Hannity's America with Doug Kennedy on Antidepressants

Fox News: Hannity's America with Doug Kennedy,
on antidepressants, violence, suicide, and homicide.

Screening brings labeling, drugs

Of Interest is this letter to the editor in the Boston Globe by a psychiatrist from the State of New York, regarding the recent start of mental health screening for children under the care of the Medicaid program.

As a psychiatrist since 1947, I am appalled that mental health screening is now being required of Massachusetts children on Medicaid ("Mental screening for young to begin," Page A1, Dec. 27). Such screening greatly exaggerates the significance of the normal variations in psychological state.
more stories like this

Normal kids will therefore be labeled "sick" and referred for "treatment." That labeling is often harmful in itself; once tagged, how does a kid prove he's not mentally ill?

In some middle-class families, treatment may be individual or family counseling. Whether it helps or is merely wasteful, it usually causes relatively little harm. For Medicaid kids, however, treatment will almost always involve powerful drugs whose serious side effects can include the stunting of growth. Mental health screening is thus a harmful invasion of the privacy of Medicaid youngsters.

Dr. NATHANIEL S. LEHRMAN
Roslyn, N.Y.

See also Our own earlier report

Survey questions doctors on ethics - Nearly half fall short of standard

This report looks at conventional doctors. We note that, based on other data, that certain types of unethical behavior are much more common among psychiatrists, etc than in other specialties. We leave you to draw your own conclusions.

Nearly one of two doctors in a national survey said they didn't turn in a colleague who was clearly incompetent, made a serious medical mistake or was somehow impaired.

The survey, published this month in the Annals of Internal Medicine journal, suggests physicians often fall short of their own ethical standards in dealing with unnecessary medical tests, financial conflicts of interest and peers who might be endangering patients.

About 96 percent of the 1,662 doctors surveyed in 2003 and 2004 agreed they should report other doctors who are clearly impaired or incompetent. But about 45 percent indicated they'd been in situations in the past three years where they hadn't turned in colleagues.

About 46 percent of the doctors said they didn't report serious medical errors that occurred at their hospitals, clinics or medical groups.

"It's not surprising. It's unfortunately not surprising," said Julie D'Angelo Fellmeth, administrative director of the Center for Public Interest Law at the University of San Diego. The published survey didn't define what it meant to be impaired, but Fellmeth worries most about doctors ignoring signs that a colleague is abusing alcohol or drugs.

"Impaired people are often in denial about their condition and their ability to control it," she said. "Even one moment of impairment can mean irreparable harm to patients."

Fellmeth, who monitors healthcare regulation in California, said she believes doctors tend to protect one another because of empathy and fear of repercussions.

State law shields doctors who report peers to the state medical board from civil penalties, but there can be other consequences.

A co-author of the report based on the survey said researchers were flooded with e-mails from doctors who said their careers were ruined because they reported other doctors' violations.

"They were ostracized by their peers. They were forced out of their practices. Their lives were awful," said Dr. David Blumenthal, director of the Institute for Public Policy at Massachusetts General Hospital in Boston. "We need to make it safe for physicians to be honest about what they observe."

Some doctors argue the survey reveals little more than a tendency to try to help peers in trouble rather than report them to authorities.

"Say you thought someone was impaired, and you weren't totally correct," said Dr. Robert Lum, a radiation oncologist from Oxnard and the outgoing president of the Ventura County Medical Association. "You're talking about destroying someone's career. It's not something you do lightly."

Lum said he doesn't believe the implication that many doctors wouldn't report colleagues who were endangering lives.

"If I saw someone who was drunk before surgery, I would turn him in. Obviously, that's not right," he said, suggesting the harder calls involve gray areas, such as an on-call doctor summoned to the hospital after having a drink at a party. "I would say, If you're going in, are you OK?'"

'A code of silence'

Of the 7,259 complaints made last fiscal year to the California agency that regulates doctors, about 327 came directly from doctors and professional groups. About 241 reports to the Medical Board of California came from miscellaneous or anonymous sources.

Doctors say more reports are made to hospitals, clinics or medical societies.

A spokesman for the Federation of State Medical Boards said about two-thirds of the states have so-called "snitch laws" compelling doctors to report possible violations. California doesn't have such a statute.

If a law brought penalties against doctors who fail to report peers, it could make a difference, said Tina Minasian, a patient advocate from Sacramento who has unsuccessfully urged the state medical board to sponsor such legislation.

"There's definitely a code of silence," said Minasian, a patient who lost a lawsuit against a plastic surgeon she believes was impaired by alcohol in a case that is still before the medical board. "Doctors are one of the top income earners in America. For another doctor to report a doctor, you've just blackballed him from the industry."

Actions don't meet standard

Fellmeth and others, however, aren't convinced a snitch law would help, because it's almost impossible to enforce. Many of the states that have such laws don't back them up with sanctions against doctors who don't report violations.

Dr. Ronald C. Thurston argued the survey's most important finding has been camouflaged. If 45 percent of doctors say they haven't reported colleagues at least once, that means 55 percent report all instances when they believe other doctors are impaired or incompetent.

"I think that's a pretty high percentage," said the Ventura psychiatrist and incoming president of the county medical association, suggesting other professions would have difficulty matching that number.

The authors say the survey shows doctors hold themselves to high standards.

About 93 percent of those surveyed said a patient's inability to pay shouldn't affect healthcare, and even more said the patient's interests trump a doctor's financial interests.

Their actions didn't always meet the standard. About 69 percent of doctors said they were accepting uninsured patients who can't pay. About 36 percent said they would order an unnecessary MRI to mollify a patient who insisted the test be done.

'Those are stunning findings'

About 24 percent said they would refer patients to facilities in which they were part owners without disclosing their financial interest. About 11 percent said they had revealed confidential information about patients.

Only 1 percent said they had lied to patients' family members, and 3 percent said they had withheld information.

"My bottom line isn't a simple conclusion that doctors are bad and need to behave better," said survey author Blumenthal, a primary care doctor, noting the study shows the healthcare system makes it hard for physicians to reach their ethical standards.

He called for better training and for systems at hospitals and clinics that emphasize peer review, making it easy and safe for violations to be reported. He said the doctors who might be most prone to falling short of ethical standards are those isolated in solo practices with no access to peer review.

Eric Campbell, another of the survey's authors, said many of the same things but then returned to the finding that 45 percent of doctors hadn't reported colleagues.

"I think those are stunning findings given all the efforts we have put into patient safety," he said.

Do Antidepressants Make Murderers?

More lawyers are picking up on the fact of the liability issues involved with psychiatric drugs, especially when the side effects are so deadly. As seen on the Injury Board website.

Antidepressants are again under scrutiny.

According to a Yahoo! News Article dated December 18, 2007, the Supreme Court will hear a case regarding a teen, Christopher Pittman, sentenced to 30 years of prison for killing his grandparents and setting fire to their home at age 12.

His attorneys argue that the lengthy sentence violates the teen's Eighth Amendment protection from cruel and unusual punishment. They claim that this is the only case in the country that gives such a harsh punishment to a minor.

This case is most noted for its association with the drug, Zoloft. In the original trial, Pittman's attorneys unsuccessfully tried to argue that the drug influenced their client.

According to an August 24, 2004 New York Times article written at the time the original case was pending, most medical experts do not believe in a link between antidepressants and acts of extreme violence and aggression.

Pittman claimed that something told him to commit the murders and that he was feeling isolated and aggravated a few days after starting the drug. Conversely, his doctor's notes about his behavior state that he was energetic and had no plans to harm himself.

The article also makes note of two other cases with similar fact patterns. In 2001, the drug company, GlaxoSmithKline, the maker of Paxil, paid $6.5 million to the relatives of a man in Wyoming who killed his wife, daughter, granddaughter and himself. This was the first time that a jury concluded a SSRI-type of antidepressant may lead users to suicide or homicidal behavior.

In April of 2004, a man in California was acquitted of attempted murder when it was found that his reaction to Zoloft made him unaccountable for his actions.

Zoloft is the most widely prescribed anti-depressant in the United Dates. Following some tests in 2004, the FDA put a "black box" warning on the drug, the strongest warning label that can be given to a drug, because of its association with an increased risk for suicide in children.

Court Mandated Mental Health Marketing For Children begins in Massachusetts

An effort to expand the psychiatric services market to children in Massachusetts is now underway. This despite the horrific death of young Rebbecca Riley due to overdoses of psychiatric drugs.

This is part of a court ordered remedy due to another psychiatric screwup. Unfortunately, the inappropriate answer ordered was more psychiatry. Inappropriate due to the woeful track record of psychiatry, especially as documented on this site.

As seen in this report.

As of Monday, annual checkups for the nearly half a million Massachusetts children on Medicaid will carry a new requirement: Doctors must offer simple questionnaires to detect warning signs of possible mental health problems, from autism in toddlers to depression in teens.

The checklists vary by age but ask questions about children's behavior - whether they are spending more time alone, seeming to have less fun, having trouble sleeping - that are designed to trigger discussion between parents and doctors. The conversations may or may not lead to a referral to a specialist.

