Mental Gymnastics

Can Kids Oscillate Better?

2009-10-13T06:53:00.002-04:00

A new study shows that children and adolescents may be able to switch attention from one thing to another--say studying to texting--with more aptitude than adults. They have grown up with this technology, for one. Granted, this literature is in its infancy but I am sure many teens will love this study! See the article in the New York Times.

Medical Students Online

2009-09-23T06:42:00.002-04:00

A new study in JAMA indicates that medical students posting photos of unprofessional conduct or inappropriate language is fairly common. Of 78 schools responding to the survey, 47 indicated that students had posted unprofessional content online. See the abstract here.

The Roots of Happiness

2009-05-17T20:30:00.003-04:00

Psychiatrist George Vaillant has spent his career chronicaling the lives of a group of Harvard men. By doing so, he has sought to identify the roots of happiness. He has discovered that the following factors play a role in those men who have led the most rewarding lives: 1) using mature defenses (like humor and altruism); 2) education; 3) stable marriage; 4) not smoking; 5) not abusing alcohol; 6) some exercise; and 7) healthy weight. Nevertheless, those whom may have appeared the healthiest as young men did not always remain that way. Another key finding is the power of relationships that allows for successful aging.

See the article in The Atlantic.

Thoughts on attention

2009-05-12T19:21:00.002-04:00

As William James put it, “My experience is what I agree to attend to.” In other words, you make many choices during the day and these choices constantly affect your experience. A new book by Winifred Gallagher describes that one makes deliberate choices about what to pay attention to. Attention is finite and these choices determine your subsequent subjective experience.

Health Care Reform

2009-04-05T21:04:00.002-04:00

See this op-ed by David Grande in The Philadelphia Inquirer for an insightful look at the influence of the insurance industry on health care reform.

Teens and Texting

2009-04-05T08:09:00.004-04:00

According to Common Sense Media, checking time is the number one use of the cell phone. Texting is number 2. Kids sends hundreds of text messages a week, including photos and video.

If you want to communicate with your kids, you need to learn how to text! However, remember to monitor cell phone usage, including texting. Teens have been given tools that they need to learn how to use properly, including proper cell phone etiquette. Set rules about cell phone use/texting and stick with them. Examples include turning off the phone during family time and leaving the phone in a public place overnight.

You can see Common Sense Media's recommendations on texting here.

Another Reason for Health Care Reform

2009-04-05T08:05:00.001-04:00

Here is an article in the NYT discussing how doctors taking Medicare are dropping like flies.

A Dangerous Inheritance

2009-04-04T15:34:00.002-04:00

Linda Gray Sexton, the daughter of poet Anne Sexton, discusses her ongoing struggle with depression and the legacy of her mother's suicide in an op-ed in the New York Times this week. A moving tribute.

More On Psychiatrists and Industry

2009-04-04T15:26:00.002-04:00

Online this month in Psychotherapy and Psychosomatics is an article discussing financial ties between the authors of the practice guidelines for the APA. 18 of 20 authors have financial ties to industry. Certainly an important consideration in light of the need for transparency. See the article in The Boston Globe.

Screening for Depression in Teenagers

2009-03-31T06:46:00.004-04:00

Two important articles appear in the April edition of Pediatrics. The United States Preventive Services Task Force has recommended that all teenagers be screened for depression. In order to treat children who are identified this way, the task force emphasizes the importance educating pediatricians and family physicians on how to care for children with mental illness. See the related article in the New York Times.

Study 15

2009-03-18T08:39:00.002-04:00

The Washington Post highlights another report on the influence of pharmaceutical companies in medication trials. This one highlights Astra Zeneca's effort to bury a study which showed that patients gained weight while taking Seroquel. The company had reported this information to the FDA but it had never been published.

Educating Doctors

2009-03-17T11:08:00.003-04:00

Richard Friedman discusses a timely issue of education of doctors. This is especially pertinent given the recent Institute of Medicine report to limit duty hours in medicine. The verdict is still out as to the impact on training of doctors. See today's article in the New York Times.

Thank You!

2009-02-06T06:35:00.001-05:00

President Obama signed the SCHIP (children's health insurance) bill into law on Wednesday. The bill was "a downpayment on my commitment to cover every single American," Obama stated.

Color Your World

2009-02-05T17:50:00.001-05:00

New evidence shows that the color blue improves creativity while red increases accuracy. An article in Science discusses this.

Health Care Reform and Media Coverage

2009-01-09T10:02:00.003-05:00

An insightful post on the Health Beat blog discusses the impact of the media on health care reform. It may be that the media can "make or break it" on this issue.

And face it, the topic of health care reform is dull. It hardly provides the edge of your seat drama that our 24 hour a day media world currently thrives on. Let us hope for the best!

Gupta as Surgeon General?

2009-01-06T20:07:00.001-05:00

A Washington Post blog site is reporting that Sanjay Gupta has been asked by Obama to be Surgeon General.

NY Touting Tax On Sugary Sodas

2009-01-04T17:42:00.002-05:00

A video on YouTube shows Richard Daines, MD, the New York State Health Commisioner, to propose adding an 18% tax on sugary sodas

As a physician, I spend an inordinate amount of time talking to patients and families about eating properly, including minimizing the amount of sugary drinks. It is important that people realize the effect that extra sugar intake has on children and adolescents.

The Prudent Reader Test?

