Physician Depression and Suicide Prevention

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Suicide is the 2nd leading cause of death for young people and is extremely high for physicians. Suicide doesn’t have to be a death sentence it is preventable. Below is an article by American Foundation for Suicide Prevention

Suicide Prevention

In October 2002, AFSP sponsored a workshop to address the disproportionately high rates of suicide among physicians and physicians in training. Studies in the last 40 years have confirmed that physicians die by suicide more frequently than others of their gender and age in both the general population and other professional occupations. On the average, death by suicide is about 70 percent more likely among male physicians in the United States than among other professionals, and 250 percent to 400 percent higher among female physicians. Unlike almost all other population groups in which men die by suicide about four times more frequently than women, among physicians the suicide rate is very similar for both men and women.

This initial workshop brought together experts from a variety of different fields to discuss the many factors that appear to contribute to physician suicide, especially the frequent failure of physicians to recognize depression in themselves (and also in their patients and colleagues). Workshop discussions also focused on institutional barriers that interfere with physicians seeking help when they are aware they are depressed. In some states, the mere fact that a physician is in psychiatric treatment can trigger an intrusive investigation by a state licensing board that can lead to sanctioning regardless of whether there is any evidence of impaired functioning. Within some hospitals and medical centers, appropriate concerns about protecting patients from impaired physicians have inadvertently created a climate that leads depressed physicians to be concerned for their academic and career prospects if they seek the treatment that might prevent impairment from developing.

Following the AFSP workshop, a consensus statement was published in the Journal of the American Medical Association that included recommendations for needed changes in professional attitudes and institutional policies to encourage physicians with mental health problems to seek help.

AFSP subsequently played a leadership role in organizing working groups of experts from major healthcare organizations and medical institutions to further develop recommendations in eight key areas: medical student and resident education, medical student and resident health, hospital policies toward physicians with depression and other mental disorders, policies related to licensing of physicians, policies related to physician malpractice and disability insurance, and needed research on physician depression and suicide. In July 2005, AFSP and the Milbank Memorial Fund cosponsored a meeting of these expert groups to share the results of their work and develop actions plans for implementing each group’s recommendations. Results of this meeting were reported in the American Medical Association’s Medical News.

The initial workshop for this project was supported by the Bob and Lynn Bernard Charitable Fund of the Ayco Charitable Foundation.
AFSP is currently working on two new projects aimed at reducing the high suicide mortality rate among physicians:

Physician Depression and Suicide Prevention Film Project

Wyeth and the American College of Psychiatrists have joined AFSP in funding a one-hour documentary film as part of an educational campaign to heighten awareness about physician depression and suicide. The FREDDIE award-winning documentary, Struggling in Silence: Physician Depression and Suicide, premiered on KCET-TV of Los Angeles in the spring of 2008, and has aired on over 300 PBS stations nationwide. The campaign includes educational films and a website, DoctorsWithDepression.org.

A companion film targeted to medical school students, Out of the Silence: Medical Student Depression and Suicide, is being disseminated by AFSP to medical schools across the country, and third film has been created for use in hospitals, residency trainings and at educational conferences and seminars. Both these films include resource materials. The films were produced by the Academy Award®-winning State of the Art Inc.

Through this campaign, AFSP seeks to educate physicians about depression so that they can better recognize the symptoms in themselves and their patients while also cultivating a better understanding of mood disorders in the community at large.

Media coverage of this campaign has been extensive, with more 15 million impressions to date, and an article in Newsweek magazine. More>

Outreach to Medical Students, Residents and Physicians at Risk for Suicide

A pilot project is underway to extend the outreach methods developed through the College Screening Project to medical students, residents and hospital physicians. The goals of this project are to identify individuals with serious depression and other problems that put them at risk for suicidal behavior, and encourage them to get treatment. It is hoped that the anonymous online “dialogues” with a clinician that the screening method allows will prove effective in helping medical students and physicians resolve concerns about treatment that are currently preventing many from seeking help. An initial participant in the pilot project is the University of Pittsburgh. It is anticipated that four more institutions will join the project as additional funds are obtained

Autistic Children Sensitive to Stereotypes

 

autism awareness

Autism is treatable

  Children with autism, who are unable to grasp the mental states of others, can nonetheless identify with conventional stereotypes based on a person’s race and sex, researchers report in the June 19th issue of Current Biology, published by Cell Press.

 “Even with their limited capacities for social interaction and their apparent inability to orient to social stimuli, these autistic kids pick up and endorse social stereotypes as readily as normally developing kids,” said Lawrence Hirschfeld “One take-away point is that stereotypes are very easy to learn and very robust. They don’t require higher order attention, or apparently even attention to social stimuli, to develop. Stereotypes can be learned even in the face of damage to the ‘social brain’ and under extraordinarily constrained conditions.”