Over the last several years, such questionnaires have increasingly become the standard of care in pediatric practices, but - spurred by legal action - Massachusetts is jumping ahead of other states by requiring the screens for all its young Medicaid recipients.

The new requirement represents "a huge step forward in a direction that is a national trend," said Dr. Robin Adair, a University of Massachusetts Medical School pediatrician and screening specialist.

Supporters say the screening can catch issues earlier, before they develop into hard-to-manage crises.

Skeptics warn that more children could end up on heavy-duty medications that they don't really need.

"In a more perfect world, screening for mental illness amongst children would clearly be a good idea," said Dr. John Abramson, a clinical instructor at Harvard Medical School and author of "Overdosed America."

"But let's look at the realities of the world we live in," he said. "What happens is that there's a very quick translation of mental health symptoms into drug treatment."

Others wonder how Massachusetts' overburdened mental health system for children will handle the new patients the screening is expected to identify.

Already, children's psychiatrists and psychologists are often overbooked. Children with serious mental illness sometimes end up stuck in psychiatric hospitals for lack of mental health services in the community.

If, as expected, the new screening requirement turns up more children with mental health problems, "I do think it creates a potential additional access problem," said Dr. David DeMaso, chief of psychiatry at Children's Hospital Boston.

The new screening requirement stems from a lawsuit, Rosie D. v. Romney, that accused the state of falling down on its obligations to poor, mentally ill children. The federal judge in the case ruled in January 2006 that Massachusetts must improve its care, and the new requirement is the first step in the state's court-ordered remedy plan.

Families may decline the screening if they wish. If a screen turns up signs of potential trouble, it is also up to the family whether to pursue further help and an official diagnosis.

The new requirement applies to the 460,000 children and young adults covered by MassHealth, the state Medicaid program, at annual checkups from birth to age 21.

The state's private insurers generally already reimburse children's doctors for such written screens, and Medicaid will now pay $9.73 to cover the testing.

[...]

As the routine screening gets underway, the state will be tracking how many children are tested and how many screens indicate a need for follow-up, said Emily Sherwood, who is overseeing the state's remedy for the Rosie D. case as director of its Children's Behavioral Health Interagency Initiatives. The state also plans to expand mental health services for children and make them more family friendly.

[...]

Study Puts the Hurt on Antidepressant Claims

The WSJ Health Blog points to this item, courtesy of the Furious Seasons Weblog regarding this study

A new analysis of published data on the efficacy of the antidepressant Cymbalta in treating depression-related pain suggests the drug’s maker, Eli Lilly, overstates its claim that Cymbalta relieves physical as well as emotional pain.

Our curiosity piqued, we went to the study author, Glen Spielmans, an assistant professor of psychology at Metropolitan State University in Minnesota. He told the Health Blog he became intrigued by Lilly’s “Depression Hurts” campaign to market Cymbalta for depression-related pain.

He conducted a statistical review, or “meta-analysis,” of five published studies that looked at the relationship between duloxetine and reduction of pain symptoms in people with depression, published in this month’s issue of the journal Psychotherapy and Psychosomatics.

Spielmans, who does not receive drug industry funding, found only a tenuous relationship between Cymbalta and pain relief (the significance level was .057, while anything lower than .05 is usually considered significant). And the magnitude of the effect was .115, in the “very small” range.

“I think it’s certainly misleading at best, and completely false at worst,” Spielmans told the Health Blog of Lilly’s marketing of Cymbalta.

[...]

"Chemical Imbalance"--Scientifically Debunked but Commercially Profitable

An important article from the Alliance for Human Research Protection

"The Media and the Chemical Imbalance Theory of Depression" by Jonathan Leo & Jeffrey R. Lacasse is a follow up to their seminal article in PLoS Medicine (2005), in which they debunked the "chemical imbalance" theory of depression.

The "chemical imbalance" theory in psychiatry rests on the observation that mood could be artificially manipulated with drugs-those which raised monoamine levels improved mood, while those which lowered amine levels led to depression, but it remained to be seen if naturally occurring fluctuations in neurotransmitter levels were responsible for, or caused, the ebb and flow of mood levels. As the authors point out, in spite of the enormous amount of money and time that has been spent in the quest to confirm the chemical imbalance theory, direct proof has never materialized. Moreover, during the past several decades, a significant amount of evidence has accumulated which calls the theory's validity into question.

Of particular note, in the two years since publication of their PLoS article, not a single scientific article challenged their conclusion. Indeed, the chairman of FDA Psychopharmacology Advisory Committee acknowledged that the "chemical imbalance" theory was but a "useful metaphor"--as opposed to a valid hypothesis.

Another credible, evidence-based assessment of the "chemical imbalance" theory is to be found on the website of The Mental Health Service at McGill University: "The term 'chemical imbalance' is thrown around a lot these days. True conditions caused by chemical imbalances are relatively rare. All thoughts, feelings and motions in the brain are mediated by the release of chemicals in brain pathways. Every person's brain is unique, leading each of us to have different traits and abilities. Just because your brain works in a particular way does not mean that you have a chemical imbalance. A certain amount of sadness, anxiety or other emotional upset is normal, and though we may be able to block these feelings by chemicals, this would tend to dehumanize us. Even when we use medication to help an individual with overwhelming emotions, most of the time this is not to repair a 'chemical imbalance' but simply to help contain symptoms." [Link]

However, invalid thought it may be, as Drs. Leo and Lacasse point out the "chemical imbalance" theory has had extraordinary commercial value for both the pharmaceutical industry and psychiatry: "With the advent of the chemical imbalance theory, the companies were no longer just providing soothing tonics, they were now providing medications to treat diseases, as exemplified by an early SSRI advertisement stating: "When serotonin is in short supply, you may suffer from depression."

The wording here is all-important. The advertisement takes a correlation between serotonin shortage and psychological stress-and even this is highly questionable and unverifiable in any individual case-and makes a leap of faith to the conclusion that depression is caused by a serotonin imbalance, not that psychological stress impacts the serotonin system. And the marketing did not stop with depression; eventually we were told that whatever our problems might be, whether anxiety, excessive shyness, depression, or the inability to pay attention, the underlying cause was a faulty transmitter level which could be rectified with a pill. A 2005 survey from the Harvard School of Public Health reported that nearly half of all Americans will at some point develop a mental illness, presumably from a chemical imbalance, with 29% developing an anxiety disorder and 20% a mood disorder."

The "chemical imbalance" theory has provided promoters of psychoactive "feel good" prescription drugs with the means for distancing their products from illicit street drugs whose chemical action is almost indistinguishable. Whereas drugs used to "take the edge off" stress are typically considered street drugs and are consumed by "users" or "addicts," substances used to rectify a "chemical imbalance" can be called medications--and these are legitimately consumed by patients.

A fly in the ointment occurred when Ricky Williams, the star running back for the Miami Dolphins who had been "diagnosed" with Social Anxiety Disorder, and for several years was paid by GlaxoSmithKline to promote Paxil for anxiety disorder, was described in 2002, by People magazine, as suffering from a "depression-like chemical imbalance that affects roughly three million Americans." Williams tested positive for marijuana on several occasions. But while his marijuana use was frowned upon, his use of Paxil was considered acceptable. One was a medication supposed to treat a chemical imbalance, while the other was a drug signaling a lack of willpower.

However, Williams' contract with Glaxo came to a sudden halt in 2004, when he stated that marijuana was ten times better than Paxil. What got him into hot water, Drs. Leo and Lacasse, note, was not so much praising the competition, but rather putting his sponsor's "medication" in the same category as an illicit drug. Williams threatened the assumption underlying the conventional unsupportable divide between legal and illegal drug use. His juxtaposition threatened the most powerful industries--including professional sports, the pharmaceutical industry, psychiatry, and the mass media.

Another fly in the ointment raising questions about the validity of the dividing line between prescribed and illicit psychoactive substances, is a recent controlled clinical trial conducted by researchers at Johns Hopkins.

The researchers ostensibly tested the "Mystical" effects of psilocybin, the active ingredient in mushrooms which is an illegal drug that causes hallucinations. However, two months after the trial they found that "79% of those prescribed psilocybin reported moderately or greatly increased levels of life satisfaction compared with those given a placebo. A majority said their mood, attitudes and behaviors had changed for the better." [Link] No SSRI clinical trial had that high a rate of long-lasting improvements in mood, attitude and behavior.

The authors sent inquiries to reporters who mentioned the "chemical imbalance" theory as if it had been proven, asking for citations of such proof. The responses--or lack of responses--and the biased, pro-industry reporting about mental health treatments, are no less troubling than the biased reporting in the New York Times about the events leading up to the Iraq War.

"In hindsight, as the Times editors now acknowledge (5/326/04), Judith Miller's war coverage was overly one-sided. Her fundamental flaw could be described as a lack of professional skepticism toward the Bush administration, as she willingly parroted what those pushing for war were saying, while giving little credence to the stance of the other side. Writing in the New York Review of Books, Michael Massing commented that the Times and Miller's reporting were examples of media "submissiveness."