2009-01-01T11:10:00.004-05:00

The New England Journal of Medicine discusses the pitfalls of health care media coverage in this weeks's issue. The author, a journalist, suggests "a prudent reader" test to identify holes in the journalism.

Media uses quick titles and catchy phrases to entice readers. Often, the need to entertain overrides the responsibility of providing even-handed coverage of news. Often, interpreting new studies is difficult and may have several nuances, which are difficult even for physicians to understand.

Let's hope that 2009 brings more balanced coverage of health care issues. Happy New Year!

No More Pharma Goodies

2008-12-31T08:12:00.002-05:00

Starting January 1, 2009, Pharma has announced a moratorium on branded gifts to doctors. See the NYT article. Although many argue that these gifts do nothing to influence doctors, this is a welcome step in the reduction of the amount of company logos visible in medical offices.

Revising the DSM

2008-12-18T06:26:00.002-05:00

The Diagnostic and Statistical Manual of Mental Disorders is currently being revised by a group of psychiatrists under the auspices of the American Psychiatric Association. Much debate has been ongoing about the manner in which the manual is being updated. Some feel that the process is too secretive. An article in the New York Times describes the process.

Pressure To Medicate

2008-12-15T12:06:00.002-05:00

Here is an op-ed in the Los Angeles Times by a child and adolescent psychiatrist discussing the varied pressures placed on child and adolescent psychiatrists.

Teen Brains

2008-12-05T12:42:00.002-05:00

Scientists are proposing that teen brains are changing in the digital world. See this article.

Happy Thanksgiving!

2008-11-27T07:19:00.000-05:00

Have a wonderful Thanksgiving!

Bottom of the Barrel

2008-11-27T07:17:00.001-05:00

Stigma follows psychiatrists, too. See this article.

Medicine and the Media

2008-11-25T13:52:00.002-05:00

Recent articles have highlighted the ever-widening net of entanglement between physicians, particularly psychiatrists, and pharmaceutical companies. However, less well-known is the financial connections that pharmaceutical companies have to the media. An article in this week's British Medical Journal, discusses this subject.

One example that the article mentions is Sanjay Gupta's reporting on CNN. He hosts a program called Accent Health, which is broadcast in US medical waiting rooms. The network is produced by CNN and sponsored by, among others, pharmaceutical companies.

The article also points out that a majority of patients' groups receive funding from drug or device manufacturers. Furthermore, news reports taht cite experts or studies with industry ties are disclosed in less than half of the cases. Recent evidence has shown the effect of industry-sponsored clinical trials on the medical literature. At the very least, readers should have the information revealed in order to make their own decisions on the credibility of the journalism. This was apparent in the recent disclosure of Dr. Fred Goodwin on The Infinite Mind, a National Public Radio show.

Pediatric Prescribing of Antipsychotics Reviewed by FDA Committee

2008-11-19T14:19:00.002-05:00

On November 18, 2008, the FDA Pediatric Advisory Committee met. One of the topics on the agenda was prescribing of antipsychotics, including Risperdal and Zyprexa.

Data presented at the meeting indicates that prescribing of Risperdal has increased, including off label prescribing for attention deficit hyperactivity disorder. A report on use information describes the data for Risperdal. Fifty-two percent of prescriptions were written by psychiatrists. Of that amount, 21 % of prescriptions were written by child psychiatrists. Therefore, only 11.2% of these prescriptions were written by child psychiatrists.

Family medicine doctors prescribed about 11 percent of these prescriptions. Pediatricians only prescribed 3 percent.

The data indicates that the two top diagnosis codes associated with these prescriptions were "Infantile Autism" (ICD 9 299.0) and Attention Deficit Disorder (ICD 9 314.0).

The data does not indicate which prescribers were using Risperdal for attention deficit hyperactivity disorder.

Placebos

2008-11-15T11:03:00.002-05:00

A recent article published in the BMJ addressed the use of placebos by doctors. There was much fanfare about this in the popular press. However, the definition of "placebo" in the study included pain medication, vitamins and sedatives when other treatments had not worked. The patients were told that the treatment was not approved for their illness.

Sally Patel addresses this issue in an article in the Wall Street Journal.

Health Care In The Obama Administration

2008-11-07T17:42:00.004-05:00

Forbes reports that health care will be a challenge for the Obama Administration. However, it has been a key issue in this election and a solution will need to be pursued.

And CQ opines on the possible appointees in the Obama Administration who will be key decision-makers in the health care policy field.

Health Care Spending In The Election

2008-11-07T17:33:00.003-05:00

Politico.com reported that Obama spent $113 million in health care advertising as of October 23, 2008. 68 percent of his television advertisements have included health care themes. This amount increased to 86 percent in October (versus 1.5 percent for McCain).

Hopefully, this enthusiasm for health care will continue under the Obama Administration.

Kennedy Crafting Health Care Plan

2008-10-26T13:00:00.002-04:00

The Washington Times reports that Senator Edward Kennedy is crafting a health care plan even while he struggles with brain cancer. Reportedly, he is planning to introduce a universal health care bill early in the 2009 Congress and is working across party lines to do so.

Evidence Based Medicine As Baseball?

2008-10-24T06:09:00.002-04:00

An Op Ed in today's New York Times by Billy Beane, Newt Gingrich and John Kerry equates health care with baseball.

