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.

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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.