By PAM BELLUCK and BENEDICT CAREY
The New York Times
Published: May 6, 2013
Just weeks before the long-awaited publication of a new edition of the so-called bible of mental disorders, the federal government’s most prominent psychiatric expert has said the book suffers from a scientific “lack of validity.”
The expert, Dr. Thomas R. Insel, director of the National Institute of Mental Health, said in an interview Monday that his goal was to reshape the direction of psychiatric research to focus on biology, genetics and neuroscience so that scientists can define disorders by their causes, rather than their symptoms.
While the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., is the best tool now available for clinicians treating patients and should not be tossed out, he said, it does not reflect the complexity of many disorders, and its way of categorizing mental illnesses should not guide research.
“As long as the research community takes the D.S.M. to be a bible, we’ll never make progress,” Dr. Insel said, adding, “People think that everything has to match D.S.M. criteria, but you know what? Biology never read that book.”
The entire story is here.
Saturday, May 18, 2013
Why the Fuss Over the D.S.M.-5?
By Sally Satel
The New York Times - Opinion
Originally published on May 11, 2013
LATER this month, the American Psychiatric Association will unveil the fifth edition of its handbook of diagnoses, the Diagnostic and Statistical Manual of Mental Disorders. Fourteen years in the making, the D.S.M.-5 has been the subject of seemingly endless discussion.
The New York Times - Opinion
Originally published on May 11, 2013
LATER this month, the American Psychiatric Association will unveil the fifth edition of its handbook of diagnoses, the Diagnostic and Statistical Manual of Mental Disorders. Fourteen years in the making, the D.S.M.-5 has been the subject of seemingly endless discussion.
The charges are familiar: the manual medicalizes garden-variety distress, leads doctors to prescribe unnecessary medications, serves as a cash cow for the association, and so forth.
But many critics overlook a surprising fact about the new D.S.M.: how little attention practicing psychiatrists will give to it.
There are dozens of revisions in the D.S.M. — among them, the elimination of a “bereavement exclusion” from major depressive disorder and the creation of binge eating disorder — but they won’t alter clinical practice much, if at all.
This is because psychiatrists tend to treat according to symptoms.
So why the fuss over D.S.M.-5? Because of the unwarranted clout that its diagnoses carry with the rest of society: They are the passports to insurance coverage, the keys to special educational and behavioral services in school and the tickets to disability benefits.
This is a problem because the D.S.M. is an imperfect guide to predicting what treatments will benefit patients most — a reality tied to the fact that psychiatric diagnoses are based on clinical appearances that tend to cluster, not on the mechanism behind the illness, as is the case with, say, bacterial pneumonia.
Friday, May 17, 2013
Reconsidering the Declaration of Helsinki
By Ezekiel J. Emanuel
The Lancet, Volume 381, Issue 9877,
Pages 1532 - 1533, 4 May 2013
doi:10.1016/S0140-6736(13)60970-8
Next year will mark the 50th anniversary of the Declaration of Helsinki. Consequently, the World Medical Association (WMA) is developing its eighth version of the Declaration. This anniversary presents an excellent opportunity to reconsider the problems of the Declaration and how they can be remedied to ensure the document retains its prominent status.
In 1964 when the Declaration of Helsinki was initially enacted, it contained 11 articles and 713 words. At that time, the Declaration was unique. Over the years, ethical guidance on research involving human participants has proliferated substantially to encompass the Belmont Report by the US National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research; the International Ethical Guidelines for Biomedical Research Involving Human Subjects of the Council for International Organizations of Medical Sciences; multiple laws and regulations, such as the US Federal Policy for the Protection of Human Subjects (known as the “Common Rule”, 45 CFR part 46) and the European Union's Clinical Trials Directive; and the eight principles of What Makes Research Ethical?. Simultaneously, the Declaration of Helsinki has been revised six times and tripled in size with its 35 articles and 2045 words. The revisions have often been extensive. For instance, the distinction between “clinical research combined with professional care” and “non-therapeutic clinical research” was eliminated after much withering criticism. The article that relates to use of placebos was revised and scaled back multiple times between 2000 and 2008.