 The profound inability of children with autism to engage in everyday social interaction, as well as impairments in verbal and nonverbal communication, had been attributed to a severe delay in “theory of mind” (ToM) development—the ability to attribute mental states to oneself and others and to understand that others have beliefs, desires, and intentions that are different from one’s own. If the use of stereotypes and mental states were part and parcel of the same underlying cognitive process, then autistic children would have similar difficulties with both.

 In fact, the researchers found that autistic children who have a verbal age between 6 and 7 years—and who fail ToM tasks—know and use gender and race stereotypes just like normal children. Hirschfeld said he suspects the stereotypes originate within subtle and seemingly incidental messages that saturate the culture—for example, through advertising or biased attention by the media. The kids might also learn about stereotypes from parental behaviors, such as locking car doors when in certain neighborhoods, even if parents carefully monitor what they say about race to their children.

 Stereotypes are not inherently negative, he said. “We wouldn’t be able to think without social categories,” he said. “Stereotypical roles are important for navigating everyday interactions. Finding a plumber would be difficult if we thought of people only as unique individuals. Getting through the check-out line would be unwieldy if we didn’t have simple scripts about the roles that both shoppers and cashiers play.”

 The results suggest that different kinds of social reasoning occur through independent mechanisms in all people. The autistic children’s surprising ability to recognize broad categories of people might also lead to new methods for helping them improve their ability to function in society, he said.

 Caregivers today often attempt to teach children with autism ToM skills, particularly techniques that make them more sensitive to other people’s mental states. Capitalizing on the kids’ strengths in understanding social categories might offer an alternative and easier learning method for interpreting the behavior of others, one that doesn’t involve “swimming upstream,” Hirschfeld said.

A couple of programs that may help categorize emotion are available. The first one is free  and focuses on positivity which may help if the person needing training is sad or has anger problems and the second one is reasonably priced and an excellent tool for learning emotion for normal and autistic individuals . This can be trial tried online with no sign up. It is important to stress that people with autism are individual people who have autism and different paths will work depending on their individual qualities

If you live in Florida in the Broward or West Plam Beach Areas. There is a brain optimization center in Boca Raton where autistic children and adults have been successfully treated. It is called Sparks of Genius

Brain Art Restores Mind Potential

A mind for every child (Photo by permission Brain Revolution 2009)

A mind for every child (Photo by permission Brain Revolution 2009)

By Amy Price PhD

Dr. Evian Gordon of Brain Resource Company is hosting an art exhibit to jump start the Brain Revolution. If you are in the New York City Tribeca area please feel welcome to visit and see the future in the making. Please spread the word – everyone is invited!

I have travelled as a consultant and on the mission field in many third world countries and have met children and young people. Many of them could experience the joy of having brain power ravished by disease and malnutrition restored with simple interactive tools. These strategies will enable lost generations to contribute to society and provide for their families. A working brain should be a right and freedom for all. Dr. Gordon and those working with him have taken steps to help this happen by investing wisely in others without immediate tangible return for themselves.

The Brain Revolution project serves to empower children around the world with ideas and ways to train their brain for Self Mastery. The overall goal of the project is to contribute to Brain Development being a Human Right.

As part of the Exhibition, there will be excerpts from the evolving documentary about the Brain Revolution Project – Brainstorm, by award winning documentary filmmaker Pat Fiske and Executive Producer Steen Rees. As part of the project, and filmed in Brainstorm, Dr. Evian Gordon has invited children around the world to explore and paint their own BrainArt. These paintings will be on display.

A multilayered musical exploration Brain Sound Scape, composed for the exhibition by renowned composer, Mal Green, will also be on display.

These pieces expemplify the Brain Revolution. For more information on the Brain Revolution – visit www.brainrevolution.org
I hope to see you there!

Cord Banking and Cerebral Palsy

Vodpod videos no longer available.

By Amy Price PhD

Chloe Levine  is  another one of the children in the Duke University study who has shown pronounced improvement of cerebral palsy after treatment with her own umbilical cord. There have been multiple questions from parents on cord banking and the advantages of banking umbilical cords. This is a follow up on the Dallas Hextell story

It should be noted that  if you choose to private  bank there may be issues with transporting the cord cells across state lines or out of  the country both with safe transport for the cells and with legal issues. There is also a great deal of expertise needed to bring the cells back from a frozen state to where they will be of use to grow out healthy stem cells. It may be best to check  carefully in these areas to avoid complications later on down the road if the cells are needed and you have relocated.

