Medical knowhow raises suicide risk for doctors
Fri, 09 May 2008 03:19:34 GMT
By LINDSEY TANNER, AP Medical Writer
CHICAGO - There's a grim, rarely talked-about twist to all that medical know-how doctors learn to save lives: It makes them especially good at ending their own. An estimated 300 to 400 U.S. doctors kill themselves each year — a suicide rate thought to be higher than in the general population, although exact figures are hard to come by.
Some doctors believe the stigma of mental illness is magnified in a profession that prides itself on stoicism and bravado. Many fear admitting psychiatric problems could be fatal to their careers, so they suffer in silence.
And when the pain is too much, doctors have easy access to prescription drugs and a precise knowledge of both how the body works and the amount of a drug needed for an overdose to stop breathing and halt the heart.
"All physicians have access to neat, clean ways to commit suicide," said Dr. Robert Lehmberg, a
Little Rock, Ark., surgeon who has battled depression and long considered suicide "an exit strategy if absolutely necessary."
The
American Medical Association has called physician suicide "an endemic catastrophe," and pledged two years ago to work to prevent the problem.
But the suicides have persisted. So the American Foundation for Suicide Prevention has launched an educational campaign in hopes of making troubled doctors more willing to seek help.
The foundation, the
American College of Psychiatrists and Wyeth Pharmaceuticals, a maker of antidepressant pills, paid for the program. It includes a documentary titled "Struggling in Silence" that begins airing on public television stations this week.
"It really has been swept under the carpet," said Dr. Paula Clayton, the suicide foundation's medical director.
The foundation says 300 to 400 doctors commit suicide each year, based on estimates from research, but that more studies are needed to get a more precise count.
Another estimate of 250 yearly comes from an online article by Dr. Louise Andrew and in American Medical News, an AMA publication. But a spokesman said the AMA doesn't track doctor suicides because accurate numbers aren't available.
Suicide figures in broader society are not completely reliable because suicide is often not given as the cause of death.
The overall U.S. suicide rate among men is four times higher than in women — about 23 per 100,000 versus about 6 per 100,000 in women, according to the most recent government data.
But among doctors, suicide rates are about equal for men and women.
A 28-state study from 1984-95 found women doctors were more than twice as likely as women in the general population to kill themselves. Men were more than 70 percent more likely inside the medical profession than overall to commit suicide.
One explanation is that most suicide attempts in the broader population are unsuccessful, while doctors know how to successfully commit suicide, said Dr. Erika Frank, who specializes in research on physician health.
Depression is often the problem.
Depressed doctors frequently decide to self-medicate but don't seek psychotherapy that could help them deal with underlying issues, said Dr. Glenn Siegel, who runs a suburban Chicago program that treats doctors with
drug abuse, depression and other psychiatric problems.
"It's not a safe topic to be as open about in that profession because you're responsible for the well-being of others," Siegel said. "If you're admitting something like that, you're saying maybe you're not fit to do your job."
Adds Lehmberg, the
Arkansas surgeon, who is featured in the documentary: "You just would rather take a risk with your health than your career. It's not like you get a second chance with it."
A psychiatrist in the
New York area who asked to remain unidentified said he had suicidal thoughts every day for several years. But in medical school in the 1980s, he said he was so embarrassed about seeking help for depression that he went to a pay phone instead of his dorm to call a therapist.
Since then, some schools have begun teaching medical students about depression among doctors, but, he said in an interview, "so much more needs to be done."
Because the stigma persists, he said he didn't want his name used to avoid hurting his family and
relationships with colleagues and patients.
Some studies have suggested depression is more common among doctors, especially women physicians, and that the high demands of a job dealing with life-and-death issues makes them prone.
But Frank questions that and said she worries that singling out physicians risks "pathologizing" a profession whose members generally "have it awfully good."
"I think the situation gets portrayed as far more grave than it really is for physicians compared to anyone else in the world," Frank said.
There could be reasons why the stigma would be worse for doctors, "but you can come up with just as many reasons why physicians would be better equipped to acknowledge" mental illness, she said.