Over the years problems with, and objections to, the document have accumulated. I propose that there are nine distinct problems with the current version of the Declaration of Helsinki: it has an incoherent structure; it confuses medical care and research; it addresses the wrong audience; it makes extraneous ethical provisions; it includes contradictions; it contains unnecessary repetitions; it uses multiple and poor phrasings; it includes excessive details; and it makes unjustified, unethical recommendations. For instance, the Declaration reads like a haphazard list of articles without an overall logical framework. The topics of articles 21 to 24 are literally a jumble: they cover the importance of the research outweighing research risks, the requirement for voluntary consent, the need to protect participants' privacy, and informed consent requirements for competent individuals, respectively.
The entire article is here.
The Lancet, Volume 381, Issue 9877,
Pages 1532 - 1533, 4 May 2013
doi:10.1016/S0140-6736(13)60970-8
Next year will mark the 50th anniversary of the Declaration of Helsinki. Consequently, the World Medical Association (WMA) is developing its eighth version of the Declaration. This anniversary presents an excellent opportunity to reconsider the problems of the Declaration and how they can be remedied to ensure the document retains its prominent status.
In 1964 when the Declaration of Helsinki was initially enacted, it contained 11 articles and 713 words. At that time, the Declaration was unique. Over the years, ethical guidance on research involving human participants has proliferated substantially to encompass the Belmont Report by the US National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research; the International Ethical Guidelines for Biomedical Research Involving Human Subjects of the Council for International Organizations of Medical Sciences; multiple laws and regulations, such as the US Federal Policy for the Protection of Human Subjects (known as the “Common Rule”, 45 CFR part 46) and the European Union's Clinical Trials Directive; and the eight principles of What Makes Research Ethical?. Simultaneously, the Declaration of Helsinki has been revised six times and tripled in size with its 35 articles and 2045 words. The revisions have often been extensive. For instance, the distinction between “clinical research combined with professional care” and “non-therapeutic clinical research” was eliminated after much withering criticism. The article that relates to use of placebos was revised and scaled back multiple times between 2000 and 2008.
Over the years problems with, and objections to, the document have accumulated. I propose that there are nine distinct problems with the current version of the Declaration of Helsinki: it has an incoherent structure; it confuses medical care and research; it addresses the wrong audience; it makes extraneous ethical provisions; it includes contradictions; it contains unnecessary repetitions; it uses multiple and poor phrasings; it includes excessive details; and it makes unjustified, unethical recommendations. For instance, the Declaration reads like a haphazard list of articles without an overall logical framework. The topics of articles 21 to 24 are literally a jumble: they cover the importance of the research outweighing research risks, the requirement for voluntary consent, the need to protect participants' privacy, and informed consent requirements for competent individuals, respectively.
The entire article is here.
Thursday, May 16, 2013
One Fifth Of Suicidal Teens Have Access To Guns At Home
By Joseph Nordqvist
Medical News Today
Originally published May 6, 2013
Around twenty percent of adolescents in the U.S. who are considered "suicidal" have guns in their homes, according to a recent study published at the Pediatric Academic Societies (PAS) annual meeting in Washington, DC.
In addition, the researchers revealed that 15 percent of those at risk of suicide know how to use the guns and the ammunition and have access to both.
According to data from the Centers for Disease Control and Prevention data, among young people between the ages of 10 and 24, suicide is the second leading cause of death.
Around half of teenage suicides are carried out using a firearm.
Suicide is a serious public health issue worldwide. It is the most prevalent cause of death in female teenagers and the second most common among male teenagers after road traffic accidents. Official estimates reveal that suicide causes close to 164,000 deaths every year.
The researchers carried out the study to create and develop a new tool for doctors to use which can help identify teenagers and young adults who require some form of intervention to prevent them from harming themselves. They asked the youths about their access to firearms as well as ammunition.
The entire story is here.
Medical News Today
Originally published May 6, 2013
Around twenty percent of adolescents in the U.S. who are considered "suicidal" have guns in their homes, according to a recent study published at the Pediatric Academic Societies (PAS) annual meeting in Washington, DC.
In addition, the researchers revealed that 15 percent of those at risk of suicide know how to use the guns and the ammunition and have access to both.
According to data from the Centers for Disease Control and Prevention data, among young people between the ages of 10 and 24, suicide is the second leading cause of death.
Around half of teenage suicides are carried out using a firearm.
Suicide is a serious public health issue worldwide. It is the most prevalent cause of death in female teenagers and the second most common among male teenagers after road traffic accidents. Official estimates reveal that suicide causes close to 164,000 deaths every year.
