States Differ Widely in Spending on Health Care, Study Finds

A new federal study shows huge variations in personal health spending among states, ranging from an average of nearly $6,700 a person in Massachusetts to less than $4,000 in Utah.
The study, published on Monday in the Web edition of the journal Health Affairs, said that Massachusetts, Maine, New York, Alaska and Connecticut had the highest per capita spending on health care in 2004. The lowest-spending states were Utah, Arizona, Idaho, New Mexico and Nevada. Per capita spending in Utah was 59 percent of that in Massachusetts.

Senate Passes Mental Health Parity Bill

The Senate passed legislation Tuesday night that would require equal health insurance coverage for mental and physical illnesses when policies cover both. The bill, which passed by unanimous consent, moves advocates one step closer in their years-long quest for a concept known as mental health parity.
"The passage tonight of the Mental Health Parity bill underscores our commitment to treat all patients facing all diseases with the dignity and respect they deserve," said Sen. Edward Kennedy, D-Mass. "This new legislation will bring dramatic new help to millions of Americans who today are denied needed mental health care and treatment." Passage came on the same day that supporters inundated House Speaker Nancy Pelosi's office, urging a vote on mental health parity legislation in the House.

Medicare-for-all would keep everyone covered

The number of uninsured Americans has jumped by 2.2 million to 47 million. This rise in the number of people without health insurance is the biggest jump reported by the Census Bureau since 1992. There are now more uninsured people in the United States than at any time since the passage of Medicare and Medicaid in the mid-1960s.

Clinton unveils universal health care plan

Democrat Hillary Rodham Clinton called for universal health care on Monday, plunging back into the bruising political battle she famously waged and lost in her husband's administration on an issue that looms large in the 2008 presidential race. "This is not government-run," the party's front-runner said of her plan to extend coverage to an estimated 47 million Americans who now go without. Her declaration was a clear message to Republicans, the insurance industry, businesses and millions of voters who nervously recall what sank her effort at health care reform 13 years ago — fear of a big-government takeover.

How Are You Likely to Die?

This is a graphical way of displaying relative risk for dying from a variety of causes.

U. S. Critics Slam Canada's Health Care System

The birth of identical quadruplet girls to a Canadian woman in Montana last month has ignited debate in the United States with editorial writers and bloggers attacking the Canadian health-care system.
A shortage of neonatal beds in Calgary meant that Karen Jepp and her husband J.P. had to travel to Great Falls, Mont., for the birth of Autumn, Brooke, Calissa and Dahlia on Aug. 12.
The chance of giving birth to identical quadruplets is one in 13 million, so the event attracted widespread international attention and caused many Americans to focus on Canada's universal system of health care.

Abortion in the Philippines: a national secret

The backstreet abortions . . . may become more common as a United States government aid program plans to stop distributing contraceptives in the Philippines in 2008. This will leave birth control up to the government which under the influence of Catholic bishops advocates unreliable natural birth control methods rather than the pill and condoms.

Crisis on campus

Now, with the overall number of mentally ill college students rising, college administrators, mental-health professionals and students across the country are weighing that right to privacy against the need to assist those students who are deeply distressed or mentally ill. Several recent high-profile cases have pitted parents against colleges that refused to divulge details of students' mental-health status. A federal lawmaker has introduced legislation that could pave the way for colleges and universities to more easily share information with family members. And the April 16 massacre at Virginia Tech has provided a real-life worst-case scenario for what can happen when students don't get appropriate help and information is not shared among college officials and the student's family.

Bipolar disorder in youths may be over-diagnosed

The diagnosis of bipolar disorder in children and adolescents has risen fortyfold since 1994, according to a study released Monday. But researchers partly attributed the dramatic rise to doctors over-diagnosing the serious psychiatric disorder.The report in the journal Archives of General Psychiatry said bipolar disorder was found in 1,003 of every 100,000 office visits from children and adolescents in 2002-03, compared with 25 of 100,000 office visits in 1994-95.The diagnosis of bipolar disorder among adults increased twofold during the same period, researchers said.

Mentally ill 'suffering neglect'

Mentally ill people in the developing world are being badly neglected, according to a study published in the Lancet medical journal. The authors say mental illness makes up about 14% of global disease, more than cancer or heart disease.
Up to 800,000 people commit suicide each year, mostly in poorer countries. Despite this, the authors say, 90% of sufferers in developing countries receive no care - and in some cases are chained to trees or kept in cages.

Many Immigrants Face Cultural Barriers, Other Obstacles to Psychiatric Treatment

The parents had tried with little success to cope with their son's accelerating deterioration. Unable to concentrate, he had dropped out of college and moved back home. When he could no longer function at the job he had held briefly, his parents kept him sequestered in their house, his condition a closely guarded secret. By the time the trio arrived in the emergency room, the youth was hallucinating and had assaulted his parents.
When psychiatrist Amir Afkhami asked why the couple had waited two years to seek treatment for their son's schizophrenia, the answer was simple: "We thought he was just spoiled."

Youth Suicides Increased As Antidepressant Use Fell

From 2003 to 2004, the suicide rate among Americans younger than 19 rose 14 percent, the most dramatic one-year change since the government started collecting suicide statistics in 1979, the study found. The rise followed a sharp decrease in the prescribing of antidepressants such as Prozac, Zoloft and Paxil after parents and physicians were confronted by a barrage of warnings from the Food and Drug Administration and international agencies.

Suicide Trends Among Youths and Young Adults Aged 10--24 Years --- United States, 1990--2004

In 2004, suicide was the third leading cause of death among youths and young adults aged 10--24 years in the United States, accounting for 4,599 deaths. (MMWR Report)

Lancet Series (for those of you interested in international mental health)

The Lancet Series on Global Mental Health: Article Collection
Launching a new movement for mental health
“Despite the great attention western countries pay to the mind and human consciousness in philosophy and the arts, disturbances of mental health remain not only neglected but also deeply stigmatised across our societies.”
These are the introductory words of The Lancet's editor Dr Richard Horton, in a comment to introduce the series. He says: “For the most part, these organisations have done far too little, if anything at all?

Bill Bradley on Politics (New York Times Editorial)

A party based on charisma has no long-term impact. Think of our last charismatic leader, Bill Clinton. He was president for eight years. He was the first Democrat to be re-elected since Franklin Roosevelt. He was smart, skilled and possessed great energy. But what happened? At the end of his tenure in the most powerful office in the world, there were fewer Democratic governors, fewer Democratic senators, members of Congress and state legislators and a national party that was deep in debt. The president did well. The party did not. Charisma didn’t translate into structure.