Although health care is somewhat different than baseball, their point is well taken. Establishing an institute of evidence-based medicine would be a step in the right direction to help provide efficient, quality care for patients. However, many other steps will need to be taken as well.

A No Brainer

2008-10-17T11:26:00.002-04:00

The CDC reports that "car surfing" is dangerous and that teens should avoid this form of risky behavior. Apparently, videos are showing up on YouTube which glorify this behavior.

So, you parents out there make sure you are asking your teens what they are doing when they are out!

Statistics and Medicine

2008-10-17T06:51:00.003-04:00

ABC news reports that statistics are often misleading, even to physicians. The report stems from an article in the October 8th issue of Psychological Science in the Public Interest.

Pharma Contributions to Congress

2008-10-17T06:35:00.003-04:00

Opensecrets.org reports that overall contributions by Pharma to Congress has shifted from 67% Republicans and 31% Democrats in 2006 to 51% Republicans and 48% Democrats in 2008. In absolute numbers, total donations increased to Democrats (from $6,065,172 to $10,470,136) and decreased for Republicans (from $13,040,480 to $11,131,628).

The top three recipients of Pharma contributions are Barack Obama, Hillary Clinton and John McCain, in that order. Barack Obama has received more that twice as much ($1,147,154) in contributions as has John McCain ($538,881). See the list here.

Until 2006, Republicans had the majority in Congress. It is likely that the shift in monies has to do with Democrats now having the majority.

Pharmaceutical Investments in Congress

2008-10-17T06:29:00.002-04:00

Opensecrets.org has published the top investments of Congress by industry. Pharmaceuticals/health products was the 7th largest investment by members of Congress. Both Pfizer and Johnson & Johnson made the list of the top ten investments by members of Congress. See that list here.

Stimulant Use To Boost Learning

2008-10-13T18:39:00.003-04:00

A poll by the journal Nature indicates that up to one-fifth of adults, including college students and shift workers, may be using stimulants to improve learning power. Such medications are not approved for such usage.

Expect An Increase In Mental Health Concerns

2008-10-11T06:47:00.001-04:00

The current economic crisis is likely to increase mental health problems. See the Reuters article.

Grassley's Letter to Medtronic

2008-10-05T15:23:00.002-04:00

Here is the letter to Medtronic seeking more information about payments to doctors from the medical device company. Senator Grassley was following up on a recent article in the Wall Street Journal which describes a lawsuit brought by a former Medtronic lawyer. The lawsuit alleges that surgeons received a wide variety of kickbacks, including entertainment at a Memphis strip club, royalties on patents that the surgeons did not have a part in developing and trips to Alaska.

Mental Health Parity Passes!

2008-10-04T07:57:00.002-04:00

In a strange twist of fate, the Mental Health Parity bill became intertwined with the economic bail out package and was passed yesterday!

Broadway Show About Teenage Anxiety

2008-10-02T15:36:00.002-04:00

Teenage anxiety is the subject of a new Broadway show called "13." Jason Robert Brown wrote the score and lyrics for the musical. In an article in the New York Times , he notes how the subject hits home for him.

Campaign Contributions From The U.S. Health Sector

2008-09-26T11:58:00.003-04:00

This week's New England Journal highlights the influence that the U.S. Health Sector, including pharmaceutical companies, hospitals, HMOs, PACS and health care professionals has on the current election. Since 2006, the health sector has spent more on lobbying than any other sector of the economy, according to data from the Center for Responsive Politics. See the article.

The NEJM also has an early release article highlighting Obama and McCain's proposals for health care reform.

UK Psychiatrists Manage To Host Annual Meeting Without Pharma Support

2008-09-26T11:02:00.002-04:00

The British Medical Journal reports that the British Royal College of Psychiatrists held its annual meeting without any support from the pharmaceutical industry. See the article. A previous article had described efforts in Australia to separate from industry support.

Cognitive Behavior Therapy In Teens

2008-09-25T07:48:00.002-04:00

Here is a story from NPR discussing cognitive behavior therapy in teenagers.

NPR Story Focuses on Depression in College Students

2008-09-25T07:42:00.003-04:00

Here is a link to a story that appeared on NPR today. It focuses on a student at Johns Hopkins who has started a mental health awareness group on campus called Active Minds.

Pfizer Political Donations

2008-09-17T12:31:00.003-04:00

Medtronic recently announced that it would publish charitable contributions to customers in a Charitable Donations Registry. I thought I would check out a company that markets psychiatric drugs and found the following information.

This data is the political contributions made by Pfizer and its PAC from January to December 2007. It is interesting given the recent political conventions and the current debate about transparency. Among other donations (despite all the talk about politicians divorcing themselves from lobbyists), Pfizer gave $250,000 to each of the Republican and Democratic Host Committees. Don't mean to single out Pfizer (I am sure other corporations have made similar contributions); the information was readily available on their site.

Presidential Candidates and Health Care

2008-09-17T11:21:00.001-04:00

Do you know where the Presidential candidates stand on health care? Take this quiz in Newsweek and see.

Deals Between Pharma and Academia Thriving

2008-09-16T12:34:00.002-04:00

The Financial Times reports that pharmaceutical companies, including Astra Zeneca, Pfizer and GlaxoSmithKline have struck large deals with universities this year. The incentives to pharma include new sources of possible new megabuster pharmaceuticals while universities benefit from the infusion of cash, particularly in light of NIH grants that have decreased when adjusted for inflation. These partnerships differ from the traditional ones, where universities have pursued the research; on the contrary, these relationships involve university and pharma scientists working together.

