The coming burden of Alzheimer's disease

In 2005, Medicare paid out $91 billion for costs related to Alzheimer's and other forms of dementia. By 2015, those costs are expected to climb to $189 billion. Medicaid paid $21 billion in nursing home costs for Alzheimer's and dementia patients in 2005; by 2015, those costs will climb to $27 billion. It seems ironic that Alzheimer's-related costs are set to balloon as the billions of dollars pumped into treating and preventing other maladies are beginning to show results. In recent years, medical care has advanced to the point that deaths from cancers, heart disease and stroke, the leading causes of death in the U.S., have dropped dramatically. Very quietly though, deaths from Alzheimer's disease have climbed 44 percent, from 49,558 to 71,696. There is no cure for Alzheimer's. Its biggest risk factor is old age.

Some psych patients wait days in hospital ERs

Emergency rooms, they say, have become all-purpose dumping grounds for the mentally ill, with patients routinely marooned a day or more while health care workers try to find someone to care for them. A survey of hundreds of U.S. hospitals released last month by the American College of Emergency Physicians found that 79 percent reported that they routinely "boarded" psychiatric patients in their waiting rooms for at least some period of time because of the unavailability of immediate services. One-third reported that those stays averaged at least eight hours, and 6 percent said they had average waits of more than 24 hours for the next step in a patient's care.

Psychiatric Group Faces Scrutiny Over Drug Industry Ties

Commercial arrangements are rampant throughout medicine. In the past two decades, drug and device makers have paid tens of thousands of doctors and researchers of all specialties. Worried that this money could taint doctors’ research plans or clinical judgment, government agencies, medical journals and universities have been forced to look more closely at deal details.
In psychiatry, Mr. Grassley has found an orchard of low-hanging fruit. As a group, psychiatrists earn less in base salary than any other specialists, according to a nationwide survey by the Medical Group Management Association. In 2007, median compensation for psychiatrists was $198,653, less than half of the $464,420 earned by diagnostic radiologists and barely more than the $190,547 earned by doctors practicing internal medicine. But many psychiatrists supplement this income with consulting arrangements with drug makers, traveling the country to give dinner talks about drugs to other doctors for fees generally ranging from $750 to $3,500 per event, for instance.

States turn down US abstinence education grants

Doctors are supposed to prescribe tests and treatments that are medically necessary for their patients. Health insurers are expected to cover that care, while keeping inappropriate expenses in check. But what happens when that process breaks down and sick patients are left to fight for medical care? Each year, thousands of Californians find themselves at odds with their health insurers over whether they, as patients, should get the treatment their doctors prescribed.
Peter Isgro of Santa Cruz is among them. His insurer, Anthem Blue Cross, stopped paying for certain chemotherapy drugs after his cancer progressed, a decision that has been upheld in two appeals. Isgro said he feels like the insurance company is second-guessing his doctor. "If your doctor wants to give you something and they can deny it, that's wrong," he said.

Female circumcision: A tradition steeped in blood

Children as young as five are held down and cut, sometimes with razor blades or broken glass, in a ritual driven by a range of cultural demands, including a desire to demonstrate a girl's virginity on her wedding night. The practice, which survives mainly in 28 countries in East and West Africa, has been targeted as a fundamental human rights violation in recent years by the United Nations and individual states, including the UK. The World Health Organisation estimates that up to 140 million girls and women around the world have suffered some type of genital mutilation, and around three million girls, most of them under 15, undergo the procedure every year.

Mentally ill children stuck in hospital limbo (Boston Globe)

Parents and advocates report that in recent weeks across the state, at least a dozen children and teens in crisis - threatening violence to themselves or others - have waited three, five, even seven days in hospital emergency rooms or medical wards for psychiatric beds.
Kelly Rowell, left, diagnosed with developmental disabilities and bipolar disorder, waited for a week in a hospital emergency room. By all accounts, the state has made significant progress toward solving the problem of "stuck kids" - children with mental illness deemed well enough to leave hospital psychiatric units but stuck in them for lack of treatment programs outside.
But while it has gotten easier for children to leave the state's mental health facilities, which should make more beds available, it appears to have gotten harder, in some cases, to get in.

Nearly 100 Japanese commit suicide each day

An average of almost 100 Japanese people killed themselves each day last year, according to figures out today, dealing a serious blow to a government campaign to drastically reduce the suicide rate by 2016. A total of 33,093 people committed suicide in 2007, up 3% from 2006 and the 10th year in a row the number has exceeded 30,000, the national police agency said. The figure is the second highest after the 34,427 recorded suicides in 2003. Depression was identified as the main factor in around a fifth of cases, followed by physical illness and debt. The number of elderly people who killed themselves rose 9% from a year earlier as Japan grapples with a rapidly aging society and rising poverty among pensioners. People aged over 60 made up the biggest individual group of victims, rising to a record high of 36.6% of the total, the agency said.

Anonymous rape tests to go nationwide

Starting next year across the country, rape victims too afraid or too ashamed to go to police can undergo an emergency-room forensic rape exam, and the evidence gathered will be kept on file in a sealed envelope in case they decide to press charges.The new federal requirement that states pay for "Jane Doe rape kits" is aimed at removing one of the biggest obstacles to prosecuting rape cases: Some women are so traumatized they don't come forward until it is too late to collect hair, semen or other samples.

Screening for Abuse May Be Key to Ending It

In a recent nationwide study of nearly 5,000 women, only 7 percent said a health professional had ever asked them about domestic or family violence. When surveyed, doctors often respond that they don’t ask such questions because of a lack of time, training and easy access to services that help these patients. Some have reported that they worry about offending patients and believe asking won’t make any difference. . . .
Dr. Rodriguez and other experts say that urging an abused patient simply to leave may not be realistic or safe, for several reasons: The risk of being murdered is highest at the time one leaves, the woman may depend on her partner for food and shelter, and patients may not respond well to a doctor who dictates what to do. . . .
According to the Bureau of Justice Statistics, from 2001 to 2005 (the last year for which statistics are available) there was an annual average of nearly 511,000 violent assaults against women — and 105,000 against men — by a spouse or intimate partner, about half resulting in physical injury.

Newsweek story on bipolar disorder

The mothers of bipolar kids often say their babies are born screaming. These are children who live at the extremes: so giddy they can't speak in sentences, so low they refuse to speak at all. Unlike bipolar adults, they flit rapidly between emotions; sometimes they seem to feel everything at once. At least 800,000 children in the United States have been diagnosed as bipolar, no doubt some of them wrongly. The disease is hard to pin down. The bipolar brain is miswired, but no one knows why it develops that way. There are many drugs, but it's unclear how they work. Often, they don't work at all, and they may interfere with normal brain growth. There are no studies on their long-term effects in children. Yet untreated bipolar disorder can be disastrous; 10 percent of sufferers commit suicide. Parents must choose between two wrenching options: treat their children and risk a bad outcome, or don't treat and risk a worse one. No matter what they do, they are in for uncertainty and pain.

A Debunking on Teenagers and 'Technical Virginity'

Contrary to widespread belief, teenagers do not appear to commonly engage in oral sex as a way to preserve their virginity, according to the first study to examine the question nationally.
The analysis of a federal survey of more than 2,200 males and females aged 15 to 19, released yesterday, found that more than half reported having had oral sex. But those who described themselves as virgins were far less likely to say they had tried it than those who had had intercourse.
"There's a popular perception that teens are engaging in serial oral sex as a strategy to avoid vaginal intercourse," said Rachel Jones of the Guttmacher Institute, a private, nonprofit research organization based in New York, who helped do the study. "Our research suggests that's a misperception."
Instead, the study found that teens tend to become sexually active in many ways at about the same time. For example, although only one in four teenage virgins had engaged in oral sex, within six months after their first intercourse more than four out of five adolescents reported having oral sex.

