News & Notes

A policy statement issued by the American Medical Association (AMA) in June bars physicians from conducting, directly participating in, or monitoring an interrogation with an intent to intervene. The AMA policy went through several iterations, and the final statement, which was endorsed by the American Psychiatric Association, the American Academy of Psychiatry and the Law, and the American Academy of Child and Adolescent Psychiatry, represents the unified voice of organized medicine on this issue.

To participate in interrogations "undermines the physician's role as healer and thereby erodes trust in the individual physician-interrogator and in the medical profession," according to a report detailing the policy by the AMA's Council on Ethical and Judicial Affairs (CEJA).

The AMA policy permits physicians to develop "effective interrogation strategies for general training purposes." The final language of the AMA policy is closer to that of APA's policy on interrogations, which was issued in May. However, earlier AMA drafts were ambiguous about whether physicians could advise interrogators on strategies for questioning specific individuals. Under pressure from APA leaders, the CEJA clarified language in the final draft to emphasize that physicians could develop interrogation strategies only for "general training purposes."

Limitation of the physician's role to general training conforms with the APA policy, which states that psychiatrists should not directly participate in interrogation, which includes "advising authorities on the use of specific techniques with particular detainees." Psychiatrists may, however, provide training "on recognizing and responding to persons with mental illnesses, on the possible medical and psychological effects of particular techniques and conditions of interrogation, and on other areas within their professional expertise."

The AMA policy was also endorsed by Physicians for Human Rights, which issued a statement noting that the AMA policy appears "to conflict directly with the rules released [in June] by the Pentagon for guiding the involvement of military physicians and other health personnel in interrogations. The Pentagon guidelines … find no ethical obstacle to physicians' playing an active role in the interrogation process."

"The AMA acted today to defend the basic principles of medical ethics and to protect the men and women bravely serving our country as military health personnel," stated retired Brigadier General Stephen Xenakis, M.D., an advisor to Physicians for Human Rights and an APA member. "Since 2001, the civilian leadership at the Pentagon has been engaged in a full frontal assault on the basic standards of medical and military ethics, from the Hippocratic Oath to the Geneva Conventions. All the major medical associations are now standing together to demand that this administration respect the core values of both the health professional and the soldier."

An estimated 220,000 to 640,000 Americans under age 65 have Alzheimer's disease or related dementia, according to a new report by the Alzheimer's Association. Individuals with early-onset dementias face unique problems that current health care systems and public insurance programs are not prepared to address.

The estimates were derived from analysis of data from three sources: the 2000 Health and Retirement Study, a longitudinal national survey; 1990-1994 epidemiologic data from Minnesota; and a 2003 nationally representative telephone survey conducted by the Alzheimer's Association and the National Alliance for Caregiving. All found that the incidence of dementia among persons under age 65 was higher than expected.

Getting a timely diagnosis is a critical problem faced by individuals with early-onset dementia, according to the report. Health care providers generally do not look for Alzheimer's disease or related dementia among younger patients, who can go for months or years without proper treatment. These individuals are often still working when symptoms emerge, and changes in job performance may not be understood or addressed. Those who leave jobs before a diagnosis may be denied employer assistance that would otherwise be provided to persons with disabilities. In addition, almost a third of persons with early-onset dementia have no health insurance. If they are not covered by Medicare or an employee insurance plan and do not qualify for Medicaid, they may not be able to afford health care or other living expenses.

The report concludes that not nearly enough is known about the prevalence of early-onset Alzheimer's disease and related dementia or about the unique characteristics of early-onset diseases and the problems faced by those who have them. Therefore, a national study sponsored by the government and the private sector leads the list of recommendations in the report. Prevention research is also called for, as is research on how to delay progression of dementia among younger people. Analyses of work environments with emphasis on workplace accommodations that enhance productivity are also needed. The report urges development of a national education program targeting different groups.

In the policy area, the report recommends elimination of the two-year waiting period for Medicare coverage of individuals under age 65 who have qualified for Social Security Disability Insurance, affordable health insurance for individuals with early-onset dementia who do not have access to other coverage, and expansion of Medicaid income limits and services funded by the Administration on Aging to accommodate this group.

