Comments invited on latest draft of DSM
A new version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders has come out every decade or so (it varies widely) since 1952. 
It hasn’t substantially changed since 1994, but the next revision is slated to come out in 2013. It’s a pretty big event, as the book’s diagnostic criteria are used around the world to determine who is diagnosed with mental disorders.
With the release of the new version, lines may shift and folks who were diagnosed with mental disorders may find themselves “undiagnosed.” Others will have labels changed and gain labels they didn’t have before.
The latest draft proposal of the May 2013 revisions, upon which public comment will be accepted until April 20, 2010, was posted on Feb. 9. APA workgroups will review the comments and begin trials soon after. Benedict Carey rounded up and evaluated some of the biggest proposed changes for The New York Times. In addition to bipolar disorders in children and autism spectrum disorders, Carey discusses the sheer significance of the changes.
“Anything you put in that book, any little change you make, has huge implications not only for psychiatry but for pharmaceutical marketing, research, for the legal system, for who’s considered to be normal or not, for who’s considered disabled,” said Dr. Michael First, a professor of psychiatry at Columbia University who edited the fourth edition of the manual but is not involved in the fifth.
“And it has huge implications for stigma,” Dr. First continued, “because the more disorders you put in, the more people get labels, and the higher the risk that some get inappropriate treatment.”
FDA warns against promoting unapproved drugs
Filed under: Health journalism, Hot Health Headline
The New York Times‘ Natasha Singer looked into the FDA’s recent warning of prominent cosmetic doctor Leslie Baumann (bio) for the promotion of an unapproved drug, based on comments she made about Botox-like Dysport (she was an investigator in a trial of the treatment) in outlets such as Allure, Elle and the Today Show. Singer also considered the chilling effect this warning might have on other clinical investigators upon which the media has traditionally relied.
Now, some industry experts say the F.D.A. warning may curb the media enthusiasm of certain cosmetic doctors who until now have provided scoops about coming medical products — or have talked up the latest unapproved cosmetic uses for drugs and devices that the agency had approved only for other purposes.
“It’s a wake-up call,” said Nancy Behrman, owner of Behrman Communications, a public relations firm in Manhattan. Her firm has represented cosmetic medical companies as well as doctors. “The whole business has spiraled out of control, and we need to step back and slow it down.”
FDA representatives say that there’s a line between scientific discussion and drug promotion, and that investigators are welcome to talk to the media as long as they don’t cross it.
Thomas W. Abrams, director of the agency’s Division of Drug Marketing, Advertising and Communications, said that investigators were free to have scientific conversations about investigational drugs with their peers and with journalists. But an investigator should not promote any unapproved prescription drug — or an unapproved use of an already approved drug — as being safe or effective if the agency has not yet deemed it to be so, he said.
Singer also talks to another of the media’s favorite doctors, dermatologist Fredric S. Brandt, who said that, in future discussions with media he would take care to offer only scientific facts on unapproved drugs, and leave his opinions and recommendations out of the discussion.
NYT: Millions drink contaminated water
Having exposed the nation’s toxic waters, The New York Times‘ Charles Duhigg has now turned his attention to the Safe Drinking Water Act. Duhigg has found that “since 2004, the water provided to more than 49 million people has contained illegal concentrations of chemicals like arsenic or radioactive substances like uranium, as well as dangerous bacteria often found in sewage.”
Furthermore, Duhigg found that only 6 percent of violators were ever fined or punished.
Duhigg used EPA data on Safe Drinking Water Act violations as well as other parts of the massive Toxic Waters database.
Related
- Paper’s investigation reveals contaminated drinking water
- Reporter finds efforts to monitor groundwater contamination leave much to be desired
- Overwhelmed sewage systems spread pathogens
AP finds contaminated water in schools
The Associated Press has analyzed a decade of Environmental Protection Agency data and found that tests at thousands of American schools had shown the drinking water to be contaminated, with the water at some schools hitting unsafe levels in as many as 20 separate inspections. As part of the investigation, the AP provided an interactive map with which you can search and sort violations in your area. Although some children have become sick and some schools have resorted to bottled water, the AP found that the contaminants are generally not present in levels that would harm adults.
(Hat tip to Poynter’s Al Tompkins)
Related
- Leah Beth Ward of the Yakima Herald-Republic explains how she reported the “Hidden wells, dirty water” series.
- Greg Barnes of the Fayetteville Observer gives a behind-the-scenes look at the award-winning “What lies beneath” series that revealed contaminated drinking water in the Fayetteville area.
- NYT investigates Clean Water Act violations
- Herbicide levels high in many water supplies
- NYT’s Toxic Waters series takes on ag polluters
- Abandoned mercury mines taint water, fish
Reinhardt breaks down income statements
Filed under: Health data, Public records, Studies
Princeton economist – and Health Journalism 2009 keynote speaker – Uwe Reinhardt’s latest post on The New York Times’ Economix Blog provides a clear primer on how to read an insurance company’s income statement.
Uwe Reinhardt at Health Journalism 2009
In the post, Reinhardt systematically runs through insurance heavyweight WellPoint’s income statement and, not only explains exactly how major insurers earn their money, but also teaches the reader how to deduce all of this from a publicly available income statement.
Reinhardt promises another blog posting this week that will “explore how the add-ons for marketing, administration and profits on top of expected outlays for health care to set the insurance premiums can be astonishingly high for individually sold policies. Up to half the premium can go for these non-medical items.”
Related
- Princeton economist Uwe Reinhardt’s Health Journalism 2009 presentation on the economics of health care
- Reinhardt calls for price research/transparency
Is Baucus’ excise on ‘Cadillac’ plans too broad?