Tallying Mental Illness' Costs (Time Magazine)

Serious mental illnesses (SMIs), which afflict about 6% of American adults, cost society $193.2 billion in lost earnings per year, according to findings published in this month's American Journal of Psychiatry. Surveying data from nearly 5,000 participants, researchers determined that people suffering from a SMI — defined as a range of mood and anxiety disorders, including suicidal tendencies, that significantly impaired a person's ability to function for at least 30 days over the past year — earned at least 40% less than people in good mental health. "The results of this study confirm the belief that mental disorders contribute to enormous losses of human productivity," says Ronald Kessler, a Harvard professor of health care policy and lead author of the study, funded by the National Institute of Mental Health. . . . . "Each year the economic cost of untreated mental illness is staggering — over $100 billion on untreated mental health disorders and $400 billion on addiction disorders," Sullivan said. "Our country cannot afford to continue losing $500 billion a year to these treatable diseases."

Philippines bans kidney transplant 'tourism'

The Philippines today announced a ban on kidney transplants involving overseas patients in an effort to stamp out the murky organ trade, which preys on some of the country's most vulnerable and impoverished people. The thriving "transplant tourism" trade made the Philippines one of the world's cheapest places for wealthy foreign patients seeking to buy a new kidney. But gangs of organ traffickers often lured poor Filipinos into giving up one of their kidneys - invariably for a pittance - as the traders profited from the sales. "They feast on our poverty," said Francisco Duque, the Philippines health secretary, as he unveiled new rules barring living donors from giving organs to non-relatives. "The sale of one's body parts is condemnable and improper. We have to stop it."

Dental Clinics, Meeting a Need With No Dentist

The dental clinic in this village on the edge of the Bering Sea looks like any other, with four chairs, a well-scrubbed floor and a waiting area filled with magazines. But to the Alaska Dental Society and the American Dental Association, the clinic is a place where the rules of dentistry are flouted daily. The dental groups object not because of any evidence that the clinic provides substandard care, but because it is run by Aurora Johnson, who is not a dentist. After two years of training in a program unique to Alaska, Ms. Johnson performs basic dental work like drilling and filling cavities.
Some dentists who specialize in public health, noting that 100 million Americans cannot afford adequate dental care, say such training programs should be offered nationwide. But professional dental groups disagree, saying that only dentists, with four years of postcollegiate education, should do work like Ms. Johnson’s. And while such arrangements are common outside the United States, only one American dental school, in Anchorage, offers such a program.

Getting married for health insurance

In a poll released today, 7% of Americans said they or someone in their household decided to marry in the last year so they could get healthcare benefits via their spouse."It's a small number but a powerful result, because it shows how paying for healthcare is reflected not only in family budgets but in life decisions," said Drew E. Altman, president of the Kaiser Family Foundation, which commissioned the survey as part of its regular polling on healthcare.On a broader scale, the survey found that healthcare costs outranked housing costs, rising food prices and credit card bills as a source of concern. Twenty-eight percent of those surveyed said they had experienced serious problems because of the cost of healthcare, compared with 29% who had problems getting a good job or a raise. Gasoline prices were the top economic worry, with 44% saying they had serious problems keeping up with increases at the pump.

The changing healthcare landscape

. . . . While doctor nurses are still a rare breed nationally, that's about to change dramatically. The first class of 24 doctor nurses graduated in December from the University of Minnesota's School of Nursing, one of a handful of schools at the forefront of this trend. All have returned to their jobs or new positions, some with expanded roles and pay. Now more than 90 nursing schools have introduced DNP programs and 200 more are about to start. Beginning next year, the University of Minnesota is converting its entire master's of nursing practice program into a doctoral course, meaning any nurse practitioner who passes board exams will be a doctor nurse. . . . . Experts are forecasting a shortage of physicians in the country by 2020 because the population has grown even as enrollments in medical schools have remained flat. What's more, 36 percent of active physicians are older than 55 and most will retire by 2020 . . . . The shortage is already showing up in primary care, which includes family medicine, pediatrics and internal medicine. This year, U.S. medical graduates filled just 1,156 of 2,387 residency positions nationally in family medicine; the rest were filled by foreign medical graduates. Primary care doctors are paid far less than specialists. . . . According to Delaney, there is already an 80 percent overlap between what nurse practitioners do and what primary care physicians do.

Curbing guns, but not too much

ON APRIL 16th last year a deranged student, Cho Seung-hui, killed 32 people before shooting himself at Virginia Tech university. He had legally acquired the two handguns he used that morning. Before his rampage on the campus, which spreads over the rolling hills of Blacksburg, teachers and university police were already worried about his volatile behaviour and violent writings. He was recommended for psychiatric treatment but, because of cracks in the state mental-health system, never received it.
Virginia's rush to reform has been dramatic but incomplete. At the urging of the state's governor, Timothy Kaine, the legislature has funnelled an extra $42m into mental-health treatment and staff. Virginia has also rewritten its laws for identifying and monitoring the mentally ill. One new law requires colleges to alert the parents of students who may be a danger to themselves or to others. And the state now requires mental-health questions on the instant-background checks for gun-buyers. These might have kept firearms out of Cho's hands.

The oldest Americans are also the happiest

It turns out the golden years really are golden. Eye-opening new research finds the happiest Americans are the oldest, and older adults are more socially active than the stereotype of the lonely senior suggests. The two go hand-in-hand: Being social can help keep away the blues."The good news is that with age comes happiness," said study author Yang Yang, a University of Chicago sociologist. "Life gets better in one's perception as one ages." A certain amount of distress in old age is inevitable, including aches and pains and the deaths of loved ones and friends. But older people generally have learned to be more content with what they have than younger adults, Yang said. This is partly because older people have learned to lower their expectations and accept their achievements, said Duke University aging expert Linda George. An older person may realize "it's fine that I was a schoolteacher and not a Nobel prize winner."

President Is Rebuffed on Program for Children

The Bush administration violated federal law last year when it restricted states’ ability to provide health insurance to children of middle-income families, and its new policy is therefore unenforceable, lawyers from the Government Accountability Office said Friday.The ruling strengthens the hand of at least 22 states, including New York and New Jersey, that already provide such coverage or want to do so. And it significantly reduces the chance that the new policy can be put into effect before President Bush leaves office in nine months.At issue is the future of the State Children’s Health Insurance Program, financed jointly by the federal government and the states. Congress last year twice passed bills to expand the popular program, and Mr. Bush vetoed both.

Before Medicare, Sticker Shock and Rejection

IF you want to retire before you are 65 and eligible for Medicare, health insurance is vital to your plans. Without it, you risk losing everything. Less than a third of employers offer retiree health benefits, down from almost half in 1993, according to a survey by the Mercer Health and Benefits consulting firm. Those without retiree health benefits who are eligible can use a patchwork of federal and state laws to build an insurance bridge — although an expensive one — to Medicare.Usually, however, the best, least-expensive option is to buy an individual policy, but that can be problematic if you have pre- existing health conditions.

Few US doctors answer e-mails from patients

Doctors have their reasons for not hitting the reply button more often. Some worry it will increase their workload, and most physicians don't get reimbursed for it by insurance companies. Others fear hackers could compromise patient privacy — even though doctors who do e-mail generally do it through password-protected Web sites.
There are also concerns that patients will send urgent messages that don't get answered promptly. And any snafu raises the specter of legal liability.
Many patients would like to use e-mail for routine matters such as asking for a prescription refill, getting lab results or scheduling a visit. Doing so, they say, would help avoid phone tag or taking time off work to come in for a minor problem.
Still, a survey conducted early last year by Manhattan Research found that only 31 percent of doctors e-mailed their patients in the first quarter of 2007. . . Dr. Daniel Z. Sands, an assistant clinical professor at Harvard Medical School, is among the early adopters who doesn't get paid for e-visits. He sees communicating with patients online as no different from phoning them, a practice that also is not billable.

Congress Near Deal on Genetic Test Bias Bill

Congress reached an agreement clearing the way for a bill to prohibit discrimination by employers and health insurers on the basis of genetic tests. . . . Some of the tests already exist, like one for breast cancer risk, and new ones are being introduced almost every month. But backers of the legislation say many people are afraid of taking such tests because they fear the results would be used to deny them employment or health insurance.

