INdiana Systemic Thinking

October 7, 2008

IST Gets Ranked as a “Top Pharmacy” Blog

Filed under: Uncategorized — kurtglmft @ 6:00 am

The Blogmeister firmly believes in the old adage that says something to the effect of “you have to say good things about yourself, because no one else will.” So, in that vain (pun intended)…

We are happy to report writer Joel West has ranked INdiana Systemic Thinking as number 33 on his top pharmacist blogs. He writes:

33. Indiana Systematic Thinking: Posts related to mental health pharmacology, as well as other pharmacology-related posts are available through Indiana Systematic Thinking.

While we don’t feel our primary focus is pharmacology related posts, it does appear we do our fair share of it. Thanks so much to and Joel…we appreciate it!

October 6, 2008

Complicated Grief Just Got More Complicated

Filed under: Uncategorized — kurtglmft @ 9:26 pm

Newsweek’s online edition carried an interesting story recently on new research focusing on complicated grief.  According to Newsweek:

In a paper in the journal Neuroimage, O’Connor and her colleagues describe using an fMRI machine to probe the neurological basis for complicated grief among a small sample of women who had lost a close relative to breast cancer. Ordinary grief is apparent on a brain scan: show a bereaved daughter a picture of her mother, and areas of the brain that process emotional pain are activated. The women with complicated grief showed that pattern, but something else as well: activity in the nucleus accumbens, a brain region associated with pleasure, rewards and addiction. “When the women came out of the scanner, the complicated-grief group rated themselves as feeling more negative than the others,” O’Connor said. “But they also said things like, ‘Oh, it was so nice to see my mom again.’ These are the ones who pore over picture albums, talk about the person all the time, almost as if she was still here.” The women in that situation were unconsciously prolonging their grief, she concluded, because memories of the person they missed gave them pleasure—as well as pain.

Interesting, but it causes one to wonder…  As practicing clinicians what are we to do to treat these patients?  Do we encourage them not to look at pictures, etc, or do we encourage it.  Perhaps further studies will give us some direction, but the basic research provided here gives a good explaination of what is going on with these grief stricken individuals.

October 5, 2008

GlaxoSmithKline Pays out big on Paxil… …Again!

Filed under: Uncategorized — kurtglmft @ 9:20 pm

The Wall Street Journal’s Health Blog is reporting GlaxoSmithKline is paying out another 40 million in ongoing litigation regarding the antidepressant, Paxil.depression

GlaxoSmithKline is shelling out another $40 million to deal with the fallout over the use of its antidepressant Paxil in kids. This time, the money is going to insurers who paid for the drug to be used in children and adolescents.

A class-action lawsuit argued that Glaxo had promoted the drug for use in children, while withholding evidence that the drug was neither safe nor effective in kids. Glaxo denied those charges and told the WSJ it settled to “avoid the costs, burdens and uncertainties of ongoing litigation.”

October 4, 2008

Mental Health Parity Passes as part of Bailout Bill

Filed under: Uncategorized — kurtglmft @ 5:32 pm

As I reported here early Friday morning, Mental Health Parity was attached to the bailout bill passed by the Senate last Wednesday.  It went to the House of Representatives on Friday, and was passed.  I recieved a confirmation of this yesterday from the American Association of Marriage and Family Therapists, which I would like to post, but my email server is currently down, so I can’t paste it into this post.  However, CNN has a story here that explains, as well as confirms passage.

All I can say is it’s about damn time, and to all those who worked tirelessly for this cause, I applaud and thank-you.  Sometimes we get all wrapped up in how “pork” should be left out of bills, but in this case, parity is something that should have happened a long time ago and everyone will benefit.

Big Insurance and “The Sentinal Effect”

Filed under: Uncategorized — kurtglmft @ 1:09 pm

Dr. Benjamin Brewer had a great article on the Wall Street Journal site about insurance companies requiring preauthorization for medications and services.  Most people don’t know, as mental health professionals, we almost always face the same unjust scrutiny by big insurance.  As this quote points out, insurance companies, in an effort to save money, hope that by making the preauthorization process as difficult as possible, we will all just give up, saving them money.