Middle-Class Americans Join Ranks of Uninsured in 2006 as Private Coverage Shrinks

The U.S. Census Bureau released data today showing that the number of uninsured Americans jumped by 2.2 million in 2006 to 47.0 million people, with nearly all the increase (2.03 million) concentrated among middle-class Americans earning over $50,000 per year, according to an analysis by Physicians for a National Health Program (PNHP). Strikingly, 1.4 million of the newly uninsured were in families making over $75,000 per year. An additional 600,000 were in families earning $50,000 to $75,000 per year. (The median household income in 2006 was $48,200).
"Middle income Americans are now experiencing the human suffering that comes with being uninsured. It makes any illness a potential economic and social catastrophe," said Dr. Steffie Woolhandler, co-founder of Physicians for a National Health Program and Associate Professor of Medicine at Harvard Medical School.

Medical Homes Promote Equity in Health Care

The Commonwealth Fund 2006 Health Care Quality Survey finds that when adults have health insurance coverage and a medical home—defined as a health care setting that provides patients with timely, well-organized care, and enhanced access to providers—racial and ethnic disparities in access and quality are reduced or even eliminated. When adults have a medical home, their access to needed care, receipt of routine preventive screenings, and management of chronic conditions improve substantially.

Why can't Americans give up their guns?

According to the U.S. government's Center for Disease Control and Prevention, in 2004 — the latest year for which such figures are available — a total of 11,624 people were shot dead or murdered. That averages out to 32 a day. In the same year an additional total of 16,750 people shot themselves to death with firearms, 649 people died in gun accidents, and 311 in "legal intervention," that is, shot dead by police. Also, 235 people died for unknown reasons though it was clear that they did so of gun wounds. A grand total of 29,569, or an average of 81 people a day, were killed or died by use of guns.

Romney's rhetoric glosses Massachusetts years

On the presidential campaign trail, Mitt Romney points to healthcare reform as his major achievement as Massachusetts governor, presenting the plan as an example of how he used conservative principles to provide affordable health insurance for all state residents without a government takeover. But he does not mention aspects of the plan that may hold less appeal for his Republican audiences. For example, he decries "socialized medicine" and says the Massachusetts plan is "all a private initiative, a private-based, market-based healthcare" -- omitting the fact that the state and federal governments subsidize much of the overall cost and that a public board negotiated the benefits and prices that private insurers now offer. . . .

Science vs. politics gets down and dirty

Malicious, vindictive and mean-spirited. These are words that might surface in divorce court.
But they have been lobbed in the course of a different estrangement: the standoff between the Bush administration and the nation's scientific community.
The relationship, which has been troubled since the dawn of the Bush presidency, hit a new low last month when Richard Carmona, surgeon general from 2002 to 2006, lashed out at his former colleagues in testimony before a House committee.

Lawmaker Calls for Registry of Drug Firms Paying Doctors

WASHINGTON, Aug. 3 — An influential Republican senator says he will propose legislation requiring drug makers to disclose the payments they make to doctors for services like consulting, lectures and attendance at seminars.
The lawmaker, Charles E. Grassley of Iowa, the senior Republican on the Senate Finance Committee, cited as an example the case of a prominent child psychiatrist, who he said made $180,000 over just two years from the maker of an antipsychotic drug now widely prescribed for children.

Under the influence

For many Americans, a doctor's decision to prescribe medication is something of a sacred transaction. A physician considers the patient and symptoms and chooses the best drug for the job, drawing upon years of training and clinical experience. It is an exchange conducted in a hushed sanctuary, far from the heat and noise of the marketplace -- a place where cool judgment reigns. That sanctuary has been breached. Today, drug manufacturers do everything in their considerable power to ensure that their brand-name prescription medications are on the lips of patients and in the minds of physicians every time the two meet across an exam table. A growing chorus of critics says their efforts have begun to rewrite the dialogue between patient and doctor, influence physicians' judgments and open the act of prescribing to forces more profit-minded than sacred.

Children’s Health Plan Focus of New Struggle

The Children’s Health Insurance Program has suddenly become a vehicle for an ideological struggle between President Bush and Congress over the future of the health care system.
But in the short term, members of both parties say, the broader outline of that struggle is likely to be reduced to a simple question: “Are you for or against children?” . . . . Representative John Shadegg, an influential conservative from Arizona, said, “This debate is the opening salvo in a battle over the future of health care in America.” . . . . Republicans say Mr. Bush’s opposition to the House and Senate bills stems from conviction and principle, not a political calculus. But, they say, he is not running for re-election and appears oblivious to the political risks for Republicans.

Child abuse claims raise queries about Maori culture

The case of a three-year-old girl who was allegedly hung from a washing line and spun in a tumble-dryer has reignited debate in New Zealand about the touchy subject of child abuse within Maori communities. . . . In many such cases, it has emerged that the victim's extended family knew the child was being mistreated. But it is Maori custom that people sort out their problems themselves, rather than report them to the police.

Bill Would Let States Force Drug Discounts

U.S. Rep. Chris Van Hollen is preparing legislation that would allow states to make prescription drugs more affordable for low- and moderate-income Americans, a challenge to Bush administration policies that have thwarted such efforts in Maryland and elsewhere.
Van Hollen (D-Md.) said he will introduce a bill early this week allowing states to use their purchasing power to require drug companies to provide discounts on medications for low-wage workers. Under the proposal, states could negotiate the same breaks they get for people on Medicaid, the state-federal health-care program for the poor.

Skipping doses could be deadly

Consider it the other drug problem: Millions of people don't take their medicine correctly — or quit taking it altogether — and the consequences can be deadly. On average, half of patients with chronic illnesses like heart disease or asthma skip doses or otherwise mess up their medication, says a report being issued later this week that calls the problem a national crisis costing billions of dollars.

The Right Rx for Sadness

. . . [T]here's a growing concern that medicine often goes to people who shouldn't be taking it. And a consensus has formed that the estimate of how many people will develop depression at some point—1 in 6—might be greatly inflated. "There's no question that the availability of these drugs has increased the diagnosis of depression," says Jerome Wakefield, a professor of social work at New York University. Wakefield is coauthor of the new book The Loss of Sadness, which argues that selective serotonin reuptake inhibitors—Prozac, Paxil, Zoloft—are commonly overused to treat sadness, a normal and healthy response to divorce, sudden unemployment, the end of a friendship, a house foreclosure.

Bush Aide Blocked Report

A surgeon general's report in 2006 that called on Americans to help tackle global health problems has been kept from the public by a Bush political appointee without any background or expertise in medicine or public health, chiefly because the report did not promote the administration's policy accomplishments, according to current and former public health officials.