For those that have questions on using donated umbilical cords I have found stem cell companies that claim postitive results but I have not been able to locate peer reviewed research on children or large animals for this area. This does not mean they do not exist as the stem cell research arena grows daily so if anyone has cerebral palsy stem cell therapy research using other means  I would be happy to add this

Dr Frances Verter of Parent’s Guide to Cord Blood Foundation graciously helped us  out with some answers. This site has excellent in depth information.

Dr. Amy Price wrote:

It is not clear if children whose cord blood is stored in a public bank will have access to their own cord blood should the need arise. Could you please elaborate on this? Obviously unless the disease is genetic it would make sense to use own donor supplied cells….There is a mail in component but this does not make it clear how a parent would take these steps ….please advise, we get a lot of parents asking about this

Dear Amy,

The “consent” form signed by the mother when they donate to a
public bank makes it very clear that  they are giving up all
ownership or rights to the cells.

Will the parents be able to donate?
Only IF
1) IF they are delivering the baby at a hospital which collects
for a public bank
2) IF they deliver during whatever hours the public bank operates
(sometimes only day shift)
3) IF the mother passes the maternal history screening
4) IF they register early enough

Will they get them back should a need arise?
Yes, but only IF:
1) IF the cells were not discarded.  Typically 60% of donations
to public banks are discarded, usually because of low volume, other
reasons could be infectious disease testing, etc.
2) IF the cells have not been released to someone else.

A lot of parents have the misguided idea that donation is a cheap
way to preserve for themselves.  They should not think in those terms.
Donations is an altruistic act.

There is only one bank which accepts mail-in donations,
Cryobanks Intl in Florida.  I have heard that their rejection
rate is very high, because on top of sample size there is also
shipping time issues.  Here is their enrollment form:
http://www.cryo-intl.com/enroll/donating/

I hope this helps,
Fran Verter

Falsely Accused: Context and Probability

 

Left or Right What do You See?

Left or Right Cick here?

Illusory statements and human error can set context that overthrows justice. In my life I have seen the guilty walk and the innocent executed based on what passes for science. Probability and statistics are used as weapons promoting authority over individuals unlearned in the field with little regard for the human carnage and heartbreak that follows. 

Want to see the power of  optical illusions? They are not as powerful as those that can be created by illusory context. Illusions are the gap between perception and processing, they operate in all senses and we are all susceptible

I recently enjoyed a forensics experiment where we were given a cursory fingerprinting class and then were given prints to compare for accuracy. There is a commonly held 16 points of accuracy that until recently was used to determine probability…plenty of room for error, even though  Sir Francis Galton says mathematically the chances of   identical fingerprints are 60 billion +.

I was interested in the case of a Scottish police officer who because of mistaken identity, lost her job, reputation and was driven to near bankruptcy because her accusers needed to be right more that they cared about justice. The officer later settled for 1.75 million pounds without the agency admitting guilt. I shudder to think how little she would have recovered for personal use after all the  3 ds (denial,delay and) were exercised. In fact those that brought faulty evidence were later exonerated by the department. Of course a 273 page document explaining how to do it better was produced but I doubt the officer gets royalties…

 Dr Itiel Dror shared in an interview with the BBC  how he  engaged forensic specialists in a study where he  linked context with perception during fingerprint analysis.  There was a large error rate. The video and study is worth viewing. He shows how the stage can be set for seasoned professionals to make errors

In another case a Lawyer was held in Oregon as a terror suspect, his life was derailed and finally with the words “regrettably there was an error” he was released. I doubt that fixed much for him or bought him back time  that was stolen in the prime of his life. He will likely be remembered as the ‘Terror Suspect” rather than for other contributions he makes. 

In the experiment most of us correctly identified these prints as not matching his. What went wrong? Try it  for yourself

Mayfield Print

Mayfield Print

What is the take home message? Before you render judgement or accusation really listen with a mind to hear. Your ‘facts’ may be clouded by context and false perception. At any rate we can choose a blame free course where together we fix the things that are broken and produce unity instead of destruction

FDA Saves Lives?

