News Briefs: February 7, 2010

The Role of Mental Health Professionals in Torture

Hoai Le

An investigation by Derrick Silvone and Susan Rees of the University of New South Wales reports that mental health professionals should not be expected to partake in the torture of detainees. US military personnel have long argued that a psychologist's presence is necessary during interrogations to prevent the risk of abuse and harm. However, associations of psychologists and psychiatrists all agree that mental health professionals should not participate in the interrogation process of detainees or any activities that may lead to torture. Besides the obvious ethical problems involved, there is no scientific evidence to support the claim that psychologists have the ability to accurately assess the level of pain that an individual is experiencing. In addition, it is even more difficult to judge the long term psychological consequences of torture because some individuals show delayed symptoms. The report concludes that if US military personnel were really concerned with the safety of detainees, they are better off consulting a human rights expert than a mental health professional.

Reference: BMJ 2010;340:c124



The Cost of Autism on Families

Eriene-Heidi Sidhom

Autism is a growing problem in the United States; in 2007 it was reported that one in every 150 children were diagnosed with autism and since then that number has risen to one in every 110 children. Although treatments and therapies for autism are publicized, the prices associated with them are rarely spoken about. Unfortunately, the doctor visits, prescriptions, therapy and special education can cost a family $67,000 to $72,000 per year and $3.2 million over a lifetime. With limited or no coverage from insurance companies and very little government or financial assistance, this cost is not being addressed properly and has become a financial burden for many families.

However, improvement is being made and there is help being made available. Some large employers have policies to cover treatment and fifteen states have passed laws mandating some autism-related coverage. Additionally, some states offer Medicaid coverage for children with autism; although this is usually reserved for more serious cases and the waiting list for a Medicaid waiver can be long. Autism advocacy groups, such as Autism Speaks, are affiliated with local chapters that provide autism resources and support groups and organizations, like the National Autism Association, can offer financial help. Organizations like these and continuing financial aid is becoming increasingly mandatory because of the increasing cases of autism; in fact, Pat Kemp, executive vice president of the advocacy group Autism Speaks, predicts that “Unless we attack this like a national health crisis, we’re going to have a huge economic crisis on our hands.”

Reference: Konrad, Walecia. (2010, January 23). Dealing With the Financial Burden of Autism. The New York Times, p. B6.

The Fifth Phase of Epidemiologic Transition: Obesity

Adam Snider

Phases of epidemiologic transition have been categorized based on the most prevalent causes of death in a population. The first phase was characterized by death due to pestilence and famine. As cities became cleaner, and food production became more efficient, a second phase arose, defined by infectious disease. This phase was then replaced by one identified by degenerative and human-made health concerns such as smoking, fat-laden diets, and cardiovascular disease. Many of these problems were combated by advances in both preventative care and treatment, such as anti-smoking programs, and drugs to control blood pressure. Since 1960, we have entered a fifth wave: the age of obesity and inactivity. The percentage of adults considered obese (BMI>30) has risen over the past 50 years, bringing with it a host of associated health risks, including coronary heart disease, type 2 diabetes, joint disease, cancer and others. These trends have been reflected in today's youth: 17% of school age children are obese, facing similar long-term healthcare prospects as light smokers. Unlike smoking, there is no clear consensus on how to treat this growing epidemic. Pharmacology and bariatric surgery hold short-term promise, but have yet to be proven in a longer-term setting. The promotion of healthy lifestyles has yielded poor results. Currently, experts believe the best treatment is a combination of all three. Effective treatment is of dire need, as obesity-related healthcare costs currently pose a $147 billion burden on the system.

Reference: JAMA. 2010;303(3):275-276

The Pros and Cons of Simulated Patients

Namratha Rao

Trial and error used to be the most common practice among young doctors to practice team coordination and efficiency in medical cases. However, there has been an increase in medical simulation training in many organizations; previously only used to teach standard techniques, like chest compressions, the technology has expanded to recreate an entire clinical situation, even including the difficult conversations with family members. Apart from providing experience, without the stress of real patients, simulations enhance team-work and decision-making skills. However, this is also a criticism of medical simulations because some claim that actual medical practice on patients is very different. Additional criticisms include the difficulty to assess the success of simulation training and the high costs with no guarantee of a return.

Organizations currently employing medical simulation training include Stanford University School of Medicine, Banner Health, a non-profit system and New York City Health and Hospitals Corporation Institute.

Reference: Chen, Pauline W., M.D. (2010, January 28). Practicing on Patients, Real and Otherwise. The New York Times. Retrieved February 1, 2010 from http://www.nytimes.com/2010/01/29/health/28chen.html.

Keeping those New Year's Resolutions

Kanupriya Tewari

Make New Year’s resolutions you can’t keep? There may be a scientifically proven reason as to why. Advances in neuroimaging have enabled researchers to peer inside the brains of addicts and patients with addictive behaviors. They can see in real-time what gets patients addicted: how the brain's reward system - based largely on the neurotransmitter dopamine - asks for more, while inhibitory control centers experience a system failure. The pattern is similar across all kinds of behaviors; from cocaine and tobacco addiction to overeating. Therefore, changing the mind may be the first step toward breaking a habit, but altering the brain's neural machinery is the real challenge

Petros Levounis, MD, director of the Addiction Institute of New York at St. Luke's and Roosevelt Hospitals in Manhattan says that “Drug-taking and other addictive behaviors ‘hijack’ the brain's reward system”. He further emphasizes "Imagine what a strong hold these hijacked reward pathways take on our brains and our whole existence when they're so closely connected, geographically and anatomically speaking, with our memories and our emotions”.

These neural pathways have been well studied in the brains of hardcore addicts. Now, researchers say they see similar pathways involved in other bad behaviors. Researchers have identified two means through which to fix this problem. Basically, the idea of medications that act on the dopamine system is "to cool down those reward pathways," Levounis says. There are two strategies for doing so: an agonist strategy, or an antagonist strategy. The agonist strategy is "feeding the beast, providing activity in the cell so that the cravings go down," Levounis said. Classic examples are nicotine patches, or methadone for opioid dependence. On the other hand, the antagonist strategy is to block the receptors. Naltrexone, for example, will block opioid receptors so that the drug addict won't feel anything if they attempt to get high.

Reference: Fiore, Kristina. (2010, January 30). Doctor's Orders: Brain's Wiring Makes Change Hard. MedPage Today. Retrieved February 1, 2010 from http://www.medpagetoday.com/Psychiatry/Addictions/18207.

Eriene-Heidi Sidhom is the 2009 - 2010 News and Analysis Editor.