Sunday, May 27, 2007

My Three Shrinks Podcast 22: Forced Treatment

[21] . . . [22] . . . [23] . . . [All]

Note: Chapter 6 is up on Double Billing:

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Aarghh!! This is the second version of these show notes. Blooger helpfully auto-saved the first one into oblivion (how do you turn this "feature" off?).

Anyway, Welcome back! Dinah's friend, Victor, joins us again this week, providing his insights into salutations and valedictions. And, for our US listeners, don't forget to celebrate National Duckling Month this weekend (oh, and Memorial Day, too).

May 27, 2007: #22 Forced Treatment

Topics include:
  • Physician-Assisted Executions. The American Medical News had a story by Kevin B. O'Reilly about how some states are trying to force physicians to participate in executions. The ethics of such activities are debated.

  • Realizing the Promise of Pharmacogenomics. A draft federal report is available for public comment (by June 1) about the development of pharmacogenetics and the impact of genomic medicine on the future of health care. You can find the report and comment form here. "The report identifies a number of challenges for the development of pharmacogenomics and its effective integration into health care practice, including the need to improve the health-information infrastructure, to provide education and training for practitioners, and to maintain the confidence of all stakeholders by effectively addressing ethical, legal and social issues arising from pharmacogenomics."

  • Dopamine, Genetics, and Environmental Stressors in ADHD. As an example of the above, this month's Archives of General Psychiatry has an article by Manfred Laucht, et al., showing evidence of an interaction between a mutation in the Dopamine Transporter (DAT) gene and severe environmental stress (e.g., abuse) triggering symptoms of ADHD. Also mentioned in the podcast is data suggesting that certain Serotonin Transporter Promoter (5HTTP) mutations predict one's response to SSRI antidepressants, the development of side effects to these drugs, and the propensity to develop psychiatric symptoms.

  • Forced Outpatient Treatment in PA. Liz Spikol, who writes the blog and newspaper column, Trouble with Spikol, for the Philadelphia Weekly, writes about Pennsylvania Senate Bill 226, which would make it easier to make people with severe mental illness who are "unlikely to survive safely in the community without supervision." A long debate on the podcast ensues (half the 'cast) about the ethics and practicality of such tactics.

  • Don't miss Roy's telling of the official (according to psychologist, Richard Wiseman) funniest joke in the world (around the 25 minute mark). Just to be on the safe side, be sure you aren't driving when you listen to it.

Find show notes with links at: The address to send us your Q&A's is there, as well.
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Thank you for listening.


Midwife with a Knife said...

ooh! Genomics. Cool.

I'm an epigenetics geek now, I guess. My thesis project involves the study of epigenetics on early embryonic and trophoblast development. I look at 3-d chromatin structure and how it effects gene expression and functioning. (kind of a long story, I'll start there... and my project isn't really working well anyway)

Part of the problem with using those microarray chips (like the Affy platform you mentioned, but there's also other brands, Illumina, Nimblegen, etc.) is that they don't really cover all of the human genome (even if they say they do), and the statistical evaluation of these things is nightmarishly complex. In traditional statistics, you have to correct your level of significance, etc. for each comparison. So, when you're doing 1000, 10000, 100000 etc comparisons at a time, it's really hard to separate the real findings. It's like a needle in a haystack.

Midwife with a Knife said...

P.S. It must be a good sign that I had time to listen to the entire podcast in one sitting even though I'm on in house call tonight!

Jessica said...

That joke was in my psychology book in high school... Though my psych book had a different joke listed as being second funniest.

Anonymous said...

There alot of wonderful stuff with some exciting news also in this blog. Anyway that joke is okay and not bad neither and its a good to share with everybody so that no only drytears, your psych book have that jokes.

Zoe Brain said...

The biggest argument against Capital Punishment is not the effect it has on the condemned, but on the executioners.

Rach said...

I didn't understand a single word in that comment, save for thesis.

LOL. Haven't listened to the joke yet.

Anonymous said...

Great podcast, yadda, yadda....
I just had to say...




Gerbil said...

I have to admit to some confusion about the capital punishment issue. If AMA membership is voluntary, then non-members cannot be expected to adhere to AMA guidelines, policy statements, etc., unless these are incorporated into the laws of the state in which the non-member is licensed to practice medicine. And even if an AMA member violates something the AMA holds sacred but which is perfectly legal in his/her state, I would guess that the AMA can't do anything beyond kicking the member out.

I'm basing my confusion on the fact that not all licensed psychologists belong to APA, and not all APA guidelines are state law. (I'm referring to the American Psychological Association, where we know youse guys as "little ApA." Because, well, we're bigger.) Various people, including the infamous Paul Cameron, have been kicked out of APA for violating ethical guidelines; but this in itself doesn't strip them of their license to practice psychology. APA will kick people out if they've committed a felony or had their license rescinded, but it doesn't work the other way around.

So I guess what I'm saying is that there is not necessarily a conflict between an AMA statement on the death penalty and the presence of physicians in the execution chamber... as long as the physicians are not AMA members.

(For the record: why, exactly, do we kill people who've killed people in order to show other people that killing people is wrong? I don't get it.)

Roy said...

Gerbil- it is considered a badge of dishonor to be kicked out of AMA, of course. But, most specialties require that one conform to the AMA Code of Ethics, so it can affect you even if not a member. I don't know how many states include it in their statute, but it is practically the Hippocratic Oath for us.

But, the point of the story, I think, was that state licensing boards were requiring state-employed physicians to participate in executions.

Oh, and we refer to your APA as "the other APA"... or sometimes, just "the Others" (jk).

ClinkShrink said...

As Roy said, the issue in the capital punishment case was that a state licensing board was going to take action against any physician who chose to participate (don't ask why they didn't just challenge the law requiring participation---maybe they did and lost), and the state DOC filed an injunction on the grounds that the board didn't have jurisdiction on this issue. (Eg. it's not treatment so butt out.)

It's a disturbing thing to think that a correctional system is trying to lay claim to defining a medical scope of practice.

Gerbil said...

Ah, okay. As usual, I was thinking about philosophical aspects of events, rather than the actual events themselves.