Carmona told lawmakers that, as he fought to release the document, he was "called in and again admonished . . . via a senior official who said, 'You don't get it.' " He said a senior official told him that "this will be a political document, or it will not be released."

Paul Krugman: The Waiting Game

Being without health insurance is no big deal. Just ask President Bush. “I mean, people have access to health care in America,” he said last week. “After all, you just go to an emergency room.”
This is what you might call callousness with consequences. The White House has announced that Mr. Bush will veto a bipartisan plan that would extend health insurance ... to an estimated 4.1 million currently uninsured children. After all, it’s not as if those kids really need insurance — they can just go to emergency rooms, right?...

Yes, We Can All Be Insured

[T]he public knows the American health-care system is breaking up, no matter how much its backers cheer. For starters, there's the 46 million uninsured (projected to rise to 56 million in five years). There's the shock of the underinsured when they learn that their policies exclude a costly procedure they need—forcing them to run up an unpayable bill, beg for charity care or go without. And think of the millions who plan their lives around health insurance—where to work, whether to start a business, when to retire, even whom to marry (there are "benefits" marriages, just as there are "green card" marriages). It shocks the conscience that those who profit from this mess tell us to suck it up.
. . . .
Right now, Congress is trying to bring 3.3 million uninsured children into the State Children's Health Insurance Program. President George W. Bush says he'll veto the expansion as "the wrong path for our nation." He objects to "government-run health care" (like Medicare?) and says that SCHIP "deprives Americans of ... choice" (like the choice to go uninsured?). Buzzwords like "government run" are supposed to summon up monsters like "socialized medicine" that apparently still lurk under our beds. If these terror tactics work, prepare for another 46 million uninsured.

Children’s health must be nation’s priority (John Kerry on SCHIP)

We have been modest where we should have been bold. If we, as senators, don’t stand for insuring every child in America, then what do we stand for? If America can spend $10 billion each month in Iraq, surely we can also spend $10 billion each year on children’s health.
Even more troubling, the president has launched a disinformation campaign to denounce this bill as a larger Democratic strategy or plot to massively expand federalized medicine. He has stubbornly pledged to veto a bill he hasn’t even read. Apparently, confronted with a bipartisan compromise to extend health care coverage to half of the 9 million American children without insurance today, the president sees only a vast, left-wing conspiracy.

Shortage of doctors affects rural U.S.

A national shortage of doctors is hitting poor places the hardest, and efforts to bring in foreign physicians to fill the gap are running into a knot of restrictions from the war on terror and the immigration debate. Doctors recruited from places such as India, the Philippines and sub-Saharan Africa to work in underserved areas like the Mississippi Delta and the lonesome West already face an arduous and expensive gauntlet of agencies, professional tests and background checks to secure work papers and permanent residency. . . .The government estimates that more than 35 million Americans live in underserved areas, and it would take 16,000 doctors to immediately fill that need, according to the American Medical Association. And the gap is expected to widen dramatically over the next several years, reaching 24,000 in 2020 by one government estimate. A 2005 study in the journal Health Affairs said it could hit an astonishing 200,000 by then, based on a rising population and an aging work force.

Express-Lane Medicine (Newsweek)

[By] offering patients quicker, cheaper alternatives to doctors, so-called convenience-care clinics—staffed by nurse practitioners who offer low-cost treatment for easy-to-diagnose conditions—are spreading faster than a cold in a kindergarten.

The Politics of Sex

Despite years of evidence clearly showing that these [abstinence] programs are ineffective and harmful, federal funding continues at over $200 million a year and growing. Under the Bush administration, abstinence-only subsidies have gushed forth -- creating a deluge of funding for far-right religious groups, amidst a dearth of federal oversight. . . . In reality 95 percent of Americans do have sex before marriage, most before they reach age 19. We must stop funding harmful and ineffective abstinence-only programs and instead support a more comprehensive approach to sexuality education and reproductive health.

Healing Healthcare (LA Times)

VOTERS IN THE United States rank healthcare second only to Iraq as an issue of concern in the presidential campaign. Close to 45 million people in this country lack healthcare coverage, including 6.5 million in California — roughly 17% of the state's population. Increasingly, Americans realize that our healthcare system, which at $2 trillion a year represents 18% of GDP, with spending expected to double by 2016, is probably unsustainable. That adds up to an economic crisis that must command the attention of the 18 candidates with serious aspirations to become the next president. . . .
The cost question is a painful one because it inevitably leads to the question of sacrifice. If everyone is going to be covered, every treatment probably won't be. Clear conversation on this, however, begins with the recognition that this country already rations healthcare — those without insurance routinely go without care.The complexity of the country's healthcare crisis makes it difficult to debate in the rapid-fire exchanges that too often characterize our modern political campaigns. So it is all the more important that candidates present substantive proposals. America has a chance to grapple with this fundamental issue now. If we succumb instead to slogans, we will long regret it.

Sicko Review (The New Yorker)

Just this year, in my own surgical practice, I have seen a college student who couldn’t afford the radiation treatment she needed for her thyroid cancer, because her insurance coverage maxed out after the surgery; a breast-cancer patient who didn’t have the cash for the hormone therapy she needed; and a man denied Medicare coverage for an ambulance ride, because the chest pain he thought was caused by a heart attack wasn’t—it was caused by a tumor. The universal human experience of falling ill and seeking treatment—frightening and difficult enough—has been warped by our dysfunctional insurance system.

Senate Panel Adds Billions for Health

Defying a veto threat from President Bush, the Senate Finance Committee approved a major expansion of the Children’s Health Insurance Program on Thursday, with a majority of Republicans joining all Democrats on the panel in supporting the legislation.
The vote, 17 to 4, sends the measure to the full Senate, which is expected to take it up within two weeks. Mr. Bush has repeatedly denounced the bill as a step toward “government-run health care for every American,” describing it as a “massive expansion of the federal role” in health care, financed by “a huge tax increase.”

Start from ground up to fix health care

Earlier in the week, PricewaterhouseCoopers' Health Research Institute reported that the United States will be short 1 million nurses and 24,000 doctors by 2020. It said that while applications to nursing program had risen, the number of students denied admission had grown six fold since 2002, mostly because of a shortage of instructors. . . . "People in the United States spend $532 billion (a year) on health. That $532 billion is not spent very wisely."

Critics Accuse Bush Administration of Trumping Science With Politics

Health experts said Wednesday they agreed with former Surgeon General Richard H. Carmona's claim that the Bush administration has continually silenced medical and scientific opinions in favor of politics and religious dogma.

