Aging Doctors Face Greater Scrutiny

By Sandra G. Boodman
Originally published on December 10, 2012
Kaiser Health News in collaboration with The Washington Post

A distinguished vascular specialist in his 80s performs surgery, then goes on vacation, forgetting he has patients in the hospital; one subsequently dies because no doctor was overseeing his care. An internist who suffered a stroke gets lost going from one exam room to another in his own office. A beloved general surgeon with Alzheimer's disease continues to assist in operations because hospital officials don't have the heart to tell him to retire.

These real-life examples, provided by an expert who evaluates impaired physicians, exemplify an emotionally charged issue that is attracting the attention of patient safety experts and hospital administrators: how to ensure that older doctors are competent to treat patients.

About 42 percent of the nation's 1 million physicians are older than 55 and 21 percent are older than 65, according to the American Medical Association, up from 35 percent and 18 percent, respectively, in 2006. Their ranks are expected to increase as many work past the traditional retirement age of 65, for reasons both personal and financial.

Many older doctors remain sharp, their skills up-to-date and their judgment honed by years of experience. Peter Carmel, the AMA's immediate past president, a 75-year-old pediatric neurosurgeon in New Jersey, recently wrote about "going full tilt."

Unlike commercial airline pilots, who by law must undergo regular health screenings starting at age 40 and must retire at 65 -- or FBI agents, whose mandatory retirement age is 57 -- there are no such rules for doctors. Nor are any formal evaluations required to ensure the continued competence of physicians, many of whom trained decades ago. Most states require continuing education credits to retain a medical license, but, as Ann Weinacker, chief of the medical staff at Stanford Hospital and Clinics in California, observed, "you can sleep through a session, and if you sign your name, you'll get credit."

The entire article is here.

New Taxes to Take Effect to Fund Health Care Law

By ROBERT PEAR
The New York Times
Originally Published: December 8, 2012

For more than a year, politicians have been fighting over whether to raise taxes on high-income people. They rarely mention that affluent Americans will soon be hit with new taxes adopted as part of the 2010 health care law.


The new levies, which take effect in January, include an increase in the payroll tax on wages and a tax on investment income, including interest, dividends and capital gains. The Obama administration proposed rules to enforce both last week.

Affluent people are much more likely than low-income people to have health insurance, and now they will, in effect, help pay for coverage for many lower-income families. Among the most affluent fifth of households, those affected will see tax increases averaging $6,000 next year, economists estimate.

To help finance Medicare, employees and employers each now pay a hospital insurance tax equal to 1.45 percent on all wages. Starting in January, the health care law will require workers to pay an additional tax equal to 0.9 percent of any wages over $200,000 for single taxpayers and $250,000 for married couples filing jointly.

The new taxes on wages and investment income are expected to raise $318 billion over 10 years, or about half of all the new revenue collected under the health care law.

The entire article is here.

The Violence Carousel Has Gone Around Again

By Stephen A. Ragusea

This time the violence involves semi-automatic weapons and scores of elementary school children.  There are also dead teachers, a dead principal and a dead school psychologist.   All seven adults were women and my bet is that, as we learn more about the psychodynamics of the disturbed young man who was the shooter, we will find that the gender of the victims was not a coincidence, but part of his thought disturbance.

We all want to know why this thing happened and we would prefer that there be one single, clear reason.  But, as a clinical psychologist, I can assure you that there were several contributing factors, because human beings rarely do anything for one simple reason.   We are complex creatures, we humans.  Why did this happen?   Part of the answer is that we live in a culture that encourages violence and that culture is held up for worship on the altars of television screens and movie theatres each and every day.  It’s in our lust for blood in boxing matches and our appreciation of helmet cracking tackles in football and ice hockey.  It’s in movies from “Rambo (I through V)” to Brad Pitt’s “Killing Them Softly.”  It’s on television via movie reruns and shows like “The Sopranos” and your favorite version of “CSI.” We are a culture that embraces violence.

And, don’t forget our love of guns.  ABC News recently reported that during the three day Thanksgiving holiday weekend alone, over 250,000 guns were sold in the United States.

Over the next couple of weeks, you’ll hear the same question over and over in the news media: does violence in the media increase violent behavior?  For nearly fifty years the American Psychological Association has issued a variety of reports answering that critical question with an emphatic “Yes!”  In psychological research, the viewing of large amounts of violence on television by young children has been correlated with increases in violent behavior into adulthood.  Well, if TV viewing can impact our aggressive tendencies, what about the music we listen to?

