Supervising the Countertransference Reactions of Case Managers

Supervising the Counter Transference of Case Managers

This chapter is found in the public domain.

Need to heal thyself?

Up to a third of all graduate students are coping with mental health problems alongside the demands of school. To whom can they turn for help?

By Cassandra Willyard

gradPSYCH

Print version: page 28

The last six years of graduate school haven't been easy for Gretchen Foster (not her real name), who describes herself as a "high-achiever who wants to do everything right." Her clinical psychology program was exceedingly competitive, and she had trouble figuring out the complex politics of her department. Foster often had more work than she could handle, so she had to let some assignments go unfinished. And being new to the area, she had few friends outside of the department.

Those issues might sound familiar to many graduate students, but they were especially trying for Foster, who was diagnosed with an anxiety disorder at age 17. "I would push myself really hard and feel sort of like I had exhausted my supply of energy," she says. Medication helped her cope, but some days the anxiety overwhelmed her. "I would just have to go home and give up the day and know that there was no way I would be able to get work done," she says. Foster feared that those lost days would cause her to fall behind her peers, and she felt frustrated with herself.

Trying to handle grad school's heavy workload while still having a social life and maintaining a healthy lifestyle can be enough to stress anyone out, says John C. Norcross, PhD, a psychology professor at the University of Scranton in Pennsylvania who studies self-care and personal therapy among psychologists. These challenges can be especially daunting for students suffering from a mental illness, he notes.

"Most studies of full-time doctoral students show they are routinely working 60-plus hours [a week]," he says. "And when you're working that many hours, self-care tends to plummet."

Just how prevalent mental health problems are among graduate students is an open question. Only a few surveys have been conducted, and the magnitude of the problem appears to vary from school to school, depending in part on how they define mental health issues.

A 2008 survey at the University of California–Irvine, for example, found 17 percent of students reported having a serious mental disorder and nearly 30 percent reported having a mental health concern that affected their well-being or academic performance. A survey from 2006 at Berkeley found that 45 percent of graduate students polled said they had a mental health issue that affected their well-being or academic performance, and almost 10 percent of respondents reported they had considered suicide in the past year.

The entire article is here.

Medical Academics Could Be Legally Liable for Ghostwritten Articles

By Josh Fischman

The Chronicle of Highe Education

Originally published January 24, 2012

Condemnation by ethicists and loss of grant money are not the only penalties facing academics who put their names on medical-journal articles they didn't write. Personal-injury lawyers have them in their sights now, too.

In an article published Tuesday in the journal PLoS Medicine, the authors laid out three possible areas of liability, including the federal anti-kickback statute, which can carry prison time plus fines of up to $250,000.

Researchers at major universities, including Brown, Emory, Harvard, Stanford, Tufts, and Yale, have been accused in recent years of signing their names to medical-journal articles that were written by others, articles that promoted the benefits of various medications and were produced under the auspices of pharmaceutical companies trying to boost their products. Last year The Chronicle reported that a University of Pennsylvania psychiatry professor accused five other academics of signing an article that was ghostwritten for the maker of the antidepressant Paxil and made unsupported claims for it.

"By lending his name, the author is contributing to fraud," says Bijan Esfandiari, one of the authors of the PLoS Medicine article. "And the ghostwriter is involved in the conspiracy as well."

Mr. Esfandiari is a lawyer with the firm of Baum, Hedlund, Aristei & Goldman in Los Angeles. ("For 25 years we have championed death and injury claims for thousands of clients nationwide," reads the firm's Web site.) His co-authors are Xavier A. Bosch, a professor in the department of medicine at the University of Barcelona, and Leemon McHenry, a lecturer and specialist in bioethics in the philosophy department at California State University at Northridge.

The entire story is here.

I Disclose ... Nothing

The Hard Truths About Disclosure
By Elisabeth Rosenthal
The New York Times Sunday Review
Originally Published January 22, 2012

IN New York and a growing number of American cities, diners are encountering sanitary grades in restaurants’ windows — A, B or C. That system is an example of helpful disclosure, researchers say: information that is simple and comprehensible, important to recipients and easily acted upon. I recently chose between outwardly identical Japanese noodle shops on East Ninth Street in Manhattan based on the system, walking into the A rather than the B.

But as greater disclosure has become the go-to solution for a wide range of problems — from unethical campaign financing to rising corporate carbon emissions — it has often delivered lackluster results, researchers say.

Just last week, the Obama administration announced plans to require drug companies to disclose a wide variety of payments and gifts to doctors, from speaking fees to the purchase of breakfasts for office staffs, in the hope of reducing commercial influence on prescribing practices. President Obama has promised to run the most open, transparent administration in history. But is more disclosure the solution?

If recent history serves as a guide, disclosure laws — meant to elucidate — do not necessarily lead to greater transparency or prevent the things they were meant to deter. Every holder of a subprime mortgage that is now underwater once signed an elaborate disclosure statement required by the Truth in Lending Act describing precisely the risky terms of their loan. Likewise, “super PACs” in the presidential campaign are technically compliant with financial disclosure laws, but have so far proved successful at hiding many of the sources of their money.

Everyone agrees that openness is a virtue in a democracy. So what is going wrong?