The silent tsunami (Economist article)

A wave of food-price inflation is moving through the world, leaving riots and shaken governments in its wake. For the first time in 30 years, food protests are erupting in many places at once. Bangladesh is in turmoil; even China is worried. Elsewhere, the food crisis of 2008 will test the assertion of Amartya Sen, an Indian economist, that famines do not happen in democracies.
Famine traditionally means mass starvation. The measures of today's crisis are misery and malnutrition. The middle classes in poor countries are giving up health care and cutting out meat so they can eat three meals a day. The middling poor, those on $2 a day, are pulling children from school and cutting back on vegetables so they can still afford rice. Those on $1 a day are cutting back on meat, vegetables and one or two meals, so they can afford one bowl. The desperate—those on 50 cents a day—face disaster.

Every year, between 300 and 400 doctors take their own lives—roughly one a day

The unsettling truth is that doctors have the highest rate of suicide of any profession. Every year, between 300 and 400 physicians take their own lives—roughly one a day. And, in sharp contrast to the general population, where male suicides outnumber female suicides four to one, the suicide rate among male and female doctors is the same. . . . One way to address physician suicide, says Reynolds, is to focus on medical students and residents, since depression often starts in young adulthood. Medical schools across the country have launched programs that, among other things, guarantee students who seek help that it will not appear on their records.

Should Pro-suicide Internet Websites be Banned?

Researchers used four search engines to look for suicide-related sites, the British Medical Journal said. The three most frequently occurring sites were all pro-suicide, prompting researchers to call for anti-suicide web pages to be prioritised. Mental health campaigners said such sites preyed on vulnerable people. Unlike in some countries, pro-suicides sites are not banned in the UK.

Is This Good Policy?

France's lower house of parliament today adopted a groundbreaking bill that would make it illegal for anyone to publicly incite extreme thinness. Fashion industry experts said that the law, which would apply to magazines, advertisers and websites, would be the strongest of its kind anywhere. Valerie Boyer, from the ruling UMP party, proposed the new legislation which she said would give judges the power to imprison offenders and fine them up to 30,000 euros (£24,125) if convicted of "inciting others to deprive themselves of food" to an "excessive" degree.

Study: Boomers to flood medical system

"We face an impending crisis as the growing number of older patients, who are living longer with more complex health needs, increasingly outpaces the number of health care providers with the knowledge and skills to care for them capably," said John W. Rowe, professor of health policy and management at Columbia University. Rowe headed an Institute of Medicine committee that released a report Monday on the health care outlook for the 78 million baby boomers about to begin turning 65. The report from the institute, an arm of the National Academy of Sciences, said:
_There aren't enough specialists in geriatric medicine.
_Insufficient training is available.
_The specialists that do exist are underpaid.
_Medicare fails to provide for team care that many elderly patients need. . . .
The federally required minimum number of hours of training for direct-care workers should be raised from 75 to at least 120, the report said, noting that more training is required for dog groomers and manicurists than direct-care workers in many parts of the country.
And it said pay for geriatric specialists, doctors, nurses and care workers needs to be increased.
A doctor specializing in elderly care earned $163,000 on average in 2005 compared with $175,000 for a general internist, even though the geriatric specialist required more training.

Clinton, Obama differ slightly on health plans

Sens. Obama and Clinton both say they make reducing the number of people without health insurance - 47 million - a cornerstone of their health plans. Their approaches are so similar that some health experts say this is not the issue that will help most voters decide between the two Democrats. The real fireworks will come in the fall when one of them faces Sen. John McCain, the presumptive Republican nominee, whose proposal is starkly different and represents a greater departure from the status quo. . . . Both Clinton and Obama say they want to build on the current mix of public and private health insurance to make coverage universal and affordable. Both say they would offer tax subsidies to help people buy insurance, require most employers to help pay for insurance, and limit insurance company profits. Individuals and small businesses could join big groups to buy private insurance or a Medicare-like public plan.
The big difference between the two is that Clinton would require everyone to have health insurance and Obama would mandate it only for children.

States 'recycle' meds to battle costs

The struggle to keep soaring medical costs in check is feeding an increase in state programs that collect unused prescription drugs to give away to the uninsured and poor. Some states allow donations of sealed drugs from individuals, while others only accept pharmaceuticals from institutions, such as doctor's offices or assisted-living homes. Drugs are typically vetted by pharmacists to cross-check safety, then distributed by hospitals, pharmacies or charitable clinics. The type of drugs donated run the gamut and include antibiotics, antipsychotics, blood thinners and antidepressants. At least 33 states have laws to allow or study drug recycling programs, according to the National Conference of State Legislatures. Most state programs are just a few years old or still in the test stages, but officials envision huge gains.

Antidepressants and suicide

A health warning meant to alert doctors about the potential risks of prescribing antidepressants to youth may have actually triggered a significant rise in suicides among Canadians under age 18, a new study has found. The findings, published today in the Canadian Medical Association Journal, are adding new fuel to an already heated controversy about whether certain antidepressants may pose a risk to Canadians, particularly teens and children, or if the drugs help reduce suicide rates.

In Massachusetts, Universal Coverage Strains Care

In pockets of the United States, rural and urban, a confluence of market and medical forces has been widening the gap between the supply of primary care physicians and the demand for their services. Modest pay, medical school debt, an aging population and the prevalence of chronic disease have each played a role. Now in Massachusetts, in an unintended consequence of universal coverage, the imbalance is being exacerbated by the state’s new law requiring residents to have health insurance. Since last year, when the landmark law took effect, about 340,000 of Massachusetts’ estimated 600,000 uninsured have gained coverage. Many are now searching for doctors and scheduling appointments for long-deferred care.

Researchers Find Huge Variations in End-of-Life Treatment

New research shows huge, unexplained variations in the amount, intensity and cost of care provided to Medicare patients with chronic illnesses at the nation’s top academic medical centers, raising the possibility that the government could save large amounts of money.

In a report being issued on Monday, Dartmouth researchers say that total Medicare spending in the last two years of life ranges from an average of $93,842 for patients who receive most of their care at U.C.L.A. Medical Center to $53,432 at the Mayo Clinic’s main teaching hospital in Rochester, Minnesota.

Is Prevention Always Cost Effective?

In 1986, a health economist named Louise B. Russell published "Is Prevention Better Than Cure?," in which she concluded that prevention activities tend to cost more than they save. Since the book's appearance, her observation has been borne out by studies of hundreds of interventions -- everything from offering mammograms to all women and prescribing drugs to people with high cholesterol to requiring passenger-side air bags in cars and shortening the response time of ambulances.

Should CEO Salaries at Not-for-Profits be Capped?

The Boston Herald on Wednesday featured an article about hospital CEO salaries in the Bay State. According to the article, 14 top executives at nonprofit Massachusetts hospitals have "million-dollar-plus pay packages". A
state legislator is proposing to cap compensation at nonprofits in the state.

Abortion Restored in Reproductive Health Database

Dean of the Johns Hopkins University Public Health School, Dr. Michael J. Klag, ordered the school’s federally-funded online database of reproductive health literature reprogrammed to restore the word 'abortion' as a search term. Administrators had set POPLINE, the world’s largest database on reproductive health, with more than 360,000 records and articles on family planning, fertility and sexually transmitted diseases, to ignore abortion as a search term.
The move to censor abortion-related materials was met with harsh criticism from libraries trying to access the articles and women’s health advocates, according to UPI. POPLINE representatives said that the decision to do so was tied to their funding from the US Agency for International Development (USAID).

One in 4 Teen Girls Has a Sexually Transmitted Disease

More than 3 million teenaged girls have at least one sexually transmitted disease (STD), a new government study suggests. The most severely affected are African-American teens. In fact, 48 percent of African-American teenaged girls have an STD, compared with 20 percent of white teenaged girls. "What we found is alarming," Dr. Sara Forhan, from the U.S. Centers for Disease Control and Prevention, said during a teleconference Tuesday. "One in four female adolescents in the U.S. has at least one of the four most common STDs that affects women." "These numbers translate into 3.2 million young women nationwide who are infected with an STD," Forhan said. "This means that far too many young women are at risk of the serious health effects of untreated STDs, including infertility and cervical cancer."