See the article here.

Brain Maturation

2008-09-16T12:16:00.002-04:00

Here is a visual portrayal of the maturation of the prefrontal cortex from age 2 to 21, showing the reasons for some of the emotional and cognitive changes in children as they mature. See it here.

Diagnosing Depression

2008-09-16T10:33:00.004-04:00

Ronald Pies, M.D. has an article in September 16 issue of the New York Times discussing the difference between normal sadness and clinical depression.

Bipolar Disorder in Young Children

2008-09-12T12:57:00.005-04:00

Worth a read: This weekend's New York Times Magazine features an article on bipolar disorder in children, written by Jennifer Egan. The article raises several important points in the discussion of bipolar disorder in young children: making the diagnosis is extremely difficult; treating bipolar disorder is complicated; and the long-term prognosis is unknown. Also, the article discusses the significant frustrations and difficulties with which these families struggle.

Health Policy Expertise in the White House

2008-09-11T13:08:00.003-04:00

The New England Journal ponders the perils of health policy expertise in the White House in this week's issue. See the article. The author maintains that health policy expertise needs to stay separate from politics. However, in order to ensure political success, the experts must occasionally defer to politics. His point is well taken, as it is easier to propose a better, more efficient, system for health care than it is to follow through with that proposal. But we need to factor in the public response and political support for such a program.

Health policy expertise is even more complicated than purely the policy versus politics debate, however. As Dr. Hacker mentions in his article, a wide variety of persons are involved in forming these policies. Justifiably, economists take a leading role in such advice and expertise. Doctors, lawyers, and holders of public policy degrees also provide expertise. It makes sense that the public and the political process are also stakeholders in this process.

Another Take on Pharma-Medical School Interactions

2008-09-11T09:51:00.002-04:00

An AP article has more on the pharma-medical school debate. See it in the Washington Post. As the article states, medical schools are struggling to define proper patterns of gifts and of allowing pharmaceutical sales reps to see their physicians. The key is getting to them early, although many still claim that gifts do not affect their prescribing habits.

Each institution needs to make their own decision. I have seen both sides of the coin, so to speak. Where I did my internship and residency, gifts and contact by pharmaceutical representatives were allowed; whereas at my child and adolescent residency did not allow any contact with residents at all.

Emotional and Behavioral Difficulties in Children

2008-09-08T09:58:00.003-04:00

In 2005-2006, 15% of children (18% of boys and 11% of girls) aged 4-17 years old had parents who talked to a health care provider or school staff about their child's emotional or behavioral difficulties.

Approximately 2.9 million children (5.1%) were prescribed medication for these difficulties. 89% of these children received medication for symptoms of ADHD.

5.3% of children received treatment other than, or in addition to, medication for emotional and/or behavioral difficulties. One-half of these children received medication as well as other treatments. More than 50% received treatment at a mental health clinic or center while close to 4 in 10 received treatment at school. One quarter of the children received treatment at a pediatric or general medical clinic.

See the report here.

CDC Reports That Depression Affects More Than 1 in 20 Americans

2008-09-08T09:38:00.002-04:00

A new CDC study (see report) states that in any 2 week period, 5.4% of Americans aged 12 or older are depressed. Only 29% of all persons with depression reported contacting a mental health professional in the past year; 39% of persons with severe depression had done so. Females, persons living below the poverty level and non-Hispanic black persons had higher levels of depression than other groups.

Lowering the Drinking Age?

2008-08-26T20:38:00.004-04:00

A group of college presidents, including those at Duke, Johns Hopkins and Middlebury, have endorsed the Amethyst Initiative, a group of college and university presidents that state that "21 is not working." This group states that the higher drinking age of 21 encourages binge drinking because students are more apt to drink alcohol "secretly" off campus.

Btw, amethyst means "not intoxicated" in Ancient Greek.

GSK to Report Grants To U.S. Healthcare Organizations

2008-08-25T21:36:00.002-04:00

GlaxoSmithKline has announced that it will publicly disclose grants made to U.S. healthcare organizations. The report, which will be issued quarterly, will include the name of the recipient (including hospitals, teaching institutions, managed care organizations, professional associations, patient advocacy groups, and continuing medical education companies), the amount of the grant, and a description of the grant. Consulting agreements with medical providers will not be included in the report. See article in Modern Healthcare.

NIH Grant at Stanford Drops Psychiatrist

2008-08-20T16:04:00.001-04:00

From the August 8th issue of Science, (8 Aug, vol. 323, p. 757), the magazine of the Amer Assoc for the Adv of Science the "Sciencescope" column:

"Psychiatrist Dropped From Grant

"Under congressional pressure, Stanford University is temporarily pulling a faculty member off a National Institutes of Health (NIH) grant involving a company in which he owns millions of dollars in stock. The company, Concept Therapeutics, is testing the drug mifepristone as a treatment for depression, and Alan Schatzberg is principal investigator on a multipart NIH grant that includes a mifepristone depression study. Although Stanford says Schatzberg had reported his stock and was not involved with the trial, university officials last week told NIH that they "can see how" the situation "may create an appearance of conflict of interest." U.S. Senator Chuck Grassley (R-IA) has been investigating the broader issue in U.S. universities. (Science, 27 June, p. 1708). . . ."

