Ethics Education and Psychology

Doctors Protest Psychiatric Manual Revision in Global Petition

2013-05-22T05:55:00.000-04:00

By Natasha Khan
Bloomberg News
May 15, 2013

Doctors are protesting new guidance for the diagnosis of some mental disorders, including autism, contained in the revised edition of a professional manual to be released in coming days.

The so-called “psychiatric bible,” whose first update in 19 years will be released at a medical meeting that opens in San Francisco on May 18, also influences the way patients are treated and reimbursed for mental disorders. A petition that raised concerns about the manual’s diagnostic categories and patient safety received more than 3,000 signatures from Paris to Montreal in recent months.

The Diagnostic and Statistical Manual of Mental Disorders is the standard used by mental-health professionals for diagnosing illness and for research. The newest edition is meant to incorporate the latest research findings and has collapsed several conditions, including Asperger’s syndrome and child disintegrative disorder, into a single autism diagnosis.

The entire article is here.

Medicine's big new battleground: does mental illness really exist?

2013-05-22T05:53:00.000-04:00

The latest edition of DSM, the influential American dictionary of psychiatry, says that shyness in children, depression after bereavement, even internet addiction can be classified as mental disorders. It has provoked a professional backlash, with some questioning the alleged role of vested interests in diagnosis

By Jaime Doward
The Observer
Originally published May 11, 2013

It has the distinctly uncatchy, abbreviated title DSM-5, and is known to no one outside the world of mental health.

But, even before its publication a week on Wednesday, the fifth edition of the Diagnostic and Statistical Manual, psychiatry's dictionary of disorders, has triggered a bitter row that stretches across the Atlantic and has fuelled a profound debate about how modern society should treat mental disturbance.

Critics claim that the American Psychiatric Association's increasingly voluminous manual will see millions of people unnecessarily categorised as having psychiatric disorders. For example, shyness in children, temper tantrums and depression following the death of a loved one could become medical problems, treatable with drugs. So could internet addiction.

Inevitably such claims have given ammunition to psychiatry's critics, who believe that many of the conditions are simply inventions dreamed up for the benefit of pharmaceutical giants.

A disturbing picture emerges of mutual vested interests, of a psychiatric industry in cahoots with big pharma. As the writer, Jon Ronson, only half-joked in a recent TED talk: "Is it possible that the psychiatric profession has a strong desire to label things that are essential human behaviour as a disorder?"

Psychiatry's supporters retort that such suggestions are clumsy, misguided and unhelpful, and complain that the much-hyped publication of the manual has become an excuse to reheat tired arguments to attack their profession.

The entire article is here.

Your Privacy Online

2013-05-21T06:08:00.000-04:00

A Project by the Markkula Center of Applied Ethics - Santa Clara University

This looks to be a great teaching tool.

Your Privacy Online

Should you care about privacy?

This group of resources addresses that question, including an exploration of what privacy has to do with ethics, threats to privacy, and steps you can take to protect your privacy.

The site has sections labeled:
* Defining Privacy
* A Privacy Quiz
* Loss of Privacy: What's the Harm?
* Information about you = $
* Are Attitudes Changing about Privacy?
* A Case Study on Online Privacy
* How to Protect Your Online Privacy
* The Ethics of Online Privacy Protection

DSM-IV Boss Presses Attack on New Revision

2013-05-21T06:07:00.000-04:00

By John Gever, Deputy Managing Editor
MedPage Today
Published: May 17, 2013

A new edition of psychiatry's diagnostic guide "will probably lead to substantial false-positive rates and unnecessary treatment," charged the man who led development of the last version.

To be released this weekend at the American Psychiatric Association's annual meeting, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, "introduce[s] several high-prevalence diagnoses at the fuzzy boundary with normality," according to Allen Frances, MD, who chaired the task force responsible for DSM-IV issued in 1994.

Frances, now an emeritus professor at Duke University, wrote online in Annals of Internal Medicine that changes from DSM-IV will apply disease labels to individuals who may be unhappy or offensive but still normal. Such individuals would include those experiencing "the forgetfulness of old age" as well as children with severe, chronic temper tantrums and individuals with physical symptoms with no medical explanation.

