Wednesday, May 11, 2005

Advance Directives: Stigma Strikes Again  Brief essay in Psychiatric Services introducing two articles in the current issue - "Stigma's effects are often most pernicious when they are least conscious. A case in point: Do people with mental illness not develop physical ailments as well? Might they not have preferences for how they wish to be treated if they become seriously ill? If the answer to those questions is, "Yes, of course," then why—with all the attention paid in the past two decades to promoting advance directives for end-of-life care—have persons with serious mental illnesses been utterly neglected when it comes to efforts to stimulate the use of advance directives? Two papers by Foti and colleagues in this issue of Psychiatric Services underscore the irrationality of ignoring the needs and desires of people with mental illnesses with regard to end-of-life care. Interviewing a sample of community-dwelling patients, these authors found a high level of concern about end-of-life issues and strong interest in providing guidance to future decision makers about their treatment preferences." The articles by Foti et al are available for a fee.  
  

FDA goes straight to press  USA Today opinion column by Scott Gottlieb, a fellow at the American Enterprise Institute who was director of medical policy development at the Food and Drug Administration in 2003-04 - "...The FDA made a splash, through a press release, about new labeling to warn patients about an unapproved use of these atypical antipsychotic drugs in the treatment of symptoms of dementia. The approach echoed the one the FDA took with a recent "public health advisory" about a category of popular painkillers. That warning, which covered drugs such as Aleve and Advil, sent a wave of worry across the country as patients who didn't know better wondered whether they faced an increased risk of heart attacks. The problem with both warnings is the agency's message went to the media before reaching practicing physicians. My patient's misguided fears are not unique. It is what happens when medical regulation is enforced through the press."  
  

State Medicaid Developments Item in the Kaiser Daily Health Policy Report on recent developments in Georgia, Iowa, Missouri and New Hampshire, with links to related news stories.  
  

Mental health: an 'unfinished revolution' (UK) Story in the Guardian - "Mental health, for so long the Cinderella service, may be about to go to the ball. There are clear signs that policy-makers are finally waking up to the enormous social and economic costs of mental distress, and to how those costs could be tackled. The third-term Labour government looks poised to take the agenda very seriously indeed. Playing fairy godmother in this context is Richard (Lord) Layard, professor at the London School of Economics, who is credited with much of the thinking behind Labour's New Deal and the successful attack on unemployment. The author of a recent acclaimed book on happiness, Layard addressed a pre-election seminar organised by the Downing Street strategy unit, where he presented a paper entitled Mental Health: Britain's Biggest Social Problem?" See also Layard's paper at the web site of the Prime Minister''s Strategy Unit.