More On Industry Money

2008-08-04T10:19:00.010-04:00

A recent Businessweek article discusses the decision by Pfizer to suspend funding of CME events for doctors. The article also mentions that Zimmer Holdings, a medical device manufacturer, has decided to fund courses by identifying an independent third part to organize the events. This still means funding, however. Thus far, medical device manufacturers have not had as much scrutiny as the pharmaceutical companies in issues of transparency.

Pediatricians Are Not Immune From Pharma Dollars

2008-07-28T09:29:00.005-04:00

See the link below for a clip from last Friday's CBS evening news.
http://www.cbsnews.com/sections/i_video/main500251.shtml?id=4296233n

Theories of Overweight

2008-07-22T11:04:00.002-04:00

News stories indicate the prevalence of obesity in America. A recent article in the Los Angeles Times wonders why. Theories include stress, taking too many drugs, too much pollution and smoking cessation. My favorite theory is the high fructose corn syrup one.

Virtual Playgrounds

2008-07-21T12:37:00.002-04:00

A recent article in the LA Times shows that even elementary school children are engaging in cyberbullying. Another reason to encourage appropriate parental supervision and monitoring

NIH This Time...

2008-07-15T22:06:00.000-04:00

Science magazine (July 4, vol 321, p 25) reports : "Congressional appropriators want . . . NIH Director Elias Zerhouni to stiffen his agency's oversight of the financial ties between academic scientists and pharmaceutical companies. . . . Last week the Senate spending panel ordered NIH's parent body, the Department of Health and Human Services, to begin the process of rewrtiting regulations meant to avoid financial conflicts of interest among nonfederal scientists. Grantees now must report to their institutions relevant income from any company exceeding $10,000 annually. (NIH intramural scientists are banned from receiving all such income) . . . Senator Charles Grassley (R-iA) . . . is investigating several cases in which academic researchers may have failed to report income from drug companies. . . . "

Asking For More Transparency In Medicine

2008-07-15T09:13:00.002-04:00

Following up to the recent Vermont AG report, this letter to the Rutland Herald was written by Thomas Simpatico, M.D., the President of the Vermont Psychiatric Association.

Psychiatry and Technology

2008-07-15T07:13:00.001-04:00

Richard Friedman, M.D. identifies the perils of mixing psychiatry and technology in an article in today's New York Times.

The Saga Continues

2008-07-15T06:44:00.003-04:00

Apparently, Senator Grassley has received funds from pharmaceutical companies himself. FEC data published at OpenSecrets.org shows that he received $231,722 from pharmaceutical companies.

APA Under Fire

2008-07-13T15:15:00.003-04:00

Yes, it's true. The President-Elect of the American Psychiatric Association receives pharma money too. And now Senator Grassley is after the APA. See the article in the NYT.

Frankly, psychiatrists are easy targets for pharma. They are generally lower paid than other medical specialties. Therefore, it is no wonder that pharmaceutical companies target them. Also, with insurance companies paying less for psychotherapy visits and wanting instant fixes, providing medication is another way to provide the instant fix that we Americans need.

However, there must be a way to limit pharma moneys and still provide psychiatrists the information they need....

Former First Lady Speaks Out For Children's Mental Health

2008-07-11T16:02:00.002-04:00

Rosalynn Carter, former First Lady, wrote an op-ed in the July 10th Boston Globe encouraging support for children's mental health. Thank you!

The Real Scoop

2008-07-10T20:30:00.002-04:00

Vermont Attorney General William Sorrell released a report on pharmaceutical marketing efforts in Vermont on July 8, 2008. See the report here. Media has been reporting the aggregate amounts that psychiatrists earned the most money from these payments. Eleven psychiatrists received roughly 20 % of these funds. However, the second largest aggregate amount went to cardiologists. Two cardiologists shared payouts of $312,898, or an average of $156,440 each, no small potatoes.

An interesting finding is the medications that were promoted. The top ten medications promoted were the following:

1. Strattera (ADHD)
2. Metadate CD (ADHD)
3. Januvia (Type 2 Diabetes)
4. Lexapro (Depression)
5. Cymbalta (Depression)
6. Lantus (Diabetes)
7. Seroquel (Bi-Polar Disorder and Schizophrenia)
8. Namenda (Alzheimer’s)
9. Vytorin/Zetia (Cholesterol)
10. Benicar (Hypertension)

The top five spenders in Vermont on marketing (accounting for 56% of the total amount spent or $1,756,150.56) during FY 07 were:
1. Eli Lilly and Company
2. Pfizer, Inc.
3. UCB, Inc.
4. Novartis Pharmaceuticals Corporation and
5. Merck & Co., Inc.

The top 100 recipients received a total of $2,127,325.00 in FY 07, or 68% of the total payments. Of the top 100 recipients, psychiatrists were the largest beneficiaries of payments. Eleven psychiatrists received a total of $626,379.00, or approximately 20% of the overall total. Further breakdown of this recipient group is as follows:
􀂾 The average payment to the nine psychiatrists in the top 100 recipient group in
FY 07 was $56,944.00. The average payment in FY 06 to the eleven psychiatrists among the top 100 recipient group was $45,692.00, and in FY 05 the average payment to the 14 psychiatrists among the top 100 recipient group was $20,835.00.
􀂾 The average payment to psychiatrists in FY 07 is a 25% increase over the previous fiscal year, and a 173% increase over the average payment made to psychiatrists in the top 100 recipient group in FY 05.

