Wednesday, October 31, 2007


They say that there are no atheists in foxholes. Being unable to sell one's house can also turn a person away from atheism:

The Catholic saint has long been believed to help with home-related matters. And according to lore now spreading on the Internet and among desperate home-sellers, burying St. Joseph in the yard of a home for sale promises a prompt bid.
With the worst housing market in recent years, St. Joseph is enjoying a flurry of attention. Some vendors of religious supplies say St. Joseph statues are flying off the shelves as an increasing number of skeptics and non-Catholics look for some saintly intervention to help them sell their houses.
Some Realtors, too, swear by the practice. Ardell DellaLoggia, a Seattle-area Realtor, buried a statue beneath the "For Sale" sign on a property that she thought was overpriced. She didn't tell the owner until after it had sold. "He was an atheist," she explains. "But he thanked me."

Catholic leaders also say that faith and devotion are necessary, in addition to burying a statue, otherwise the practice amounts to little more than superstition or magic. But they are also enjoying the saint's newfound popularity. "If they have a good result and they think it was St. Joseph, it might inspire them to practice more," says Msgr. Connell.

Tuesday, October 30, 2007

Mediocre Care for the Poor Elderly

Vulnerable elderly receive mediocre health care, study finds
The quality of care for vulnerable elderly people on Medicaid and Medicare is “mediocre,” the authors of a new study concluded.
Researchers did a cohort study of 100,528 dual Medicaid/Medicare enrollees from 19 California counties who were age 75 and older in 1999 and 2000. They measured the care provided for 44 quality indicators (QIs) by condition, like heart failure, and intervention, such as medication, using QIs developed by the Assessing Care of Vulnerable Elders project. The article was published in the October Medical Care.

This study, as summarized by the American College of Physicians, found "medicore" care for elderly dual Medicare/Medicaid enrollees. This is the sickest, toughest population to treat. Reimbursement is less than mediocre, though that's no excuse.

Monday, October 22, 2007

Keeping Kids Calm with Video Games

If ritalin isn't enough, child psychiatrists have found a new way to keep children calm- video games. Psychiatric Times presents a case in which playing video games 6-7 hours a day helped a child's self esteem:
Case Vignette: Games and Attention/ Learning Disorders
Alex, a 13-year-old boy, spends 6 to 7 hours a day playing video games. He locks himself in his room, misses meals, and often stays up most of the night, which results in school tardiness. He learns "cheats" (tricks to find quick solutions to game-based problems) online, converses with players in chat rooms, and has accumulated a great deal of knowledge about the intricacies of the many, often violent, games he plays.
Although very bright, Alex has a nonverbal learning disability, social difficulties, poor athletic skills, and attention problems, and he was often made fun of at school. The primary source of his self-esteem, beyond academic achievement, is his video game prowess.
His parents have no understanding of the games, nor of the video games' central importance in his life. Other children in school often come to him for advice about games and strategies and ask to play with him. This has become his claim to fame in and out of school.
While his parents need to educate themselves about the games he is playing and to set limits on his game play, their initial response to curtail them has been modified over time, allowing for an important avenue in the socialization of their son.
Therapy for Alex and his parents involved their appreciation of the role and meaning of games in his life. His parents needed to understand that competence is a crucial component of positive self-esteem—something Alex needed tremendously in order to take on academic and social challenges. Video games provided a means for Alex to feel more confident in moving ahead in these areas. With a greater understanding of the role the games played in his life, his parents were much more tolerant of his game playing.

If your child doesn't play video games, it could be a problem:
Ironically, Seung-Hui Cho's college roommates found it odd that he never joined them in playing video games.
(Seung-Hui Cho was the Virginia Tech shooter)

The full article, Children and Video Games: How Much Do We Know? by Cheryl K. Olson, ScD, Lawrence Kutner, PhD, and Eugene V. Beresin, MD is on the Psychiatric Times website.

I encourage readers of this blog to read the full text of this distubing article. Ritalin and video games... what will child psychiatrists recommend next to control our children???