Home bipolar disorder test causes stirs

Dr. John Kelsoe has spent his career trying to identify the biological roots of bipolar disorder. In December, he announced he had discovered several gene mutations closely tied to the disease, also known as manic depression. Then Kelsoe, a prominent psychiatric geneticist at the University of California, San Diego, did something provocative for the buttoned-down world of academic medical research: He began selling bipolar genetic tests straight to the public over the Internet last month for $399. His company, La Jolla-based Psynomics, joins a legion of startups racing to exploit the boom in research connecting genetic variations to a host of health conditions. More than 1,000 at-home gene tests have burst onto the market in the past few years. The proliferation of these tests troubles many public health officials, medical ethicists and doctors. The tests receive almost no government oversight, even though many of them are being sold as tools for making serious medical decisions. Health experts worry that many of these products are built on thin data and are preying on individuals' deepest anxieties.

Are you addicted to the Internet?

Excessive gaming, viewing online pornography, emailing and text messaging have been identified as causes of a compulsive-impulsive disorder by Dr Jerald Block, author of an editorial for the respected American Journal of Psychiatry. Block argues that the disorder is now so common that it merits inclusion in the Diagnostic and Statistical Manual of Mental Disorders, the profession's primary resource to categorise and diagnose mental illnesses. He says internet addiction has four main components:
· Excessive use, often associated with a loss of sense of time or a neglect of basic drives;
· Withdrawal, including feelings of anger, tension and/or depression when the computer is inaccessible;
· The need for better computers, more software, or more hours of use;
· Negative repercussions, including arguments, lying, poor achievement, social isolation and fatigue.

Culture gap

Among newcomers to this nation - one in eight Americans is now foreign-born - mental illness can be an alien, stigmatizing term, and many immigrants from Latin America, Africa, and Asia are far more likely to talk initially about physical ailments than seek psychiatric services.
Over the past several years, top mental health specialists have begun a number of new initiatives to improve psychiatric care for immigrants. The Massachusetts Department of Mental Health, along with a team of researchers, are educating primary care doctors around the state about what physical symptoms might be signs of mental disorders.

Gap in Life Expectancy Widens for the Nation

New government research has found “large and growing” disparities in life expectancy for richer and poorer Americans, paralleling the growth of income inequality in the last two decades.
Life expectancy for the nation as a whole has increased, the researchers said, but affluent people have experienced greater gains, and this, in turn, has caused a widening gap. One of the researchers, Gopal K. Singh, a demographer at the Department of Health and Human Services, said “the growing inequalities in life expectancy” mirrored trends in infant mortality and in death from heart disease and certain cancers.

Rising Health Costs Cut Into Wages

Recent history has not been kind to working-class Americans, who were down on the economy long before the word recession was uttered. The main reason: spiraling health-care costs have been whacking away at their wages. Even though workers are producing more, inflation-adjusted median family income has dipped 2.6 percent -- or nearly $1,000 annually since 2000.
Employees and employers are getting squeezed by the price of health care. The struggle to control health costs is viewed as crucial to improving wages and living standards for working Americans. Employers are paying more for health care and other benefits, leaving less money for pay increases. Benefits now devour 30.2 percent of employers' compensation costs, with the remaining money going to wages, the Labor Department reported this month. That is up from 27.4 percent in 2000.

The Myth of ‘Best In The World’

In international comparisons of health care, the infant mortality rate is a crucial indicator of a nation's standing, and the United States' position at No. 28, with seven per 1,000 live births—worse than Portugal, Greece, the Czech Republic, Northern Ireland and 23 other nations not exactly known for cutting-edge medical science—is a tragedy and an embarrassment. Much of the blame for this abysmal showing, however, goes to socioeconomic factors: poor, uninsured women failing to get prenatal care or engaging in behaviors (smoking, using illegal drugs, becoming pregnant as a teen) that put fetuses' and babies' lives at risk. You can look at 28th place and say, yes, it's terrible, but it doesn't apply to my part of the health-care system—the one for the non-poor insured.

McCain's stand on tobacco is put to test

Ten years ago, Senator John McCain took on the tobacco industry, saying he would never back down from legislation to regulate the industry. He also supported a $1.10-per-pack tax on cigarettes to fund programs to cut underage smoking. "I still regret we did not succeed," he said as recently as last October. Now, McCain's longtime effort to crack down on tobacco is being put to a new test. Within weeks, the Senate is expected to vote on legislation to allow the Food and Drug Administration to regulate tobacco. McCain agreed months ago to cosponsor the current bill with Senator Edward M. Kennedy, but McCain's policy adviser said the senator won't commit to voting for it until he sees the final legislation. McCain has also dropped his support for increasing cigarette taxes. Last year, McCain voted against legislation that would have used a 61-cents-per-pack tax to expand a children's health program. He told a television reporter earlier this year that he would have a "no new taxes" policy as president.

Clinton Details Premium Cap in Health Plan

Senator Hillary Rodham Clinton said in an interview on Wednesday that if elected president she would push for a universal health care plan that would limit what Americans pay for health insurance to no more than 10 percent of their income, a significant reduction for some families.
In an extensive interview on health policy, Mrs. Clinton said she would like to cap health insurance premiums at 5 percent to 10 percent of income. The average cost of a family policy bought by an individual in 2006 and 2007 was $5,799, or 10 percent of the median family income of $58,526, according to America’s Health Insurance Plans, a trade group. Some policies cost up to $9,201, or 16 percent of median income. The average out-of-pocket cost for workers who buy family policies through their employers is lower, $3,281, or 6 percent of median income, according to the Kaiser Family Foundation, a health research group.

Women and Alcohol

Having more than one alcoholic drink per day increases a woman's chances for high blood pressure, stroke, some types of cancer, injury (e.g., motor vehicle crashes, violence), and suicide. Alcohol use, especially binge drinking (four or more drinks in about two hours), might also lead to an unplanned pregnancy, a sexually transmitted infection, or sexual assault. Some people, including pregnant women and women who might become pregnant, should not drink alcohol at all. Drinking alcohol during pregnancy is one of the top preventable causes of birth defects and developmental disabilities, known as fetal alcohol spectrum disorders (FASDs).

The Murky Politics of Mind-Body

Now a critical moment has been reached in a 15-year debate in statehouses and in Congress over whether treatment for problems like depression, addiction and schizophrenia should get the same coverage by insurance companies as, say, diabetes, heart disease and cancer.This month, the House passed a bill that would require insurance companies to provide mental health insurance parity. It was the first time it has approved a proposal so substantial.The bill would ban insurance companies from setting lower limits on treatment for mental health problems than on treatment for physical problems, including doctor visits and hospital stays. It would also disallow higher co-payments. The insurance industry is up in arms, as are others who envision sharply higher premiums and a free-for-all over claims for coverage of things like jet lag and caffeine addiction. Parity raises all sorts of tricky questions. Is an ailment a legitimate disease if you can’t test for it? A culture tells the doctor the patient has strep throat. But if a patient says, ‘‘Doctor, I feel hopeless,’’ is that enough to justify a diagnosis of depression and health benefits to pay for treatment? How many therapy sessions are enough? If mental illness never ends, which is typically the case, how do you set a standard for coverage equal to that for physical ailments, many of which do end?

Unequal Perspectives on Racial Equality

Social psychologists Philip Mazzocco and Mahzarin Banaji once asked white volunteers how much money would cover the "costs" of being born black instead of white. The volunteers guessed that about $5,000 ought to cover the lifetime disadvantages of being an average black person rather than an average white person, in the United States. By contrast, when asked how much they wanted to go without television, the volunteers demanded a million dollars.