The New York Times‘ Reed Abelson writes that the excise tax on premium health insurance plans that Montana Sen. Max Baucus is counting on to pay for about a quarter of his $774 billion reform proposal will hit urban families and union workers as hard as it will Goldman Sachs executives. Proportionally, in fact, union workers with less disposable income will suffer even more from the tax, which hits any plan that costs more than $8,000 for individuals or $21,000 for families, than high-flying white collar types.
The current national average for family policies is around $13,375, and only 1/10 of them would fall under the tax. But, Abelson reports, the pace of health premium inflation is such that far more policies will be caught in the tax net by the time the excise would go into effect in 2013.
The tax is based on the theory that it will help control health care costs by discouraging insurers from offering fancy plans that cover too many unnecessary tests and procedures. AHCJ immediate past president Trudy Lieberman writes for CJR.org that even this attempt to rein in costs will likely just increase them further as insurers pass the costs onto customers and the weaker coverage and corresponding rise in underinsurance forces folks faced with catastrophic conditions into financial difficulty or bankruptcy.
NYT’s Toxic Waters series takes on ag polluters
Filed under: Hot Health Headline, Public health, Public records
In the latest installment of the Toxic Waters series, The New York Times‘ Charles Duhigg turns his investigative spotlight toward agricultural runoff and the havoc it has wrought upon water supplies around the country.
According to Duhigg, “runoff from all but the largest farms is essentially unregulated by many of the federal laws intended to prevent pollution and protect drinking water sources” and regulation and enforcement are instead left up to local authorities, who often lack the necessary resources.
Duhigg makes the scope of the contamination clear:
“Agricultural runoff is the single largest source of water pollution in the nation’s rivers and streams, according to the E.P.A. An estimated 19.5 million Americans fall ill each year from waterborne parasites, viruses or bacteria, including those stemming from human and animal waste, according to a study published last year in the scientific journal Reviews of Environmental Contamination and Toxicology.”
In the end, Duhigg seems to indicate that the only real hope of reigning in this contamination lies in overcoming powerful, entrenched ag interests and giving the E.P.A. broader powers to regulate agriculture.
Related
- Leah Beth Ward of the Yakima Herald-Republic explains how she reported the “Hidden wells, dirty water” series.
- Greg Barnes of the Fayetteville Observer gives a behind-the-scenes look at the award-winning “What lies beneath” series that revealed contaminated drinking water in the Fayetteville area.
- NYT investigates Clean Water Act violations
- Herbicide levels high in many water supplies
NYT investigates Clean Water Act violations
Filed under: Government, Health data, Hot Health Headline, Public records
In the latest installment of The New York Times‘ Toxic Waters series, Charles Duhigg says that, for this investigation, the Times “compiled a national database of water pollution violations that is more comprehensive than those maintained by states or the E.P.A.” (That database can be found here.)
In that database, Duhigg found serious violations across the country, from wells tainted by wet manure used to fertilize fields to seashores soiled by runoff from overwhelmed sewer systems, and discovered that while 60 percent of Clean Water Act violations were judged to be serious, only 3 percent “resulted in fines or significant punishment.”
The investigation found that agencies at every level of government had contributed to what amounts to a national failure to enforce the Clean Water Act. The causes of this failure are every bit as diverse as its manifestations, with lack of agency funding and political pressure from powerful industries being the worst culprits.
Duhigg’s story touches on points across the country, but focuses on the particularly egregious violations of West Virginia mining companies. He also details the Environmental Protection Agency’s response to the investigation, as well as its plans for correcting the systematic problems revealed by the Times‘ database.
Related
- Paper’s investigation reveals contaminated drinking water
- Reporter finds efforts to monitor groundwater contamination leave much to be desired
Ghostwriting: Journals’ dirty, not-so-little secret
Filed under: Conflicts of interest, Health data, Health journalism, Hot Health Headline, Studies
The New York Times‘ Duff Wilson and Natasha Singer reported the results of a Journal of the American Medical Association study showing that, in an anonymous survey of contributors to six major medical journals, 7.8 percent “acknowledged contributions to their articles by people whose work should have qualified them to be named as authors on the papers but who were not listed.”
Reuters Health’s Brendan Borrell describes the lengths one editor goes to when trying to track down ghostwriters and disclose them in his journal’s articles.
Meanwhile, an editorial in the nonprofit open-access Public Library of Science’s PLoS Medicine calls upon journals to “get serious” in the war against ghostwriting.
Philly VA doc defends himself before Congress
The New York Times‘ Walt Bogdanich has followed up his investigation into a “rogue” cancer unit at a Philadelphia VA hospital with a report on the questioning of one of the alleged rogue doctors, Gary Kao, at a congressional panel headed by Pennsylvania Sen. Arlen Specter. Kao defended himself by claiming that the mistakes he made during a process called brachytherapy (in which tiny radioactive seeds are inserted into a patient’s prostate) were nothing out of the ordinary.
Dr. Kao did not deny placing large numbers of seeds outside the prostate, but he said investigators were wrong to single him out. “It’s a recognized risk of the procedure,” he told the panel.
Dr. Kao’s assertion was disputed by Steven A. Reynolds, who oversees materials safety at the N.R.C., which regulates all nuclear materials. Cases where large numbers of seeds miss the prostate, Mr. Reynolds said, “happen very, very infrequently.”
Kao said he voluntarily appeared before the panel to set the record straight and correct what he called “very serious false allegations” made by Bogdanich’s initial article.
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