Friday, October 19, 2007

Gray Friday

The Dow Jones industrial average dropped more than 360 points Friday - the 20th anniversary of the Black Monday crash - as lackluster corporate earnings, renewed credit concerns and rising oil prices spooked investors.
The major stock market indexes turned in their worst week since July after Caterpillar Inc. (
CAT), one of the world's largest construction equipment makers, soured investors mood Friday with a discouraging assessment of the U.S. economy. In a week dominated by mostly negative results from banks facing difficult credit markets and rising mortgage delinquencies, investors appeared surprised that an industrial name was feeling an economic pinch, too.
The Dow fell 366.94, or 2.64 percent, to 13,522.02. The Dow was down for the fifth straight session and for the week was off 4.05 percent. For the year, the blue chip index is now up 8.5 percent.
Broader stock indicators also fell sharply Friday. The Standard & Poor's 500 index fell 39.45, or 2.56 percent, to 1,500.63, and the Nasdaq composite index dropped 74.15, or 2.65 percent, to 2,725.16.
Friday's pullback pales in comparison to what investors had to contend with 20 years ago. On Oct. 19, 1987 - Black Monday - the Dow plunged 23 percent amid concerns about interest rates and slowing economic growth. A decline of similar proportion given the market's current levels would mean a drop of some 3,100 points.
Friday's decline - the third biggest point and percentage drop this year - was the 9th biggest point drop in the Dow since Black Monday.
via Drudge

Wednesday, October 17, 2007

Winning a Nobel Prize Doesn't make you Right

Al Gore is wrong about the role of humans in global warming. James Watson, one of the discoverers of the mysteries of DNA, is wrong about genes and racial intelligence:
One of the world's most eminent scientists was embroiled in an extraordinary row last night after he claimed that black people were less intelligent than white people and the idea that "equal powers of reason" were shared across racial groups was a delusion.
James Watson, a Nobel Prize winner for his part in the unravelling of DNA who now runs one of America's leading scientific research institutions, drew widespread condemnation for comments he made ahead of his arrival in Britain today for a speaking tour at venues including the Science Museum in London.
The 79-year-old geneticist reopened the explosive debate about race and science in a newspaper interview in which he said Western policies towards African countries were wrongly based on an assumption that black people were as clever as their white counterparts when "testing" suggested the contrary. He claimed genes responsible for creating differences in human intelligence could be found within a decade.

from The Independent

Monday, October 15, 2007

Stark III

Stark version three is apparently out:

In issuing the third phase of the final regulations implementing the physician self-referral rule, also known as the Stark law, the Center for Medicare and Medicaid Services has returned to a stance it held in the first phase.
The Stark law governs whether, how, and when it is acceptable for physicians to refer patients to hospitals, laboratories, imaging facilities, or other entities in which they may have an ownership interest.
Under the new rule, known as Stark III, published in the Federal Register on Sept. 5, physicians will be considered to be “standing in the shoes” of the group practice when their investment arrangements are evaluated for compliance, according to several attorneys.
This reversion back to the initial Stark policy is among the most important changes in the 516-page document, said Daniel H. Melvin, J.D., a partner in the health law department of McDermott, Will & Emery's Chicago office.
As a result, “the application of exceptions will be different going forward,” Mr. Melvin said in an interview.
That means most physicians who have referral arrangements will have “a lot of contracts that will have to be looked at and possibly revised,” said Amy E. Nordeng, J.D., a counsel in the government affairs office of the Medical Group Management Association. Ms. Nordeng agreed that the return to the “stand in the shoes” view was the most significant component of Stark III.
Under Stark II—an interim policy that began in 2004—physicians were considered to be individuals, outside of their practices.
Exceptions to the law were evaluated using an indirect compensation analysis, which ended up being onerous and was the subject of many complaints to CMS. In comments on Stark II, physician groups, hospitals, and other facilities (called designated health services, or DHS entities under the Stark law) urged CMS to revert to the old policy.
CMS itself came to see the indirect compensation analysis as a loophole that allowed potentially questionable investment arrangements to slip through, said Mr. Melvin.
In the Stark III rule, CMS wrote that the change in policy means that, “many compensation arrangements that were analyzed under Phase II as indirect compensation arrangements are now analyzed as direct compensation arrangements that must comply with an applicable exception for direct compensation arrangements.”
There were several other notable changes in Stark III.
The regulations clarify that physicians who administer pharmaceuticals under Medicare Part B (such as chemotherapy or infusions) or who prescribe physical therapy, occupational therapy, and speech-language pathology, are entitled to get direct productivity credit for those orders, said Mr. Melvin.
The clarification applies to those two ancillary services only, not to radiology or laboratories, or other services typically offered in-house, he said.
CMS also lifted the prohibition on noncompete agreements. Under Stark II, practices could not impose noncompete agreements on physician recruits. Now, practices can bar competition for up to 2 years, but it's not clear how far, geographically, that noncompete can extend, he said.
With the new rule, practices have to “go back and look at everything,” including how their physicians are being compensated and the arrangements the practice may have for equipment and leasing or services with hospitals or other DHS entities, Mr. Melvin said.
“At the very least, they're going to want to do a review of the arrangements in place,” to see if any of the exceptions being relied on will change with Stark III, added Ms. Nordeng.
The final Stark rule goes into effect on Dec. 5, 2007.