Mazzocco and Banaji were taken aback: The average black person in America is 447 percent more likely to be imprisoned than the average white person, and 521 percent more likely to be murdered. Blacks earn 60 cents to the dollar compared with whites who have the same education levels and marital status. The black poverty rate is nearly twice the white poverty rate. Blacks tend to die five years earlier than whites; the infant mortality rate among black babies is nearly 1 1/2 times the rate among white babies. And because of long-standing patterns of inheritance, blacks and whites begin life with substantial disparities in family wealth.

Should Pharmacists be Required to Fill Prescriptions for Emergency Contraception?

Pharmacists asked the Illinois Supreme Court Tuesday to overturn a rule forcing them to dispense emergency contraception over their religious convictions. Gov. Rod Blagojevich's three-year-old edict requires pharmacists to fill orders for the so-called "morning-after pill." Taken within days of having sex, the pill can interfere with conception, which some pharmacists argue is the equivalent of abortion. . . . When Blagojevich introduced the rule, he said pharmacists had an obligation to fill all prescriptions despite any personal qualms. Someone in need of emergency contraception should always be able to get it, "No delays. No hassles. No lectures," he said then.

Jail 'not the solution' to drug crime

Convicted drug users should not be sent to prison because it does more harm than good, a report from the influential UK Drug Policy Commission will say tomorrow. Up to 65,000 prisoners in England and Wales are thought to be problem drug users and, of these, two-thirds are convicted of less serious crimes such as shoplifting and burglary. The commission believes these offenders should not be jailed. Although the report accepts that almost a third of heroin and crack users arrested admit to committing an average of one crime a day, it says that community treatment programmes would be more effective than prison.

Should High Risk Children Be Red Tagged?

Primary school children should be eligible for the DNA database if they exhibit behaviour indicating they may become criminals in later life, according to Britain's most senior police forensics expert. Gary Pugh, director of forensic sciences at Scotland Yard and the new DNA spokesman for the Association of Chief Police Officers (Acpo), said a debate was needed on how far Britain should go in identifying potential offenders, given that some experts believe it is possible to identify future offending traits in children as young as five. 'If we have a primary means of identifying people before they offend, then in the long-term the benefits of targeting younger people are extremely large,' said Pugh. 'You could argue the younger the better. Criminologists say some people will grow out of crime; others won't. We have to find who are possibly going to be the biggest threat to society.' Pugh admitted that the deeply controversial suggestion raised issues of parental consent, potential stigmatisation and the role of teachers in identifying future offenders, but said society needed an open, mature discussion on how best to tackle crime before it took place

How much sexual innuendo can an advertiser pack into 15 seconds?

Pfizer has always straddled a line marketing Viagra, insisting that the drug treats a serious medical condition, impotence, and deserves insurance coverage, while promoting the drug with wink-and-a-nod ads that have irritated regulators. In 2004, the Food and Drug Administration told the company to stop running ads that included the lines, “Remember that guy who used to be called ‘Wild Thing’? The guy who wanted to spend the entire honeymoon indoors?”
The ads come as Viagra is losing market share to other impotence drugs. Last year, Pfizer’s Viagra sales totaled $1.7 billion, including $800 million in the United States.

The Case for Another Drug War, Against Pharmaceutical Marketers’ Dirty Tactics

Our Daily Meds begins by illustrating the established drug-company practices that have led to this sorry juncture. There is the rigging of studies, so that to be deemed “effective” a drug need only perform better than a sugar pill. There are the promotional strategies that evade the need for F.D.A. warnings by, say, planting logos for the sexual enhancement drug Viagra and the antidepressant Wellbutrin on Nascar vehicles. There is the co-option of doctors and university researchers by aggressive, payola-dispensing drug company representatives. . . . But she moves to weightier matters in assessing the directions in which heavy drug dependence is leading Americans. First of all there are the business strategies that have created illnesses out of what used to be facts of life, labeled them as syndromes, and have hooked customers into long-term use of medication to cure them. . . . Second, there are the economics of creating chronic consumers for marginally necessary drugs. . . . Irate as she is that in a period (1980-2003) when Americans doubled what they spent on cars they increased their spending on prescription drugs by 17 times, Ms. Petersen steps back to consider the long-term consequences of this shift in consumption. She notes that the first generation of children raised in front of ubiquitous, sunny drug-company advertisements (which became legal in 1997) has acquired the notions that prescription pills fix everything, and that they are less dangerous than street drugs. Then, looking to the elderly, she points out that increasing numbers of drugs are accumulating in these patients, with little regard for the consequences.

Cutting Dosage of Costly Drug Spurs a Debate

When a drug can cost more than $300,000 a year, the right dose becomes a matter of public debate. The drug in question, Cerezyme, is used to treat a rare inherited enzyme deficiency called Gaucher disease. Some experts say that for most patients, as little as one-fourth the standard top dose would work, saving the health care system more than $200,000 a year per Gaucher patient. “It is economic malpractice to give a much higher dose of an expensive drug than is required,” said Dr. Ernest Beutler, an authority on Gaucher disease at the Scripps Research Institute. Some other Gaucher specialists argue otherwise, saying that skimping on the medicine could endanger patients. . . . [C]ritics say the company’s development costs were minimal, because the early work on the treatment was done by the National Institutes of Health, which gave Genzyme a contract to manufacture it. And analysts estimate the current cost of manufacturing the drug to be only about 10 percent of its price.

Student Stress and Suicide in India

In 2006, 5,857 students — or 16 a day — committed suicide across India due to exam stress. And these are just the official figures. Shimla superintendent of police (crime), Punita Bhardwaj, said incidents of children committing suicide because of examination stress often did not get reported as traumatized parents wanted to keep the issue under wraps.

Genes and Post-Traumatic Stress

Why is it that when a group of soldiers share a horrific battle experience, some are able to work through it and get on with their lives while others suffer the persistent anxiety, emotional numbness and bomb-blasted nightmares of post-traumatic stress disorder (PTSD)? The answer, researchers have long believed, is that an individual's response to trauma — whether in battle, or as result of a natural disaster, a violent crime or some other horror — depends not only on the intensity of that trauma but also on a complex interplay of past experiences and genetic factors. A new paper, published in the current issue of the Journal of the American Medical Association, provides remarkable support for this explanation and identifies a specific gene that influences susceptibility to PTSD.

Op-Ed on Hunger by Secretary General of the United Nations

The price of food is soaring. The threat of hunger and malnutrition is growing. Millions of the world's most vulnerable people are at risk. An effective and urgent response is needed.
The first of the Millennium Development Goals, set by world leaders at the U.N. summit in 2000, aims to reduce the proportion of hungry people by half by 2015. This was already a major challenge, not least in Africa, where many nations have fallen behind. But we are also facing a perfect storm of new challenges.

Double jeopardy in Alzheimer's families

One parent with Alzheimer's disease is tough enough, but imagine the memory-robbing illness striking both parents - and knowing chances are high you'll get it, too. A study of more than 100 families for the first time gauges the size of that risk. . . . The study, appearing in March's Archives of Neurology, found more than 22 percent of the adult children of 111 couples with Alzheimer's had the disease themselves. Risk grew with age. Among offspring older than 60, more than 30 percent were affected. In those older than 70, nearly 42 percent had the disease.
Prior studies have found a 6 to 13 percent prevalence of the disease in the U.S. population older than 65.

Does Pornorgraphy Provide a Safe Outlet for Pedophiles?

Japan is to bow to international pressure and ban the possession of child pornography, although the new law is expected to anger child welfare groups by exempting manga comics and animated films. . . . Currently, Japan and Russia are the only G8 countries in which it is still legal to own pornographic images of children provided they do not intend to sell them or post them on the internet. . . . Sexually explicit comics account for a sizeable chunk of Japan's 500bn yen manga market. Many feature schoolgirls or childlike adults being raped or engaging in sadomasochism.
Manga belonging to the popular "lolicon" - Japanese slang for Lolita complex - genre are likely to escape the ban, as MPs are concerned that outlawing them could infringe on freedom of expression and drive men who use them as an outlet for their sexual urges to commit more serious offences.

