way to reach patients in hospitals, prisons, veterans’ health care facilities and rural clinics — all supervised sites.

But today Skype, and encrypted digital software through third-party sites like CaliforniaLiveVisit.com, have made online private practice accessible for a broader swath of patients, including those who shun office treatment or who simply like the convenience of therapy on the fly.

One third-party online therapy site, Breakthrough.com, said it has signed up 900 psychiatrists, psychologists, counselors and coaches in just two years. Another indication that online treatment is migrating into mainstream sensibility: “Web Therapy,” the Lisa Kudrow comedy that started online and pokes fun at three-minute webcam therapy sessions, moved to cable (Showtime) this summer.

“In three years, this will take off like a rocket,” said Eric A. Harris, a lawyer and psychologist who consults with the American Psychological Association Insurance Trust. “Everyone will have real-time audiovisual availability. There will be a group of true believers who will think that being in a room with a client is special and you can’t replicate that by remote involvement. But a lot of people, especially younger clinicians, will feel there is no basis for thinking this. Still, appropriate professional standards will have to be followed.”

The pragmatic benefits are obvious. “No parking necessary!” touts one online therapist. Some therapists charge less for sessions since they, too, can do it from home, saving on gas and office rent. Blizzards, broken legs and business trips no longer cancel appointments. The anxiety of shrink-less August could be, dare one say ... curable?

Ms. Weinblatt came to the approach through geographical necessity. When her therapist moved, she was apprehensive about transferring to the other psychologist in her small town, who would certainly know her prominent ex-boyfriend. So her therapist referred her to another doctor, whose practice was a day’s drive away. But he was willing to use Skype with long-distance patients. She was game.

Now she prefers these sessions to the old-fashioned kind.

But does knowing that your therapist is just a phone tap or mouse click away create a 21st-century version of shrink-neediness?

The entire story can be read here.

Nearly all U.S. doctors are now on social media

By Pamela Lewis Dolan
amedness.com

The number of physicians using sites such as Facebook and Twitter has grown so quickly that Gabriel Bosslet, MD, realized the moment his study on physician social media use appeared in June that it already was out of date.

The data, collected by Dr. Bosslet between February and May 2010 and posted more than a year later on the Journal of General Internal Medicine site, found that 41.6% of doctors use social media sites.

However, between April and May 2011, research and consulting firm Frost & Sullivan found that 84% of doctors use social media for personal purposes. Then in August, nearly 90% of physicians reported that they used at least one social media site personally, according to a survey by the online physician learning collaborative QuantiaMD.

By those numbers, physicians are well ahead of the general adult population -- 65% of the general public use social media, according to a study published in August by the Pew Internet & American Life Project.

"The rise in social media has been so meteoric," said Dr. Bosslet, an internist at Indiana University Health and an affiliate faculty member at the Charles Warren Fairbanks Center for Medical Ethics in Indianapolis, which sponsored his research. The time that passed between data collection to his study's results being posted was like a "generation later," he said.

However, although physicians appear to be embracing social media, they are still feeling their way around it. According to QuantiaMD, 87% of physicians make personal use of social media, but a lesser amount, 67%, use it professionally. And one thing that hasn't changed during those 18 months is the lack of patient-physician communication on social media.

One-third of the QuantiaMD survey respondents said they had received a friend request from a patient on Facebook. Three-quarters of the physicians declined those invitations.

"There is a real reticence on the part of many physicians to use social media, or even email for that matter, to communicate with patients," said Nancy Fabozzi, health care market research and competitive intelligence specialist with Frost & Sullivan. Not only are physicians worried about liability and privacy issues, but also "there's not enough hours in the day, quite frankly," she said.

The entire story can be found here.

5 ways to manage your online reputation

By Pamela Lewis Dolan amednews staff. Posted Sept. 12, 2011

Even if some physicians themselves are not online, their names, comments on their style of practice, and complaints or compliments about them probably are.

All of the online content devoted to a particular physician could negatively impact his or her reputation, and subsequently his or her business, if steps aren't taken to manage that content and -- when necessary -- defend it. This is often referred to as online reputation management.

Online reputation management has become big business, as evidenced by the number of radio and online ads offering to help physicians. But physicians can manage their own reputations, help build positive ones, and prevent negative content from turning into a crisis that needs to be dealt with professionally.

As quickly as online content can spread, especially in the age of social media, experts say online reputation management should be a key component to any business plan.