During his testimony before a Congressional panel on Tuesday, Carmona said that "top Bush administration officials repeatedly tried to weaken or suppress important public health reports because of political considerations,"The New York Timesreported.

It doesn't surprise us to hear that the administration was ignoring science and attempting to silence scientists. That's how they have operated about stem cells for years. . . ."

Psychiatrists Top List in Drug Maker Gifts

As states begin to require that drug companies disclose their payments to doctors for lectures and other services, a pattern has emerged: psychiatrists earn more money from drug makers than doctors in any other specialty. How this money may be influencing psychiatrists and other doctors has become one of the most contentious issues in health care. For instance, the more psychiatrists have earned from drug makers, the more they have prescribed a new class of powerful medicines known as atypical antipsychotics to children, for whom the drugs are especially risky and mostly unapproved.

Bush calls a Democratic effort to expand a popular program a move toward government takeover of healthcare.

Laying down a marker on healthcare, President Bush on Wednesday strongly criticized a push by Democrats and some moderate Republicans to broaden a popular children's insurance program. Bush called the plan a step toward a government takeover of medicine.After months of watching from the sidelines as Congress ignored his healthcare ideas, Bush forcefully reinserted himself into the debate. His bottom line: Government healthcare programs should focus on the poor and near-poor, not on middle-class families.

Closing the Divide: How Medical Homes Promote Equity in Health Care

The Commonwealth Fund 2006 Health Care Quality Survey finds that when adults have health insurance coverage and a medical home—defined as a health care setting that provides patients with timely, well-organized care, and enhanced access to providers—racial and ethnic disparities in access and quality are reduced or even eliminated. When adults have a medical home, their access to needed care, receipt of routine preventive screenings, and management of chronic conditions improve substantially. The survey found that rates of cholesterol, breast cancer, and prostate screening are higher among adults who receive patient reminders, and that when minority patients have medical homes, they are just as likely as whites to receive these reminders.

Backlash on bipolar diagnoses in children

No one has done more to convince Americans that even small children can suffer the dangerous mood swings of bipolar disorder than Dr. Joseph Biederman of Massachusetts General Hospital.
From his perch as one of the world's most influential child psychiatrists, Biederman has spread far and wide his conviction that the emotional roller coaster of bipolar disorder can start "from the moment the child opened his eyes" at birth. Psychiatrists used to regard bipolar disorder as a disease that begins in young adulthood, but now some diagnose it in children scarcely out of diapers, treating them with powerful antipsychotic medications based on Biederman's work.

States Face Decisions on Who Is Mentally Fit to Vote

Rhode Island is among a growing number of states grappling with the question of who is too mentally impaired to vote. The issue is drawing attention for two major reasons: increasing efforts by the mentally ill and their advocates to secure voting rights, and mounting concern by psychiatrists and others who work with the elderly about the rights and risks of voting by people with conditions like Alzheimer’s disease and dementia.

Bush Again Vetoes Bill on Stem Cell Research

President Bush today issued his second veto of a measure lifting his restrictions on human embryonic stem cell experiments, a move that effectively pushed the contentious scientific and ethical debate surrounding the research into the 2008 presidential campaign.
At the same time, Mr. Bush issued an executive order intended to encourage scientists to pursue other forms of stem cell research that he does not deem unethical. But that research is already going on and the plan provides no new money.
Advocates for embryonic stem cell research called the new plan a ploy to distract from Mr. Bush’s opposition to the studies. “I think the president has issued a political fig leaf,” said Sean Tipton, spokesman for the Coalition for the Advancement of Medical Research, an advocacy group. “He knows he’s on the wrong side of the American public.”

Study Finds 1.8 Million Veterans Are Uninsured

As the nation struggles to improve medical and mental health care for military personnel returning from Afghanistan and Iraq, about 1.8 million U.S. veterans under age 65 lack even basic health insurance or access to care at Veterans Affairs hospitals, a new study has found.

. . . . Rep. Bob Filner (D-Calif.), the committee's chairman, said taking care of veterans is a continuing cost of war. "All veterans should have access to 'their' health-care system," he said. "This is rationing health care to veterans, those who have served our nation. And I think it's unacceptable for a nation of our wealth and our ability."

http://www.nytimes.com/2007/06/09/washington/09surgeon.html

President Bush’s nomination of Dr. James W. Holsinger Jr., a Kentucky cardiologist, to be surgeon general is drawing criticism from gay rights groups, physicians and lawmakers who say they are troubled by opinions critical of homosexuality that Dr. Holsinger has voiced in nearly 20 years as a high-ranking layman in the United Methodist Church.

A National Survey of Physician–Industry Relationships

A new national survey finds nearly all physicians (94%) have some type of relationship with the pharmaceutical industry—from receiving drug samples or food in the workplace, to being reimbursed for professional meetings, to receiving consulting fees.
The authors of "A National Survey of Physician–Industry Relationships" (New England Journal of Medicine, Apr. 26, 2007) document widespread relationships between physicians and the pharmaceutical, medical device, and other medically related industries, and also find that such relationships vary according to type of specialty, practice setting, and other factors.

Doctors, Legislators Resist Drugmakers' Prying Eyes

Many doctors object to drugmakers' common practice of contracting with data-mining companies to track exactly which medicines physicians prescribe and in what quantities -- information marketers and salespeople use to fine-tune their efforts. The industry defends the practice as a way of better educating physicians about new drugs. . . . The American Medical Association . . . makes millions of dollars each year by helping data-mining companies link prescribing data to individual physicians. It does so by licensing access to the AMA Physician Masterfile, a database containing names, birth dates, educational background, specialties and addresses for more than 800,000 doctors.

An International Update on the Comparative Performance of American Health Care

Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. . . . Compared with five other nations—Australia, Canada, Germany, New Zealand, the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. The U.S. is the only country in the study without universal health insurance coverage, partly accounting for its poor performance on access, equity, and health outcomes. The inclusion of physician survey data also shows the U.S. lagging in adoption of information technology and use of nurses to improve care coordination for the chronically ill.

The Millions Left Out

By BOB HERBERT
The New York Times
May 12, 2007

The United States may be the richest country in the world, but there are many millions — tens of millions — who are not sharing in that prosperity.

According to the most recent government figures, 37 million Americans are living below the official poverty threshold, which is $19,971 a year for a family of four. That’s one out of every eight Americans, and many of them are children.