STDs and Abstinence Only Education

A disturbing national study released this week has found that one in four girls and young women is infected with at least one of four common sexually transmitted diseases. The statistics are even more staggering for African American teenagers ages 14 to 19 - nearly half had a sexually transmitted disease, compared with 20 percent for white teenagers. The numbers are another indication that the White House's insistence on reserving millions of sex-education dollars for abstinence-only programs isn't working.
Certainly, abstinence is the best way to avoid STDs, but many teenagers are making the decision to have sex, and they need to know there are other ways to reduce the danger of disease or pregnancy. One researcher called the new study, presented at a Centers for Disease Control and Prevention conference in Chicago, "alarming" and evidence that the infections are a major public health threat. The diseases monitored in the study were human papillomavirus (HPV), chlamydia, genital herpes and trichomoniasis, a common parasite. The first national study of these diseases found that 15 percent of the infected girls had more than one STD. The findings clearly show that America can no longer afford the Bush administration's $1 billion abstinence program. Too much is at stake.

As Population Grows Older, Geriatricians Grow Scarce

While the U.S. population age 55 and older is growing rapidly, according to a 2005 census report, the number of medical school grads going into geriatrics has been slow to keep up. According to one estimate, the nation's teaching hospitals are producing one or two geriatricians for every nine cardiologists or orthopedic surgeons.
Low reimbursements and the allure of higher-paying specialties have been largely responsible. Then, too, the prospect of working long hours treating severely ill patients in their homes or at a hospital or nursing facility can be a turnoff, some physicians say. "These are hard patients to treat because they're usually burdened with multiple complex disorders like Alzheimer's, dementia and congestive heart failure, and are often at the end of life," says Pittsburgh geriatrician Judith Black. Geriatrics isn't sexy, Black says, "but it can be extremely rewarding."

Psychotherapy for All: An Experiment

The clinic is at the forefront of a program that has the potential to transform mental health treatment in the developing world. Instead of doctors, the program trains laypeople to identify and treat depression and anxiety and sends them to six community health clinics in Goa, in western India.

Depression and anxiety have long been seen as Western afflictions, diseases of the affluent. But new studies find that they are just as common in poor countries, with rates up to 20 percent in a given year.

Researchers say that even in places with very poor people, the ailments require urgent attention. Severe depression can be as disabling as physical diseases like malaria, the researchers say, and can have serious economic effects. If a subsistence farmer is so depressed that he cannot get out of bed, neither he nor his children are likely to eat.

Will mandating the purchase of health insurance lead to universal coverage?

The biggest domestic-policy difference between Hillary Clinton and Barack Obama almost certainly concerns health care. Mrs Clinton proposes individual mandates, which would require people to buy health insurance. To help the poor afford it , she promises subsidies from the government.
Boosters of the individual-mandate approach, with which Massachusetts is now experimenting, hope that it would lower average costs by forcing the many young and healthy people now currently without coverage to buy a health plan. As Mrs Clinton pointed out this week, such people do get health care, but in the most expensive way—by turning up at emergency rooms uninsured.
Maybe not, if a report issued by the official Centres for Medicare and Medicaid on February 25th is to be believed. The government's actuaries calculate that even without any new universal-care scheme, spending on health care in America will reach nearly 20% of GDP by 2017, up from about 16% last year, with Medicare spending nearly doubling over that period.

About Those Health Care Plans by the Democrats

While Senators Hillary Rodham Clinton and Barack Obama fight over who has the better health plan for the uninsured, they say little about a more immediate challenge that will confront the next administration, whether Democratic or Republican: how to tame the soaring costs of Medicare and Medicaid. The two programs, for older Americans and low-income people, cost $627 billion last year and accounted for 23 percent of all federal spending. With no change in existing law, the Congressional Budget Office says, that cost will double in 10 years and the programs will account for more than 30 percent of the budget.

Into the Fray Over the Cause of Autism

“It’s indisputable that autism is on the rise among children,” Senator John McCain said while campaigning recently in Texas. “The question is, What’s causing it? And we go back and forth, and there’s strong evidence that indicates that it’s got to do with a preservative in vaccines.”
With that comment, Mr. McCain marked his entry into one of the most politicized scientific issues in a generation.

House Approves Bill on Mental Health Parity

After more than a decade of struggle, the House on Wednesday passed a bill requiring most group health plans to provide more generous coverage for treatment of mental illnesses, comparable to what they provide for physical illnesses. The vote was 268 to 148, with 47 Republicans joining 221 Democrats in support of the measure. The Senate has passed a similar bill requiring equivalence, or parity, in coverage of mental and physical ailments. Federal law now allows insurers to discriminate, and most do so, by setting higher co-payments or stricter limits on mental health benefits.

Issues for DSM-V: Internet Addiction

Am J Psychiatry 165:306-307, March 2008 Editorial Issues for DSM-V: Internet AddictionJerald J. Block, M.D. Internet addiction appears to be a common disorder that merits inclusion in DSM-V. Conceptually, the diagnosis is a compulsive-impulsive spectrum disorder that involves online and/or offline computer usage (1, 2) and consists of at least three subtypes: excessive gaming, sexual preoccupations, and e-mail/text messaging (3). All of the variants share the following four components: 1) excessive use, often associated with a loss of sense of time or a neglect of basic drives, 2) withdrawal, including feelings of anger, tension, and/or depression when the computer is inaccessible, 3) tolerance, including the need for better computer equipment, more software, or more hours of use, and 4) negative repercussions, including arguments, lying, poor achievement, social isolation, and fatigue (3, 4). Some of the most interesting research on Internet addiction has been published in South Korea. After a series of 10 cardiopulmonary-related deaths in Internet cafés (5) and a game-related murder (6), South Korea considers Internet addiction one of its most serious public health issues (7). Using data from 2006, the South Korean government estimates that approximately 210,000 South Korean children (2.1%; ages 6–19) are afflicted and require treatment (5). About 80% of those needing treatment may need psychotropic medications, and perhaps 20% to 24% require hospitalization (7). . . .

U.S. Imprisons One in 100 Adults, Report Finds

For the first time in the nation’s history, more than one in 100 American adults are behind bars, according to a new report. Nationwide, the prison population grew by 25,000 last year, bringing it to almost 1.6 million, after three decades of growth that has seen the prison population nearly triple. Another 723,000 people are in local jails. The number of American adults is about 230 million, meaning that one in every 99.1 adults is behind bars. Incarceration rates are even higher for some groups. One in 36 adult Hispanic men is behind bars, based on Justice Department figures for 2006. One in 15 adult black men is, too, as is one in nine black men ages 20 to 34.

Only Severely Depressed Benefit From Antidepressants

While popular antidepressants such as Prozac are widely prescribed for people with varying degrees of depression, the drugs are only effective for those with the most severe depression, a new study suggests. "Although patients get better when they take antidepressants, they also get better when they take a placebo, and the difference in improvement is not very great," lead researcher Irving Kirsch, a professor of psychology at the University of Hull in Great Britain, said in a prepared statement. "This means that depressed people can improve without chemical treatments," he added. . . . Based on these results, there appears to be little reason to prescribe these antidepressants to anyone but the most severely depressed patients, the study authors concluded.

(To read the actual article, go here.)

What Addicts Need (Newsweek Article)

While the roots of addiction remain a dark tangle of factors—most experts agree that addicts trying to quit will always need psychological support—the old white-knuckle wisdom that addicts simply lack resolve passed out of fashion decades ago. The American Medical Association recognized addiction as a disease back in 1956. But only now are we beginning to see treatments that target the underlying biochemistry of that disease.