He also worried about new marketing pushes from the pharmaceutical industry seeking to exploit what he believes are "loose" diagnostic criteria in the new edition. "Drug companies take marketing advantage of the loose DSM definitions by promoting the misleading idea that everyday life problems are actually undiagnosed psychiatric illness caused by a chemical imbalance and requiring a solution in pill form," he wrote.

The entire article is here.

Did Mormon Morality Teachings Really Make it Harder for Elizabeth Smart to Run?

2013-05-20T05:50:00.000-04:00

By Joanna Brooks
Religion Dispatches
Joanna Brooks Blog post
Originally published May 8, 2013

Elizabeth Smart made big news this week—from Associated Press headlines to feminist blogs like Wonkette and Jezebel to the Mormon bloggernacle—when she connected her inability to run from her kidnappers to feelings of worthlessness stemming from harsh sexual morality lessons traditional to Mormon culture.

Speaking to a human trafficking forum at Johns Hopkins University last week, Smart recalled that it was not only fear for the safety of her family that kept her from running but also a sense that rape had ruined her:

“It goes beyond fear. It’s feelings of self worth. Who would ever want me now? I’m worthless. That is what it was for me the first time I was raped. I was raised in a very religious household, one that taught that sex was something very special that only happened between a husband and a wife who loved each other... For that first rape, I felt crushed. ‘Who could want me now?’ I felt so dirty and so filthy. I understand all too well why someone wouldn’t run because of that alone. If you can imagine the most special thing being taken away from you? And feeling not that that was your only value in life, but that devalued you? I remember in school one time I had a teacher who was talking about abstinence, and she said, imagine, you’re a stick of gum and when you engage in sex, that’s like getting chewed, and if you do that lots of times, you’re going to be an old piece of gum, and who’s going to want you after that? And that’s terrible, but nobody should ever say that, but for me, I thought, I’m that chewed up piece of gum. Nobody ever rechews a piece of gum. …That’s how easy it is to feel that you no longer have worth, you no longer have value. Why would you even bother screaming out?”

The entire blog post is here.

See Elizabeth Smart speak here.

Mental Evaluations Endorse Insanity Plea in Colorado Shootings, Defense Says

2013-05-20T05:48:00.000-04:00

By Jack Healy
The New York Times
Published May 13, 2013

Mental health experts who evaluated the man accused of killing 12 people in a Colorado movie theater last year have offered a diagnosis that bolsters an insanity plea in the case, his lawyers said at a hearing here on Monday.

“We now have a diagnosis that’s complete,” Daniel King, a defense lawyer for the suspect, James E. Holmes, said in court. “We now have an opinion by qualified professionals.”

Mr. Holmes, 25, a former graduate student in neuroscience, faces 166 counts of murder, attempted murder and weapons charges in the July 20 shooting during a midnight premiere of the Batman movie “The Dark Knight Rises” at an Aurora movie theater. Officials say he slipped out of an emergency exit shortly after the movie began, sheathed himself in commando-style gear and then returned through the same door to spray the sold-out crowd with gunfire.

Mr. Holmes’s lawyers made a long-expected move on Monday to change his plea to not guilty by reason of insanity. At an arraignment in March, a judge entered a straightforward not guilty plea on Mr. Holmes’s behalf after his lawyers said they were not ready to enter a plea.

The entire story is here.

California Senate leader proposes mental health program expansions

2013-05-19T07:58:00.000-04:00

By Patrick McGreevy
The Los Angeles Times
Originally posted May 7, 2013

State Senate leader Darrell Steinberg (D-Sacramento) on Tuesday proposed a plan to significantly increase mental health services in California with the goal of reducing the number of people ending up in prison, jail and emergency rooms.

Steinberg said the plan is in response to the Newtown, Conn., school massacre, in which a gunman killed 20 students and six adults, as well as a scandal involving a Nevada hospital dumping patients in other states, and the recent order by a federal court to further cut the number of inmates in California prisons

“It’s time for action,” he told reporters at the Capitol. Steinberg proposed expanding a program providing mental health services to prison parolees with mental illness from 1,500 to 5,000 people. Those in the program have a recidivism rate of 24%, nearly a third of the rate for those not in the program.