Psychiatrists, Children and Drug Industry’s Role

[T]he intersection of money and medicine, and its effect on the well-being of patients, has become one of the most contentious issues in health care. Nowhere is that more true than in psychiatry, where increasing payments to doctors have coincided with the growing use in children of a relatively new class of drugs known as atypical antipsychotics.

These best-selling drugs, including Risperdal, Seroquel, Zyprexa, Abilify and Geodon, are now being prescribed to more than half a million children in the United States to help parents deal with behavior problems despite profound risks and almost no approved uses for minors.

Suicidal Acts Using Firearms Highly Lethal Compared to Other Means

Boston, MA -- In the first nationally representative study to examine the relationship between survey measures of household firearm ownership and state level rates of suicide in the U.S., researchers at the Harvard School of Public Health (HSPH) found that suicide rates among children, women and men of all ages are higher in states where more households have guns. The study appears in the April 2007 issue of The Journal of Trauma.
"We found that where there are more guns, there are more suicides," said Matthew Miller, Assistant Professor of Health Policy and Management at HSPH and lead author of the study.
Suicide ranks as one of the 15 leading causes of death in the U.S.; among persons less than 30 years old, it is one of the top three causes of death. In 2004, more than half of the 32,439 Americans who committed suicide used a firearm.

Lawmakers urge closing gaps in federal-state gun laws

WASHINGTON -- Grappling with the deadliest shooting spree in U.S. history, lawmakers said Sunday they want to eliminate a gap between state and federal laws that can allow someone with a history of mental illness to buy guns.

Members of Congress have shown little political appetite, however, for attempting to expand federal gun control in response to the massacre at Virginia Tech.

Seung-Hui Cho, who gunned down 32 people on campus and killed himself Monday, was evaluated at a psychiatric hospital in late 2005 and deemed by a judge to present "an imminent danger to himself as a result of mental illness." That should have disqualified him from purchasing a gun under federal law, experts say.

But Virginia court officials insist that because the judge ordered only outpatient treatment -- and did not commit Cho to a psychiatric hospital -- they were not required to submit the information to be entered in the federal databases for background checks.

Lawmakers pushed Sunday to eliminate such breakdowns. They called for uniformity between state and federal reporting to make background checks more dependable.

How Should Universities Respond to Potentially Violent Students?

For the most part, universities cannot tell parents about their children’s problems without the student’s consent. They cannot release any information in a student’s medical record without consent. And they cannot put students on involuntary medical leave, just because they develop a serious mental illness.

Nor is knowing when to worry about student behavior, and what action to take, always so clear.

“They can’t really kick someone out because they’re writing papers about weird topics, even if they seem withdrawn and hostile,” said Dr. Richard Kadison, chief of mental health services at Harvard University. “Most state laws are pretty clear: you can only bring students to hospitals if there is imminent risk to themselves or someone else, so universities are in a bit of a bind that way.”

Phil Zimbardo on the Daily Show

Stanford social psychologist Philip Zimbardo discusses his book The Lucifer Effect and similarities between the Stanford Prison Experiment and Abu Ghraib.

Resisting the Drums of War

Social psychologist Roy Eideslon discusses the ways in which the Iraq war was sold to the American public by exploiting five core concerns: Vulnerability, injustice, distrust, superiority, and helplessness.

A Shock Wave of Brain Injuries

About 1,800 U.S. troops, according to the Department of Veterans Affairs, are now suffering from traumatic brain injuries (TBIs) caused by penetrating wounds. But neurologists worry that hundreds of thousands more -- at least 30 percent of the troops who've engaged in active combat for four months or longer in Iraq and Afghanistan -- are at risk of potentially disabling neurological disorders from the blast waves of IEDs and mortars, all without suffering a scratch.

How do young people manage without health insurance?

They offer insurance at Home Depot, but you’re only allowed to sign up during a two-week period and I missed it. If it’s a cut or bruise or whatever, I try to patch it up myself. I usually know what to do. I bruised a rib last winter. I just wrapped it in rags to keep it tight, and it got better after a few weeks. Also, I cut my head on a wineglass back at Halloween. I was very drunk, and there was blood all over the place. My friend wanted to call the ambulance, but I told her not to. I just cleaned it out myself. Now I’ve got a scar, but at least I’m not broke.

Confronting Confinement

On any given day, 2.2 million people are incarcerated in the United States, and over the course of a year, many millions spend time in prison or jail. 750,000 men and women work in correctional facilities. The annual cost: more than 60 billion dollars. Yet within three years, 67 percent of former prisoners will be rearrested and 52 percent will be re-incarcerated. At this moment, the effectiveness of America's approach to corrections has the attention of policy makers at all levels of government and in both political parties. The Commission and its report, Confronting Confinement, make a unique contribution to this timely national discussion by connecting the most serious problems and abuses inside jails and prisons with the health and safety of our communities.

ACLU Free Speech Victory

In one of the most important student free speech cases in decades, the ACLU joined attorneys for former student Joseph Frederick before the U.S. Supreme Court this week and urged the high court not to abandon its famous 1969 ruling that students do not “shed their constitutional rights to freedom of speech or expression at the schoolhouse gate.”

Families USA Publications

A Pound of Flesh: Hospital Billing, Debt Collection, and Patients' Rights provides an overview of some of the progressive reform measures that state policymakers have implemented to help families struggling with medical debt. [Recommend you read this document, along with any of the other publications that may interest you.]

Families USA Global Health Initiative

"With globalization, the same sea washes all of humankind. We are all in the same boat. There are no safe islands. There is no dividing line between "foreign" and "domestic" infections...There is no them: only us.” –UN Secretary General Kofi Annan

Is Genuine Health Care Reform Finally Feasible?

It has been nearly a decade and a half since the last effort to overhaul the nation's health care system. But the issue is back, driven by recent state initiatives seeking ways to provide universal health care and by the 2008 presidential campaign. . . . The phrase "universal health care" has been widely used among the Democratic presidential candidates.
Sen. Barack Obama, the Democrat from Illinois, recently told the International Association of Fire Fighters that he will make sure that everybody in the country has universal health care by the end of his first term as president.
Not to be outdone, Democrat John Edwards, the former North Carolina senator and presidential candidate, has already laid out a fully detailed plan for universal health coverage. On NPR's Talk of the Nation, Edwards pledged that he would implement his plan even faster than Clinton and Obama would: before the end of his first presidential term.

Can the Best be the Enemy of the Good?

It’s Kennedy versus Kennedy as two members of Congress from the same family face off over competing versions of legislation that would require many health insurance companies and employers to provide more generous benefits to people with mental illness.
Representative Patrick J. Kennedy, Democrat of Rhode Island and chief sponsor of the House bill, has criticized as inadequate the Senate bill introduced by his father, Senator Edward M. Kennedy, Democrat of Massachusetts. Representative Kennedy is trying to mobilize mental health advocates to lobby for what he describes as “the stronger of the two bills, the House bill.”