This depiction could just as well apply to the media's reporting of mental health issues. As just one example, in some cases, the media still go to the people responsible for the original problems. For instance, several of the researchers involved with the studies of SSRIs in children are still cited in the press even though the following information has come out about their published studies: they downplayed the suicide risk; they exaggerated the benefits; and the papers published under their names were actually written by ghostwriters paid by the pharmaceutical industry.

The Times editors have acknowledged both the problems with Miller's reporting and their own lack of editorial oversight of her. It remains to be seen if members of the media will ever look inward and reflect on their role in the promotion of the chemical imbalance theory. (For those familiar with the New York Times' coverage of mental health issues over the past 10 years, it is refreshing that after a series of health reporters who essentially abdicated their role as investigative journalists, there is a newer group of Times reporters with more skeptical inclination..."

Both articles by Jonathan Leo and Jeffrey Lacasse are freely accessible. [Link] and [Link]

Harvard Psychiatrists Target 4-year old Children (New Video)

I recently came across this post, complete with YouTube Video as evidence. Originally I found it on an automated website, generated with stolen pages for content. I tracked it back to the original post, and found it was from the fine folks at the Alliance For Human Research Protection.

Four-year old Rebecca Riley' was a casualty of psychiatric "treatment. Her death from a combination of prescribed of toxic psychotropic drugs is a demonstration of medicine derailed from its legitimate therapeutic mission. The public was shocked that when still a toddler--aged 28 months--Rebecca was "diagnosed" with both bipolar disorder and ADHD by a board certified psychiatrist.

But a cadre of child psychiatrists at the nation's most prestigious medical centers, have made their career by working hand in glove with drug manufacturers on whose behalf they test the most toxic drugs in young children and lend their reputations to promote the use of these drugs--and drug combinations for young children--seemingly without regard for children's safety or welfare.

An example of crass commercialism can be seen in a MGH advertisement (2001) posted on YouTube that sought to recruit children as young as 4 to serve as human guinea pigs in one of its numerous lucrative psychotropic drug trials.

The ad is an example of disease mongering and pathologizing childhood behavior. MGH department of psychiatry instills fear in parents by insinuating that their child's behavior problems are biological:

"Your child may be facing a chemical problem that you can't manage without help." "We're Mass General, and we can help." The number given to call is 617-724-4MGH.

A report in the Boston Globe (2005) revealed that "After decades of offering continuing medical education classes in Boston, Harvard Medical School teaching hospital--Massachusetts General Hospital (MGH)--last year raised $6.5 million from Cephalon Inc., Janssen Medical Affairs, GlaxoSmithKline, and Wyeth for its 2005 program. The pool of money will allow the psychiatry department to dramatically expand its continuing medical education program with live lectures in 24 cities, teleconferences, and around-the-clock webcasts."

Dr. Robert Birnbaum, medical director of the Division of Postgraduate Education for the psychiatry department insults our intelligence when he claims : "The companies don't have any input into the curriculum, and there is no ongoing dialogue throughout the year."

As Dr. Arnold Relman, a Harvard Medical School professor, former editor of the New England Journal of Medicine, observed: "I am skeptical that a company would give a lot of money just to be able to say 'We were nice to the Mass. General Hospital."

The post also extensively quotes from the Boston Globe article

Psychologist facing charges of attempted murder and home Invasion.

Another shrink goes off the deep end. As seen in this report from the Kalamazoo Gazette

A 50-year-old psychologist and community college instructor is being held in the Genesee County Jail on charges of a double stabbing in Flint.

William Harshman faces charges of assault with intent to murder and first-degree home invasion in a Christmas Eve attack that wounded a woman and a teenager.

Authorities say Harshman went after Lisa Heintz and 17-year-old Edward Lapine at the woman's home.

The Flint Journal reports Lapine was helping Heintz's family pack boxes for a move.
Detective Matt Harburn told a judge Wednesday that Harshman stabbed Lapine in the back with a kitchen knife before going after Heintz, who suffered a broken arm and cuts on her chest.

The Heintz family has been in the mortgage business and reportedly had dealings with Harshman.

We also have this follow up report from The Flint Journal

A Grand Blanc Township family allegedly was on a "hit list" of eight people a local psychologist said he was going to kill, a township police detective testified Wednesday.

That testimony from Detective Matt Harburn came as he swore out charges of first-degree home invasion and two counts of assault with intent to murder against William L. Harshman, 50, a Mott Community College psychology instructor and psychologist at the Oakland Psychological Clinic.

Harshman of Grand Blanc Township, who has been held in the Genesee County Jail since his arrest, was charged with stabbing Lisa Heintz at the home she and husband Kurt share at 8259 Pine Hollow Trail just before 6 p.m. Monday. Her arm was broken in the assault.

Just before Harshman was alleged to have attacked Heintz, he is accused of entering her home and stabbing Edward Lapine, 17, of Flint, who was working for the Heintz family. Lapine, whom Harburn said was stabbed in the back, was able to flee the house with a friend, another teen.

Police said the Heintzes, who had been in the mortgage business, had known Harshman, who lived nearby at an address on McCandlish Road. Officers arrested Harshman in his driveway after police followed his tracks through some trees between his home and the subdivision where the Heintzes' home is located.

In Genesee County's Central District Court, Harburn told Davison District Judge John L. Conover that Lisa Heintz was undergoing surgery to have a plate put in her left arm, which was broken in the attack when she raised it to protect herself.

Harburn also testified that just 30 minutes before Harshman allegedly entered the Heintz home, he made a phone call to a woman he knew and told her that he was standing in front of a house where he was going to kill three people on a list of eight he'd made.

The investigator didn't specify who the people on Harshman's "hit list" were.

Harburn said Harshman had been drinking before the attacks Monday evening and had destroyed property such as clothing and photos that belonged to his wife. His wife, concerned about his behavior, had previously moved out, the detective said.

Harburn said Harshman allegedly used a black-handled kitchen knife in the attack on Lisa Heintz. Police have not yet located that knife, he said.

During his arraignment by video link between the court and the county jail, Harburn listened quietly to the charges against him and told the judge he didn't have an attorney or the means to hire one, even though he had income of $75,000 a year.

Conover ordered Harshman held without bond on the assault with intent to murder charges, and said he would be interviewed by court officials about having an attorney appointed to defend him.

He is scheduled for a preliminary examination in early January.

More on the NY state audit of Mental Health Care Providers

Further details on a NY state audit. As seen in this report, with a link to our earlier story here.

A psychiatrist improperly billed Medicaid on eight separate occasions for more than 24 hours of treatment in a single day and appears to have billed for patients he never treated, among other improper practices, according to an audit released by State Comptroller Thomas P. DiNapoli.

"Most doctors work hard, but it is difficult to imagine how anyone can put in more than 24 hours in one day on multiple occasions," DiNapoli said. "This should have immediately raised red flags and the psychiatrist should never have been paid. Better systems must be put in place by the Department of Health to prevent these types of payments from being made in the first place."

In an analysis of payments for mental health services from August 1999 to October 2006, auditors identified more than $1.3 million in Medicaid overpayments for mental health services - many of which could have been prevented with additional controls in the eMedNY Medicaid claims processing system. The State Department of Health (DOH) administers Medicaid and the eMedNY system.

Among the audit’s primary findings:

One mental health provider who was paid more than $436,000 billed Medicaid on eight separate occasions for more than 24 hours - and as high as 42 hours in one instance - of service in a single day. He admitted to auditors he did not see certain patients for which he billed Medicaid. Auditors also discovered his clinical social worker saw certain patients but Medicaid was billed at the higher psychiatrist’s rate.

389 providers submitted more than 27,000 claims valued at $662,000 for mental health services and pharmacologic management provided on the same day. Under Medicaid rules, psychiatrists who provide mental health evaluation and management services for patients cannot bill the program for prescribing medication - known as pharmacologic management - on the same day.

106 clinic-based mental health practitioners received 21,132 payments totaling more than $381,000 from June 2002 through December 2005 for services for which the clinic also received payment. When services are provided at clinics, only the clinic not the individual service provider is permitted to bill Medicaid.

1,898 instances were identified in which 27 different clinics had billed Medicaid twice at different rates for the same services. From June 2001 through October 2006, the overpayments totaled $302,568.

Auditors met with nine of these providers who double billed, eight of whom indicated that they were confused about the rules and misinterpreted DOH policy. The auditors recommended that DOH add a control to the eMedNY system to block payment for pharmacologic management when it is billed in conjunction with other mental health services. Auditors made a similar recommendation to improve the eMedNY system to block duplicate payments.

DOH indicated in its response to the audit that it would implement recommended controls and other strategies to avoid many of the overpayments found by auditors and would seek to recover any funds paid to providers in error. The complete response is included in the audit.

The findings of the audit have been referred to the Office of the Attorney General.

For a copy of the audit visit

http://www.osc.state.ny.us/audits/allaudits/093008/06s53.pdf

Lawsuits Against Child Abuse in Utah Based Troubled Teen Homes

This story trickled out last week, and has potential to be bigger news because of the connection to presidential candidate Mitt Romney. As reported here (full story with more political details at the link.)

