APA Petitions Congress to Enforce Parity in Florida

APA is petitioning Congress and the Obama administration to enforce the Mental Health Parity and Addiction Recovery Act. The petition is in response to recent actions by Blue Cross and Blue Shield of Florida, which terminated mental health care providers from their network and told them that they had to reapply and accept less-favorable contract terms if they wanted to continue seeing BCBSFL patients. APA maintains that BCBSFL’s actions discriminate against mental health patients and has learned that the insurer's actions have resulted in many such patients going without necessary care. APA is urging members and others to review this petition here and sign to show support. If you are a Florida mental health care clinician, patient, or caretaker of a patient, please also complete this survey here.

For more coverage of the Florida insurer's actions regarding mental health care, see Psychiatric News here.

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GOP Candidates Spar Over Health Reform Law

Republican presidential hopefuls Rick Santorum and Mitt Romney had a testy sparring match over who is more opposed to the Patient Protection and Affordable Care Act—the health care reform law—during Wednesday's debate in Arizona. Santorum insisted that “Romneycare”—the reform law passed in Massachusetts when Romney was governor—is the model for President Obama's health care reform law, while Romney countered that political positions taken by Santorum helped ensure the passage of the reform law. Both candidates slammed the health reform law and the individual mandate requiring people to buy health insurance or pay a penalty, and both vowed to rescind the law if elected. Today's Washington Post reported that about 50,000 Americans have so far taken advantage of the law's provision of health insurance to those who have been turned down by private plans because of preexisting conditions. 

For coverage of the individual mandate see Psychiatric News here. Learn more about the health reform law in the APA publication, "Health Care Reform: A Primer for Psychiatrists," here.

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Is Ice Cream Addictive?

Is ice cream as addictive as drugs? That's the question that research from the Oregon Research Institute, published in this week's American Journal of Clinical Nutrition, has raised. And the answer appears to be "yes." Investigators tested their hypothesis that frequent ice cream consumption would be associated with reduced activation in reward-related brain regions, such as the striatum, in response to receipt of an ice cream–based treat. They had 151 healthy-weight adolescents undergo fMRI during receipt of an ice cream milkshake and during receipt of a tasteless solution. Percentage body fat, food intake, and food craving were assessed.

Milkshake receipt robustly activated the striatal regions, yet frequent ice cream consumption was associated with a reduced response to milkshake receipt. Percentage body fat, total energy intake, percentage of energy from fat and sugar, and intake of other energy-dense foods were not related to the neural response to milkshake receipt. "Our results provide novel evidence that frequent consumption of ice cream, independent of body fat, is related to a reduction in reward-region responsivity in humans, paralleling the tolerance observed in drug addiction," they concluded.

Other recent brain-imaging studies have supported the theory that overeating is also an addiction. Read more about it in Psychiatric News here.

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FDA Advisors Back Weight-Loss Pill

A panel of advisers convened by the Food and Drug Administration (FDA) yesterday voted 20 to 2 to approve the weight-loss drug Qnexa, a controlled-release combination of phentermine and topiramate being developed by Vivus. The FDA previously rejected Qnexa due to safety concerns, but then scheduled yesterday's review by the Endocrinologic and Metabolic Drugs Advisory Committee, which recommended Vivus be required to conduct a large, follow-up study of the pill's cardiovascular effects, but said that study could come after FDA approval because the impressive weight-loss results seen with Qnexa might outweight those concerns.


Peter Tam, president of Vivus, said the advisory-panel vote underscores the need for effective weight loss drugs. "I think they see the medical need. Right now there aren't any good treatments out there besides dieting and bariatric surgery." The FDA is not bound by the recommendations of its advisory committees, but will consider the guidance during its April 17 review of the New Drug Application that was submitted for Qnexa in October 2011.


Read about the fate of some weight-loss drugs previously approved by the FDA in Psychiatric News here.

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Antidepressant Drugs and the Placebo Effect Make Headlines

The effects of antidepressant medications are all in people's heads. That’s what a Harvard psychologist told Lesley Stahl on “60 Minutes” last Sunday. Irving Kirsch, Ph.D., said that antidepressant drugs are no better than placebo pills for people with mild to moderate depression. He agreed that people with severe cases show a much stronger response.

Kirsch’s studies of the placebo effect lead him to argue that taking the drugs may work, but that "the reason [people] get better is not because of the chemicals in the drug.” Simply the act of taking a pill or the added attention from clinicians may make patients feel better, he said.

Psychiatrists and Food and Drug Administration scientists interviewed on the program disagreed with Kirsch’s views. “It is unfortunate that ‘60 Minutes’ has provided its viewers with highly misleading information, and I encourage everyone taking antidepressants to talk with your doctor before making any changes,” said APA President John Oldham, M.D., in a statement.

APA’s treatment guidelines on depression recommend psychotherapy first for mild to moderate depression, and only if this intervention falls short should the physician decide whether antidepressants are needed.

For a discussion in Psychiatric News about the complexities of the placebo effect, click here. And for an in-depth review of medications in depression treatment, see The Evidence-Based Guide to Antidepressant Medications from American Psychiatric Publishing.