Do You Support Prescriptive Authority for Appropriately Trained Psychologists?

Community health centers across the state and the Hawaii Primary Care Association strongly endorse Senate Bill 1004 and House Bill 1456, which address prescriptive authority for certain psychologists. We believe that the requirements outlined in these bills regarding psychopharmacological training, supervised practice, standardized testing, board review and authorization, restrictions on what drugs can be prescribed, and practice only within community health center settings will ensure that patients will be well served rather than jeopardized.

The Best Health System in the World?

With some of the best-equipped hospitals and most highly specialized physicians in the world, it is no wonder that many people believe the U.S. health system is the best on earth. The evidence, however, suggests this confidence is misplaced.
According to the National Scorecard on U.S. Health System Performance, the United States scored just 66 out of 100 when comparing the nation's average performance on three dozen indicators against benchmarks set either within the U.S. or abroad. Given America's high standards—and high spending on health care—that is simply unacceptable.

Social Isolation Is Hazardous to Men's Health

Researchers at the Harvard School of Public Health who looked at more than 28,000 men over a period of 10 years found that those who were socially isolated were more likely than others to have died of all manner of illness, accidents and suicide. This study and others show that men who lack strong social networks are at far greater risk of developing heart disease and that those who already have heart disease are more likely to die from it. And men who are not connected with other people run a higher risk of depression and other mental health problems.

Harvard economist proposes team approach on healthcare

WASHINGTON -- A renowned Harvard economist unveiled a plan yesterday to revamp the US healthcare system by focusing on the value of care to patients, arguing that improving the quality of medical services can by itself save money and provide a road map to a national health plan. . . . The nation's healthcare system is using "21st-century technology delivered with a 19th-century system," Porter said. Medical care, he added, is "the only sector in our economy that has not undergone reconfiguration seen everywhere else."

Paying for Care Episodes and Care Coordination (Karen Davis, NEJM)

The fee-for-service system of provider payment is increasingly viewed as an obstacle to achieving effective, coordinated, and efficient care. It rewards the overuse of services, duplication of services, use of costly specialized services, and involvement of multiple physicians in the treatment of individual patients. It does not reward the prevention of hospitalization or rehospitalization, effective control of chronic conditions, or care coordination.

Price Variations for Generic Drugs

Wolf began snooping around and found that two chains, Costco and Sam’s Club, sold generics at prices far, far below the other chains. Even once you factor in the cost of buying a membership at Costco and Sam’s Club, the price differences were astounding.

[Note to Class: Will you refer your clients to Sam's Club? Do you have any ethical concerns about supporting companies like Walmart? Poke around this website and explore some of the interesting stories, and, if you have the time, read this book.]

Does Treatment Work for Sex Offenders?

Similar to aspects of Alcoholics Anonymous, relapse prevention has sex offenders own up to wrongdoing and resign themselves to a lifelong day-to-day struggle with temptation. But one of the few authoritative studies of the method, conducted in California from 1985 to 2001, found that those who entered relapse prevention treatment were slightly more likely to offend again than those who got no therapy at all.
Clinicians who work with sex offenders cling to relapse prevention nonetheless, and its durability speaks volumes about the troubled, politically fraught science of treating sex offenders. Not only is relapse prevention of questionable value, but so are the tests to gauge whether sex offenders in treatment still get inappropriately aroused, the drugs used for so-called chemical castration and the methods of predicting risk of reoffending.
Treatment methods have become particularly topical as thousands of sex offenders are confined or restricted beyond their prison terms under civil commitment laws on the books in 19 states.

Should sex offenders be released after they have finished their prison terms?

The decision by New York to confine sex offenders beyond their prison terms places the state at the forefront of a growing national movement that is popular with politicians and voters. But such programs have almost never met a stated purpose of treating the worst criminals until they no longer pose a threat.
About 2,700 pedophiles, rapists and other sexual offenders are already being held indefinitely, mostly in special treatment centers, under so-called civil commitment programs in 19 states, which on average cost taxpayers four times more than keeping the offenders in prison.

Health-care debate revives

After sorry 14-year hiatus, health-care debate revives - USATODAY.com: "Hopes were high 14 years ago when Bill and Hillary Clinton proposed an ambitious plan to provide health insurance for all Americans. Democrats and Republicans alike cheered when the president threatened to veto anything less than universal coverage.
That promising moment didn't last long. After initially winning support from medical, business and labor groups, the Clintons' top-down plan collapsed under the weight of its own complexity. Attacks on 'Hillary Care' helped Republicans win control ofCongress in 1994. Ever since, health care reform has been considered too costly, in dollars and political capital, for most politicians to touch. But the beleaguered system's problems — one in seven people without insurance, rising premiums and lower reimbursements for those who have insurance, endless payment hassles — haven't gone away. Attempts at fixing them have been incremental and timid at best. That could be about to change. Several groups that usually are at odds on health care now agree on the need for broad reform. These strange bedfellows are still a long way from agreeing on a plan, but the fact that they now see a common need signals a shift in the political dynamic. "

Drug Company Detailers

Independent lens - The Boston Globe: "Drug companies flood doctors' offices with attractive salespeople whose mission is to boost the number of prescriptions written for their products. But some say that the tactics used by the representatives, known as detailers, wrongly hype expensive new drugs when older, cheaper treatments work just as well. To combat the sales pitches, critics are now employing the same marketing methods that drug companies use to sell doctors on new products."

Child Health Care Splits White House and States - New York Times

Child Health Care Splits White House and States - New York Times: "Governors clashed with the White House on Monday over the future of the popular Children’s Health Insurance Program, an issue that some members of both parties said was as important as money for the Iraq war. Michael O. Leavitt, the secretary of health and human services, held a hearing with governors Monday at their winter conference. In the session at the White House, when President Bush reported on progress of the war, governors pressed him to provide more money so they could guarantee health insurance for children. In response, administration officials said states should make better use of the money they already had."