"The best defense in these cases is good offense," said Scott Sobel, president of Media and Communications Strategy, a Washington-based public relations firm specializing in crisis management.

Christian Olsen, vice president of Levick Strategic Communication's digital and social media practice, said social media has changed the dynamics of reputation management, because in addition to physicians communicating with their patients, their patients are now communicating with one another on social media websites.

For most physicians, there are five simple steps they can take to manage and maintain a good reputation online. For others, managing their online reputations may require more time and expertise than they have available.

One: Google yourself

Olsen said many make the mistake of thinking that because they don't have a website or are not involved in social media they are not online. "It just means your voice is not being heard in a conversation about you," he said.

The first step in managing a reputation is knowing what there is to manage. Reputation management experts recommend that physicians conduct Google searches on themselves at least once a month, preferably more often. Things can spread quickly online, so seeing what content is there on a regular basis will help doctors stay ahead of a potential crisis. It's also a good way to see what positive things are being said about you, which you may be able to build on.

Steven Wyer, managing director of Reputation Advocate Inc. and author of the book Violated Online, said physicians should set up alerts on Google and Yahoo. These alerts work by registering keywords, such as a name, that the search engines will use to comb the Internet looking for any new mention of those keywords on blogs, websites, online forums and other sites. When it finds a new mention, it will send an email detailing where the keywords were mentioned, what was said and a link to the website.

The mistake many physicians make, however, is to not include all reasonable variations of their name in an alert, Wyer said. For example, John Smith, MD, could have several variations, including Dr. John Smith, Dr. John C. Smith, Dr. John Smith, MD, etc. Alerts for a handful of those variations should be set up.

Two: Correct mistakes and false information

The easiest places to start are websites that show up high in Google searches. Those sites are likely to be physician finder or rating sites or health plan physician finders. The sites often include wrong or outdated contact information and incomplete biographical and educational history.

The entire story can be found here.

Suicide Draws Attention to Bullying of a Gay Teen

By Anahad O'Connor
The New York Times



Five months ago, Jamey Rodemeyer, a Buffalo junior high school student, got on his webcam and created a video urging other gay teenagers to remain hopeful in the face of bullying.

The 14-year-old spoke of coming out as bisexual and enduring taunts and slurs at school. And he described, in at times desperate tones, rejection and ridicule from other teenagers.

Jamey made the video as part of the It Gets Better project, a campaign that was started last fall to give hope to bullied gay teenagers. “All you have to do is hold your head up and you’ll go far,” he said. “Just love yourself and you’re set. … It gets better.”

But for Jamey, the struggle apparently was just too much. This week his parents announced that their son was found dead, an apparent suicide. He didn’t leave a note, but his parents said he had endured “constant taunting, from the same people over and over.” They added that his school had intervened to help, and that Jamey appeared to be benefiting from counseling.

News that a bullied teenager had succumbed to the very pressures he urged others to resist came as a shock to supporters of the It Gets Better project. And it provided a sobering reminder that bullied teenagers who appear to be adjusting may still be in trouble.

Dan Savage, the advice columnist and co-founder of It Gets Better, noted on his blog on Tuesday that Jamey’s death showed that “sometimes, the damage done by hate and by haters is simply too great.”

It sounds like Jamey had help — he was seeing a therapist and a social worker and his family was supportive — but it wasn’t enough. Whatever help Jamey was getting clearly wasn’t enough to counteract the hatred and abuse that he had endured since the fifth grade, according to reports, or Jamey’s fears of having to face down a whole new set of bullies when he started high school next year.

As suicides among lesbian, gay, bisexual and transgender teenagers have gotten more attention in the past year, researchers have sought to identify the factors that play the largest role. One study published in the journal Pediatrics in May, which looked at nearly 32,000 teenagers in 34 counties across Oregon, found that gay and bisexual teenagers were significantly more likely to attempt suicide than their heterosexual peers. The risk of an attempt was 20 percent greater among gay teenagers who lacked supportive social surroundings, like schools with gay-straight alliance groups or school policies that specifically protected gay, lesbian and bisexual students.

An editorial accompanying the study said the findings pointed to the need for schools to adopt policies that create “more supportive and inclusive surroundings.”

“By encouraging more positive environments,” the report stated, “such policies could help reduce the risk of suicide attempts not only among LGB students, but also among heterosexual students.”

Watch Jamey’s It Gets Better video above.

The entire story was found here.

This story captured the attention of Lady Gaga, gay rights activist and a supporter of anti-bullying programs.  Lady Gaga dedicates a song to Jamey.