[...] In a lawsuit filed in the U.S. District Court for the District of Utah, 133 plaintiffs have alleged that Robert Lichfield, co-chairman of Romney’s Utah finance committee owned or operated residential boarding schools for troubled teenagers where students were “subjected to physical abuse, emotional abuse and sexual abuse.”

The complaint, which plaintiffs amended and resubmitted to the court last week, alleges children attending schools operated by Lichfield suffered abuses such as unsanitary living conditions; denial of adequate food; exposure to extreme temperatures; beatings; confinement in dog cages; and sexual fondling.

A second lawsuit filed by more than 25 plaintiffs in July in the U.S. District Court of the Northern District of New York alleges that Lichfield and several partners entered into a scheme to defraud them by operating an unlicensed boarding school in upstate New York. The suit does not allege physical or emotional abuse.

These are two active lawsuits against Lichfield. Several others suits have alleged child abuse on behalf of dozens of plaintiffs, but judges have thrown out the suits for procedural reasons. As a result, the merits of the allegations have not been weighed. In some suits, plaintiffs have settled their cases for undisclosed amounts of money.

The allegations could force Romney to re-examine his relationship with his Utah finance co-chairman or put pressure on him to give away the contributions Lichfield helped raise.

[...]

Plaintiffs represented by the Dallas-based Turley Law Firm claim Lichfield and WWASPS helped to run boarding schools where staff abused students and “acted in concert” to “fraudulently conceal the extent and nature of the physical, emotional, mental and sexual abuse occurring at its [member] schools,” their complaint states.

The plaintiffs include former boarding school students and their parents.

The president of WWASPS, Ken Kay, said in an interview the lawsuits are a ploy to get money and dismissed the credibility of former students making allegations.

[...]

The legal disputes shine light on the obscure world of boarding schools for troubled teens.

Years ago, parents set their troublesome teenagers to military schools. In recent years, boot-camp boarding schools, where staff emphasize discipline, have become popular. The schools affiliated with Lichfield and WWASPS fit this mold.

The parents suing Lichfield sent their kids to WWASPS-affiliated schools such as Cross Creek Center for Boys in LaVerkin, Utah; Majestic Ranch Academy in Randolph, Utah; and The Academy at Ivy Ridge in Ogdensburg after they got into trouble for insubordination, drug use or petty theft.

The parents learned of the boarding schools through Teen Help, a business owned by Lichfield that matched parents and their children with boarding schools around the country and in Mexico, Costa Rica, and American Samoa. Lichfield had consulting relationships with nearly all the schools, according to Kay. In some instances Lichfield rented property to the schools, said Kay, who did not name the properties specifically.

Plaintiffs have alleged that Lichfield made millions from the schools.

Former students allege they were transported against their will — sometimes in handcuffs — by operators such as Clean and Sober Solutions and Teen Escort Services to far-away locations.

Once at the boarding schools, they say they were subject to harsh treatment. Some students say they never attended classes and simply received books to read on their own without supervision. Others allege that staff at the schools threatened them with cattle prods and punished severely violations of school rules. Several students alleged in legal complaints that they were forced to lie face down on the floor for hours at a time, forbidden from moving their arms or legs.

Kay said WWASPS worked only with the schools and never had direct contact with the students. He also said only a very small percentage of former students have brought complaints.

Kay also said that the vast majority of former students never alleged abusive treatment.

A survey by The Hill found at least nine lawsuits filed in the last nine years against specialty boarding schools affiliated with Lichfield. Judges threw out more than half of the complaints because of procedural objections.

For example, a suit filed in Los Angeles Superior Court in 2005 on behalf of more than 20 plaintiffs was dismissed by a judge who found California did not have jurisdiction over the matter, according to Henry Bushkin, the plaintiffs’ attorney. Bushkin said he would gather more evidence to show a California court could hear the suit.

One of the lawyers making allegations against Lichfield is Thomas M. Burton, by his own account, a relative of Romney through marriage and a one-time friend of the ex-governor’s late father, George Romney.

Burton said he has filed six unsuccessful suits against Lichfield. He said judges have thrown out his complaints because of various procedural difficulties.

Citing an example, Burton said one case could not proceed because his client, Clayton Bowman, a resident of the state of Washington, could not bear the psychological anguish of testifying about his experience at one of the WWASP-affiliated schools.

Psychiatrist Among Those Arrested in Israeli Insurance Fraud Scheme

A Report in YNet News, there is certain to be more on this, as least in Israel

Israel Police National Economic Crimes Unit investigators Tuesday morning arrested 15 people —about half of whom are doctors — suspected of being involved in an insurance-fraud scheme.

Police have accused the 15 of inventing car accidents to defraud the National Insurance Institute of Israel (NII) and insurance companies of estimated millions of shekels.

In an operation dubbed "White Robe", conducted with the assistance of the NII and Avner insurance, a large scam was discovered whereby suspects used counterfit car accidents to receive money from the NII and insurance companies for damages and surgeries. Among those arrested are an assistant district psychiatrist, an orthopedic surgeon, and a radiologist.

Evidence collected by the police points to a "well-oiled" machine operated by several suspects, two of whom assisted the "claimants" by guiding them through the process of faking accidents, acquiring falsified doctors' forms, accompanying them until receiving money from the NII and insurance companies, and finally splitting this sum.

Dr. Phil Opinion on a Hollywood Mother.

As noted by one gossip wag and elsewhere:

People Magazine got Dr. Phil to weigh in on the Spears family drama over the weekend, and believe it or not, America's favorite psychologist (and a friend of Brit and Jamie Lynn's folks) says "An asset that Britney and Jamie Lynn both have is a great and dedicated mother."

Ummmmm, maybe if she hadn't been quite so "dedicated" to her daughters' careers she might have noticed that Jamie Lynn was having unprotected sex at the age of 16!

Being a Celebrity Doc(tm), I can imagine that he wants to be supportive of his Hollywood friends. But really, if this was a no name guest on his show, would he be so kind and forgiving?

Update: This story is making the rounds, and was seen in the NY Post as well as Fark

Health Ministry seeks inquiry into death of patient at psychiatric hospital

Report from the Israeli Newspaper Ha'Aretz - A truly disturbing set of circumstances

The Health Ministry's Northern District Psychiatrist, Dr. Eli Griner, has called for an independent investigation into the death last month of a 55-year-old former patient at the Mizra state psychiatric hospital in Acre. Her case was referred to the ministry's ombudsman, Prof. Shimon Glick.

The patient died on November 15 in Closed Ward No. 10. Griner's recommendation to Health Ministry Director General Avi Israeli was prompted by "substantial question marks" regarding the physical and mental treatment the patient received at the hospital, the product of a review of the case by his deputy, Dr. Nabil Jeraisi.

According to Mizra's internal review report, the patient was diagnosed with schizophrenia and slight retardation and lived at a Galilee hostel for mental patients. She was treated for years with psychiatric medications and for cardiac and thyroid conditions. On October 28 she was forcibly admitted to Mizra in a severely psychotic state that manifested as violent behavior toward those around her and psychomotor disquiet, which led to severe falls and bruising.

On November 6 she began having convulsions. She was sent to Western Galilee Hospital in Nahariya, where she spent eight days in an internal medicine ward. There she was found to have pneumonia, and the suggestion arose that her convulsions were an adverse reaction to a psychiatric drug she had received by injection. A substitute medication was recommended.

On November 15, after her return to Mizra, she was found to be suffering a speech disturbance, and was placed under observation. Her doctors decided that after she recovered from pneumonia she should receive electroshock therapy - a treatment that had previously brought about improvement in her mental state. In preparation for this treatment, she was referred for consultation with an internist and a neurologist.

On November 15, at 4:30 P.M., the patient was placed in a wheelchair in the ward and tied with a sheet to prevent her falling out. About five minutes later she was found in the chair, dead.

Mizra appointed an internal review, led by Dr. Mina Kushnir, which concluded that the hospital had acted correctly. But Jeraisi's team, while acknowledging that Mizra's staff had worked hard to treat the patient and addressed the medical recommendations of the Nahariya hospital, said that the cause of death "remains in our opinion unclear," and questioned part of the treatment.

In Griner's report to Israeli, the psychiatrist wrote that he cannot understand why the woman was not sent back to Nahariya immediately upon her return, since she displayed "dramatic changes for the worse in her condition" in a short period of time, to the point where she could not hold a pen in hand to sign her name.

Griner also asked why the woman was not examined the day she returned from the Nahariya hospital by Mizra's expert internists and neurologists. He noted that the doctors at Mizra began preparations for the course of ECT despite the patients's "poor physical condition."

Haaretz has learned that another patient died two years ago in that same closed ward at Mizra. In that case, the patient, a 32-year-old man from Peki'in, was admitted after his mental state deteriorated. Then too, an internal review headed by Dr. Kushnir ruled that "the treatment was without failings." The Health Ministry found that the patient had been "very heavily medicated" and that "without a doubt" some of the drugs he received increase the risk of cardiac arrest, but that there was no reason to suspect negligence. It was therefore decided that no external investigation was necessary.

The problem of soaring psychiatric drug use.