"We've all done psychiatric training. We all know bad
mental health outcomes happen to good people," she said.
A study in Denmark, published last year, found more suicides in doctors than among more than 20 other professions, including nurses, factory workers, elementary school teachers, corporate managers and architects.
But there are few comprehensive studies on suicides among U.S. doctors.
Some have been based on newspaper obituaries, which are "flawed at best" because suicide often isn't listed as a cause of death, said Dr. Morton Silverman, a
University of Chicago suicide expert.
New Jersey physician Ron Brown suffered from depression and killed himself in 2002. His widow, Mumtaz Bari-Brown, said she believes the stigma kept her husband from getting help in time to save his life.
As a boy, Brown had been told his father died of a heart attack, not the real cause of suicide, the widow said.
"We have to stop the hiding and the ignorance and recognize it as a disease like high blood pressure or diabetes," said Bari-Brown, who also is featured in the new documentary.
Dr. G. Richard Smith, Lehmberg's doctor and director of the
University of Arkansas for Medical Sciences' psychiatric research institute, said doctors need assurance they won't risk their jobs if they seek psychiatric help.
Smith succeeded in getting changes to questions on medical license applications in
Arkansas that he believes will help. The old application asked doctors if they were being treated for mental illness or ever had been. A "yes" answer required a psychiatrist's note declaring they were fit to practice medicine. Now, they need only disclose
mental health treatment that was advised or required by medical authorities.
The previous form didn't keep doctors with psychiatric problems from practicing, Smith said. But it did keep "doctors who needed treatment from getting the treatment that they needed."
___
On the Net:
American Foundation for Suicide Prevention: http://www.doctorswithdepression.org
AMA: http://www.ama-assn.org
Report Child viral death toll up to 34 in China
Fri, 09 May 2008 07:45:44 GMT
BEIJING - The death toll from a viral illness that is striking children across
China has risen by four to 34, while the number of reported infections jumped to nearly 25,000, state media reported Friday.
Two of the latest deaths occurred in the hardest-hit central province of
Anhui, where 22 children have already died of hand, foot and mouth disease, the official
Xinhua News Agency said.
The other two deaths were reported in the southern province of
Guangdong and in neighboring Guangxi, the agency said.
Also Friday, the U.S. Embassy said that Health and Human Services
Secretary Mike Leavitt was planning a trip to
Beijing next week to meet with Chinese officials to discuss relevant health issues, including the viral outbreaks.
In Guangdong, an 8-month-old girl died of the disease early Monday. She tested positive for enterovirus 71, which can cause a severe form of hand, foot and mouth disease, a common childhood ailment that typically causes little more than a fever and rash, Xinhua said. The disease is unrelated to the foot and mouth disease that affects livestock.
An 18-month-old boy died after falling into a coma in Guangxi, the agency said.
As of late Thursday, the number of reported cases of the disease jumped to 24,932, up from 19,962 a day earlier, Xinhua said.
Health experts have said they expect the number of reported infections to rise as a result of an order issued this week by the Ministry of Health requiring health care providers to report infections within 24 hours. The disease is expected to peak in the hot months of June and July.
Hand, foot and mouth disease spreads through contact with saliva, feces, fluid secreted from blisters or mucus from the nose and throat. There is no vaccine or specific treatment, but most children affected by the disease typically recover quickly after suffering little more than a fever and rash.
Susan Stevenson, spokeswoman for the U.S. Embassy in Beijing, said details of Leavitt's trip have not been worked out.
Last year, 80,000 hand, foot and mouth cases were recorded nationwide with 17 deaths, the health ministry has said. Spokesman Mao Qun'an said the figures were probably incomplete because reporting was not mandatory then.
More than half of US diabetics have arthritis
Thu, 08 May 2008 20:39:39 GMT
By MIKE STOBBE, AP Medical Writer
ATLANTA - More than half of U.S. adults with diabetes also have arthritis, raising a serious obstacle for diabetic patients urged to exercise, according to a government study.
The survey of nearly 800,000 people is the first extensive look at the overlap between the two conditions, said Dr. John Klippel, president of the Arthritis Foundation.