One fundamental problem is that disclosure requirements merely get information onto the table, but themselves demand no further action. According to political theory, disclosure is both a citizen’s right and a tool to ensure good government and consumer protection, because it provides information that leads to informed decisions. Instead, disclosure has often become an endpoint in the chain of responsibility, an act of compliance with the letter of the law rather than the spirit of transparency.

“In the beginning, disclosure was a means to an end, and now it’s often an end in itself,” said Kevin P. Weinfurt, professor of psychiatry and behavioral science at Duke University. “People think, ‘If we’ve disclosed we’ve fulfilled our responsibilities.’ ”

The entire story is here.

From neural ‘is’to moral ‘ought’:what are the moral implications of neuroscientific moral psychology?

From Neural 'is' to moral 'ought': What are the Moral Implications of Neuroscientific Moral Psychology?

Johnson & Johnson settles Texas lawsuit for $158M

AUSTIN, Texas (AP) — Texas and a subsidiary of health care giant Johnson & Johnson reached a $158 million settlement in a Medicaid fraud lawsuit Thursday, allowing the drugmaker to pay a fraction of the potential $1 billion in penalties and fines that state officials had initially sought.

The lawsuit was one of dozens of state and federal cases alleging that the company committed fraud by making false or misleading statements about the safety, cost and effectiveness of the expensive anti-psychotic medication Risperdal, and improperly influencing officials and doctors to push the drug.

Janssen Pharmaceuticals Inc., one of the J&J subsidiaries that had been sued, said in a statement it will pay the money to fully resolve all claims in Texas. The company said it is not admitting any liability or fault with the settlement.

Texas Attorney General Greg Abbott, who initially called on the company to repay $579 million that the state's Medicaid program had spent on Risperdal prescriptions plus up to $500 million in penalties, called the settlement a warning to drugmakers.

But analysts called the $158 million figure a victory for J&J, which made billions off Risperdal, because the deal allowed the company to avoid a much larger verdict in a state with a reputation as an easy place to win big jury awards.

The entire story is here.

Physician Guilty of Medicare Fraud Put Patients at Risk

By Robert Lowes

Medscape Medical News

Published January 18, 2012

A stiff prison sentence handed down to a physician in Los Angeles, California, last week for his role in a massive Medicare scam highlights how a seeming burlesque of medicine posed a danger to patients.

Alexander Popov, MD, was sentenced to 8 years and 1 month in prison in a federal court in Sacramento, California, after a jury last year found him guilty of conspiring to — and committing — healthcare fraud. An indictment issued in 2010 stated that Dr. Popov and 4 other physicians allowed a man named Vardges Egiazarian, who owned 3 clinics in the California cities of Carmichael, Richmond, and Sacramento, to submit Medicare claims in their names. Dr. Popov took on the role of co-owner and practitioner at the Sacramento clinic but never saw a patient there, according to federal prosecutors.

Over the course of 2 and a half years, Dr. Popov and the other physicians submitted more than $5 million worth of bogus claims to Medicare for nonexistent or unnecessary services, of which they received $1.7 million. The physicians' share of the take was 20% of what was paid out under their Medicare provider number.

In a sentencing memo filed in the case, federal prosecutors credit Dr. Popov and the other conspirators with doing "everything necessary to establish and operate a health clinic, with the exception of actual healthcare." As part of their hustle, they paid "cappers" to recruit and transport patients to the clinics, and the patients themselves received $100 each for showing up — a kind of reverse copay.

The patients, who were predominantly elderly immigrants who did not speak English, received little if any medical care during their visits. Clinic employees nevertheless recorded in their charts that they had received a comprehensive exam and a broad array of diagnostic tests. Staff would plug in off-the-shelf test results or would run tests on themselves and use those numbers. Dr. Popov, who lived in Los Angeles, saw none of these patients in person, but signed the charts anyway, according to prosecutors.

The entire story can be found here.

Small medical practices greatly at risk for data breaches

They often lack sophisticated technology to deter thieves, making them bigger targets.

By PAMELA LEWIS DOLAN, amednews staff. Posted Jan. 16, 2012.

Data breach experts are issuing a warning to small practices -- don't be the vulnerable target that data thieves assume you are.

Kroll Fraud Solution's Top Cyber Security Trends for 2012 reported that small practices are more susceptible to security vulnerabilities because they are "the path of least resistance." Many rely on outdated technology. Basic security protections, such as proper use of encryption, often are overlooked as practices focus on meeting regulatory requirements, such as those related to meaningful use.

Small practices often lack the technical sophistication to know what tools to put in place to avoid attacks, said Jason Straight, managing director of Kroll's Cyber Security and Information Assurance unit. Or they have the right tools, but the tools are not implemented or monitored correctly, he said. One example is having incorrectly installed data encryption.

Large organizations have become more "hardened," meaning they spend more money to safeguard their data, said Beth Givens, founder and director of the Privacy Rights Clearinghouse, an education and advocacy group that has tracked publicly reported data-breach trends across all industries since 2005. "It only stands to reason [that data thieves] would go after small practices," she said.

The story can be found here.

Pro-anorexia websites pose public health challenge

Pro-Anorexia Websites Pose Public Health Challenge _ the Lancet

The Lancet published this article in the public domain.