A report from Aberdeen, Scotland. As is typical in many of these reports, in the original story there is a sop to the industry with the mention of a sentimental story of some mother praising the drugs, distracting from the obvious criminal increase in their usage. Here are some snippets with the relevant information

Use of a controversial drug on unruly children has rocketed in the North-east.

This year Ritalin has been prescribed 7,268 times, compared to 5,937 last year by NHS Grampian.

The figures are among the latest health statistics from NHS Scotland.

It marks an astonishing rise in use of the stimulant, which was prescribed just 167 times in Grampian back in 1996.

Ritalin is used to control people, mainly five to 14-year-olds, who have attention deficit hyperactivity disorder (ADHD).

[...]

Its side effects include difficulty sleeping, stomach aches, diarrhoea and headaches.

[...]

Yesterday's statistics also revealed a rapid rise in the use of anti-depressants.

In 2006/07 there were 297,157 prescriptions for anti-depressants in Grampian compared to 284,661 in 2005/06. Back in 1992/93 there were just 97,162 prescriptions.

Nobody from NHS Grampian was available for comment.

[...]

And now from our sponsors: Diseases for Sale

We found a post that probably needs to be quoted in full:

If you're a physician, you know Medscape. A division of that internet health care behemoth, WebMD, Medscape pounds our inboxes daily with offers of free CME. Much of the CME is industry-sponsored, which is not exactly a news item for most of us. But what you may not be aware of is that Medscape sells its disease-specific "resource centers" to the highest bidder. For example, the ADHD Resource Center is purchased by Shire, the Bipolar Disorder Resource Center is owned by GlaxoSmithKline, and the Pharmacological Management of Pain Resource Center is now the property of Cephalon.

How much do companies pay in order to take control of what doctors learn? Good luck extracting this information from Medscape, but rumor has it that about $500,000 gets you a sort of "base package" which includes four articles. The sponsoring company gets to specify the topics and the authors, of course. There is a menu of extras, so if you really want to saturate the medical mind with your marketing message, you can presumably part with well over a million. And this doesn't include income from the advertising banners that appear to populate each and every web page on the site.

Yes, doctors know Medscape. And Medscape knows money.

Massachusetts lets Rotenberg Center use electric shock as punishment for children for one year

When is this state going to come to its senses? Another case where the superstition continues that electric shock is good for the Human Brain. Of course, they are so lacking in imagination that they say they can't think of any other possible thing that might be therapeutic or helpful.

In a similar fashion, it is my opinion that it would be a good idea if the staff and directors each received shocks identical to the ones the are responsible for giving to the children, proportionate to body weight. And of course, the director would get shocked the most.

As reported in the Boston Globe

State authorities have given a controversial special education school in Canton a one-year extension of its authority to use electric shock treatments on students, provided the center makes a series of significant changes.
more stories like this

Among them, the Judge Rotenberg Educational Center must prove that it uses shock treatments only for the most dangerous and self-destructive behaviors and that the aversive therapy actually led to a reduction of those harmful actions.

The center must also stop electric shocks for "seemingly minor infractions," such as getting out of a seat without approval or swearing. And it must show greater commitment to phasing out shock treatments, especially for those about to leave the school to enter mainstream society.

Past reauthorizations have been for two years, rather than the one year given this time.

Jean McGuire, assistant secretary of the state's Office of Health and Human Services, said the state has issued this conditional reauthorization well aware of the events last August in which two teenagers wrongfully received dozens of electrical shocks at the direc tion of a caller posing as a supervisor. The caller told staff to wake up the teenagers and give them dozens of shocks each based on alleged behavior that had occurred at least five hours earlier.

McGuire said the center has promised to eliminate delayed punishments and end the delivery of shocks to students who are sleeping. While the school's critics want the state to ban any form of shock treatment, McGuire said the state also had to consider the many parents who defend the school as the only effective place for their hard-to-teach youngsters.

School spokesman Ernest Corrigan said he believes the one-year authorization is a sign of the state's continuing faith in the school. He said that many of the state's top psychologists and physicians were involved in the state's inspections of the school this year and that their decision to recommend conditional reauthorization of shock treatment is a "reaffirmation of some of the good work" at the school.

Critics of the Rotenberg Center expressed disappointment that state officials, especially in light of the August episode, did not order the school to end the shock treatment program, which critics consider ineffective and inhumane.

"The state needed to go further," said Leo Sarkissian, executive director of The Arc of Massachusetts, a group representing people with intellectual and developmental disabilities.

The provisional reauthorization was given by the Department of Mental Retardation, which is responsible for overseeing the shock therapy program. The Rotenberg Center is the only school in the nation that depends so heavily on shock treatments for its students, most of whom are autistic, mentally retarded, or have serious emotional problems.

According to the report, the school has about 250 students, nearly all of whom attend the center's Canton school and live in one of its 38 group homes in nearby communities. Two-thirds are minors; the rest are adults. Roughly one-third are from Massachusetts. About 60 percent of all students have court-approved plans that allow for shock treatment.

In the reauthorization, state officials criticized the center for producing generic-looking treatment and assessment plans for the students, seemingly using a common template for many of them.

They also said the center failed to consider circumstances that may have provoked an offending behavior or to reduce those triggering situations.

One student observed by inspectors looked bored sorting Popsicle sticks. This boredom, the report found, may "serve to lower the threshold for engaging in inappropriate behaviors," thus triggering a potential punishing shock.

McGuire said the state plans to inspect the school next month, as well as repeatedly throughout the year to make sure the required changes are being addressed.

"We're being as aggressive as we can," McGuire said.

Another Psychiatrist Investigated for Child's Drugging Death, Loses Medical License

As reported in the Tacoma News Tribune. Sadly, this is a case where not much information is immediately available online. in comparison to other cases such as the sad situation of the late Rebecca Riley

The state medical board Friday suspended the license of a Tacoma psychiatrist after his alleged misuse of 13 medications over two months “possibly caused” the death of a 17-year-old girl under his care in 2002.

Messages left Friday by The News Tribune with the answering service and at the home of the psychiatrist, Dr. Andrew Hwang, were not returned.

State documents allege Harris prescribed a series of psychiatric and other types of medication to the girl, whose name was not released, and did not respond properly when she started to show severe side effects.

On Jan. 26, 2002, the documents state, the teen felt very confused, and did not feel well. The next morning, her parents found her in her room, stuperous and nonresponsive.

“She was taken to the hospital, where she was found to have suffered severe brain damage,” the documents state. “She was taken off life support and died Jan. 29.”

The case resulted in a malpractice lawsuit. The settlement of the suit was reported to the state in September 2006, leading to a state investigation, said Peter Harris, a staff attorney involved with the state Department of Health.

Hwang “has not changed the way he treats patients following (the girl’s) death,” the state alleged, making the suspension of license necessary.

He can appeal the state’s actions and seek reinstatement of his license, Harris said.

Woman's Estate Sues Over Suicide at Connecticut Psychiatric Hospital

From this report in the Danbury News Times

The Rev. Dale Rosenberger remembers his friend Ruth Farrell as "a lost soul in whom light still shone."

Farrell, who was a Ridgefield resident, died nearly six years ago, and her death has become the subject of a malpractice suit brought by David Kervick, the executor of her estate, against Silver Hill Hospital in New Canaan and Farrell's psychiatrist there, Dr. Ellyn Shander.

Farrell, who was 41 when she died, reportedly committed suicide Jan. 28, 2002, while a patient at Silver Hill. She was found hanging from a bathroom door, according to court documents.

The suit -- believed to be only the second such one in Connecticut history filed against a hospital following a patient's suicide -- is now before a jury in Stamford Superior Court.

[...] court documents reveal Farrell had been a patient at Silver Hill Hospital "on various occasions" since 1999.

Over those years, she exhibited "suicidal behavior" and made suicide attempts, according to the suit. The hospital and her psychiatrist should have been aware that she was at risk, the suit alleges.

In response to the suit, Silver Hill Hospital denies Farrell was a suicide risk at the time of her admission in January 2002 and claims in court documents that it was Kervick's "abusive" relationship with Farrell that drove her to suicide.

Danbury attorney Gregory Klein, who is not involved in the case, spoke generally about similar cases.

He noted that in reviewing the state of Connecticut Judicial Branch Web site, he found only two cases, including Kervick's, of a patient or patient's estate suing a hospital for malpractice after a suicide.

Klein cited a similar case "where a doctor who was the victim of childhood sexual abuse hanged herself while committed to the hospital." The plaintiff's estate was compensated in that case, Klein said.

"Places like Silver Hill are entrusted to care for and manage people who cannot do it for themselves," he said. "When there is known suicidal ideation, the hospital's responsibility is to be vigilant in taking all steps necessary to prevent that outcome."

Silver Hill is a 76-year-old nonprofit hospital specializing in treating psychiatric disorders and substance abuse. It sits on 45 acres that include walking trails and tennis courts.

It has treated celebrities like Billy Joel and Mariah Carey in its country club-like setting.

[...]

Supreme Court asked to hear Zoloft case

From the Buffalo News

Attorneys have asked the U.S. Supreme Court to hear the case of a teen sentenced to 30 years in prison for killing his grandparents when he was 12, arguing that the sentence is cruel.