What is the cost of the war in Iraq? (The Times of London Editorial)

The Bush Administration was wrong about the benefits of the war and it was wrong about the costs of the war. The president and his advisers expected a quick, inexpensive conflict. Instead, we have a war that is costing more than anyone could have imagined.
The cost of direct US military operations -- not even including long-term costs such as taking care of wounded veterans -- already exceeds the cost of the 12-year war in Vietnam and is more than double the cost of the Korean War.
And, even in the best case scenario, these costs are projected to be almost ten times the cost of the first Gulf War, almost a third more than the cost of the Vietnam War, and twice that of the First World War. The only war in our history which cost more was the Second World War, when 16.3 million U.S. troops fought in a campaign lasting four years, at a total cost (in 2007 dollars, after adjusting for inflation) of about $5 trillion. With virtually the entire armed forces committed to fighting the Germans and Japanese, the cost per troop (in today's dollars) was less than $100,000 in 2007 dollars. By contrast, the Iraq war is costing upward of $400,000 per troop.

Mentally ill unfairly portrayed as violent

[In] recent weeks, the news has been full of horrendous stories involving killers with known or suspected mental illness. As I write this, the nation is still reeling from the shootings at Northern Illinois University. Press reports now indicate that the shooter had a long history of mental illness and had recently stopped taking antidepressant medication.
To make matters worse, three psychotherapists have been assaulted or murdered in the past month. The most brutal attack involved a Manhattan psychologist murdered by a man who also gravely injured a psychiatrist. The New York Times reported that the accused man blamed the psychiatrist for having him institutionalized 17 years ago; apparently, the psychologist was not the intended victim. And only a few weeks ago, a social worker in Andover was killed, allegedly by her 19- year-old patient, during a visit to the man's home.
What do these attacks say about mental illness? Surely they create the impression that individuals with mental illness are a dangerous and violent lot. And as professor John Monahan and colleagues at the University of Virginia School of Law wrote recently, "the more a member of the general public believes that mental disorder and violence are associated, the less he or she wants to have an individual with a mental disorder as a neighbor, friend, colleague, or family member."
Yet the impression that we are awash in a sea of psychotic violence is clearly unfounded. Writing in the Nov. 16, 2006, New England Journal of Medicine, Dr. Richard A. Friedman of the Weill Cornell Medical College notes that only about 3 to 5 percent of violence in the general population is attributable to those with "serious mental illness," conventionally defined as schizophrenia, major depression, or bipolar disorder. The combined lifetime prevalence of these conditions in the US general population is estimated at 19 percent - far larger than their contribution to violence.

Glutamate and Schizophrenia

The trial results were a major breakthrough in neuroscience, says Dr. Thomas R. Insel, director of the National Institute of Mental Health. For 50 years, all medicines for the disease had worked the same way — until Dr. Schoepp and other scientists . . . . focused their attention on the way that glutamate, a powerful neurotransmitter, tied together the brain’s most complex circuits. Every other schizophrenia drug now on the market aims at a different neurotransmitter, dopamine.
The Lilly results have fueled a wave of pharmaceutical industry research into glutamate. Companies are searching for new treatments, not just for schizophrenia, but also for depression and Alzheimer’s disease and other unseen demons of the brain that torment tens of millions of people worldwide.

Antidepressant Discontinuation Syndrome

Steven Kazmierczak's bolt-from-the-blue shooting spree on Feb. 14 reignited a long-running debate over the benefits and risks of antidepressants -- taking them and discontinuing them."It's sad to watch this," says Ann Blake Tracy, executive director of the International Coalition for Drug Awareness and co-founder of a website, SSRI stories.com, that catalogs violent crimes like Kazmierczak's and links them to psychiatric drug use. "You find suicide, murder, rape, arson" -- all caused by drugs such as Prozac, she says. "How did they convince us that this is therapeutic?" Most in the psychiatric profession would counter that antidepressants overwhelmingly save lives, and salvage those hobbled by sadness and anxiety. They doubt that coming off these drugs -- especially Prozac, which Kazmierczak was reported to have taken -- led the Illinois gunman to kill. And they fret that depressed patients who believe the charges of critics like Tracy will turn their backs on medicine that can work wonders if taken -- and stopped -- correctly." When a story like this is brewing, people think, 'If this medication can possibly be related to a bad outcome, I'd better get off it now,' " says UCLA psychiatrist Andrew Leuchter. "We're talking about millions and millions of people who've been treated successfully with these drugs and stopped treatment without any kind of dramatic changes of behavior." At the center of the latest tempest over psychotropic drugs is a long-recognized phenomenon called Antidepressant Discontinuation Syndrome. First identified in psychiatric journals in the late 1990s, the condition is an assortment of symptoms that can plague patients for several weeks and, in a few cases on medical record, months after coming off a wide range of antidepressants. They include dizziness, headache, fatigue, changes in sleep patterns and appetite, vivid or disturbing dreams, agitation and anxiety. Some patients experience tingling or "electric zap" sensations passing through their extremities or head and, in rare cases, spasmodic jerking in the extremities, especially while sleeping.

A shortage of primary care doctors is predicted

The supply of primary care physicians is not keeping up with demand, which could be the start of a serious shortage, doctors and health advocates say. The gap is caused by retirements, better working hours and increased interest in specialty fields such as radiology and dermatology that offer higher salaries, health officials say. The Council on Graduate Medical Education projects an 85,000 physician shortfall in the United States by 2020.

Blue Cross halts letters amid furor

Facing a torrent of criticism Tuesday, Blue Cross of California abruptly halted its practice of asking physicians in a letter to look for medical conditions that could be used to cancel patients' insurance coverage.In a statement issued about 6 p.m., the state's largest for-profit insurer said, "Today we reached out to our provider partners and California regulators and determined this letter is no longer necessary and, in fact, was creating a misimpression and causing some members and providers undue concern.

Doctors balk at request for data

The state's largest for-profit health insurer is asking California physicians to look for conditions it can use to cancel their new patients' medical coverage. Blue Cross of California is sending physicians copies of health insurance applications filled out by new patients, along with a letter advising them that the company has a right to drop members who fail to disclose "material medical history," including "pre-existing pregnancies."
"Any condition not listed on the application that is discovered to be pre-existing should be reported to Blue Cross immediately," the letters say. The Times obtained a copy of a letter that was aimed at physicians in large medical groups.The letter wasn't going down well with physicians."We're outraged that they are asking doctors to violate the sacred trust of patients to rat them out for medical information that patients would expect their doctors to handle with the utmost secrecy and confidentiality," said Dr. Richard Frankenstein, president of the California Medical Assn. Patients "will stop telling their doctors anything they think might be a problem for their insurance and they don't think matters for their current health situation," he said.

Is Tobacco Money Tainted?

Here's a recipe for academic controversy: First, find dozens of hard-core teenage smokers as young as 14 and study their brains with high-tech scans. Second, feed vervet monkeys liquid nicotine and then kill at least six of them to examine their brains. Third, accept $6 million from tobacco giant Philip Morris to pay for it all. Fourth, cloak the project in unusual secrecy. At UCLA, a team of researchers is following this formula to produce what it hopes will be a groundbreaking study of addiction. So far, the scientists have proved that the issues of animal testing and tobacco-funded research are among the most contentious on university campuses.

ERs fail as the nation's safety net

The long waits that government inspectors say endanger emergency room patients at Harbor-UCLA Medical Center can also be found in backlogged hospitals across the country, according to emergency care experts who have been trying for years to draw attention to the nation's overloaded safety net."Overcrowding in our emergency departments is a national crisis," said Dr. Linda Lawrence, president of the American College of Emergency Physicians, an advocacy group based in Washington D.C. "We no longer have the capacity to serve as the safety net for society."The group surveyed 1,000 emergency care physicians in September and found that one in five knew of a patient who had died because of having to wait too long for care, Lawrence said.

Do Free Pens and Lunches Influence Doctors' Prescribing Behavior?

A new UPMC conflicts-of-interest policy will take effect that day aimed at making doctors' decisions free from influence created by gifts or improper relationships with the drug or medical device industries. Among other provisions, the policy bans gifts such as pens, note pads and food provided by industry representatives as they work to present information about their products at doctors' offices. . . . The policy directly applies to about 50,000 faculty, staff and students of the university's Schools of the Health Sciences and other professionals and staff employed or contracted by UPMC's U.S. operations.