And its findings highlight a significant challenge: Most diabetics are told exercise is important to their health, but experts say many of them don't do it.
People with diabetes who exercise have better control of their blood sugar and a much lower risk of heart disease complications. But the new research suggests many diabetics see themselves as unable to exercise because of arthritis, said Julia Simard, a
Harvard School of Public Health researcher who has studied rheumatoid arthritis and diabetes.
"If you have this perception of ill health, it may affect your willingness to be active," said Simard, who was not involved in the new research.
More than 46 million Americans have some form of arthritis, and nearly 21 million have diabetes. Other research indicates exercise is important in managing both conditions.
The study found that 52 percent of diabetics said they also had arthritis. The conditions and the overlap were most common in Americans 65 and older.
The analysis was based on telephone surveys in the years 2005 and 2007 by the Centers for Disease Control and Prevention. Researchers relied on what people said about their health, and did not verify diagnoses.
The researchers also asked about exercise and physical activity. People with both diabetes and arthritis were 30 to 40 percent more likely to be physically inactive than those who had diabetes alone.
"If we're ever going to successfully control a disease like diabetes, we're going to have to pay a lot of attention to arthritis," Klippel said.
Exercise that put less
stress on joints, such as walking, biking and aquatics, are recommended for people with arthritis, said Dr. Chad Helmick, a
CDC epidemiologist who co-authored the study.
___
On the Net:
The
CDC publication: http://www.cdc.gov/mmwr
The Arthritis Foundation: http://www.arthritis.org
Chantix recommended to quit smoking despite safety concerns
Thu, 08 May 2008 20:57:12 GMT
By CARLA K. JOHNSON, Associated Press Writer
CHICAGO - The federal government's new advice to doctors for helping smokers quit recommends the drug Chantix, which has recently been linked with depression and suicidal behavior. The new guidelines mention the psychiatric risks but also say the popular
Pfizer Inc. drug is the most effective at helping people get off cigarettes.
The guidelines mention other options, too, and highly recommend combining counseling and medication. But doctors are encouraged to talk to all smokers who want to quit about trying medication.
Consumer advocates cautioned that the safety picture on Chantix is incomplete because it's a relatively new drug, on the market just since 2006.
"It is somewhat better than other therapies; on the other hand, it appears to have more risk," said Dr. Sidney Wolfe of the watchdog group Public Citizen. "That part of the risk-benefit equation is missing, and it's changing rapidly."
Another issue with the
quit-smoking guidelines, released this week by the U.S. Public Health Service, is the lead author's past connections with
Pfizer. Dr. Michael Fiore, an expert on
smoking and health issues, was a consultant to the maker of Chantix. But he said he cut those ties in 2005.
Fiore's views are shaped by his past ties to the drug industry, and those ties still pose a conflict, at least one consumer advocate said. John Polito, a
smoking cessation educator who runs the WhyQuit.com site advocating quitting "cold turkey," called the revised guidelines "a sales pitch" for the drug industry.
The task force overlooked research showing that quitting cold turkey works, Polito said, and studies showing Chantix is superior don't reflect how it's used "in the real world."
"People are quitting smoking to save their lives," Polito said. If Chantix's risks outweigh its benefits, "then it's insane for people to risk their lives" by using it, he said.
The guidelines are based on an extensive review of scientific evidence, were reviewed by 90 independent experts and were endorsed by 60
public health entities, Fiore said, adding that his past financial ties to the drug industry had no influence.
"Independent reviewers of it came to the conclusion that this is a document that reflects the science, and that's what we were charged to do," Fiore said.
The guideline authors analyzed 83 studies and found that Chantix helped 33 percent stay off
tobacco for six months after quitting, compared with a nearly 14 percent abstinence rate for dummy pills.
The guidelines recommend combining counseling and medication as the most effective way to kick the
tobacco habit, stating "both counseling and medication should be provided to patients trying to
quit smoking."
Medications have not been shown to be effective in certain groups, the guidelines say. Those groups include pregnant women, smokeless tobacco users, light smokers and adolescents.