One 2003 study published in the Journal of Personality and Social Psychology suggested that listening to songs that contain violent lyrics results in an increase in aggressive thoughts and emotions.  Some think that listening to powerful, violent, angry, songs can provide a “venting” of these powerful feelings, but this research provides evidence that just the opposite is true.

Of course, we must also ask ourselves “How much violence do we expose our children to?”  One 2007 study found that “By the time the average U. S. child starts elementary school, he or she will have seen 8,000 murders and 100,000 acts of violence on TV.”  And, that doesn’t include exposure via music and movies.

Add into that mix the fact that a small percentage our population suffers from various forms of severe mental illness and that we perpetually underfund treatment for psychological disorders.  Make semi-automatic weapons available to that group and sooner or later, we will see an explosive incident such as that which occurred in Newtown, Connecticut.  If we don’t do something to influence this course of events, we’ll see these incidents occur again and again.

Violence directly and negatively impacts our physical and mental health. Because violent content in movies, television, and songs has so consistently been shown to increase violent behavior, these characteristics should be diminished in our entertainment products.  Psychologists have been giving that research-based advice to American society for almost 50 years.  Quite frankly, nobody seems to be listening.

We can do better.  Each one of us can decide to stop consuming these products.  When enough people boycott media violence, producers will stop creating these violence-encouraging forms of “entertainment.”  We can do better and we’d better do that.


Stephen A. Ragusea, Psy D, is a clinical psychologist in Key West and on the medical staff of The Lower Keys Medical Center.

The Ratings Game

Online physician-review sites pose legal challenges

By Andis Robeznieks
ModernHealthCare.com
Originally Posted: November 10, 2012

People who sue people may receive more undesired attention than anyone else in the world.

That is the general idea behind the “Streisand Effect,” a phenomenon that occurs when an attempt to stifle publicity creates more publicity for something that might never have received much attention in the first place.

According to legend, the term was coined when singer Barbra Streisand tried to have a photo of her home—one among thousands of pictures that were part of an online display showing coastline erosion in California—deleted from that site. The ensuing publicity essentially guaranteed the image will never disappear from the Internet.

It could be unlikely that combative efforts to counter negative profiles on physician review websites will lead to a similar occurrence known as a the “Dr. McKee Effect,” but no one can predict how these things turn out.

Dr. David McKee, a neurologist from Duluth, Minn., is suing a patient's family member for defamation after the man posted negative reviews of him online. The case was argued in September before the Minnesota Supreme Court and, while its legal precedent-setting impact might not extend beyond the state's boundaries, attorneys for both sides say it could serve as a guide in future legal proceedings—wherever the jurisdiction may be.

The entire article is here.

Mental health and disadvantage in Indigenous Australians

Editorial
The Lancet
Volume 380, Issue 9858, Page 1968


Last week, Australia's National Mental Health Commission released A Contributing Life: the 2012 National Report Card on Mental Health and Suicide Prevention, its first such publication. The report card takes a whole-of-life approach, recognising that, like everyone else, people who have a mental illness need a stable home, a decent education, a job, good physical health, and a support network, as well as access to high-quality treatment and services.

There is a special focus on the first Australians, the Aboriginal and Torres Strait Islanders, who still face enormous disadvantages when compared with the general population. This disadvantage starts before birth. For example, three in ten Aboriginal and Torres Strait Islanders, including pregnant women, report barriers to accessing health services. 50% of pregnant Aboriginal and Torres Strait Islander women smoke. And one in seven new Indigenous mothers have postnatal depression. As the report notes, a child born into these circumstances does not have an auspicious start in life. Furthermore, an Indigenous child is two and a half times more likely to be born into the lowest income group, and has a one in two chance of living in a one-parent household when compared with the general population. All these factors play into adolescence and adulthood, and increase the risk of mental health problems and associated issues such as substance misuse in the Indigenous population. Up to 15% of the 10-year life expectancy gap compared with non-Indigenous Australians has been attributed to mental health disorders.