The researchers carried out the study to create and develop a new tool for doctors to use which can help identify teenagers and young adults who require some form of intervention to prevent them from harming themselves. They asked the youths about their access to firearms as well as ammunition.
The entire story is here.
Minnesota now 12th state to approve gay marriage
By Sofia Perpetua
NBCNews.com
Originally published May 15, 2013
As thousands cheered outside the state Capitol with rainbow and American flags, Governor Mark Dayton signed a bill on Tuesday that makes it possible for same-sex couples to get married.
Minnesota is the 12th state to pass a gay marriage bill and the first Midwestern state to do so through a legislative vote.
"What a day for Minnesota!" Dayton, a Democrat, declared moments before putting his signature on a bill. "And what a difference a year and an election can make in our state."
The bill was signed a day after it was approved by the Senate in a 37-30 vote.
"It is an overwhelming joyful day, the culmination of years of work. Two years ago it would have been unimaginable to be here," said Jake Loesch, communications director with Minnesotans United, a LGBT group. "It was incredible, we had 7,000 people cheering as the bill as signed, it was probably the biggest crowd the Capitol has ever seen."
The entire story is here.
NBCNews.com
Originally published May 15, 2013
As thousands cheered outside the state Capitol with rainbow and American flags, Governor Mark Dayton signed a bill on Tuesday that makes it possible for same-sex couples to get married.
Minnesota is the 12th state to pass a gay marriage bill and the first Midwestern state to do so through a legislative vote.
"What a day for Minnesota!" Dayton, a Democrat, declared moments before putting his signature on a bill. "And what a difference a year and an election can make in our state."
The bill was signed a day after it was approved by the Senate in a 37-30 vote.
"It is an overwhelming joyful day, the culmination of years of work. Two years ago it would have been unimaginable to be here," said Jake Loesch, communications director with Minnesotans United, a LGBT group. "It was incredible, we had 7,000 people cheering as the bill as signed, it was probably the biggest crowd the Capitol has ever seen."
The entire story is here.
Wednesday, May 15, 2013
One Step Forward On Mental Health Parity
The American Psychiatric Association
Press release on May 1, 2013
Yesterday, the United States District Court for the District of Vermont became the first court in the country to interpret the Mental Health Parity and Addiction Equity Act of 2008—and that decision is favorable to mental health patients.
In C. M. v. Fletcher Allen Health Care, Inc., plaintiff C. M. challenges her health plan’s administration of mental health benefits. Specifically, she alleges that the Plan violates MHPAEA by: (1) requiring pre-approval for routine mental health services but not for medical-surgical services; (2) conducting concurrent reviews of mental health services but not requiring such reviews for medical-surgical services; and (3) initiating automatic review processes triggered by a fixed number of visits for mental health services but not for medical-surgical services.
The defendant argued that the Interim Final Regulations under MHPEA require that, in addition to demonstrating that mental health services were treated in a different manner than medical-surgical services, patients have to demonstrate that “no clinically appropriate standard of care would permit a difference,” to prove violation of MHPAEA. The Court disagreed, finding that “the Parity Act was promulgated to eliminate impermissible disparity in the benefits afforded for mental health and substance abuse disorders when compared to those afforded medical/surgical conditions. ... It stands to reason that plan administrators would also bear the burden of establishing, under the Parity Act, why mental health and medical benefits are treated differently based upon divergent clinical standards.”
According to Colleen Coyle, General Counsel of the American Psychiatric Association, “this is significant because it clearly puts the burden on the insurance industry to provide clinically appropriate standards of care to justify treating mental health claims differently than medical-surgical claims. Mental health and substance disorder patients have a right to know whether they are being treated differently than patients with other physical or surgical issues, and if so, on what clinical grounds the insurance companies justify that difference.” The APA assisted the plaintiff’s counsel in briefing the MHPAEA arguments in this case, has filed another lawsuit against insurers Anthem and WellPoint, and is in the process of challenging several other insurance carriers it believes are violating mental health parity.
Lead attorney representing C.M., Alison J. Bell, partner at Langrock Sperry & Wool, LLP, said, “Mental health parity is an important lifeline for my client, who was denied benefits for medical care desperately needed in order to live a healthy life. We are grateful for the APA’s assistance with MHPAEA issues.”