The guidelines say doctors should consider asking about their patients' psychiatric history before prescribing Chantix. Doctors also should monitor patients for changes in mood and behavior while on the drug.
Lois Biener, a researcher of tobacco use and control efforts at the University of Massachusetts in Boston, said most people who quit do so without
smoking-cessation drugs.
There's little evidence that these drugs are superior in the long run to quitting without help, and while a few studies have shown some benefit, it's "way less than what is claimed" by medication advocates, Biener said.
Three of 24 panelists who wrote the guidelines reported "significant financial interests" in the pharmaceutical industry, including speaking fees and stock ownership.
___
Associated Press Medical Writer Lindsey Tanner contributed to this report.
Too much too little sleep tied to ill health in CDC study
Thu, 08 May 2008 20:57:12 GMT
By MIKE STOBBE, AP Medical Writer
ATLANTA - People who sleep fewer than six hours a night — or more than nine — are more likely to be obese, according to a new government study that is one of the largest to show a link between irregular sleep and big bellies.
The study also linked light sleepers to higher
smoking rates, less physical activity and more alcohol use.
The research adds weight to a stream of studies that have found obesity and other health problems in those who don't get proper shuteye, said Dr. Ron Kramer, a
Colorado physician and a spokesman for the
American Academy of Sleep Medicine.
"The data is all coming together that short sleepers and long sleepers don't do so well," Kramer said.
The study released Wednesday is based on door-to-door surveys of 87,000 U.S. adults from 2004 through 2006 conducted by the
National Center for Health Statistics, part of the Centers for Disease Control and Prevention.
Such surveys can't prove cause-effect relationships, so — for example — it's not clear if smoking causes sleeplessness or if sleeplessness prompts smoking, said Charlotte Schoenborn, the study's lead author.
It also did not account for the influence of other factors, such as depression, which can contribute to heavy eating, smoking, sleeplessness and other problems.
Smoking was highest for people who got under six hours of sleep, with 31 percent saying they were current smokers. Those who got nine or more hours also were big puffers, with 26 percent smoking.
The overall U.S. smoking rate is about 21 percent. For those in the study who sleep seven to eight hours, the rate was lower, at 18 percent.
Results were similar, though a bit less dramatic, for obesity: About 33 percent of those who slept less than six hours were obese, and 26 percent for those who got nine or more. Normal sleepers were the thinnest group, with obesity at 22 percent.
For alcohol use, those who slept the least were the biggest drinkers. However, alcohol use for those who slept seven to eight hours and those who slept nine hours or more was similar.
In another measure, nearly half of those who slept nine hours or more each night were physically inactive in their leisure time, which was worse even than the lightest sleepers and the proper sleepers. Many of those who sleep nine hours or more may have serious health problems that make exercise difficult.
Many elderly people are in the group who get the least sleep, which would help explain why physical activity rates are low. Those skimpy sleepers who are younger may still feel too tired to exercise, experts said.
Stress or psychological problems may explain what's going on with some of the lighter sleepers, experts said.
Other studies have found inadequate sleep is tied to appetite-influencing hormone imbalances and a higher incidence of diabetes and high blood pressure, noted James Gangwisch, a respected
Columbia University sleep researcher.
"We're getting to the point that they may start recommending getting enough sleep as a standard approach to weight loss and the prevention of obesity," said Gangwisch, who was not involved in the study.
___
On the Net:
National Center for Health Statistics: http://www.cdc.gov/nchs
American Academy of Sleep Medicine: http://www.aasmnet.org/
Pelvic floor maladies can impact women39s sex life
Thu, 08 May 2008 16:15:30 GMT
By Amy Norton
NEW YORK -
Incontinence and other
disorders of the pelvic organs can take a toll on a woman's sex
life, a new study suggests.
Researchers found that among 300 women age 40 and older,
those with symptoms of a pelvic floor disorder were more likely
to have a diminished libido, pain during sex, or problems
reaching orgasm.
Pelvic floor disorders refer to problems with a woman's
pelvic organs -- the
uterus, bladder and rectum -- and the
muscles and connective tissue that support them. Among the most
common of these are urinary incontinence and pelvic organ
prolapse, where weakened muscles and supporting tissue allow
one or more pelvic organs to drop down and protrude into the
vagina.