“While the governor appeals a federal court order to release thousands of state prison inmates, we also need to be smarter about crime by putting more resources into ensuring people who leave incarceration don’t commit new crimes and go back in,’’ Steinberg said.

The entire story is here.

Dangers found in lack of safety oversight for Medicare drug benefit

2013-05-19T07:45:00.000-04:00

By Tracy Weber, Charles Ornstein and Jennifer LaFleur
ProPublica
Originally published: May 11, 2013

Here is an excerpt:

But an investigation by ProPublica has found the program, in its drive to get drugs into patients’ hands, has failed to properly monitor safety. An analysis of four years of Medicare prescription records shows that some doctors and other health professionals across the country prescribe large quantities of drugs that are potentially harmful, disorienting or addictive for their patients. Federal officials have done little to detect or deter these hazardous prescribing patterns.

Searches through hundreds of millions of records turned up physicians such as the Miami psychiatrist who has given hundreds of elderly dementia patients the same antipsychotic, despite the government’s most serious “black box” warning that it increases the risk of death. He believes he has no other options.

Some doctors are using drugs in unapproved ways that may be unsafe or ineffective, records showed. An Oklahoma psychiatrist regularly prescribes the Alzheimer’s drug Namenda for autism patients as young as 12; he says he thinks it calms them. Autism experts said there is scant scientific support for this practice.

The entire article is here.

New Efforts to Overhaul Psychiatric Diagnoses Spurred by DSM Turmoil

2013-05-18T07:38:00.000-04:00

By Greg Miller
Wired Science
Originally posted May 17, 2013

Thousands of psychiatrists will descend on San Francisco this weekend for a meeting that will mark the release of the latest edition of the profession’s diagnostic guide, the Diagnostic and Statistical Manual of Mental Disorders, or DSM for short. This hugely influential book has been 14 years in the making, and it’s been dogged by controversies every step of the way.

To name just a few, there have been allegations of financial conflicts of interest, debates over whether internet addiction is really a thing (it is not, but “disordered gambling” is), arguments that the new diagnostic criteria will medicalize normal grief and temper tantrums, and lead to millions of people being falsely diagnosed with mental disorders.

With the new manual on the eve of its official debut, many experts are already looking beyond it. Some envision a future in which psychiatric diagnoses are based on the underlying biological causes instead of a description of a patient’s symptoms. Others caution that such a single-minded focus on biology ignores important social factors that contribute to mental illness. If there’s any area of agreement it’s this: There has to be a better way.

The DSM is used by doctors to diagnose patients, by insurance companies to decide what treatments to pay for, and by pharmaceutical companies and government funding agencies to set research priorities. The new edition, DSM-5, defines hundreds of mental disorders.

The fundamental problem, according to many of DSM’s critics, is that these definitions don’t carve nature at its joints.

“An obvious, easy example is schizophrenia,” said Peter Kinderman, a clinical psychologist at the University of Liverpool. “If you’re a 52-year-old man who hears voices, you’ll receive a diagnosis of schizophrenia. If you’re a 27-year-old woman with delusional beliefs, you’ll also receive a diagnosis of schizophrenia,” Kinderman said. “Two people can receive the same diagnosis and not have a single thing in common. That’s ludicrous scientifically.”

In most areas of medicine, diagnoses are based on the cause of illness. Heartburn and heart attacks both cause chest pain, but they’re different diagnoses because they have different underlying causes.

The entire story is here.

Psychiatry’s Guide Is Out of Touch With Science, Experts Say

2013-05-18T07:10:00.000-04:00

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.

Why the Fuss Over the D.S.M.-5?

2013-05-18T07:08:00.000-04:00

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 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.

The entire article is here.

Reconsidering the Declaration of Helsinki

2013-05-17T05:57:00.001-04:00

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.

Michael Shermer - The Moral Arc of Science

2013-05-17T05:57:00.000-04:00

One Fifth Of Suicidal Teens Have Access To Guns At Home

2013-05-16T06:05:00.000-04:00

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.

Minnesota now 12th state to approve gay marriage

2013-05-16T06:04:00.000-04:00

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.

One Step Forward On Mental Health Parity

2013-05-15T06:02:00.000-04:00

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.

Parity Laws: Powerful Weapon--or Pipe Dream?

