Archive for March 11th, 2009

GPs Fail Patients with Eating Disorders

March 11th, 2009 | No Comments | Source: BBC, Beat

A new survey by the UK-based Beat shows that only 15% of patients with eating disorders such as anorexia and bulimia felt their GP understood their condition or knew how to help them.

notaprettypictureSome said they felt their primary care physician did not take their problems seriously. Others felt they lacked knowledge about treatment options.

In England, the number of girls and young women requiring hospitalization for anorexia has increased 80% in the last decade. More than 1.1 million people in the UK are believed to have an eating disorder.

“People affected by eating disorders still aren’t getting the treatment and support they need,” Beat chief executive Susan Ringwood concluded.

According to the BBC, one young person in the survey was told to “go home and eat a burger,” while another was reassured she was just going through “a phase.”

Recently British Prime Minister Gordon Brown said the NHS needed to improve diagnostic and therapeutic performance on eating disorders. “Sometimes it is late and sometimes things have gone too far,” he said.

But Steve Field, chairman of the Royal College of GPs said physicians are for the most part doing an excellent job.

“It’s not very often that the patient comes to the GP and says ‘I’ve got an eating disorder’, but doctors do know what they are doing and the signs to look out for and patients should be reassured of this” he said.

Beat is the UK’s leading charity for people with eating disorders. It provides help lines, online support and self-help groups.

NICE guidelines on eating disorders state that recovery is possible provided GPs listen to their patients, act quickly and, in the case of young people, involve their families as much as possible.

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Skin in the Game II

March 11th, 2009 | No Comments | Source: NEJM, Wall Street Journal

Still basking in the glow of their study showing that financial incentives helped obese volunteers lose weight, Kevin Volpp and Co. are reporting that cash rewards help people quit smoking cigarettes too.

wewonVolpp’s team randomized 878 GE employees who smoked a pack-a-day into 2 groups.

Controls got information regarding smoking-cessation programs while the incentive group received up to $750 in cash as well.

Payouts to the incentive group participants were pegged to milestones: completing a stop-smoking program was worth $100, stopping smoking within 6 months of the enrollment date earned an additional $250, and continued abstinence for 6 months scored $400.

Claims by participants that they had quit were verified with cotinine tests. The study is in the New England Journal of Medicine.

The scientists reported that 14.7% of people in the financial incentive group quit smoking within a year, whereas only 5% in the control group had done so. At 18 months following randomization, abstainers comprised 9.4% of the paid group and 3.6% in controls.

“It was icing for me to get a monetary reward for something I was already planning to do,” GE lighting specialist Ric Barton told the Wall Street Journal.

Meanwhile, Bob Galvin, GE’s chief medical officer and a research team member said the study’s findings convinced him to implement an incentive plan for all US-based cigarette smoking employees beginning next year.

But to its credit, Volpp’s team was a bit circumspect in their write-up. The team noted that most study participants were white, well-educated, and relatively wealthy, and cautioned against extrapolating the findings to other demographic groups.

And Kenneth Warner, the University of Michigan Tobacco Research Network director worried that high recidivism might obligate companies to continue paying ex-smokers for years.

Is it too late to add that to the stimulus?

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PTSD and the Purple Heart

March 11th, 2009 | No Comments | Source: Economist

Since Blue vs. Gray, America’s military has recognized that war imposes a psychological price on combatants.

highhonorIn Civil War days, people called it soldier’s heart. By World War I, the phenomenon had been dubbed shell shock. For the Second World War, the moniker was battle fatigue, and now it’s post-traumatic stress disorder.

Whatever it’s called, the Pentagon estimates that 11% of veterans of the war in Iraq have it, and the number is nearly twice that among Afghan war vets.

The condition can range from minor readjustment difficulties to homicidal behavior or suicide, and the incidence of cases at the violent end of the spectrum has risen alarmingly in the last 2 years.

The US military recently opened PTSD treatment facilities in Bethesda and Fort Bliss, although there are families of affected individuals who say that’s too little, too late.

Meanwhile many still  believe that weak minds underlie the condition, and it was only months ago that the Army promised enlistees their careers would not be jeopardized if they sought help for this or other anxiety disorders. 

Last year, defense secretary Robert Gates suggested rather shockingly to some that soldiers afflicted with PTSD ought to receive the Purple Heart, which was originally created by George Washington for soldiers wounded in combat.

After much ado the Pentagon demurred, citing a 1932 standard which bestows the honor only on those who have, according to the Economist, suffered wounds “intentionally caused by the enemy from an outside force.”

Alas the Pentagon tends to move slowly on such matters. The World War II memorial remember, was completed in 2004.

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