Christopher Pittman shoot his grandparents Joe and Joy Pittman with a shotgun in 2001, then set fire to their home.

During his trial four years later, Pittman's attorneys unsuccessfully argued the slayings were influenced by the antidepressant Zoloft - a charge the maker of the drug vigorously denied.

In the brief submitted to the high court late Monday, attorneys from the University of Texas School of Law argued that the 30-year sentence violates Christopher Pittman's Eighth Amendment protection from cruel and unusual punishment.

Such a lengthy sentence is "unconstitutionally disproportionate as applied to a 12-year-old child," according a copy of the petition provided by the Juvenile Justice Foundation. It said Pittman "is the nation's only inmate serving such a harsh sentence for an offense committed at such a young age."

Twenty-five states and the District of Columbia set the minimum age at which a juvenile may be tried as an adult above 12, so in more than half the nation, Pittman's attorneys argue, Pittman could not have been tried as adult and could never have been sentenced to 30 years in prison.

Each year about 200,000 defendants under 18 are sent to the adult system, according to the National Center for Juvenile Justice. Most end up there because of state laws that automatically define them as adults, due to their age or offense. Those numbers escalated in the 1990s as juvenile crime soared and legislators responded, with 48 states making it easier to transfer kids into criminal court, according to the center.

Zoloft is the most widely prescribed antidepressant in the United States, with 32.7 million prescriptions written in 2003. In 2004, the Food and Drug Administration ordered Zoloft and other antidepressants to carry "black box" warnings - the government's strongest warning short of a ban - about an increased risk of suicidal behavior in children.

FDA Rebukes Wyeth for Effexor XR Advertising Claims

From the News Inferno Website

Ads for Effexor XR in a medical journal are misleading, the Food & Drug Administration (FDA) says, prompting the agency to issue a warning letter to Wyeth, the maker of the widely-used antidepressant. The FDA said the wording of the ad overplays the benefits of Effexor XR and minimizes dangerous side effects.

Effexor XR is an extended version of the original Effexor. Effexor is the top selling anti-depressant in the world, according to Wyeth, and Effexor drugs reaped sales of $958 million in the third quarter of 2007 alone.

[...] both drugs are known to have dangerous side effects, including an increased risk of suicidal thoughts and behavior when used in children and adolescents, as well as hypertension and serious withdrawal symptoms. Despite such serious side effects, Effexor and Effexor XR are marketed by Wyeth as better alternatives to antidepressants like Paxil, Prozac and Zoloft.

Now, the FDA is charging that an ad which appeared in a medical journal makes “unsubstantiated superiority” claims about Effexor XR. The FDA criticized several claims in the ad, including citation of a study claiming that said Effexor XR prevented a depressive episode in 92 percent of cases, versus 55 percent for a placebo. The agency said that claim is “based on a study that is inadequate.”

The FDA also faulted Wyeth’s claim that 20 million people have been treated with the Effexor XR, a statistic the FDA said is based on suspect data. Because people may associate the number of people treated with quality, this claim “may mislead consumers and healthcare providers,” FDA wrote.

This is not the first time Wyeth has been accused of making misleading Effexor claims. Last month, Dr. Daniel Carlat recounted his experiences as a Wyeth-paid Effexor lecturer in the New York Times.

According to Dr. Carlat, the Effexor information Wyeth instructed him to convey during visits to physician offices was often incomplete, downplayed risks, and was skewered to favor Effexor over other drugs. When Dr. Carlat, uncomfortable with the Wyeth-provided script, altered it to include more complete data on hypertension, he was visited by a district manager, who expressed concern that the doctor was not exhibiting enough “enthusiasm” in his talks. Dr Carlat quit lecturing for Wyeth shortly after that episode.

The FDA has ordered Wyeth to cease running ads for Effexor XR that make misleading claims in medical journals. The company must also provide the FDA with a list of other Effexor XR marketing materials that make similar claims, as well as a detailed plan for discontinuing the use of such materials. Wyeth has until December 21 to respond to the FDA Effexor XR warning letter.

The Effexor XR ads in question are no longer running, but a spokesperson for Wyeth told Reuters that the company believes they were “responsible.”

Problems with Understanding IQ Testing and Your Common Psychologist

Snippets from an book review in the New Yorker regarding the perils of psychological tests for IQ, and the debates about the relationship of IQ to race.

One Saturday in November of 1984, James Flynn, a social scientist at the University of Otago, in New Zealand, received a large package in the mail. It was from a colleague in Utrecht, and it contained the results of I.Q. tests given to two generations of Dutch eighteen-year-olds.

When Flynn looked through the data, he found something puzzling. The Dutch eighteen-year-olds from the nineteen-eighties scored better than those who took the same tests in the nineteen-fifties—and not just slightly better, much better.

Curious, Flynn sent out some letters. He collected intelligence-test results from Europe, from North America, from Asia, and from the developing world, until he had data for almost thirty countries. In every case, the story was pretty much the same. I.Q.s around the world appeared to be rising by 0.3 points per year, or three points per decade, for as far back as the tests had been administered. For some reason, human beings seemed to be getting smarter.

Flynn has been writing about the implications of his findings—now known as the Flynn effect—for almost twenty-five years. His books consist of a series of plainly stated statistical observations, in support of deceptively modest conclusions, and the evidence in support of his original observation is now so overwhelming that the Flynn effect has moved from theory to fact.

What remains uncertain is how to make sense of the Flynn effect. If an American born in the nineteen-thirties has an I.Q. of 100, the Flynn effect says that his children will have I.Q.s of 108, and his grandchildren I.Q.s of close to 120—more than a standard deviation higher.

If we work in the opposite direction, the typical teen-ager of today, with an I.Q. of 100, would have had grandparents with average I.Q.s of 82—seemingly below the threshold necessary to graduate from high school.

And, if we go back even farther, the Flynn effect puts the average I.Q.s of the schoolchildren of 1900 at around 70, which is to suggest, bizarrely, that a century ago the United States was populated largely by people who today would be considered mentally retarded.

[...]

This is not a trivial issue. I.Q. tests are used to diagnose people as mentally retarded, with a score of 70 generally taken to be the cutoff. You can imagine how the Flynn effect plays havoc with that system. In the nineteen-seventies and eighties, most states used the WISC-R to make their mental-retardation diagnoses. But since kids—even kids with disabilities—score a little higher every year, the number of children whose scores fell below 70 declined steadily through the end of the eighties.

Then, in 1991, the WISC III was introduced, and suddenly the percentage of kids labelled retarded went up. The psychologists Tomoe Kanaya, Matthew Scullin, and Stephen Ceci estimated that, if every state had switched to the WISC III right away, the number of Americans labelled mentally retarded should have doubled.

That is an extraordinary number. The diagnosis of mental disability is one of the most stigmatizing of all educational and occupational classifications—and yet, apparently, the chances of being burdened with that label are in no small degree a function of the point, in the life cycle of the WISC, at which a child happens to sit for his evaluation. “As far as I can determine, no clinical or school psychologists using the WISC over the relevant 25 years noticed that its criterion of mental retardation became more lenient over time,” Flynn wrote, in a 2000 paper. “Yet no one drew the obvious moral about psychologists in the field: They simply were not making any systematic assessment of the I.Q. criterion for mental retardation.”

Fortunately Flynn is able to cut through a lot of the BS that is associated with the field, when it comes to debates like IQ vs Race.

Two weeks ago, Flynn came to Manhattan to debate Charles Murray at a forum sponsored by the Manhattan Institute. Their subject was the black-white I.Q. gap in America. During the twenty-five years after the Second World War, that gap closed considerably. The I.Q.s of white Americans rose, as part of the general worldwide Flynn effect, but the I.Q.s of black Americans rose faster. Then, for about a period of twenty-five years, that trend stalled—and the question was why.

Murray showed a series of PowerPoint slides, each representing different statistical formulations of the I.Q. gap. He appeared to be pessimistic that the racial difference would narrow in the future. “By the nineteen-seventies, you had gotten most of the juice out of the environment that you were going to get,” he said. That gap, he seemed to think, reflected some inherent difference between the races. “Starting in the nineteen-seventies, to put it very crudely, you had a higher proportion of black kids being born to really dumb mothers,” he said.

When the debate’s moderator, Jane Waldfogel, informed him that the most recent data showed that the race gap had begun to close again, Murray seemed unimpressed, as if the possibility that blacks could ever make further progress was inconceivable.

Flynn took a different approach. The black-white gap, he pointed out, differs dramatically by age. He noted that the tests we have for measuring the cognitive functioning of infants, though admittedly crude, show the races to be almost the same. By age four, the average black I.Q. is 95.4—only four and a half points behind the average white I.Q. Then the real gap emerges: from age four through twenty-four, blacks lose six-tenths of a point a year, until their scores settle at 83.4.

That steady decline, Flynn said, did not resemble the usual pattern of genetic influence. Instead, it was exactly what you would expect, given the disparate cognitive environments that whites and blacks encounter as they grow older.