2013-05-15T06:01:00.000-04:00

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.

Ethics of Erasing Memory

2013-05-14T05:53:00.000-04:00

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.

Kierkegaard at 200

2013-05-14T05:52:00.000-04:00

By Gordon Marino
The New York Times - Op Ed
Originally published May 3, 2013

THE intellectual immortal Soren Kierkegaard turns 200 on Sunday. The lyrical Danish philosopher is widely regarded as the father of existentialism, a philosophical and literary movement that emphasizes the category of the individual and meditates on such gauzy questions as, Is there a meaning to life?

Not surprisingly, existentialism hit its zenith after humanity got a good look at itself in the mirror of the Holocaust, but then memories faded and economies boomed and existentialism began to seem a little overwrought.

(cut)

In one of his books Kierkegaard moans, “The present age is an age of publicity, the age of miscellaneous announcements: Nothing happens but still there is instant publicity.” In the end, Kierkegaard was concerned about the power of the press to foment and form public opinion and in the process relieve of us of the need to think matters through on our own.

Over a 17-year span, Kierkegaard published a score of books and compiled thousand of pages of journal entries. Like Nietzsche and other geniuses who were more than less immolated by the fiery force of their own ideas, Kierkegaard sacrificed his body to dance out the riches of his thoughts. Self-conscious of his own preternatural powers, he wrote, “Geniuses are like thunderstorms. They go against the wind, terrify people, cleanse the air.”

The entire piece is here.

Vignette 25: A Questionable Letter

2013-05-13T08:00:00.000-04:00

Dr. Betty Frances has been treating Peggy Olson for anxiety and depression related to job stress and intermittent spousal bullying. During their course of treatment, Mr. Olson physically abused Mrs. Olson to the point where the police arrested him on charges of domestic violence and terroristic threats. Because of the seriousness of his threats and prior criminal behavior, Mr. Olson’s family could not bail him out of prison.

After this event, Mrs. Olson became more forthcoming with Dr. Frances. His behavioral history includes stalking, assault, battery, public disturbance, public intoxication, and other out of control behaviors. Dr. Frances continues to treat Mrs. Olson for anxiety and depression on a weekly basis.

Dr. Frances arrived at her office one day and found a letter with the return address of Mr. Olson at the local detention facility. Dr. Frances feels an anxiety reaction in her body. Trying to calm down, Dr. Frances writes out a list of questions.

1. Should I open the letter now (as it is addressed to me)?

2. Should I tell the patient about the letter before I open it?

3. What are the benefits of telling the patient about the letter?

4. What are the drawbacks of telling the patient about the letter?

5. If the letter contains threatening information toward Mrs. Olson, or me, am I able to turn the letter over to the District Attorney?

6. Am I required to turn the letter over to the DA if there is threatening information in it?

7. How much control does the patient have over the letter and its contents?

8. Is the letter automatically part of the treatment record or does it depend on the contents of the letter?

9. Do I need a self-care plan as I am stressed out about this situation?

Having calmed down and written out these questions, Dr. Frances calls you for an ethics consultation about the letter.

What are your responses to her questions about the letter?

Capitalism is killing our morals, our future

2013-05-12T08:01:00.000-04:00

By Paul B. Farrell
The Wall Street Journal
Originally published April 29, 2013

Yes, capitalism is working ... for the Forbes 1,000 Global Billionaires whose ranks swelled from 322 in 2000 to 1,426 recently. Billionaires control the vast majority of the world’s wealth, while the income of American workers stagnated.

For the rest of the world, capitalism is not working: A billion live on less than two dollars a day. With global population exploding to 10 billion by 2050, that inequality gap will grow, fueling revolutions, wars, adding more billionaires and more folks surviving on two bucks a day.

Over the years we’ve explored the reasons capitalism blindly continues on its self-destructive path. Recently we found someone who brilliantly explains why free-market capitalism is destined to destroy the world, absent a historic paradigm shift: That is Harvard philosopher Michael Sandel, author of the new best-seller, “What Money Can’t Buy: The Moral Limits of Markets,” and his earlier classic, “Justice: What’s the Right Thing to Do?”