􀂾 The median payment to the nine psychiatrists in the top 100 recipient group in FY 07 was $30,529.00. The median payment to the psychiatrists among the top 100 recipient group in FY 06 was $27,912.00 and in FY 05 $16,214.00

􀂾 The median payment to psychiatrists in the top 100 recipient group in FY 07 is a 9% increase over the median payment to them in FY 06, and an 88% increase over the FY 05 median payment.

Although not being reported in the media, two other specialties received average payments larger than psychiatry: cardiology ($156,000) and "osteopath" ($99,843). In addition, two other specialties received average payments almost as high as psychiatrists: geriatrics ($49,110) and endocrinology ($45,154). In addition, an RN received payments of $23,070.

Nobel Prize Winner Decries Moral Corruption of Medical Industry

2008-07-06T19:55:00.002-04:00

Britain's Sir John Sulston, who won the 2002 Nobel Prize for medicine, says that profits are taking precedence over the needs of patients. He made his statements at the launch of an institute that will examine the ethical questions of science, the Institute for Science, Ethics and Innovation.

Conflicts of Interest in Medical Research

2008-06-30T21:44:00.003-04:00

Senator Grassley calls on NIH to identify conflicts of interest in taxpayer-sponsored research (http://finance.senate.gov/press/Gpress/2008/prg062508CEG%20urges%20NIH.pdf).

Elias Zerhouni, M.D., the Director of NIH, responded to a plea by Senator Grassley that management of conflicts of interest in NIH supported institutions should have increased transparency (letter).

The Source of Adventure?

2008-06-26T07:08:00.002-04:00

A recent study at the University College London used imaging to determine the location of the center of the brain which allows us to take chances. Using fMRI scanners, researchers showed that the region of the brain that lights up in these cases is the ventral striatum. It is believed that making a new choice that is beneficial results in the release of dopamine, reinforcing the behavior. This is similar to the novelty-seeking involved in drug addiction and gambling. Read an article describing the study.

To Be or Not To Be?

2008-06-06T09:02:00.002-04:00

Forbes.com recently published the top 10 reasons not to become a doctor. The reasons are wide and varied, including decreasing reimbursements and increasing costs. See the article.

Can You Chat and Drive at the Same Time?

2008-06-03T08:53:00.002-04:00

A recent study by a psychologist at the University of South Carolina demonstrates why drivers have more difficulty paying attention to someone while talking on a cell phone. The study found that the tasks of planning to speak and speaking tax the brain more readily than does simply listening. The hypothesis is that one forms a visual image of the other person while speaking and that this distracts from the task at hand, i.e. driving.

Marijuana Use Worsens Depression

2008-05-13T18:42:00.002-04:00

The Office of National Drug Control Policy released a study in May 2008 showing that using marijuana can worsen depression. Self-medication occurs when teens use marijuana to help relieve symptoms, to relieve stress or to cope. However, recent studies show that:
1) weekly marijuana use doubles a teen's risk for anxiety or depression;
2) depressed teens are twice as likely as peers to abuse marijuana;
3) using marijuana can cause depression and other illnesses.

The majority of teens who feel depressed are not getting the medical attention that they need. Parents need to be vigilant in monitoring their teen's behavior and mood swings in order to distinguish normal teen behavior from situations which require intervention. This also requires proper monitoring of use of substances by the teenager.

DNA Scanning

2008-04-17T06:47:00.003-04:00

Several new companies out there are stating that they can scan your genome and inform you of your risk of diseases (everything from Alzheimer's to heart disease). However, the companies generally do not look at lifestyle or family history, both of which may impact your chance of illness. The potential of genomic testing is enormous. However, it is important to remember the possible psychological consequences as well as its impact on a person's ability to obtain health insurance in the future. See the article in Newsweek.

One Fish, Two Fish, Red Fish, Blue Fish?

2008-04-08T20:04:00.001-04:00

Here is an interesting way to look at red (conservative) vs. blue (liberal) tendencies. Chances are, though, it is not quite so simple! See the article in Newsweek.

The Monty Hall Problem

2008-04-08T09:36:00.003-04:00

Have some fun and solve the Monty Hall problem. See this link. The idea is that your first choice is only 1/3 that you win the prize. Therefore, the argument goes that you should always switch your choice when the booby prize is revealed because now you are left with a 50-50 chance.

Yet another reason to take the TV out of the bedroom...

2008-04-07T10:58:00.002-04:00

At the University of Minnesota, a study has come out indicating that teens aged 15-18 who have televisions in their rooms are not as healthy as those who don't. Girls who had televisions in their rooms got less vigorous exercise, ate fewer vegetables, drank more sweetened beverages and ate fewer meals with their families. Boys with televisions in their rooms had lower grade point averages, ate less fruit and ate fewer meals with their families than boys without.

Universal Coverage Causing Further Strain On Health Care Access

2008-04-06T15:21:00.002-04:00

When are politicians going to realize that physicians are going above and beyond the call of duty? Universal coverage has been mandated in Massachusetts. Unfortunately, physician shortages contribute to the problem of access. And other physicians are moving to other professions or retiring early due to low remuneration. See this article in the New York Times.

Preemption

2008-04-06T15:19:00.002-04:00

Hard to believe that we are on the verge of preemption. See this article in the New York Times.