“They want me to incur the overhead and frustration that comes with trying to prove to a non-doctor that I know my patient and what I’m talking about. They want to cut costs, and they don’t really care about how it affects my patients or my practice. If they make the process hard enough, they hope I’ll just give up. There is even a term in the managed care literature for that kind of deterrence: the “sentinel effect.”

Just so you don’t have to click over, the Sentinal effect:

deters utilization by requiring the administrative effort necessary to authorize the procedure. “Studies have shown the sentinel effect to be persuasive

This “administrative effort” transfers over to big money, in my practice at least a third.  Of course this is passed on to our patients, but not the one’s who have insurance, as the insurance companies won’t pay us for the time it takes to cut through their red tape.  Instead, we have to charge higher rates, and pass the costs on to our private pay clients.

Just another example of how Big Insurance IS the problem in healthcare…  Not the answer.

October 3, 2008

The Bailout AND Mental Health Parity???

Filed under: Uncategorized — kurtglmft @ 3:38 am

Wow, this was a shocker when it came across the news feed. Apparently Senate proponents of mental health parity had only one legislative vehicle left to carry their bill this year…the mortgage industry bailout bill! What is mental health parity you ask??? Well, according to the Associated Press:

“Currently, insurance plans routinely require mental health patients to pick up more of the initial costs of their care through higher deductibles and co-payments. Other times, insurance plans have stricter limits on how often patients with mental problems can see their doctors.”

Specifically, the bill would make coverage the same whether the patient had a mental or physical problem and…

“…apply to health plans that cover more than 50 employees – potentially reaching 113 million people nationwide.”

Parity is a good idea for many reasons. First, a more mentally healthy workforce is a better workforce. Second, it will help put mental health care on a par with physical health care and reduce some of the stigma still prevelant in the population. Still, it had it’s detractors. Anyone know who??? Of course, our friends at big insurance who successfully lobbied so the

legislation does not mandate that group health plans cover mental health or addiction treatment. But if they do, the coverage must be equitable with other medical coverage.

Now, according to the AP, they (insurance companies) support the legislation.

For those not following all this drama, the legislation has been negotiated and renegotiated for almost seven years. It even came up for a vote a time or two. Now that all sides agree, it should pass, but the authors lacked a way to get it in front of the entire Senate. So, in a common strategic move, they have tacked it on to the mortgage bailout bill, which passed the Senate on Wednesday, and is up for a House vote today. So, despite how one may feel about the current mortgage mess, if you are a supporter of parity, you may want to support the bailout bill and encourage your Representative to as well.

Post updated here.

February 3, 2008

Public Perceptions of Presidential Candidates

The other day my wife and I were discussing how one particular candidate would never be elected President.  Our premise was public perception of this candidate’s personality was so negative the candidate could never garner a majority of the country’s votes.  Of course public perception of any candidate is probably wrong, but it appears to be important to voters none the less.  Take Ronald Reagan for example.  I think his public perception was of a kindly grandfather type who, even if he had to tell you “no”, he did it in a way that made you feel he was doing it to help you…sorta a grampa knows best approach.  If you disagree, that’s fine, it’s my perception and I’m sticking to it.  Which is really the problem.  People stick to their perceptions despite lots of evidence (and candidate spin) to the contrary.  That’s why I was really interested in this article from the Associated Press, via WTHR.  The article reports the results of a poll on the public’s perceptions of candidates and how those perceptions may change over time.   I’m not that interested in the change over time part, but, in summary, here is the public perception as it stands right now. 

Hillary Clinton – People often cite the words “female” and “feminist” when asked about her.  She is viewed as “strong, decisive and experienced but is not seen as likable, honest or refreshing.” 

“The most volunteered description of Clinton was her gender and the thought that she’s a feminist. Close behind were feelings that she is dishonest and not likable-voiced mostly by Republicans-followed by strength and mention of her husband, former President Clinton. “

Barak Obama – “Inexperience” is the word most use to describe him.  However, most view “him as refreshing, compassionate and attractive. ”

 “People mention inexperience most often, followed by those saying he is inspiring and favors change, and by people citing his race. Some said he is Muslim, an Internet-fed rumor that Obama’s campaign has labored to dispel. “

Mitt Romney – The word most used to describe him is “Morman”.