For more than three decades Sandel’s been explaining how capitalism is undermining America’s moral values and why most people are in denial of the impact. His classes are larger than a thousand although you can take his Harvard “Justice” course online. Sandel recently summarized his ideas about capitalism in the Atlantic. In “What Isn’t for Sale?” he writes:

“Without being fully aware of the shift, Americans have drifted from having a market economy to becoming a market society ... where almost everything is up for sale ... a way of life where market values seep into almost every sphere of life and sometimes crowd out or corrode important values, non-market values.”

Sandel should be required reading for all Wall Street insiders as well as America’s 95 million Main Street investors. Here’s a condensed version:

In one generation, market ideology consumed America’s collective spirit

“The years leading up to the financial crisis of 2008 were a heady time of market faith and deregulation — an era of market triumphalism,” says Sandel. “The era began in the early 1980s, when Ronald Reagan and Margaret Thatcher proclaimed their conviction that markets, not government, held the key to prosperity and freedom.”

And in the 1990s with the “market-friendly liberalism of Bill Clinton and Tony Blair, who moderated but consolidated the faith that markets are the primary means for achieving the public good.”

Today “almost everything can be bought and sold.” Today “markets, and market values, have come to govern our lives as never before. We did not arrive at this condition through any deliberate choice. It is almost as if it came upon us,” says Sandel.

The entire article is here.

You can find Harvard University's Justice with Michael Sandel here.

Schools drop Mellow’s name

2013-05-12T08:00:00.000-04:00

By Andrew Seder
The Times Leader
Originally published April 25, 2013

The name of disgraced ex-state Sen. Robert J. Mellow has been removed from two buildings, a portion of one local college campus and one park.

On Thursday, Marywood University issued a statement saying, “After thoughtful consideration, The Marywood University Board of Trustees made the decision this past Saturday at their spring meeting to rename the university’s athletic center. The center originally named for Senator Robert J. Mellow, will for the foreseeable future be referred to as The Marywood University Center for Athletics and Wellness.”

Also, Lackawanna College President Mark Volk sent an email to all college staff members Thursday informing them that the campus’ Mellow Theater has been renamed.

“The college’s board of trustees met recently and after a serious discussion decided to name the college’s theater. Effective immediately, it is officially The Theater at Lackawanna College,” Volk wrote in the email obtained by The Times Leader.

The entire story is here.

Physicians build less rapport with obese patients

2013-05-11T06:32:00.000-04:00

By K.A. Gudzune, M.C. Beach, D.L. Roter, & L.A. Cooper
Obesity (Silver Spring). 2013 Mar 20. doi: 10.1002/oby.20384.

Abstract

Objective:
Physicians' negative attitudes towards patients with obesity are well documented. Whether or how these beliefs may affect patient-physician communication is unknown. We aimed to describe the relationship between patient BMI and physician communication behaviors (biomedical, psychosocial/lifestyle, and rapport building) during typical outpatient primary care visits.

Design and Methods:
Using audio-recorded outpatient encounters from 39 urban PCPs and 208 of their patients, we examined the frequency of communication behaviors using the Roter Interaction Analysis System. The independent variable was measured patient BMI and dependent variables were communication behaviors by the PCP within the biomedical, psychosocial/lifestyle, and rapport building domains. We performed a cross-sectional analysis using multilevel Poisson regression models to evaluate the association between BMI and physician communication.

Results:
PCPs demonstrated less emotional rapport with overweight and obese patients (IRR 0.65, 95%CI 0.48-0.88, p=0.01; IRR 0.69, 95%CI 0.58-0.82, p<0.01, respectively) than for normal weight patients. We found no differences in PCPs' biomedical or psychosocial/lifestyle communication by patient BMI.

Conclusions:
Our findings raise the concern that low levels of emotional rapport in primary care visits with overweight and obese patients may weaken the patient-physician relationship, diminish patients' adherence to recommendations, and decrease the effectiveness of behavior change counseling.

And, click here for a blog post on this article, with the excerpt below:

Are Doctors Nicer to Thinner Patients?

By TARA PARKER-POPE
The New York Times - Well Column
Originally published April 29, 2013

Here is an excerpt:

“When there is increased empathy by the doctor, patients are more likely to report they are satisfied with their care, and they are more likely to adhere to recommendations of physicians,” Dr. Gudzune said. “There is evidence to show that after visits with more empathy, patients have improved clinical outcomes, so patients with diabetes have better blood sugar control or cholesterol is better controlled.”