By Amy Price PhD

Coca Cola

Coca Cola

Is the FDA always accurate? The FDA grew from a concern about human safety in the face of recorded deaths and monitors such things as drug purity, safety of new medical preparations and new drugs and devices. A n  Overview link from Wikipedia gives a good summary of the history and responsibility of the FDA.  The difficulty is that it is connected with so many other government departments there may be conflicts of interest. The FDA moves slowly and for instance is only now getting around to the claim that Cheerios (a breakfast cereal) can lower cholesterol  The manufacturer claims that the FDA approved the labelling for six years and that it is built on scientific research but interestingly does not list this research. The FDA doesn’t list it either.The real stories are behind closed doors with consumers responding like puppets to marketing and media hype from all sides. The big players when fined just call it the price of doing business.  Vioxx went through all trials in several countries and still was recalled because of deaths. Interestingly the FDA  says here they have no authourity over labelling. Cheerios anyone? Recently Coca Cola responded to studies that Sodium Benzoate used in it’s soft drinks causes DNA damage and hyperactivity in children. by stating that it plans to remove the controversial additive from its products as soon as a satisfactory alternative is discovered. Public pressure rather than a regulatory agency is forcing this decision in the UK

Coca Cola has a chequered past with room for improvement. They originally used cocaine in their preparations. Even now spent Coca leaves are used with FDA approval and imported from the FDA controlled plant  for flavor. Cocaine is still present at a molecular level  considered “safe”

On the other side helpful products are developed that patients can benefit from but they are held up by regulations. I have undergone non FDA approved medical procedures and taken unapproved or off label substances at the recommendation of trusted Drs and peers and after considerable personal research. On at least one occasion it likely saved my life. I still would not do this lightly.

Parkinson’s Disease and Stem Cells

By Amy Price PhD
I found an interesting addition to the Parkinson’s post’s in the form of an article from Nature. Many thanks from helpful individuals at the Open University in the UK for passing this on.
In the article in Nature Suchowersky O. Transplantation therapy for Parkinson disease: the good, the bad and the enigmatic. Nature clinical practice. Neurology. 2008 Sep;4(9):465
Parkinson disease (PD) affects an estimated 1 million cases in North America . Motor symptoms in PD initially
respond well to dopaminergic replacement medications, but because PD progresses the drugs gradually lose effectiveness after about 10 years resulting in gait dysfunction and complications such as dyskinesias
PD is not just a disorder of the dopaminergic system but involves other neurotransmitter systems which inform autonomic dysfunction, mood disorders, fatigue, pain, sleep disorders and cognitive function. Dopaminergic cell replacement, even if successful is thought capable of treating only motor symptoms.
Over 20 years ago, transplantation of fetal ventral mesencephalic cells into the putamen was
performed on a small sample of participants with reportedly good results. Regrettably further studies with larger participant pools failed to confirm the initial reports (Freed CR et al. [2001] N Engl
J Med 344: 710–719). PET and pathological analyses revealed adequate survival of grafted
neurons, and there was untreatable runaway dyskenesia. However clinical benefit was seen in
a small subset of patients, 16 years on autopsy results are available Mendez et al. showed survival of
grafts without PD pathology for 14 years in five patients (Mendez I et al. [2008] Nat Med14: 507–509). Another patient showed good clinical improvement l 5 years plus, before gradual worsening of motor function and development of gait and balance problems (Kordower JH et al. [2008] Nat Med 14: 504–506). Autopsy results from this patient 14 years after transplantation showed great graft survival but grafted neurons had pathological
changes typical of PD, including Lewy bodies and activated microglia (cell scavengers) were seen in large numbers
Liet al. reported similar graft pathology in three patients up to 16 years after transplantation (Li JY et al. [2008] Nat Med 14: 501–503). These results indicate that for stem cell therapy to be effectual long term in D research needs to be initiated to investigate the spread to youn grafted neurons and determine strategies to resolve this issue. I would hope that advancement in the area of Adult Stem Cell research will make this possible in the near future.
I am finding the stem cell story is not so new. I did hear about a very young women stricken with metasticized spinal cancer who was treated at Sloan Kettering with grown out adult stem cells taken from her own bone marrow over fifteen years ago. She is now a successful professional with no trace of malignancy in her body. I also remember twenty five years ago in Canada I knew three terminal patients who underwent adjustments to the bone marrow transplant protocol that involved growing out their own bone marrow cells. One person enjoyed a year free from blood cancer and then relapsed but the other two lived. It is strange that when I go to Pub Med , Google Scholar or even the University library there is no trace of this research performed for “humanitarian reasons”
There is also a lot of interest in the London Project where stem cell trials are close to human trials for those with macular degeneration. Pfizer is quoted as expected to announce backing of stem cell therapy, apparently with joint labs in Cambridge Mass and Cambridge UK but on the Pfizer site I didn’t see this in place.
Individuals are reporting encouraging success for adult stem cell treatment where they are thier own donors particularly for orthopedic and cardiac applications. These treatments are largely privately funded. It would be great to see this in the mainstream covered by insurance and available for people regardless of income levels