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

Sunday, April 8, 2012

The raid on your medical records

By Karen Angel
New York Daily News-Opinion
Originally Published April 1, 2012

After I got laid off from my job last November, I started shopping for health insurance and a funny thing happened: BlueCross BlueShield emailed me someone else’s application.

The only similarity between me and this other applicant was that we’re both named Karen. I live in New York; she lives in Virginia. We have different last names, different Social Security numbers, different health histories. I know this because all of it was contained in the application BlueCross emailed to me — and under federal law, all of it is supposed to be confidential.

By emailing me the other Karen’s health-insurance application, BlueCross violated the Health Insurance Portability and Accountability Act. An angry consumer could find plenty of grounds — breach of confidentiality, negligence — to sue.

The entire story is here.

Saturday, April 7, 2012

Sensitive personal information missing on 800,000 California residents

By Steven Harmon
Mercurynews.com
Originally published March 29, 2012

In a puzzling breach of security, computer storage devices containing identification information of 800,000 Californians using the state's child support services have disappeared.

The Department of Child Support Services reported Thursday the data devices were lost March 12 en route to California from the Colorado facilities of IBM, one of the contractors in charge of the storage devices.

Authorities have begun to notify customers by mail about the incident, warning them that the devices include names, addresses, Social Security numbers, driver's license numbers, names of health insurance providers and employers.

Friday, April 6, 2012

How the FDA forgot the evidence: the case of donepezil 23 mg

By Lisa M Schwartz & Steven Woloshin
British Journal of Medicine
Published March 22, 2012

What is the difference between 20 and 23? If you said three, you are off by millions—of dollars in sales, that is—at least from the perspective of Eisai, the manufacturer of donepezil (marketed as Aricept by Pfizer).

A little context helps make the maths clearer. Donepezil, the biggest player in the lucrative market for Alzheimer’s disease treatments, was a blockbuster, with over $2bn in annual sales in the United States alone. But the drug, first approved in 1996, had reached the end of the road: the patent expired in November 2010. Investors call this “going over the cliff,” an anxious reference to plummeting sales as market share is lost to generic competitors. Necessity, however, is the mother of invention. Just four months before the expiry of the patent, the US Food and Drug Administration (FDA) approved a new dose for moderate to severe Alzheimer’s disease: donepezil 23 mg. Is 23 an odd number? Not really, when you consider that you cannot get to 23 mg using the 5 mg and 10 mg doses that were going generic. The “new” 23 mg product would be patent protected for three more years.

Now it was time for the marketing to begin. In addition to their sales force, the manufacturers deployed dedicated teams of “Aricept 23 mg clinical nurse educators” to reach prescribers. They focused particularly on “priority targets”—neurologists and high volume facilities for the long term care of people with Alzheimer’s disease—to promote the idea that “there are no ‘stable’ AD [Alzheimer’s disease] patients—therefore aggressive treatment is required.

The entire story is here.

Thanks to Ken Pope for the information.

Thursday, April 5, 2012

It’s Too Late to Apologize: Therapist Embarrassment and Shame

By Rebecca Klinger, Nicholas Ladany, and Lauren Kulp
The Counseling Psychologist
For reprints, contact Rebecca Klinger via the hyperlink provided


Abstract
The purpose of this study was to identify events in which therapists felt embarrassment, shame, or both in a therapy session and to investigate the relationship of the embarrassing-shameful events with the therapist reactions. Ninety-three therapists participated in this study, and the most frequent events reported were having a scheduling mistake, forgetting or confusing client information, being visibly tired, falling asleep, and arriving late. Implications and need for further research, particularly concerning the effects of therapist embarrassment and shame on therapy process and outcome, are discussed.

Introduction

Embarrassment and shame are common self-conscious emotions often addressed in the psychotherapy literature (Gilbert, 1997; Leith & Baumeister, 1998; Lewis, 1971; Tangney, 2002; Tracy & Robins, 2004). In fact, exploring the embarrassment and shame felt by clients is frequently an integral part of thetherapeutic process (Gilbert, 1997; Pope, Sonne, & Greene, 2006; Sorotzkin, 1985). Therapist embarrassment and shame, however, have rarely been inves- tigated even though therapist embarrassment and shame are believed to have an important effect on the therapeutic relationship (Pope et al., 2006) and cli- ent outcome (Covert, Tangney, Maddux, & Heleno, 2003; Leith & Baumeister, 1998; Pope et al., 2006). The primary purpose of our study was to identify events in which therapists felt embarrassment, shame, or both in a therapy session and the corresponding reactions of the therapist.


For reprints, contact Rebecca Klinger via the hyperlink provided above.

Thanks to Gary Schoener for this information.

Wednesday, April 4, 2012

Vignette 12: A Request for Assistance



Dr. Lilith Crane, a psychologist from a small rural campus, calls you on the phone for a consultation.
Dr. Crane currently works with an undergraduate student, Dan, on issues related to self-esteem and depression.  An ongoing theme in therapy revolves around his sexual orientation.  Dan recently came out to his parents, who were accepting of his gay orientation and lifestyle.  From that positive experience, Dan wants to start a support organization for other GLBTQ students on campus. 
Dan explained to Dr. Crane that this group would be student-led and meet on campus.  He does not view it as a therapy group.  Dan’s vision is that the group would meet periodically to provide one another with support, to do problem solving, to share information and personal struggles, and perhaps to provide some psycho-educational work on campus.  Dan indicates that they may also want to engage in fundraising in order for GLBTQ students to attend state or national events.
Dan asked a number of faculty members to be the faculty advisor of this group.  While most were supportive, all declined the invitation (likely because the campus is small and in a conservative area of the state).
Out of options, Dan asked Dr. Crane to be the faculty advisor.  Dr. Crane applauded and appreciated the student’s energy and creativity, but indicated some concern about dual role with the student.  She told the student that she would think about the request prior to answering.
Dr. Crane is questioning the pros and cons of being the psychologist and the faculty advisor.  Dr. Crane feels ambivalent because of their therapeutic relationship, but also wants to help Dan because he appears to have limited options.
What are the possible downsides to entering the dual relationship?
What are the possible steps Dr. Crane can take to mitigate any potential difficulties?
What are other steps that the psychologist may want to take in this situation?