Black children are more likely to be raised in single-parent homes than are white children—and single-parent homes are less cognitively complex than two-parent homes. The average I.Q. of first-grade students in schools that blacks attend is 95, which means that “kids who want to be above average don’t have to aim as high.”

There were possibly adverse differences between black teen-age culture and white teen-age culture, and an enormous number of young black men are in jail—which is hardly the kind of environment in which someone would learn to put on scientific spectacles.

Flynn then talked about what we’ve learned from studies of adoption and mixed-race children—and that evidence didn’t fit a genetic model, either.

If I.Q. is innate, it shouldn’t make a difference whether it’s a mixed-race child’s mother or father who is black.

But it does: children with a white mother and a black father have an eight-point I.Q. advantage over those with a black mother and a white father.

And it shouldn’t make much of a difference where a mixed-race child is born.

But, again, it does: the children fathered by black American G.I.s in postwar Germany and brought up by their German mothers have the same I.Q.s as the children of white American G.I.s and German mothers.

The difference, in that case, was not the fact of the children’s blackness, as a fundamentalist would say. It was the fact of their Germanness—of their being brought up in a different culture, under different circumstances.

“The mind is much more like a muscle than we’ve ever realized,” Flynn said. “It needs to get cognitive exercise. It’s not some piece of clay on which you put an indelible mark.”

The lesson to be drawn from black and white differences was the same as the lesson from the Netherlands years ago: I.Q. measures not just the quality of a person’s mind but the quality of the world that person lives in.

And of course, these results also mean that a person's IQ is changeable, given enough time, proper environment, education, and other therapeutic methods.

Child Porn Arrests in Australia-wide Operation Snare Psychologist

This is obviously a very big story in Australia. See these reports from the Herald Sun and the Courier Times, among others, as well as this original report from the Australian Federal Police. No names are available identifying the arrested culprits.

A forensic psychologist is among those arrested in the largest child pornography investigation ever by Australian Federal Police.

More than a million images were seized during the six-month Operation Irenic, including pictures of infants being raped, abused and tortured.

Australia-wide, 24 men were arrested including a former police officer and a teacher, ranging in age from 30 to 70.

Suspects include a forensic psychologist, a sales assistant and an RSPCA worker.

More than 100 police were involved in the investigation which identified one child as being at risk, resulting in its removal from harm.

"The child was at times in the presence of a person who had been downloading child abuse images and it's our understanding that that individual was actively preparing this child for abuse," said AFP acting Assistant Commissioner Kevin Zuccato.

He said investigations were far from complete and what had been discovered so far was "the tip of the iceberg".

"With these types of investigations we don't stop at just arresting the people who download the images," he said.

"Our main objective is to identify everybody that we possibly can involved in these type of offences and working internationally to bring those people to justice and hold them to account."

He praised the way in which police services from across Australia co-operated throughout the investigation.

"This shows that offenders who try to remain anonymous by using the internet to commit offences can and will be caught."

The operation had led to the arrests earlier this week of seven men who have already appeared before courts in NSW and Victoria, bringing the total alleged Australian offenders to 31.

Over the weekend police in NSW and Victoria raided eight properties, making a series of arrests and seizing computers containing thousands of images.

Days later, AFP Commissioner Mick Keelty promised more arrests as part of an ongoing international operation.

Parents suing NY State school district over kid's referral to psychiatrist

As one commenter noted on this story:

So let me get this straight..

THE SCHOOL assigns the kids to write an essay on "what would a person do if he had 24hours to live? "That is a MORBID!!!! question/assignment. Psyche services for the TEACHER whose morbid enough to come up with this trend of thought.

So now the TEACHERS LEADs the kid down this MORBID path...he answers honestly just as morbid as the question is and he needs psyche services?

What a warped bunch of a- holes these educators are. No wonder our kids are nuts!!!

[...]

I hope a whole lot of these so called educators get fired. Incompetents fools. Each and everyone of us sit in front of the boob tube and watch "movies." Did it ever occur to anyone out there that those violent scenes came out of someones morbid minds? That begs the question why hasn't the likes of Steven King/ these screen writers/ directors ever been psyche evaluated? How about Susan Lucci? why hasn't she been evaluated? for her to play role a totally psychotic dysfunctional Erica Kane is a day at the office.

POINT BEING: This kid sees SICK/DYSFUNCTIONAL Psychos all day long all over the place and NO ONE QUESTIONS it. So why is every body questioning him for having the same morbid imagination as any screen writer after some morbid teacher asked him to write an essay on a morbid topic... such as what would you do before you got snuffed out?

[...]

Here is the news item as reported in the Times Herald Record

The parents of a teenager referred to Child Protective Services because educators believed he was suicidal are suing the Warwick Valley School District.

In a federal claim, Everett Cox III, a former Warwick school board member, and Nan Ping Peng allege school officials violated their due process rights and their son's privacy rights. They want the district to pay for a private school.

"There's a level of recklessness here," said the parents' Goshen lawyer, Michael Sussman. "A kid has the right to speak out in response to a school assignment without a fear of his family being destroyed."

Sussman has had a string of legal victories suing school districts over due process violations. But those have been over suspensions from school or sports teams. This latest case gets at a more complex issue: how far schools should go to ensure children who are talking or writing about violence are not a danger to themselves or others.

Sussman said educators should be able to discriminate between a real problem and a kid who's in tune with a violent popular culture, and let parents decide what's best for a student.

But Pam Atkins, director at the Psychological Counseling Center at SUNY New Paltz, said school counselors have a duty to be sensitive to students' writing about violent behavior, and always err on the side of caution.

"Parents are specialists in raising children," Atkins said. "They are not specialists in suicide and homicide. We like to think we know our kids but so often our worries and our feelings about children interfere with our ability to see the truth about what's going on."

Warwick school officials declined comment. Their call to CPS came near the end of a school year in which the student had been in a fight with another student, been suspended for drawing on a school wall and written at least two school assignments that included references to violent activity, including suicide.

At the school's insistence, the student was evaluated by a psychologist in February, after he wrote the first essay. In April, in response to an assignment about how he would live his last 24 hours, the student wrote about doing drugs, taking poison and shooting himself.

He submitted the assignment before the April 16, 2007, massacre at Virginia Tech in Blacksburg, Va., in which a disturbed student killed 33 people, including himself. After the attack, school officials called the Child Protective Services hotline and, according to the suit, said the student was homicidal and suicidal and his parents provided "a minimal degree of care to their son."

The CPS psychiatrist who evaluated the student recommended a follow-up examination and sent him home with his parents.

Psychologist charged with filing false rape report to cover up a marital affair.

From the Pioneer Press

A psychologist who claimed she was raped by a patient in her Selby Avenue office lied about the incident to cover up her extramarital affair with the man, according to a court document.

Jill Marie Ajao, 41, was charged Friday in Ramsey County District Court with falsely reporting a crime, a misdemeanor.

A call left at her home in St. Paul was not immediately returned.

On Oct. 26, 2006, police responded to a call from Ajao at her office, where she appeared "crying and visibly upset," the complaint said.

The complaint goes on:

Ajao told police that two days earlier, a new patient named "Jeff" had come in for a scheduled appointment at 2 p.m. During the session, "Jeff" raped her, she said, providing specifics of the rape.

The next day, police contacted a Minnesota Bureau of Criminal Apprehension sketch artist, who worked with Ajao to design a likeness of the suspect.

The day after that, Ajao changed her statement, saying she'd met the man at a bar down the hall from her office. She also said she had been at a sexual aids store called the Love Doctor on University Avenue and speculated that the man had seen her there and somehow found out who she was.

On Oct. 30, police interviewed a witness from the bar, who said she recalled Ajao being there with a man, and that they seemed familiar to each other. Police released to the media a surveillance photo of the man leaving the bar and received "hundreds" of calls in response from the public.

In January, Ajao met with St. Paul police Sgt. Paul Schnell at her request - changing her story again.

This time, she said she met a man online, and they got together Oct. 24 when she called him. She told police "there was an expectation that there would be no sex" but that her real intention was to "surprise and pleasure her husband" by putting an encounter together.

It was not immediately clear what she intended regarding her husband.

Still later, in February, Ajao sent an e-mail to the man, which was obtained by police. In it, the man asked if she "finally admitted that the encounter was consensual and that she claimed rape to cover up an affair." She replied that she had.

Police said the case is highly unusual and emphasized that real victims would be believed, as Ajao initially was

Nebraska Report Show High Goverment Psychiatrist Pay

A new report (pdf) from the State of Nebraska Auditor's Office reveals who are the highest paid people on the state's payroll. Not unexpectedly, the highest paid were associated with the University of Nebraska football program. But many of the top paying jobs not involved with football went to government psychiatrists. See this snippet from the report:

Over 200 State Employees received gross salaries of $100,000 and above. The Department of Health and Human Services takes many of the top spots on the list, followed by Supreme Court, District and County Judges.