It does not make much sense that an agency which is underfunded, undermanned and basically in the pocket of Big Pharma will provide yet another reason to be immune to a lawsuit.

Doctor Shortages: When Will Folks Take Notice?

2008-03-26T20:37:00.002-04:00

An article in today's Wall Street Journal highlights the shortage of doctors which is looming. This is true not only in family practice but also in psychiatry and child psychiatry (and other specialties as well).

Monitoring Emails and Chatting By Teens

2008-03-17T15:46:00.003-04:00

An article in the New York Times called "The Undercover Parent" discusses the importance of monitoring email communications and chat room conversations by teens. The very nature of the medium means that parents should be monitoring their children--closely. The question is whether this violates the teen's right to privacy.

Although the article doesn't mention it, texting would probably fall into this category too.

Teens have been pushing the limit ever since technology began to expand the horizons of young adults. When telephones came into their lives, parents had to deal with new ways of communicating. However, phone conversations are much more public than conversations that children and teenagers are engaging in online.

Supervision and monitoring are extremely important in this technological medium. Moreover, the computer is not always a private place and your teen needs to be aware of that. Talk to your teen about his participation in such forums. Find out who he is talking to. Take the computer out of the bedroom and place it in the family room. Use the computer or chat room as a mechanism to start talking to your teen. Who do they like to talk to? Who are their friends talking to? Parents need to expand the means of communication as teens will continue to find ways to avoid

Treating Anxiety Disorders in Kids

2008-03-17T15:39:00.002-04:00

Treating anxiety disorders could have a huge public impact, according to Ronald Kessler, PhD, of Harvard Medical School. In the keynote address of the Anxiety Disorders Association of America, Kessler indicated that treating anxiety early on would be helpful since such patients have high rates of comorbid illness. No studies have been done of the effectiveness of treating such studies, whether it would prevent the comorbid psychiatric illness down the road in these patients.

Something to think about!

The Text Message Generation

2008-03-11T17:06:00.002-04:00

An article in the New York Times Sunday magazine discusses the phenomena of texting. Teens pick it up readily and often must teach their parents how to do it. Many parents state that this is yet another barrier to communication with a teen. Others say that it helps keep in touch more easily. Whatever the outcome, the realities of texting are here.

Texting helps make our lives easier in many ways, as do cellphones. However, it does not replace communication. Kids and teens still need to learn to communicate, as in speak, to one another. Furthermore, kids and teens need to learn proper etiquette in communication. In other words, delaying the return of the cellphone call until after the ballet performance or returning the text message after class. This is behavior that adults are engaging in too. Texting during meetings or performances is distracting to others and portrays the user as more important than those around him. Bottom line is that we should use the technology to help us but we still need to consider actual interpersonal relations while doing so.

Shyness Gene Discovered

2008-03-06T13:02:00.003-05:00

Researchers have discovered a gene, called RGS2, linked to shyness in children and introversion in adults. See this article. The findings were published in the March 6, 2008 Archives of General Psychiatry.

Turn Off The TV!

2008-03-04T13:10:00.002-05:00

Turning off the television is one way to keep kids healthy. We all know this, right? The assumption is that turning off the television means that kids will then be more active. This may or may not be true. However, recent research does reveal that kids that watch more television, eat more. This is possibly related to snacking while watching television. Another possibility is that advertisements show less healthy food options which kids then eat later.

At the State University of New York, researchers have been testing a device which helps parents turn off the television. The article appeared in the Archives of Pediatric and Adolescent Medicine.

Whatever the reason, turn off the television!

Adults Not Getting Enough Sleep?

2008-02-29T13:39:00.003-05:00

A study released by the CDC shows that 10 percent of adults may not be getting enough sleep or rest in the past month. The study surveyed adults in four states--Delaware, Hawaii, New York and Rhode Island. An extimated 50-70 million people suffer from chronic sleep loss and sleep disorders.

If you suffer from chronic insomnia, it is important to have a full medical evaluation to determine the cause. Insomnia may be associated with health problems, including sleep apnea, obesity and depression. In order to treat insomnia, the underlying cause needs to be determined and addressed. This includes assessing behavior patterns which may be contributing to the insomnia.

Pfizer Drops Jarvik

2008-02-27T06:54:00.002-05:00

Pfizer has decided to drop pitchman Jarvik, who was touting Lipitor. The advertisements had questionable legitimacy. Jarvik is an inventor and a researcher. He never completed residency and is not licensed to practice medicine or to prescribe drugs. See the article in the New York Times.

Ecoanxiety?

2008-02-17T16:36:00.002-05:00

Is altruism underlying the green movement? See the article in the New York Times which discusses the "EcoMom." Just "think positive" when you realize that not all of your light bulbs have been changed to flourescent bulbs.

The Importance of Play

2008-02-17T09:11:00.004-05:00

The New York Times has an article highlighting the functions of play in the February 17th magazine.

Most of us understand that play is a way for children to not only blow off steam but also is a way for children to learn. Play allows testing of not just motor skills, but also allows creative and imaginative skills to be tested and developed. Many have proposed that it is a way for children to test skills they will need as adults.

However, play may also provide a means for children to express themselves and may be one of the keys to emotional stability. As the nature of play changes, people are beginning to wonder how this is affecting our children. More structured days mean less problem solving skills and more obesity in children, for example. Does less play also mean that children have less flexibility and adaptability? The verdict is still out.