Tuesday, April 3, 2012

Arkansas court strikes down law banning teacher-student sex

By Douglas Stanglin
USA Today
Originally published March 30, 2012

The Arkansas Supreme Court has struck down a law banning sexual contact between teachers and students, saying people over 18 have a constitutional right to engage in a consensual sexual relationship.

In its ruling, the high court sided with David Paschal, 38, a history and psychology teacher at Elkins High School who is serving a 30-year prison sentence after admitting to having a five-month consensual sexual relationship with an 18-year-old student, the Associated Press reports.


Chief Justice Jim Hannhan wrote that the law on sexual contact between students under 21 and public school employees such as teachers, coaches and principals "criminalizes sexual conduct between adults."

The entire story is here.

Dual-Relationship Dilemmas of Rural and Small-Community Psychologists

Dual Relationships in Rural and Small Community Psychologist

Monday, April 2, 2012

Sandusky Case: Man who evaluated alleged victim was not yet psychologist

By Mike DawsonCentredaily.com
Originally published March 28, 2012

Dr. Morford
After State College psychologist Alycia Chambers talked to an 11-year-old boy about Jerry Sandusky showering with him in May 1998, she concluded Sandusky was exhibiting signs of grooming the boy for sexual abuse.

A couple days later, a counselor, John Seasock, met with the boy and had a different conclusion. The showering episode, Seasock determined, was rather the result of a routine that coaches like Sandusky do after a workout.

Centre County prosecutors did not pursue criminal charges against Sandusky after that incident, and whether the competing conclusions factored into that decision remains a subject of conjecture.

But, almost 14 years later, the fact that Seasock wasn’t a psychologist at the time, according to state records, raises questions about how much weight his opinion should have carried.

“To take that person’s word over a psychologist who has been prepared and licensed by the state is, I would say, very surprising and a serious concern,” said Marolyn Morford, a State College psychologist.

Morford said Tuesday she’s been alarmed by Seasock’s representation as a psychologist at the time in question. That’s how the Penn State police investigation report refers to him, and that’s how Seasock has been referred to in media reports after the document was leaked Saturday.

State records show that Seasock has been licensed as a professional counselor since January 2002.

The entire story is here.

Dr. Morford is a member of PPA's Ethics Committee.

Sunday, April 1, 2012

Self-Care Practices and Perceived Stress Levels Among Psychology Graduate Students

By Shannon B. Myers , Alison C. Sweeney, Victoria Popick, Kimberly Wesley, Amanda Bordfeld, & Randy Fingerhut
Training and Education in Professional Psychology, Vol 6(1), February 2012, pp 55-66.

Stress has been defined as the perception that the demands of an external situation are beyond one's perceived ability to cope (Lazarus, 1966).

DeAngelis (2002) suggests that psychologists are particularly vulnerable to stress and that, while they promote self-care practice and stress management with clients, psychologists rarely heed their own advice.

Psychology graduate students are also vulnerable to stress because of the multiple demands of graduate school including academic coursework, research, clinical training, and financial constraints.

Stress related to performance anxiety, competition, institutional demands, lack of experience, and interpersonal/professional relationships has been noted in this population (Badali & Habra, 2003).

Furthermore, psychology graduate students represent a unique population who must navigate these stressors and their new roles, while simultaneously developing the knowledge and skills necessary to provide clinical and therapeutic services to others.

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Discussion

The current study suggests that self-care practices are related to perceived stress levels among psychology graduate students across the United States. There were also some differences based on demographic factors. Age, relationship status, and sufficiency of income to cost of living were significantly related to perceived stress levels. Psychology graduate students who indicated that their household income was insufficient compared with their cost of living perceived more stress, which is consistent with previous research suggesting a reciprocal relationship between perceived stress and financial satisfaction in adult students (Sandler, 2000). Married students also reported significantly less stress than their nonmarried counterparts. This pattern has emerged in previous research in which psychology graduate students who were not in a committed relationship reported the highest levels of stress (Hudson & O'Regan, 1994). Marriage can provide a strong source of relational support, which has been linked to lower levels of stress in students (Craddock, 1996). Finally, age significantly predicted perceived stress levels, in that the older students reported less perceived stress. Previous research has suggested that older individuals report fewer daily hassles than their younger counterparts possibly as a result of the development of alternative coping strategies (Folkman, Lazarus, Pimley, & Novacek, 1987). Older students may have developed more effective ways to cope with the competing demands of graduate school and therefore perceive less stress.

The entire article is here.

The author note provides the following contact information for reprint requests, questions, and comments: Shannon B. Myers, The Cancer Institute of New Jersey-UMDNJ, 195 Little Albany Avenue, New Brunswick, NJ 08901; Email: shmyers1@hotmail.com.

Thanks to Ken Pope for this information.

Dr. Fingerhut is a member of the Ethics Committee.