Meiram Bendat, founder of Psych-Appeal, which assists mental health professionals and their patients in challenging insurance denials for mental health treatment, added “Psych-Appeal has worked hard to bring the parity issues to the forefront in this case and proudly hails its collaboration with plaintiff's counsel and the American Psychiatric Association."
Last weekend, former Congressman Patrick Kennedy held a round table discussion with psychiatrists, patients, mental health advocates, and political leaders about mental health parity, and the need for patients to speak out publicly about disparate treatment of mental health claims in order to ensure that the full vision of MHPAEA is realized. (Read one of the patient stories as previously provided in hearings held by the Connecticut Health Care Advocate’s office.) James Scully, CEO and Medical Director of the APA stated, “The APA applauds plaintiff C.M. and others who spoke at the round table last week for having the courage to stand up for the right to care. We look forward to the day when parity is fully realized and those with a mental illness and/or substance use disorders can expend their energy and resources conquering the illness, rather than battling the insurance companies for the coverage to which they are entitled and for which they and their employer have paid.”
The American Psychiatric Association is a national medical specialty society whose physician members specialize in the diagnosis, treatment, prevention and research of mental illnesses, including substance use disorders. Visit the APA at www.psychiatry.org.
Press release on May 1, 2013
Yesterday, the United States District Court for the District of Vermont became the first court in the country to interpret the Mental Health Parity and Addiction Equity Act of 2008—and that decision is favorable to mental health patients.
In C. M. v. Fletcher Allen Health Care, Inc., plaintiff C. M. challenges her health plan’s administration of mental health benefits. Specifically, she alleges that the Plan violates MHPAEA by: (1) requiring pre-approval for routine mental health services but not for medical-surgical services; (2) conducting concurrent reviews of mental health services but not requiring such reviews for medical-surgical services; and (3) initiating automatic review processes triggered by a fixed number of visits for mental health services but not for medical-surgical services.
The defendant argued that the Interim Final Regulations under MHPEA require that, in addition to demonstrating that mental health services were treated in a different manner than medical-surgical services, patients have to demonstrate that “no clinically appropriate standard of care would permit a difference,” to prove violation of MHPAEA. The Court disagreed, finding that “the Parity Act was promulgated to eliminate impermissible disparity in the benefits afforded for mental health and substance abuse disorders when compared to those afforded medical/surgical conditions. ... It stands to reason that plan administrators would also bear the burden of establishing, under the Parity Act, why mental health and medical benefits are treated differently based upon divergent clinical standards.”
According to Colleen Coyle, General Counsel of the American Psychiatric Association, “this is significant because it clearly puts the burden on the insurance industry to provide clinically appropriate standards of care to justify treating mental health claims differently than medical-surgical claims. Mental health and substance disorder patients have a right to know whether they are being treated differently than patients with other physical or surgical issues, and if so, on what clinical grounds the insurance companies justify that difference.” The APA assisted the plaintiff’s counsel in briefing the MHPAEA arguments in this case, has filed another lawsuit against insurers Anthem and WellPoint, and is in the process of challenging several other insurance carriers it believes are violating mental health parity.
Lead attorney representing C.M., Alison J. Bell, partner at Langrock Sperry & Wool, LLP, said, “Mental health parity is an important lifeline for my client, who was denied benefits for medical care desperately needed in order to live a healthy life. We are grateful for the APA’s assistance with MHPAEA issues.”
Meiram Bendat, founder of Psych-Appeal, which assists mental health professionals and their patients in challenging insurance denials for mental health treatment, added “Psych-Appeal has worked hard to bring the parity issues to the forefront in this case and proudly hails its collaboration with plaintiff's counsel and the American Psychiatric Association."
Last weekend, former Congressman Patrick Kennedy held a round table discussion with psychiatrists, patients, mental health advocates, and political leaders about mental health parity, and the need for patients to speak out publicly about disparate treatment of mental health claims in order to ensure that the full vision of MHPAEA is realized. (Read one of the patient stories as previously provided in hearings held by the Connecticut Health Care Advocate’s office.) James Scully, CEO and Medical Director of the APA stated, “The APA applauds plaintiff C.M. and others who spoke at the round table last week for having the courage to stand up for the right to care. We look forward to the day when parity is fully realized and those with a mental illness and/or substance use disorders can expend their energy and resources conquering the illness, rather than battling the insurance companies for the coverage to which they are entitled and for which they and their employer have paid.”