Some symptoms of prolapse include pressure in the vagina,
pain in the lower abdomen or lower back, and chronic
constipation.
It has been estimated that one-third of U.S. women have at
least one type of pelvic floor disorder, but studies have come
to conflicting conclusions as to whether the conditions hinder
women's sex lives.
The new findings, reported in the journal Obstetrics &
Gynecology, suggest that many women with these disorders do, in
fact, have problems with sexual function.
However, the risk of sexual dysfunction was not elevated
among women who had mild prolapse that was not causing
symptoms, lead researcher Dr. Victoria Handa told Reuters
Health.
This is important, she explained, because it indicates that
women who have sexual complaints but no other potential
symptoms of pelvic organ prolapse do not need to be evaluated
for the disorder.
"Sexual function is unlikely to be impacted by mild
prolapse," said Handa, an associate professor of gynecology and
obstetrics at
Johns Hopkins University in
Baltimore.
The findings are based on 301 patients recruited from
gynecology offices affiliated with
Johns Hopkins. Eighty women
were seeking care for a pelvic floor disorder, including
bladder control problems and pelvic organ prolapse. The rest of
the women had other conditions or were getting a routine
checkup.
All of the women completed questionnaires on their overall
health, pelvic symptoms and sexual function.
Overall, the researchers found, women with pelvic floor
disorders were more likely to have symptoms of a decreased
sex
drive, pain during sex and infrequent orgasms -- regardless of
age and whether they had gone through
menopause.
The study does not prove that the pelvic floor disorders
caused the women's sexual problems, Handa said. However, the
conditions could impair women's sexual function for a number of
reasons, from diminished body image to problems with muscle and
nerve function.
According to Handa, women with pelvic floor disorders
should talk with their doctors about any sexual difficulties
they have.
In an earlier study, she and her colleagues found that
women's sexual function often improved after having surgery to
correct significant prolapse. But more research is needed into
this area, Handa said.
If certain treatments for pelvic floor disorders are better
than others for improving sexual function, she noted, that will
be important to know.
SOURCE: Obstetrics & Gynecology, May 2008.
Health Tip Treating an Ulcer
Fri, 09 May 2008 03:47:44 GMT
-- Ulcers are sores that occur in the lining of
the digestive tract. They can be triggered by factors such as bacteria,
medication or excess production of stomach acid.
If you have an ulcer, here are things you should discuss with your
doctor to promote healing, courtesy of the
American Academy of Family
Physicians:
- Medications can help ulcers heal. Antibiotics are prescribed to thwart
bacteria, and other medications may be taken to help reduce stomach
acid.
- Avoid smoking.
- Don't take anti-inflammatory medications such as aspirin or
ibuprofen.
- Avoid caffeine and alcohol in your diet. If you do have some, try to
make sure it's after you've eaten a meal or snack.
- Don't eat foods that seem to aggravate your ulcer. Examples may
include chocolate, coffee, certain herbs and spices, and some spicy
foods.
- Eat several small meals throughout the day, rather than one big
meal.
Death toll in China disease outbreak hits 34 state media
Fri, 09 May 2008 06:26:47 GMT
BEIJING -
The number of Chinese children confirmed dead from hand, foot and mouth disease has risen to 34 with nearly 25,000 people infected but the outbreak's spread may be slowing, state media said on Friday.
Xinhua news agency reported four new deaths, including an eight-month-old girl in southern China's
Guangdong province and a one-year-old boy in the southwestern
Guangxi region.
Two more children also had died in the hard-hit eastern province of
Anhui, it said, adding that the number of cases nationwide had risen to 24,934 as of Thursday.
However, the national Health Ministry said those discharged from hospitals in Anhui now exceeded new cases for the first time.
Most new cases there also were less severe than previously, it said in a statement on its website.
Symptoms of the highly contagious disease include fever and sores. It can result in death in children due to their less-developed immune systems.
The disease is common in
China. More than 80,000 cases were reported last year, with 17 deaths.
