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.