The American Psychiatric Association is a national medical specialty society whose physician members specialize in the diagnosis, treatment, prevention and research of mental illnesses, including substance use disorders. Visit the APA at www.psychiatry.org.
Parity Laws: Powerful Weapon--or Pipe Dream?
By Heidi Anne Duerr, MPH
Psychiatric Times
Originally published May 6, 2013
Is true mental health parity really possible, even with the Mental Health Parity and Addiction Equity Act (MHPAEA)? It’s beginning to look like the answer is maybe–but only with a fight.
Across the US, the war for parity is being fought, with numerous law suits asking courts to help ensure the law has real bite. In the meantime, does this mean patients without legal support and know-how are going without proper care—or that real parity is just a pipe dream?
Just recently, the US District Court for the District of Vermont was the first court to interpret and support the MHPAEA.1 In this case, the plaintiff alleged Fletcher Allen Health Care Inc, the plaintiff’s health plan administrator, violated the parity law “by imposing, both in writing and in practice, more stringent reviews for mental health benefits than are imposed for medical benefits.”
Specifically, the complaint noted the insurer “conducts prospective and concurrent medical necessity reviews of routine, outpatient, out-of-network mental health office visits while … [the plan] conducts no such reviews for comparable medical office visits.” In addition, the plaintiff alleged that the plan “imposes a numeric cap on the number of routine outpatient visits participants may request before pre-approval is required for all subsequent medical necessity reviews.”
Meanwhile, the New York State Psychiatric Association filed a class-action suit against UnitedHealth Group for violating both federal and state antidiscrimination laws. Among other complaints, the suit noted UnitedHealth Group denied or delayed access to care and required continuing authorizations for psychotherapy, intensive outpatient treatment, and partial hospitalization.
The entire story is here.
Psychiatric Times
Originally published May 6, 2013
Is true mental health parity really possible, even with the Mental Health Parity and Addiction Equity Act (MHPAEA)? It’s beginning to look like the answer is maybe–but only with a fight.
Across the US, the war for parity is being fought, with numerous law suits asking courts to help ensure the law has real bite. In the meantime, does this mean patients without legal support and know-how are going without proper care—or that real parity is just a pipe dream?
Just recently, the US District Court for the District of Vermont was the first court to interpret and support the MHPAEA.1 In this case, the plaintiff alleged Fletcher Allen Health Care Inc, the plaintiff’s health plan administrator, violated the parity law “by imposing, both in writing and in practice, more stringent reviews for mental health benefits than are imposed for medical benefits.”
Specifically, the complaint noted the insurer “conducts prospective and concurrent medical necessity reviews of routine, outpatient, out-of-network mental health office visits while … [the plan] conducts no such reviews for comparable medical office visits.” In addition, the plaintiff alleged that the plan “imposes a numeric cap on the number of routine outpatient visits participants may request before pre-approval is required for all subsequent medical necessity reviews.”
Meanwhile, the New York State Psychiatric Association filed a class-action suit against UnitedHealth Group for violating both federal and state antidiscrimination laws. Among other complaints, the suit noted UnitedHealth Group denied or delayed access to care and required continuing authorizations for psychotherapy, intensive outpatient treatment, and partial hospitalization.
The entire story is here.
Tuesday, May 14, 2013
Ethics of Erasing Memory
By David Levin
NOVA Science Now
pbs.org
Originally posted January 13, 2011
Neuroscientists have identified a chemical that can erase the connections between brain cells, essentially wiping out memories. Although it can't target specific experiences, like a traumatic event, its existence raises a lot of big ethical issues. In this interview, we asked Art Caplan to help us sort them out. He's the director of the Center for Bioethics at the University of Pennsylvania.
The podcast and transcript are here.
NOVA Science Now
pbs.org
Originally posted January 13, 2011
Neuroscientists have identified a chemical that can erase the connections between brain cells, essentially wiping out memories. Although it can't target specific experiences, like a traumatic event, its existence raises a lot of big ethical issues. In this interview, we asked Art Caplan to help us sort them out. He's the director of the Center for Bioethics at the University of Pennsylvania.
The podcast and transcript are here.
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