However, its rapid spread across a vast region, including the capital
Beijing just months before the city hosts the
Olympics in August, has prompted the government to issue a national alert.
The World Health Organisation has said there is little fear of a devastating outbreak.
The China Daily newspaper Friday quoted a US official as saying the
Department of Health and Human Services had offered its help in containing the disease, which will be on the agenda during a visit to Beijing next week by the department's chief,
Mike Leavitt.
Most of the deaths have involved enterovirus 71, or EV71, which can lead to acute hand, foot and mouth disease and was identified early on by China as a key factor in the severity of the outbreak.
However, it seems now to have turned into a more general spread of hand, foot and mouth disease, according to state press reports.
Cases first emerged in large numbers in eastern China in early March but the problem was not made public until last week, prompting state press to accuse local officials of dragging their feet on raising the alarm.
Anhui has been hit hardest, with 22 deaths occurring in its city of
Fuyang alone.
New rule would limit insurers contact with elderly disabled
Thu, 08 May 2008 22:28:25 GMT
By KEVIN FREKING, Associated Press Writer
WASHINGTON - Agents selling private health insurance plans to the elderly and disabled would be barred from cold-calling, door-to-door solicitations and pitching their products outside hospital waiting rooms or pharmacies, under a federal rule proposed Thursday.
The rule is designed to make it harder to pressure Medicare beneficiaries into signing up for insurance products they don't need or want. It essentially restricts face-to-face solicitations to those initiated by the customer.
A new
Medicare drug benefit began Jan. 1, 2006. Since then, participants and
state insurance commissioners have complained that some agents use false information to enroll people into certain plans, particularly those offering comprehensive health insurance.
"We want to make sure that beneficiaries aren't pressured into sales," said Kerry Weems, acting administrator for the Centers for Medicare and Medicaid Services. "In parking lots, waiting rooms and those kinds of places, a salesman can create a pressure environment or a threatening environment where a beneficiary will agree to anything just to get away."
During congressional hearings, lawmakers urged the Bush administration to curb abusive marketing practices. The rule is unlikely to stop lawmakers' efforts to give states more authority to hold insurers accountable.
About 27 million people get coverage for their prescription drug needs either through a private insurance plan that offers only the drug benefit or through a "Medicare Advantage" plan that offers comprehensive health benefits. In some cases, people were enrolled in plans even after they made it clear they didn't want the product.
Advocacy groups said the rule is a step in the right direction, but it won't be enough. They want states to regulate the insurance companies that offer Medicare Advantage plans. Currently, states only regulate the activities of the agents selling the plans.
"CMS doesn't have the boots on the ground to enforce even good rules like this," said Paul Precht, policy director for the
Medicare Rights Center.
But Weems said the rule also gives CMS authority to issue fines of up to $25,000 per beneficiary affected by the company's conduct. Previously, the fine was $25,000 per contract.
"That is an extremely powerful enforcement tool," Weems said.
Several provisions in the proposed regulations are already part of voluntary guidelines for the industry. But there are some areas where Medicare went beyond what the insurance industry sought. For example, insurers routinely sent brochures in the mail explaining a product to a potential customer. Then agents would call to make sure they got the brochure. They would no longer be allowed to make those calls under the proposed rule.
Also, insurance agents commonly used their meetings about the drug benefit to pitch other types of products such as long-term care insurance or disability insurance. The regulation would prevent them from doing so — unless the agent cleared it with the potential customer before the meeting.
Karen Ignagni, president of America's Health Insurance Plans, said the rule would prevent agents from marketing at health fairs or anywhere else where health care is delivered. She said the rule is an important step in protecting beneficiaries and questioned the need for more state regulation.
"Medicare is a federal program. Moving away from federal regulation toward 50 states approaching this in 50 different ways doesn't set a uniform standard for beneficiaries," Ignagni said. "That's why our board urged additional federal requirements."
Medicare officials said they hoped to issue a final rule by late October, which would allow for the changes to take effect before the next
open enrollment season for the drug benefit.
___
On the Net:
Centers for Medicare and Medicaid Services: http://www.cms.hhs.gov