From Bush, Foe of Earmarks, Similar Items

President Bush often denounces the propensity of Congress to earmark money for pet projects. But in his new budget, Mr. Bush has requested money for thousands of similar projects. He asked for money to build fish hatcheries, eradicate agricultural pests, conduct research, pave highways, dredge harbors and perform many other specific local tasks. The details are buried deep in the president’s budget, just as most Congressional earmarks are buried in obscure committee reports that accompany spending bills. . . . The White House defines “earmarks” in a way that applies only to projects designated by Congress, not to those requested by the administration.

Planned Parenthood Blog

Missouri voters, like you, understand that votes matter and have already told us that you strongly support state funds for family planning (69%), that you believe pharmacies should dispense birth control without discrimination or delay (65%), that you believe sex education should be comprehensive (76%), and that the government should not step between a patient and her doctor (63%). Not what Governor Blunt wants to hear. But, together, we say "enough is enough to failed policies and failed politicians."

Very Premature Babies Don't Get Follow-Up Care

A groundbreaking study reports that most very low birth-weight babies born to low-income women failed to get critical follow-up care within their first two years of life. The study illustrates how these premature infants, who are vulnerable to vision, hearing and speech impairments, are falling through the cracks of the U.S. health-care system, the researchers said.
Only 20 percent of the babies with hearing problems returned for specialized care within their first six months of life, while fewer than one in four underwent recommended vision tests between 1 and 2 years of age.

In Health Debate, Clinton Remains Vague on Penalties

Senator Hillary Rodham Clinton inched closer Sunday to explaining how she would enforce her proposal that everyone have health insurance, but declined to specify — as she has throughout the campaign — how she would penalize those who refuse. Mrs. Clinton, who did not answer Senator Barack Obama’s question on the topic in a debate last Thursday, was pressed repeatedly to do so Sunday by George Stephanopoulos on the ABC program “This Week.” When Mr. Stephanopoulos asked a third time whether she would garnish people’s wages, Mrs. Clinton responded, “George, we will have an enforcement mechanism, whether it’s that or it’s some other mechanism through the tax system or automatic enrollments.” She then added that the focus on enforcement clouded a more important point, that her proposal to cover the uninsured was superior to Mr. Obama’s because she would mandate coverage for all, while he would require it only for children.
What might seem a mundane debate over health policy has taken on outsized importance in the approach to Tuesday’s voting because it is one of the few substantive differences between the two leading Democratic presidential candidates. . . . Polling has found that health care is a top concern of Democratic voters, and that they rank covering the uninsured as more important than reducing health costs or improving quality.

Online house calls click with doctors

Consulting your family physician is finally moving into the 21st century and out of the doctor's office. Since the dawn of e-mail, patients have been pleading for more doctors to offer medical advice online. No traffic jams, no long waits, no germ-infested offices with outdated magazines and bad elevator music. There was always one major roadblock: Most health insurers wouldn't pay for it. Until now.

Keeping Your Brain Fit

Just within the past few months, several groups of researchers have added support for the growing consensus that plenty can be done to slow the age-related declines in memory, mental speed, and decision making that affect most people. In November, a team from the Mayo Clinic and the University of Southern California announced that one computer-based mental training program appeared to improve older people's cognitive performance by as much as 10 years. That same month, a Harvard researcher found that long-term use of beta carotene supplements delayed cognitive decline by up to a year and a half.

Wal-Mart Expands In-Store Health Clinics

Wal-Mart Stores Inc. will open its first in-store medical clinics under its own brand name after leasing space in dozens of stores to outside companies that operate the quick-service health stops.
Bentonville, Ark.-based Wal-Mart is among several U.S. supermarket and drug store chains that in the past couple of years have begun opening store-based health clinics, which are staffed mostly by nurse practitioners or physician assistants and offer quick service for routine conditions from colds and bladder infections to sunburn.
About 7 percent of Americans have tried a clinic at least once, according to an estimate by the Convenient Care Association, an industry trade group formed in 2006.
That number is expected to increase dramatically, as chains like Wal-Mart, CVS Corp., Target Corp. and Walgreen Co. partner with mini-clinic providers like RediClinic and MinuteClinic to expand operations. The trade group estimates there will be more than 1,500 by year-end, up from about 800 in November.

Major Problem Often Overlooked When Linking Violence, Illness

Public and professional attention in recent years has tended to focus on whether people with mental illness are more likely than others to commit acts of violence, but a new study suggests that violent victimization of these individuals may be the greater public health problem.
A literature review of studies published since 1990 on the perpetration of violence by, and violent victimization of, mentally ill individuals indicates that victimization is considerably more common than perpetration. The study was published in the February Psychiatric Services as part of a special issue on violence and mental illness.
Among outpatients, 2 percent to 13 percent had perpetrated violence in the prior six months to three years, compared with 20 percent to 34 percent who had been violently victimized. Studies combining outpatients and inpatients reported that 12 percent to 22 percent had perpetrated violence in the prior six to 18 months, compared with 35 percent who had been a victim in the preceding year. "Although society may regard persons with mental illness as dangerous criminals, our review of the literature shows that violent victimization of persons with severe mental illness is a greater public health concern than perpetration of violence," wrote lead author Linda Teplin, Ph.D., and colleagues in their report.

People With Mental Illness Target of New Gun Law

Supporters of a new gun-control law claim it might have prevented the deaths of 32 people last year in a massacre at Virginia Tech carried out by a student who was mentally ill. Some psychiatrists, however, say the law falls short as a meaningful way to reduce gun violence.
The debate stems from President George W. Bush's signing of a measure in January intended to prevent people with serious mental illness from buying guns.
The legislation (HR 2640), sponsored by Rep. Carolyn McCarthy (D-N.Y.), authorizes up to $1.3 billion in state grants to improve the tracking and reporting of individuals who are legally barred from gun purchases, including those involuntarily confined to a psychiatric hospital. (McCarthy's husband was killed by a mentally ill gunman who went on a rampage on a suburban commuter train 14 years ago.)
Paul Appelbaum, M.D., a professor of psychiatry at Columbia University and chair of APA's Council on Psychiatry and Law, said that a fully funded Virginia background check that looked for involuntary psychiatric care before the gun sales to the Tech shooter and the reporting of his outpatient care by state officials might have kept him from buying his weapons. "But he could have easily gotten them through other means," such as private sales and gun-show sales, which are unregulated by the background-check system, said Appelbaum, a former APA president.

Study backs value of U.S. state anti-smoking plans

U.S. state tobacco control programs are effective at cutting the number of smokers, and states that spend more get the best results, federal health officials said on Tuesday.
Declines in adult smoking rates in individual states are directly related to increases in state per-capita investments in tobacco control and smoking cessation programs, according to a study published in the American Journal of Public Health.

Flawed embryos seen as source for stem cells

From what is now considered medical waste might be fashioned bio-treasure: stem cells able to form into any of the body's 220 cell types, including blood, nerves, bone, and skin tissue, new research suggests. The poor quality embryos are "an ethically acceptable source" for the creation of stem cell lines. Scientists at Children's Hospital Boston have forged stem cells from the "flawed" and "poor quality" early-stage embryos that in vitro fertilization clinics discard by the hundreds of thousands every year, according to research published yesterday in the journal Nature Biotechnology.

Lilly Considers $1 Billion Fine to Settle Case

Eli Lilly and federal prosecutors are discussing a settlement of a civil and criminal investigation into the company’s marketing of the antipsychotic drug Zyprexa that could result in Lilly’s paying more than $1 billion to federal and state governments. If a deal is reached, the fine would be the largest ever paid by a drug company for breaking the federal laws that govern how drug makers can promote their medicines. . . . Zyprexa has serious side effects and is approved only to treat people with schizophrenia and severe bipolar disorder. But documents from Eli Lilly show that from 2000 to 2003 the company encouraged doctors to prescribe Zyprexa to people with age-related dementia, as well as people with mild bipolar disorder who had previously had a diagnosis of depression. Although doctors can prescribe drugs for any use once they are on the market, it is illegal for drug makers to promote their medicines for any uses not formally approved by the Food and Drug Administration.