The report recommends the development and implementation of an Aboriginal and Torres Strait Islander Mental Health and Social and Emotional Wellbeing Plan to commence in 2013 as well as training and employment of more Indigenous people in mental health services. This must be a national government priority, as should addressing the deep health and social inequalities faced by Aboriginal and Torres Strait Islanders. Australia's Indigenous population should have the opportunity to thrive, not just survive.

doi:10.1016/S0140-6736(12)62139-4

Court: Off-Label Drug Marketing Is 'Free Speech'

By John Fauber, Reporter
Milwaukee Journal Sentinel/MedPage Today
Originally Published: December 04, 2012


A decision by a federal appeals court this week could have a dramatic impact on the marketing of prescription drugs in America, potentially affecting patient care and everything from TV advertising to future government prosecutions which, in the past, had yielded billions of dollars in settlements, doctors and attorneys said Tuesday.

"This risks taking us back to an era when people could promote snake oil without restrictions – a situation I would hate to see," said Richard Deyo, MD, a professor of family medicine at Oregon Health and Science University.

Citizens United Redux

However, others say the ruling by a three-judge panel of the Court of Appeals for the Second Circuit in Manhattan is a victory for free speech, one that could become the drug industry equivalent of Citizens United, the 2010 U.S. Supreme Court decision that gave corporations and unions the right to spend unlimited sums on political ads.

Like the Citizens United case, the ruling Tuesday by the prestigious U.S. Court of Appeals for the Second Circuit in New York, involved the right of commercial free speech, applying it to the complicated world of pharmaceutical industry promotion of prescription drugs.

How wide-ranging the decision becomes likely will depend on whether it gets to the U.S. Supreme Court, attorneys said.

Once the Food and Drug Administration approves a drug, physicians are free to prescribe that drug as they wish -- but the drug makers can only market the drug for the FDA-approved marketing indication.

The case involves Alfred Caronia, a sales representative with Orphan Medical who was criminally prosecuted for making off-label promotional statements about Xyrem, a drug approved in 2002 to treat narcolepsy patients with a condition known as cataplexy. Cataplexy involves weak or paralyzed muscles.

The FDA required a black box warning on the drug stating that its safety and effectiveness had not been established in people under the age of 16. The active ingredient in Xyrem is GHB, is a powerful medication that acts on the central nervous system and also is known as the "date rape" drug.

The entire story is here.

48 countries join forces against online child abuse

By Associated Press
Originally Published: December 5


Forty-eight countries united Wednesday in a global alliance to fight child sexual abuse online, a cross-border crime that experts say is increasing at alarming rates.

By conservative estimates, 1 million photographs of child pornography are on the Internet, with an additional 50,000 being posted every year, said Cecilia Malmstrom, the European Union’s commissioner for home affairs who was one of sponsors of the conference in Brussels.


“Behind each of these images there is an abused child, an exploited and helpless victim,” Malmstrom said at a news conference. “And every time someone looks at these pictures, that child is exploited and violated again and again and again.”

The alliance will focus on identifying and helping victims, prosecuting offenders, increasing public awareness and reducing the availability of child pornography online, according to a joint declaration.

The entire story is here.

Greater awareness and funding approved to address internship imbalance

APA Access | December 11, 2012

The Education Directorate and the American Psychological Association of Graduate Students worked to raise awareness of and make strides toward solving the internship imbalance.

The Education Directorate and the American Psychological Association of Graduate Students (APAGS) worked extensively over the past year to promote more quality internship positions for psychology graduate students. The effort paid off when the APA Council of Representatives approved the allocation of up to $3 million over three years for a small grant program to assist internship sites with the accreditation process. This program will potentially add up to 500 APA-accredited slots to promote quality assurance in training.

The entire story is here.

Justice Dept. recovers record $5 billion under False Claims Act

By Peter Finn
The Washington Post
Originally published: December 4, 2012


The Justice Department’s civil division recovered a record $5 billion in the past fiscal year from companies that defrauded taxpayers, with much of the abuse occurring in the health-care and mortgage industries.

The department pursued settlements and judgments under the False Claims Act, which Acting Associate Attorney General Tony West described Tuesday as “quite simply, the most powerful tool we have to deter and redress fraud.”

“Vigorous enforcement of the act allows us to protect not only taxpayer dollars but also the integrity of important government programs on which so many Americans rely,” West said.

The amount of money recovered in 2012 is up from $3.2 billion last year, and two-thirds of it was secured through the act’s whistleblower provisions.

“Many of these cases would not be possible without the whistleblowers . . . who have come forward to report fraud, often at great personal risk,” said Stuart Delery, the principal deputy assistant attorney general for the civil division.

The entire story is here.