Most Support U.S. Guarantee of Health Care - New York Times

Most Support U.S. Guarantee of Health Care - New York Times: "A majority of Americans say the federal government should guarantee health insurance to every American, especially children, and are willing to pay higher taxes to do it, according to the latest New York Times/CBS News poll. "

Insurers feel heat on mental-illness coverage

Insurers feel heat on mental-illness coverage: "Why should insurance companies be allowed to treat mental illnesses any differently from physical illnesses? They shouldn’t. And some members of Congress want to do something about it. 'This is an issue of civil rights at its core,' said U.S. Rep. Patrick Kennedy . . . . Kennedy, along with Minnesota Republican Rep. Jim Ramsted, plan next week to introduce the Paul Wellstone Mental Health and Addiction Act, named for the late Minnesota Democrat who made mental illness one of his signature issues. The bill would amend the Mental Health Parity Act of 1996 by requiring group health insurers to offer identical benefits for mental and physical illnesses. It would close loopholes that allow insurers to charge higher co-pays, co-insurance, deductibles and maximum out-of-pocket limits and impose lower day and visit limits on those seeking care for mental illnesses or addictions. "

NPR : Congress Faces Choice on Health Care Funding

NPR : Congress Faces Choice on Health Care Funding: "Congress is trying to figure out how to continue to pay for Medicare while expanding the children's health insurance program. Democrats have promised to find money to cover more children, but fixing a flaw in Medicare will also cost a lot of money."

Drug Treatment for Schizophrenia

In Schizophrenia, Drugs May Be Personal Matter - New York Times: "U.S. government-funded studies show there really is no good drug for treating schizophrenia, a mental disorder that affects about 1 percent of the population globally and 3.2 million Americans."

Washington Times 4 Part Series on India's Inbalance of Sexes

"In most places in the world, a mother can find out the sex of her unborn child, but in India, it's illegal to do so. That is because if she's a female, there is a good chance she will never be born.
Roughly 6.7 million abortions occur yearly in India, but aborted girls outnumber boys by 500,000 -- or 10 million over the past two decades -- creating a huge imbalance between males and females in the world's largest democracy. Ratios of men to women are being altered at an unprecedented rate in India and neighboring China, two countries which account for 40 percent of the world's population.

The Stigma of Mental Illness

Five times he called her a "loon" or "lunatic." Each time, the peace activist reacted to Bill O'Reilly's name-calling with a shrug or smirk. But this encounter on "The O'Reilly Factor" raised the question: Who was more outrageous? Was it O'Reilly for using words that some might interpret as slurs? Or was it the activist for not taking him to task?

A Compelling Argument for Universal Health Insurance

For Want of a Dentist
Boy Dies After Bacteria From Tooth Spread to Brain
By Mary OttoWashington Post Staff WriterWednesday, February 28, 2007; Page B01
Twelve-year-old Deamonte Driver died of a toothache Sunday.
A routine, $80 tooth extraction might have saved him.
If his mother had been insured.
If his family had not lost its Medicaid.
If Medicaid dentists weren't so hard to find.

Can People with Mental Illness Receive Adequate Treatment in Prisons?

Mentally Ill Inmate Dies Alone (60 Minutes Episode). Scott Pelley looks at the case of Timothy Souders. The inmate's death was recorded on camera while he was in solitary confinement and has instigated a look at the prison's mental health care.

America's Children: Key National Indicators of Well-Being

Presents statistics about children’s economic security, health, behavior, social environment, and education. This biennial report to the Nation on the condition of children in America provides nine contextual measures describing the changing population, family, and environmental context in which children are living, and 25 indicators depict the well-being of children in the areas of economic security, health, behavior and social environment, and education. The 2005 report has special features on children with asthma, children with specified blood lead levels, and parental reports of children’s emotional and behavioral difficulties. In addition, the report includes a special section on family structure and the well-being of children. The Federal Interagency Forum on Child and Family Statistics produces this annual report, which offers the most recent available data from official sources in a nontechnical, user-friendly format.

How Do We Solve the Problem of Doctor Shortages in Rural America?

The Wall Street Journal takes a close look at physician shortages in rural areas, noting that the problem is getting worse because of "an unusual tale of two visa programs." The J-1 visa waiver program since 1994 has allowed foreign physicians to become eligible for green cards, so long as they agree to work for three years in medically underserved areas. The program "has provided more than 1,000 doctors annually to underserved areas, outperforming scholarship and loan programs designed to attract young U.S. doctors to these same places," the Journal reports. Health centers like Yakima Neighborhood Health Services, which is featured in the WSJ story, rely on the J-1 visa program for their work force. But because of an expansion of the H1-B visa waiver program enacted in 2000 to provide U.S. companies with more foreign high-tech workers, hundreds of foreign physicians "are bypassing the J-1" and "are securing an H1-B, which doesn't require the rural stint," says WSJ. Now the number of foreign physicians with J-1 visas has dropped from 11,000 in 1995-1996 to 6,000 in 2005-2006. You can read the full story here. Download wall_street_journal_article_yakima_doctors.pdf

A Local Example of Advocacy (Post Dispatch Story)

"What's really disturbing is it's the one form of mental retardation birth defect that is 100 percent preventable," says Melinda M. Ohlemiller, director of prevention and advocacy for St. Louis Arc, an agency that advocates for people with birth defects. So the fight against fetal alcohol syndrome can be won without compromise, Ohlemiller says. That's why health experts have increased their warnings about drinking while pregnant. Even that one glass of red wine at night or a couple of beers on the weekend can have consequences for your unborn child, says Dr. Mark Mengel, professor of family and community medicine at St. Louis University School of Medicine.

Drugs, Brains, and Behavior: The Science of Addiction

The National Institute on Drug Abuse (NIDA) has released a layman's guide to alcohol and other drug addiction to complement the new HBO documentary series "Addiction," which premieres in Washington, D.C., this week.
"Drugs, Brains, and Behavior: The Science of Addiction" is a 30-page booklet that provides an overview of the science supporting the concept of addiction as a brain disease. Information on prevention and treatment also is included.

What is the Prevalence of Autism in the United States?

U.S. health officials say autism rate about 1 in 150, higher than previous estimates WASHINGTON — About one in every 150 children in the United States has autism or a closely related disorder — a figure higher than most recent estimates — according to a federal survey released Thursday, the most thorough ever conducted. The new data do not mean that autism is on the rise, because the criteria and definitions used were not the same as those used in the past. But the number of children apparently affected — 560,000 nationwide if the new statistics are extrapolated to all 50 states — makes autism an "urgent public health issue" and a "major public health concern," said Marshalyn Yeargin-Allsopp, chief of the developmental disabilities branch of the Centers for Disease Control and Prevention, which conducted the survey.