It's all pretty confusing to me. However, it is my understanding that sleep labs are not considered DHS entities so hopefully Stark III won't affect me too much.

Mississippi is Number One

Adult obesity is on the rise in 31 states, and no states have experienced a drop in obesity, according to a study from Trust for America's Health.
Mississippi topped the list of the fattest states, with the highest adult obesity rates for the third year in a row. More than 30% of the adult population in the state is obese. Colorado was ranked the “leanest” state with an obesity rate of 17.6%. No state has reached the Health and Human Services department goal of reducing the prevalence of adult obesity to 15% in every state by 2010.

From Clinical Psychiatry News

Go Ahead and Light up a Cigarette

Clinical Psychiatry News reports that cigarette smoking delays the onset of Parkinson's disease:
A pooled analysis of 11 clinical studies has confirmed that cigarette smoking protects against Parkinson's disease in a dose-dependent manner.
Many studies have suggested that smoking may play a protective role in PD, but most have been too small to provide definitive answers. Dr. Beate Ritz of the University of California, Los Angeles, and associates conducted a pooled analysis of eight case-control studies and three cohort studies involving 2,816 subjects who had PD and 8,993 controls. This large data set “enabled us to investigate aspects of cigarette smoking and subgroup-specific associations that could not be addressed adequately in previous studies,” they noted.
The risk of developing PD decreased as pack-years of cigarette smoking increased, so that the average relative risk for the disease dropped 5%–8% for every 10 pack-years of smoking. This dose-response pattern was seen in both men and women, and it was not affected by subjects' educational status.
There was also a strong dose-response trend for the number of years that had elapsed since smoking cessation. Current smokers and smokers who had recently quit showed the lowest risk for PD. People who had quit smoking in the past had a higher risk for PD, but their risk was still lower than that of people who had never smoked (Arch. Neurol. 2007;64:990–7).
Two possible mechanisms for this protective effect have been proposed. Substances such as nicotine in tobacco smoke may promote the survival of dopaminergic neurons, or smoking may alter the activity of metabolic enzymes and thus the production of toxic metabolites.
It is also possible that the same genetic or constitutional traits that raise susceptibility to PD may also deter subjects from smoking. Such traits could be a common cause for both smoking behavior and PD, Dr. Ritz and associates noted.
Tobacco's protective effect appeared to wane in subjects aged 75 and older, another finding that has been reported in previous studies. This is consistent with the hypothesis that smoking delays rather than prevents the onset of PD, the researchers added.

So if you are more scared of PD than lung cancer, COPD, and heart disease, go ahead and smoke!

Psychiatry Residency Training Becomes Even More Wimpy

The Accreditation Council for Graduate Medical Education has reduced the amount of inpatient training necessary for psychiatry residents from a minimum of 9 months to a minimum of 6 months.
At least two psychiatrists who supervise residents say this reduction, which took place in July, “threatens to seriously undermine the quality of training for psychiatry residents.” In a commentary, Dr. Sabina Lim and Dr. Robert Rohrbaugh argue that inpatient training helps foster the development of psychiatry's fundamental skills in indispensable ways, and they note that other specialties appear to place great value on inpatient training (Academic Psychiatry 2007;31:266–9).