Dr. David L. Katz, director of the Yale-Griffin University Prevention Research Center, says that overweight patients often complain to him that doctors appear judgmental about their weight, at the expense of other health concerns.

“You come in with a headache, and the doctors say, ‘You really need to lose weight.’ You have a sore throat, and the doctor says, ‘You really need to lose weight,’ ” he said. “These patients feel like the doctor doesn’t help them and they insult them, and so they stop going.”

In dealing with patients who are overweight, Dr. Katz added, doctors often show the same biases and prejudices as the culture at large. The problem may be compounded by the fact that doctors are trained to deal with immediate medical problems that have specific solutions, like a pill to lower blood pressure or emergency treatment for a heart attack. But obesity is a far more complex problem that isn’t easy to solve, and that can be frustrating to doctors.

“When we can’t fix what is broken we tend to behave badly,” he said.

Genetic Testing Recommendations Contradict Professional Ethics, Experts Say

2013-05-11T06:29:00.000-04:00

By Rebecca Voelker
News@JAMA
Originally posted May 9, 2013

Recent recommendations that advise laboratories and physicians how to tell patients about incidental findings in genetic tests contradict ethical clinical practice, according to bioethicists at Stanford University’s Center for Biomedical Ethics in California.

A working group convened by the American College of Medical Genetics and Genomics (ACMG) released recommendations in March saying that clinical DNA sequencing laboratories should test for a list of specific genetic abnormalities regardless of the clinical reason for testing and report the results to the patient’s physician. In turn, the recommendations say physicians have a responsibility to give patients all the findings, even if patients don’t want results that aren’t relevant to the condition for which they were tested.

The ACMG recommends that patients who undergo genome sequencing be tested for conditions including various forms of cancer, cardiomyopathy, and familial hypercholesterolemia in addition to their primary medical condition.

Recommending that patients not be able to choose whether they want to receive incidental findings, even when test results suggest adult-onset conditions in children, “contradicts ethical clinical practice in general,” wrote bioethicists Megan Allyse, PhD, and Marsha Michie, PhD, in the journal Trends in Biotechnology.

The entire article is here.

The ACMG recommendations are here.

The Mind of a Con Man

2013-05-10T06:00:00.000-04:00

By YUDHIJIT BHATTACHARJEE
The New York Times
Published: April 26, 2013

Here are some excerpts:

Stapel was an academic star in the Netherlands and abroad, the author of several well-regarded studies on human attitudes and behavior. That spring, he published a widely publicized study in Science about an experiment done at the Utrecht train station showing that a trash-filled environment tended to bring out racist tendencies in individuals. And just days earlier, he received more media attention for a study indicating that eating meat made people selfish and less social.

His enemies were targeting him because of changes he initiated as dean, Stapel replied, quoting a Dutch proverb about high trees catching a lot of wind. When Zeelenberg challenged him with specifics — to explain why certain facts and figures he reported in different studies appeared to be identical — Stapel promised to be more careful in the future. As Zeelenberg pressed him, Stapel grew increasingly agitated.

Finally, Zeelenberg said: “I have to ask you if you’re faking data.”

“No, that’s ridiculous,” Stapel replied. “Of course not.”

That weekend, Zeelenberg relayed the allegations to the university rector, a law professor named Philip Eijlander, who often played tennis with Stapel. After a brief meeting on Sunday, Eijlander invited Stapel to come by his house on Tuesday morning. Sitting in Eijlander’s living room, Stapel mounted what Eijlander described to me as a spirited defense, highlighting his work as dean and characterizing his research methods as unusual. The conversation lasted about five hours. Then Eijlander politely escorted Stapel to the door but made it plain that he was not convinced of Stapel’s innocence.

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And yet as part of a graduate seminar he taught on research ethics, Stapel would ask his students to dig back into their own research and look for things that might have been unethical. “They got back with terrible lapses,” he told me. “No informed consent, no debriefing of subjects, then of course in data analysis, looking only at some data and not all the data.” He didn’t see the same problems in his own work, he said, because there were no real data to contend with.

The entire story is here.