Missouri democrats push for mental health program
JEFFERSON CITY — House Democrats proposed on Monday to expand funding for a mental health program that provides intensive care for the homeless, people with substance abuse problems and those who are unaware that they are ill. Supporters say the program is designed for patients who have struggled with the traditional model, which assigns patients a case worker who helps them secure a variety of health services. Jackie Lukitesch, executive director of the St. Louis office of the National Alliance on Mental Illness, said the biggest difference between the more intense treatment and traditional models is that patients who miss treatments and appointments are not automatically removed from the program. "They go out and seek out why, if they don't come in, and do not discharge them," she said.
The stepped-up care, called "assertive community treatment," has been used in several states. The Department of Mental Health asked for $5 million to fund the program in its budget requests for the next fiscal year, but Gov. Matt Blunt did not include it in his budget recommendations. A spokeswoman for Blunt said the governor had not included funding for the program "because of funding constraints."

Why Do I Need to Learn How to Set Up a Blog?

Blogging clicks with educators Chicago Tribune: "Mundelein High School social worker Julie Wheeler wanted to reach students and parents in a non-threatening way, so she took a lesson from the kids and started her own blog."

The Prescription Project Lauched

Community Catalyst and the Institute on Medicine as a Profession launched The Prescription Project on Feb 12, 2007, calling on academic medical centers, professional medical societies and public and private payers to end conflicts of interest resulting from the $12 billion spent annually on pharmaceutical marketing. Building on a series of reforms recommended last year in an article in the Journal of the American Medical Association (JAMA), the project will conduct and publicize research on conflicts of interest, advocate for policy reforms that will eliminate such conflicts, and promote prescription practices that are based on scientific evidence...

How Would Mental Health be Afffected by the President's Proposed Budget?

Significant cuts to the budgets of the Center for Substance Abuse Treatment (CSAT) and the Center for Substance Abuse Prevention (CSAP) were some of the lowlights of the Bush administration's budget for the Substance Abuse and Mental Health Services Administration (SAMHSA) -- part of an FY2008 spending plan that trims or eliminates a number of prominent federal discretionary programs.
"Bush's proposal would provide a big increase in military spending to fight the war in Iraq while squeezing federal health-care programs and cutting most domestic agencies to below fiscal 2006 levels to meet his goal of eliminating the deficit in five years," noted the American Counseling Association.

Evolutionary Psychopathology

Evolutionary psychology sees the mind as a set of evolved mechanisms, or adaptations, that have promoted survival and reproduction. Evolutionary psychopathology — abnormal psychology through an evolutionary lens — looks at what has gone wrong. The discipline is so new that "some people would say it hasn't started yet," jokes Randolph M. Nesse, a professor of psychiatry at the University of Michigan, and one of its pioneers. No one paradigm has won universal acceptance. Evolution-based therapies rely on an eclectic mix of techniques, and their effectiveness is still being tested.

The VA, Iraq and PTSD

The Department of Veterans Affairs is facing a wave of returning veterans who are struggling with memories of a war where it's hard to distinguish innocent civilians from enemy fighters -- and where the threat of suicide attacks and roadside bombs haunts the most routine mission.
Since 2001, about 1.4 million Americans have served in Iraq, Afghanistan or other locations in the global war on terror. The VA counts post-traumatic stress disorder, or PTSD, as the most prevalent mental-health disorder -- and one of the top illnesses overall -- to emerge from the wars.

Providing Mental Health Services for Prisoners in New York

Spitzer plan aids mentally ill inmates: Governor proposes adding $60 million for improved, more humane services

ALBANY -- In response to long-standing calls for better treatment for the most vulnerable segment of the prison population, Gov. Eliot Spitzer proposes to increase state spending by $60 million over three years on services for mentally ill inmates. The proposal was praised by advocacy groups that say it signals a heightened commitment toward humane care of prisoners with severe psychiatric needs.

The Power of Advocacy

The latest Super Bowl score: Advocacy Groups 2, Advertisers 0.
In the second capitulation by a corporate behemoth in less than a week, General Motors yesterday agreed to modify a TV commercial it aired during Sunday's Super Bowl to address complaints from interest groups.
Mental health organizations had peppered GM with protests about the ad, contending that it trivialized suicide. In the commercial set to the strains of Eric Carmen's "All by Myself," a clumsy auto factory robot throws itself off a bridge in despair after being drummed off an assembly line. GM said it would edit the ad to eliminate the bridge sequence.

Is It Appropriate to Lie to Get Services for Your Clients?

In 1977, Randy Revelle says, he almost killed his two young children with a fireplace poker during a psychotic hallucination brought on by untreated bipolar disorder. But at the time, his health insurer didn't cover psychiatric treatments and his family couldn't get him hospitalized. . . . "In order to get admitted, we had to threaten the doctor with jail and lie about the diagnosis," said Revelle. He responded quickly to lithium, which he still takes today, and went on to become King County executive from 1981 to 1985.

Kids' Suicides Rise, CDC Report Finds

New government figures show a surprising increase in youth suicides after a decade of decline, and some mental health experts think a drop in use of antidepressant drugs may be to blame.
The suicide rate climbed 18 percent from 2003 to 2004 for Americans under age 20, from 1,737 deaths to 1,985. Most suicides occurred in older teens, according to the data _ the most current to date from the federal Centers for Disease Control and Prevention. By contrast, the suicide rate among 15- to 19-year-olds fell in previous years, from about 11 per 100,000 in 1990 to 7.3 per 100,000 in 2003.
Suicides were the only cause of death that increased for children through age 19 from 2003-04, according to a CDC report released Monday. "This is very disturbing news," said Dr. David Fassler, a University of Vermont psychiatry professor. He noted that the increase coincided with regulatory action by the U.S. Food and Drug Administration that led to a black box warning on prescription packages cautioning that antidepressants could cause suicidal behavior in children. Fassler testified at FDA hearings on antidepressants during 2003 and 2004 and urged caution about implementing black box warnings. The agency ordered the warnings in October 2004 and they began to appear on drug labels about six months later.

Was this Sentence Appropriate?

Okla. Woman Guilty of Harming Daughter - New York Times: "A woman who experts said has a rare mental disorder has been sentenced to more than 15 years in prison after admitting she injected fecal matter into her infant daughter. Sarena Sherrard, 31, pleaded guilty Tuesday to child abuse charges. Two mental health care providers, who have cared for Sherrard since her arrest, testified she could not resist the urge to harm her daughter. They blamed a disorder known as Munchausen syndrome by proxy, in which parents create or exaggerate injury to a child to bring attention to themselves. The cause is unknown. Sherrard was arrested in August 2005 after surveillance video showed her injecting a foreign substance into her daughter's catheter at Children's Hospital in Oklahoma City. Police had put the girl's room under surveillance because doctors suspected someone was harming her, according to court papers."