The 70-page report, Early Onset Dementia: A National Challenge, A Future Crisis, is available on the Web site of the Alzheimer's Association at www.alz.org.

Goal setting for recovery: The Depression and Bipolar Support Alliance (DBSA) has developed a workbook to help consumers set goals on their way to recovery. Next Steps: Getting the Treatment You Need to Reach Real Recovery takes the user through a detailed process of articulating short- and long-term goals and understanding personal strengths and outside resources that will help in achieving them. One section of the 18-page workbook focuses on the elements that contribute to one's personal definition of wellness and provides practical advice about creating a working relationship with a health care provider, including specific issues and questions to address together. New treatments, such as vagus nerve stimulation and transcranial magnetic stimulation, are described. The workbook is available on the DBSA site at www.dbsalliance.org.

Documentation of citizenship for Medicaid beneficiaries: A law signed early this year by President Bush would have required all U.S. citizens and nationals applying for or renewing Medicaid coverage—about 55 million people—to provide documentation of their citizenship status beginning July 1, 2006. However, on July 6 the Administration, which faced a lawsuit challenging the requirement, decided to exempt more than eight million of the most vulnerable Medicaid recipients: those receiving Medicare (seniors and "dual eligibles") or Supplemental Security Income. Despite the exemptions, advocates are concerned that many who need health care the most, such as homeless people and foster children, may lose coverage. The Kaiser Commission on Medicaid and the Uninsured has issued a report on New York State's experience with a citizenship requirement for Medicaid, which has been in place since the mid-1970s. New York is one of only four states that requires such documentation, and the only state with significant experience. The 23-page report draws on legal research, interviews with Medicaid officials, and a roundtable discussion with state workers who provide personal assistance to Medicaid applicants. Citizenship Documentation Requirements in the Deficit Reduction Act of 2005: Lessons From New York is available on the Kaiser Web site at www.kff.org/medicaid/7534.cfm.

WHO initiative on global trials registry: The World Health Organization (WHO) has launched an initiative—the International Clinical Trials Registry Platform—to ensure that researcher groups and pharmaceutical companies register all medical studies that test treatments on human beings. A primary goal of the WHO initiative is to standardize the way information on medical studies is made available to the public. Another goal is to create a global identification system that will issue a standardized unique reference number for every qualified trial. The WHO Registry Platform is not in itself a clinical trials registry; rather, it provides a set of standards for all registries to use. Use of the standards is voluntary, and individual companies and institutions can adopt them at any time. Currently, there is little coordination among the hundreds of trial registries around the world. Later this year, the WHO registry will launch an international Web-based search portal through which users can search among participating registries for ongoing or completed clinical trials. More information on the WHO initiative is posted at www.who.int/ictrp/en.

Expanded NAMI outreach to faith communities: The National Alliance on Mental Illness (NAMI) has expanded its FaithNet outreach program with the inauguration of a new Web site, www.faithnetnami.org. FaithNet is a national grassroots network begun in 1998 by NAMI California. The network taps resources within faith communities to provide information about mental illness and treatment and develop more caring congregations for individuals and their families coping with mental illness. NAMI's national office is also assuming responsibility for the network's electronic newsletter, which has a circulation of about 1,500 clergy and lay leaders. The FaithNet Web site includes resources for bulletin inserts, sermons, and worship services, among other materials. NAMI FaithNet is playing a lead role in a national collaboration of Catholic, Protestant, and Jewish groups to distribute antistigma poster packets to approximately 26,000 congregations. The American Psychiatric Foundation has provided $88,000 to fund the project, which has the potential to reach 10 million people. Evaluation of the project, which will use a postcard survey and interviews with a sample of congregations, will document the extent to which congregations are better able to refer people to appropriate treatment, develop connections with NAMI affiliates and other organizations, and respond in supportive ways to individuals and families coping with mental illness. More information is available at ww.faithnetnami.org.