Recycling White Coats?

2008-02-15T08:52:00.003-05:00

In the United Kingdom, a move is afoot to ban the use of white coats in hospitals. A letter in this week's issue of the British Medical Journal suggests alternative uses for the white coat, including:
1) using it as a projector screen;
2) donating it to developing countries;
3) turning them into nappies (diapers);
4) giving it to your child for a school play.
Be creative! Come up with your own ideas for recycling white coats.

Monitoring Your Child's Internet Use

2008-02-11T21:24:00.000-05:00

The European Union sponsored a contest to determine the safest internet browsing software for children. The winner of the contest was Magic Desktop (they also won last year). However, Magic Desktop was only the clear winner for under tens. There was no clear winner for adolescents. Deloitte ran the test. The results can be seen here.

It is important to know not only the sites where your children is surfing, but also who your children are interacting with while online. Many parents are familiar with the possibility of arriving at web content which is inappropriate for a child. However, parents are not as familiar with how to monitor the interactions of children over the internet. Children today are very computer savvy. They have grown up online. They seek relationships online and want to interact. It is important to educate your child in this regard.

Talk to your children about the web sites they frequent. You should visit these sites and be familiar with them. Is it possible to interact with others? Children should be advised against revealing personal information on the internet. However, limited interactions may be appropriate. Monitoring and supervision is extremely important in this context.

We will deal with adolescents and the web another day....

NIH Comes Up Short In Tracking Conflicts of Interest

2008-01-20T16:31:00.000-05:00

A new report by the Department of Health and Human Services Inspector General's office indicates that the NIH is falling short when it comes to monitoring conflicts of interest by its researchers. NIH was unable to provide an accurate count of financial conflicts of interests between 2004 and 2006. Furthermore, since details of such conflicts do not need to be reported, the exact nature of the conflicts of interest are often unknown.

Selective Publication of Antidepressant Trials

2008-01-17T09:01:00.000-05:00

This week's New England Journal features an article on selective publication of antidepressant trials and its influence on perceived efficacy. 37 of 38 positive studies were published while the negative studies tended toward not being published. Effect sizes for published studies averaged .37 while effect sizes for unpublished studies averaged 0.15 (a significant difference).

Doctors Across New York

2008-01-15T12:23:00.000-05:00

In order to entice doctors to rural and underserved areas of New York, Governor Eliot Spitzer has proposed the "Doctors Across New York" program. (See editorial in NYT.) The idea is to entice doctors to work in underserved areas by promising loan reimbursements of up to $150,000 in exchange for a five year commitment. In addition, he is also calling for increased Medicare reimbursements to doctors and clinics in such areas.

Influence of Industry on Continuing Education

2008-01-15T12:06:00.000-05:00

In November 2007, the Macy Foundation held a conference discussing continuing education in the health professions. Themes which were discussed included the relevance of continuing education (mainly in the form of lectures) to daily practice and clinical issues as well as the need to use the internet and technology in novel ways. In addition, the influence of industry on continuing education was discussed. The summary of the conference included this statement:

"In a free-market system, commercial entities, such
as drug and device manufacturers, have a clear
responsibility to shareholders to gain market
advantage and generate a profit, while health
professionals have a moral responsibility to
provide safe, high quality care for their patients,
based on valid scientific findings. The two
responsibilities are fundamentally incompatible.
Even if bias could be avoided, the potential,
and the perception, are ever-present. Companies
with billions of dollars at stake cannot be expected
to be neutral or objective when assessing the
benefits, harms and cost-effectiveness of their
products, for they are in the legitimate business
of gaining market advantage and want clinicians
to use and prescribe their products."

Tough Love?

2008-01-11T06:30:00.000-05:00

A radio DJ in Iowa placed the following ad in the Des Moines Register when she found alcohol under the seat of her 19-year-old son's Oldsmobile:

"OLDS 1999 Intrigue. Totally uncool parents who obviously don't love teenage son, selling his car. Only driven for three weeks before snoopy mom who needs to get a life found booze under front seat. $3,700/offer. Call meanest mom on the planet."

Since then, the family has been the belle of the media, appearing on Good Morning America.

Microdeletion Identified In Autistic Patients

2008-01-09T20:35:00.000-05:00

A microdeletion of 593 kb on chromosome 16p11.2 was identified in a group of families with autism (the Autism Genetic Research Exchange). The same deletion was found in 5 of 512 patients referred to Children's Hospital in Boston and 3 of 299 persons with autism in an Icelandic population. The report states that the microdeletion and its reciprocal microreplication may account for 1% of autism cases. See the report in the January 9th issue of The New England Journal of Medicine.

Zagats To Rate Doctors

2008-01-09T20:28:00.000-05:00

Wellpoint and Zagats are launching a system to rate doctors. Yes, Zagats is the company that rates restaurants....

The categories will be as follows: 1) ability to communicate; 2) availability; 3) trust; and 4) office environment. The service is being launched in Los Angeles, Connecticut, and Ohio.

Sixth Circuit Revives Challenge To No Child Left Behind

2008-01-08T06:39:00.000-05:00

The U.S. Court of Appeals for the 6th Circuit revived a lawsuit brought by the National Education Association and individual school districts in Texas, Michigan and Vermont. This group challenged the law, maintaining that Federal support for the act was insufficient to meet the needs of the NCLB. The case will be remanded to the lower court for further review.