“Nearly half of those polled could not say anything when asked to describe McCain’s chief rival, Mitt Romney, including more than a third of Republicans-surprisingly large numbers this late in a campaign on which the former Massachusetts governor has spent $40 million of his own money to get his name and message before the voters. ”

“Among those familiar with Romney, most cited was his Mormon faith and a sense he is not authentic, including many who said he changes his mind on issues-a frequent charge leveled by his opponents.

John McCain – “Military service” and “old” are the two most cited terms regarding McCain.  However, he is “widely seen as experienced, strong, honest and decisive”.

Mike Huckabee – Is “best known for his religion. The ordained Baptist minister discusses his faith frequently while campaigning”.

So what do you think?  I think the results of the poll are pretty much in line with my perceptions of the candidates.

February 2, 2008

Andrew Card Speaks at Purdue

Former White House Chief of Staff Andrew Card spoke at Purdue University today.  From WTHR:

The University held it’s annual Agricultural Alumni Fish Fry, featuring former White House Chief of Staff Andrew Card serving as keynote speaker.

Card also served during the first Bush administration and held several positions under President Ronald Reagan. He was the man who delivered the news of the September 11 terrorist attacks to President Bush as he read to elementary school children in Florida.

“I went up to the president and whispered into his right ear, ‘A second plane hit the second tower. America is under attack’,” Card said Saturday.

He says it was that moment that showed how a president should handle crisis. His speech Saturday at Purdue was titled, “Managing Amidst Crisis.”

Yeah, don’t know if that was the best anecdote Mr. Card:


Britney Spears: Father Knows Best

Filed under: Legal/Law,Misc,Uncategorized — kurtglmft @ 6:15 pm
Tags: , , , , ,

Alright, I wasnt going to blog on this, but I’ve been a little hard on Spears.  Besides, its that or mop the kitchen!

WTHR is reporting that following her involutary committement to a Los Angeles hospital for an unknown condition, Britney’s father was awarded temporary “conservatorship” of Britney.  The father, James Spears, and an attorney were awarded co-conservators of Britney’s estate.  The court also proptly issued a restraining order against Britney’s “manager” and friend, Sam Lufti.

From the story:

A court creates conservatorships when a person cannot care for themselves or handle their affairs. Commissioner Reva Goetz said Spears would be under conservatorship until Feb. 4, at which time another hearing will be held.

“It is in the best interests of the conservatee to have conservatorship over her person,” Goetz told a packed courtroom.

      The conservator will have the power to “restrict visitors,” have around-the-clock security for Spears, and have access to all medical records, Goetz said.

      Goetz said conservatorship over the estate was “necessary and appropriate.” She gave approval for the conservator to “take all actions to secure all liquid assets including credit cards.”

The reason I wanted to blog on this was to point out how serious her condition must be.  In all the years I’ve practiced I’ve only run into two or three cases where the person’s conditon was so serious they could not make decisions for themselves or their estate.  So, while I originally thought much of this was for publicity, her condition must be very serious indeed.  Goes to prove the point no-one should evaluate another from afar, or through media reports.

Lilly to Reach Deal with Feds?

Maybe, but no one is talking, according to the Fort Wayne Journal Gazette, citing the New York Times.  Here is the background:

Zyprexa was Lilly’s top selling drug last year. It rang up $4.8 billion and accounted for 25 percent of the company’s total sales, but it also has brought the company many legal headaches.

Beginning in late 2006, a series of articles in the Times said Lilly downplayed the drug’s risks and marketed it for uses unapproved by the Food and Drug Administration.

Attorneys general from 30 states have subpoenaed documents detailing Lilly’s sales, marketing and promotional practices for Zyprexa as part of a civil investigation under state consumer protection laws.

The drug also has faced thousands of product liability claims from patients, many alleging the company did not adequately warn patients taking the medication of a heightened diabetes risk.

And here is what is being said:

Lilly spokeswoman Tarra Ryker declined to elaborate on the possibility of a settlement when reached by phone.

“We are cooperating with the government in these investigations, and the discussions around those are confidential,” she said. “We’ve said pretty much all we’re going to be able to say on this.”

She also declined to comment on the payment amount.

“We don’t know where the information came from,” she said.

The Times reported that federal prosecutors in Philadelphia are leading the settlement talks for the government, in consultation with Justice Department headquarters in Washington.

The amount being bantered around is 1 Billion dollars.

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