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Risk of Child Abuse, PTSD Tied to Gender Nonconformity

Researchers have found a troubling association between gender nonconformity in children and abuse. Childhood gender nonconformity is the term for differences from the norm for one’s sex as measured by feelings of femininity or masculinity and other indicators. It does not necessarily mean that a child will ultimately have a minority sexual orientation.

Exposure to childhood physical, psychological, and sexual abuse, and probable PTSD were higher in the 10 percent of youth reporting gender nonconformity, writes lead author Andrea Roberts, Ph.D., of the Harvard School of Public Health, in the March Pediatrics. The study was based on a survey of 9,864 youth as part of the Growing Up Today Study.

“[G]ender nonconformity…may be both an indicator of abuse and a risk factor for abuse, although evidence in favor of either causal direction is limited,” cautioned the researchers. Observing gender nonconformity should alert parents, teachers, and health care providers to a possibly increased risk of child abuse and therefore the chance to prevent, stop, or treat abuse, they concluded.

To read more about childhood sexual abuse in Psychiatric News, click here and here.

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Administration to Delay Implementation of ICD-10 Codes

The AMA is applauding a decision by the Obama administration to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition (ICD-10diagnosis and procedure codes (ICD-10). "The AMA appreciates [Health and Human Services] Secretary Sebelius' swift response to address the AMA’s serious concerns with ICD-10 implementation,” said AMA President Peter Carmel, M.D., in a statement yesterday. “The timing of the ICD-10 transition could not be worse for physicians....Burdens on physician practices need to be reduced--not created--as the nation's health care system undertakes significant payment and delivery reforms.”

In announcing the decision, Sebelius said, “We are committing to work with the provider community to reexamine the pace at which HHS and the nation implement these important improvements to our health care system.”

This is not the first such delay. For coverage in Psychiatric News, see here.

APA Announces Election Results

Jeffery Lieberman, M.D., is the victor in the three-way race to become APA's next president-elect. Lieberman, chair of APA's Council on Research and Quality Care and a member of the American Journal of Psychiatry Editorial Board, outpolled Renee Binder, M.D., and Mary Helen Davis, M.D. In the race for treasurer, David Fassler, M.D., bested Robert Feder, M.D., to win another term in that post. Three Area trustee positions were up for election. In Area 1, Jeffrey Geller, M.D., prevailed over Gail Robinson, M.D., while in Area 4 Judith Kashtan, M.D., defeated Ronald Burd, M.D., and in Area 7 Jeffrey Akaka, M.D., outpolled Annette Matthews, M.D. In addition, this year there were races for early career psychiatrist (ECP) trustee-at-large, and member-in-training trustee-elect (MITTE).  In the former, Molly McVoy., M.D., was the victor in a three-way race with Steve Koh, M.D., M.P.H., and Jose Vito. M.D. The MITTE contest was won by Erik Vanderlip, M.D., over Andrea Brandon, M.D., Ph.D., and Brian Hurley, M.D., M.B.A.

While APA has made these results public, they are not official until approved by the Board of Trustees at its March meeting. Complete vote totals and deadlines for next year's election are posted on APA's Web site under "Association Governance."

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Physicians Win Another Medicare Fee Cut Reprieve

The House and Senate last week passed yet another postponement of the huge looming cuts in the fees physicians receive for treating Medicare beneficiaries. If the lawmakers hadn't agreed to this delay, fees would have been slashed by about 27 percent on March 1. The new target date for implementing the fee cuts is January 1, 2013, assuming that President Obama, as expected, signs the legislation.

This is, however, one of those silver linings with a dark cloud around it, because each time the cut is put off—and Congress has done so annually for more than a dozen years—the size of the cut increases. Unless there is another postponement, January's average cut jumps to 32 percent. The physician fee adjustments, which usually involve cuts, are mandated by the complex formula known as the Sustainable Growth Rate (SGR) in which increases in the costs in one or more parts of the Medicare program must be offset by cuts elsewhere in its budget. APA and the AMA have for years urged Congress to throw out the SGR and develop a new, fairer system for setting Medicare reimbursements, but with such a daunting task, lawmakers have found it easier to just vote another postponement.

Read more about the SGR and physician Medicare fees in Psychiatric News here and here.

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Groundbreaking AJP Study Finds Early Brain Changes in Autism

The changes in brain development that underlie autism spectrum disorder may be detectable in children as young as 6 months, according to a groundbreaking study appearing online today in the American Journal of Psychiatry. Researchers at four clinical sites prospectively examined the growth and organization of white matter in the brains of infants deemed to be at high risk of autism spectrum disorder. They found that there was an aberrant pattern of white matter development in those infants who went on to display autism spectrum disorder by 24 months, compared to those who did not. The finding is receiving wide publicity, including coverage on ABC News and CNN, because it suggests that autism may be detectable before symptoms begin.

Study coauthor Geri Dawson, Ph.D., who is chief science officer of the advocacy group Autism Speaks, said in a statement released today, “These results offer promise that we may one day be able to identify infants at risk for autism before the behavioral symptoms are present. The goal is to intervene as early as possible to prevent or reduce the onset of disabling symptoms. One promising area of follow-up research is to identify the specific genetic and biological mechanisms behind the observed differences in brain development.”

Click here to read the AJP study.

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