The top 20 State Employees receiving gross pay of over $100,000 are:

NAME	POSITION	PAY	DEPARTMENT
Hartmann, Klaus	Psychiatrist	$206,023.70	Health and Human Services
Oneill, Stephen J	Psychiatry Clinical Director	$205,107.60	Health and Human Services
Tatay, Rafael	Psychiatrist	$200,710.55	Health and Human Services
Kohl, Randy T	Medical Director	$199,905.67	Correctional Services
Shaffer, Lawrence B	Psychiatrist/Clinical	$196,737.23	Health and Human Services
Moore, Yancey S	Psychiatry Clinical Director	$189,805.62	Health and Human Services
Stephenson, Daryl R	Psychiatrist	$180,174.56	Health and Human Services
Carpenter, Stanley H	Chancellor	$176,090.00	State Colleges
Kamal, Mohammad S	Psychiatrist	$171,375.61	Correctional Services
Roth, Barbara	Psychiatrist	$166,152.90	Health and Human Services
Dewan, Vijay	Psychiatrist	$165,000.00	Health and Human Services
Voss, Tod W Medical	Director	$164,442.97	Health and Human Services
Christensen, Douglas D	Commissioner Of Education	$159,567.24	Education
Collings, Richard J	President	$157,513.04	State Colleges
Martin, Louis C	Psychiatrist	$157,027.32	Health and Human Services
Johnson, Ben E	President	$156,404.00	State Colleges
King, Jennifer L	Medical Director	$154,603.82	Health and Human Services
Hill, Marshall	Director	$152,370.96	Coord. Comm. for Postsecondary Education
Thaut, Harold W	Medical Director	$152,367.94	Health and Human Services
Park, Janie	President	$151,664.00	State Colleges

The list of vendors and state and university personnel gross salaries was summarized from the detailed information provided at the request of State Auditor by the Nebraska Information System (NIS) team and the University of Nebraska-Central Administration.

The purpose of the Auditor of Public Accounts’ office is to provide independent, accurate, and timely audits, or reviews, of the financial operations of Nebraska State and local governments.

The Special Audit and Evaluation Unit manages a ‘whistle-blower’ hotline the public can call, anonymously if necessary, to report suspected abuse of government resources.

The hotline number for Lincoln is (402) 471-3686

and outside of Lincoln is 1-800-842-8348.

For more information, please visit:

http://www.auditors.state.ne.us

Any reasonable person looking at this would likely say that this is odd. We have to wonder what value these highly paid psychiatrists are delivering to the State of Nebraska, and we think that legislators would do well to look at these psychiatrist salaries as a prime place for cost savings.

NYU Bows to Critics and Pulls Ransom-Note Ads

As noted by the WSJ Health Blog, NYU Bows to Critics and Pulls Ransom-Note Ads

After sparking widespread criticism, the New York University Child Study Center decided this afternoon to pull ads, which featured ransom notes that personified mental illnesses as kidnappers of children suffering from the conditions.

The center’s campaign, which began earlier this month, featured images of ransom notes to drive home the message that 12 million children are being held hostage by mental health problems, such as depression and autism. See the Health Blog’s previous post on the NYU controversy here.

The campaign provoked the ire of many patient groups, who called the ads stigmatizing and fear-inducing. NYU received thousands of phone calls and e-mails since the ads became widely publicized, with about 70% against the campaign.

This from a facility who is supposed to specialize in understanding the mind (and thus people), and communication and education. Their attempt to educate and communicate with the public merely antagonized, revealing something of a lack of expertise. Hmmmmmmmm.

Closed Hearings in Psychiatrist Child Molestation Case

As reported in the Enquirer

Note: This report is not related to the NY State news report regarding gynecologist Dr. Ivan D'Souza on somewhat similar charges with female patients. We have no information on if the two are related in anyway.

A hearing examiner for the Ohio State Medical Board closed a disciplinary hearing Tuesday during an investigation of sexual abuse complaints against a Cincinnati psychiatrist.

Hearing examiner Gretchen Petrucci, referring to the board's administrative rules, cited the "sensitive nature" of testimony as cause to close the hearing to the public.

Sallie J. Debolt, staff attorney with the State Medical Board, said today's hearing will be open - at least when it begins at 9 a.m. in Columbus.

Underage male patients of Dr. Leo D'Souza are expected to testify this week about being inappropriately touched on the genitals. Five boys complained D'Souza, 66, of Clifton, abused them when they were between 12 and 19, sometimes over multiple office visits.

D'Souza has denied any inappropriate conduct. Monday, D'Souza testified that he touched one 16-year-old boy with a towel while examining a penile discharge, and that the patient worried about a possible sexually transmitted disease.

Petrucci closed Tuesday's hearing at the request of the Ohio Attorney General's Office, which is representing the State Medical Board.

Ted Hart, a spokesman for Attorney General Marc Dann, said the hearing examiner has some discretion to close a hearing "to protect compelling interests and rights or to comply with statutory requirements."

Hart said it's likely that the hearing examiner believes testimony from patients would shed light on their identities and/or their medical records. Ultimately, the public transcript of the proceedings will include everything while protecting patient identities, Hart said.

Bruce McIntosh, D'Souza's Cincinnati attorney, initially agreed to closing down part of Tuesday's proceeding "on a limited basis." McIntosh then said the hearings should be completely open.

The State Medical Board is investigating whether D'Souza should lose his medical license for the incidents that allegedly occurred at the Cincinnati Counseling Service between 1998 and 2006.

The accusations against D'Souza also could result in criminal charges.

Eight medical professionals were disciplined for sexual improprieties between 2000 and 2005, according to the State Medical Board.

NC Psychiatric Hospital Fails Surprise Inspection, Could Lose Accreditation. Director Replaced

Report from Asheville, North Carolina.

A new director was appointed at Broughton Hospital on Monday after the hospital failed a surprise accreditation inspection last week.

Dr. Art Robarge, who was director of Broughton from 1986-89, has been named interim director, replacing Seth P. Hunt, who had been director since 1995.

Inspectors from the Joint Commission on Accreditation of Healthcare Organizations, an independent nonprofit, have notified Broughton they will recommend a preliminary denial of accreditation. That will give Broughton 45 days to address the problems found by inspectors, or it will lose its ability to receive payment from private insurance companies.

The hospital also did poorly in a recent mock run-through of a Center for Medicare and Medicaid Services inspection by N.C. Department of Health and Human Services staff.

Broughton cares for about 300 patients a month. It is the westernmost of the state’s four psychiatric hospitals and serves people from 37 counties.

The hospital lost certification to receive payment from Medicaid and Medicare in August, and the state has been paying roughly $1.3 million a month to make up for the federal money lost.

[...]

Among the problems the Joint Commission found at Broughton Hospital:

Restrained patients

• There was insufficient proof that staff consistently does a daily physical exam on people who are in restraints to verify a continued need.

• The hospital had insufficient proof that staff had attempted nonphysical techniques before using manual restraint or seclusion.

Cleanliness and safety

• Infection control plans were inadequate, and there was inadequate risk analysis of infection-control data.

• The hospital provided insufficient documentation for fire alarm testing. Fire department connection tests had not been completed, and hospital plans did not show that the local fire department was called when a fire alarm sounded.

Documentation

• The hospital had inadequate proof that a patient had given informed consent for medication with psychotropic drugs.

• Legal guardianship of a patient was not always determined.

• Development of individualized treatment plans was inadequate.

• More than 50 percent of the discharge summaries that documented patient assessment, care, treatment and services were late.

Adobe Acrobat PDF Report from the state on the mock run-through of a Center for Medicare and Medicaid Services. (40 KB)

Psychiatrist Arrested for Drugs Falsified Records

From the Ashley County Ledger in Arizona

Ashley County Quorum Court members received an update of the circumstances that led to the hiring, termination and arrest of a former Ashley County Medical Center psychiatrist employed two weeks at the facility's Generations unit.

Hospital Administrator Russ Sword terminated Paul Jay Loop, 46, Monday, December 3, after Sword learned of Loop's drug abuse.

According to the ACMC hospital report presented to the court during its December meeting, Loop was terminated and his privileges to practice medicine at ACMC were revoked. The Crossett Police Department was informed of the situation, and officers arrested Loop on possession of crack cocaine in Sword's office. At the time of his arrest, six rocks of crack cocaine were found in Loop's possession. In addition to the cocaine, law enforcement officers found drug paraphernalia during a search conducted by the Crossett Police Department and the Ashley County Sheriff's Department of his hotel room at the Levee Inn.

"ACMC responded to the situation promptly and decisively and reported the matter to the Arkansas Medical Board," Sword said in its report presented to the court.

"All Arkansas hospitals, including Ashley County Medical Center, are required by state regulations to use the centralized credentialing services of the Arkansas Medical Board when reviewing physicians who are applying for hospital privileges. "

It further notes that during the medical board's review process, applicants' background, medical school, residency programs, as well as previous practices and other state medical board's recommendations are checked. "ACMC receives a written report from the Arkansas Medical Board before acting on a physician's request for clinical privileges," he added.

Although ACMC received a favorable report on Loop from the medical board, it is now known that Loop falsified his application to ACMC as well as information he submitted to the Arkansas Medical Board, according to the report.

The Arkansas Medical Board has suspended Loop’s license pending a hearing in February in regard to revoking his license.