Britney Needs Privacy, Mental Illness Group Says

Pop singer Britney Spears, hospitalized in Los Angeles, for psychiatric treatment, needs privacy, according to a mental illness group.

"A media circus and reckless speculation has surrounded events in the life of pop singer Britney Spears and her family," says Michael Fitzpatrick, executive director of the National Alliance on Mental Illness (NAMI). "Professional ethics require that mental health professionals who have not examined or treated individuals not presume to diagnose them. A person's treatment and recovery from any illness also is entitled to privacy -- which in fact may be an important factor in recovery."

Spears was hospitalized this week at UCLA after an escort involving multiple police vehicles, including helicopters. Media scrutiny of Britney Spears has been intense this week, with mainstream media giving her story prominent play. Some journalists have been quoting mental health professionals to get their take on Spears' condition.

Spears' hospitalization follows a year of increasingly erratic behavior in which Spears' two young children were removed from her custody.

"In the case of Britney Spears, professional ethics also are involved which the media must confront," NAMI's Fitzpatrick says. "Roy Peter Clark, vice-president of the Poynter Institute, a leading center of journalism training and ethics, recently wrote. 'There is clearly a danger zone, when life and health are at stake, when the best thing the press can do is back off. That time for Spears is probably now.'"

However, the Spears case does offer a chance to discuss mental illness more broadly and just focus on Britney Spears, Fitzpatrick says.

"NAMI believes it is important that such discussions in our homes, offices,
schools, and stores, as well as in the media, be based on facts," he says. "What is needed--for anyone--is understanding and support. We encourage everyone to focus not on Britney Spears, but on all the ordinary people in our own communities who deserve our attention."

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Patients with Depression Seeing Primary Care Physicians Frequently Don't Receive High Quality Care

Most patients with depression who are treated by primary care physicians do not receive care consistent with quality standards, according to a new RAND Corporation study.

Physicians had high rates of adherence to just one-third of the 20 measures of quality that researchers examined and had low rates of adherence to nearly half of the treatment recommendations studied, according to the report in the Sept. 4 edition of the Annals of Internal Medicine.

“These findings are important for patients since most cases of depression are diagnosed and treated in primary care settings,” says senior author Dr. Lisa Rubenstein, the study's senior author, and a senior scientist at RAND, a nonprofit research organization, and a physician at the Veterans Affairs Greater Los Angeles Healthcare System. “This shows that additional efforts are needed to improve the treatment of depression.”

The study also found that patients who received better-quality care reported fewer symptoms of depression up to two years after the start of treatment. The findings are among the first linking quality guidelines for depression treatment with improved patient outcomes in community settings.

“These are initial findings, but they suggest that programs that encourage doctors to follow treatment guidelines can help improve the long-term outlook for people with depression,” says Rubenstein, who also is affiliated with the David Geffen School of Medicine at UCLA.

Previous studies have shown that primary care providers do a poor job following guidelines for antidepressant use or psychotherapy. The RAND study is one of the first to assess primary care providers' adherence to a comprehensive set of treatment guidelines for depression.

Researchers from RAND Health examined the experiences of health care providers and patients who took part from 1996 to 1998 in the Quality Improvement for Depression collaboration, which was designed to encourage primary care providers to adopt comprehensive depression treatment guidelines developed by the U.S. Agency for Healthcare Research and Quality.

The RAND study examined the experiences of 1,131 patients with depression who were treated in 45 primary care practices across 13 states. Study sites ranged from small private practices to large managed care organizations. About 10 percent of patients in the study were from Veterans Affairs practices.

Researchers examined whether physicians and other health providers followed 20 different measures of quality, as well as analyzing patients' reports about the status of their depression at 12, 18 and 24 months after starting treatment.

The study found that most primary care physicians did a good job of diagnosing and beginning treatment for depression, with guidelines aimed at these issues followed more than 70 percent of the time. These guidelines includes items such as talking to patients about depression and closely monitoring patients newly placed on antidepressant medication.

But researchers found that primary care clinicians did less well following up with treatment over time. Fewer than half of the patients in the study completed the minimal course of treatment for either antidepressant drugs or psychotherapy, and only slightly more than half the depressed patients who were not treated were monitored closely.

The lowest quality of care occurred among the patients who exhibited the most serious symptoms, including patients who showed evidence of suicide or substance abuse. For example, among patients who had a previous suicide attempt, just 35 percent were referred to a mental health specialist over the next six months.

“Primary care physicians were good at diagnosing depression, but they did not do as good a good job of managing the sickest patients,” Rubenstein says. “Right now, primary care physicians don't have the tools necessary to decide which patients to treat and which to refer on to specialized mental health care.”

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Suicide Attempts Decline After Depression Treatment

In a study of more than 100,000 patients treated for depression, suicide attempts declined during the first month of treatment—whether that treatment consisted of medication, psychotherapy, or both. The findings, published by Group Health researchers in the July American Journal of Psychiatry, show a similar pattern for populations of adolescents and young adults (up to age 24) as for older adults.

The study sheds new light on the “black box” advisory that the U.S. Food and Drug Administration (FDA) placed in 2004 and has revised since then, said Greg Simon, MD, MPH, the Group Health psychiatrist who led the study. The advisory—which has concerned many patients, families, and care providers—warns that suicidal behavior may emerge soon after people younger than 25 start treatment with newer antidepressant medications called selective serotonin reuptake inhibitors (SSRIs). It was spurred by randomized placebo-controlled trials showing that starting to take an SSRI can make thoughts of suicide more common among some teens and young adults.

Dr. Simon’s study is the first published research to compare the risk of suicide attempts before and after the start of treatment with not only antidepressants but also psychotherapy. It is based on computerized medical and pharmacy records for more than 109,000 patients who started treatment for depression at Group Health from 1996 to 2005.

In the study, suicide attempts were about twice as common among patients up to age 24 as among older adults. However, the time pattern was the same for both age groups, regardless of the type of treatment they received: Suicide attempts were most likely during the month before treatment started, falling by at least 50 percent in the month after treatment began, with steady declines thereafter.

At all time points—up to three months before and six months after starting treatment—patients who received their antidepressant prescription from a psychiatrist tended to be most likely to attempt suicide. Those who received it from their primary care doctor were least likely to attempt suicide, with levels in between for those who got individual psychotherapy from a therapist other than a psychiatrist. “That’s not because seeing a psychiatrist makes you want to kill yourself,” says Dr. Simon. Rather, he suggests, these results reflect the fact that people with severe depression, who tend to be more suicidal, are more likely to be referred to psychiatrists, while those with milder depression stick with their primary doctors.

“Our study indicates that there’s nothing specific to antidepressant medications that would either make large populations of people with depression start trying to kill themselves—or protect them from suicidal thoughts,” says Dr. Simon. “Instead, we think that, on average, starting any type of treatment—medication, psychotherapy, or both—helps most people of any age have fewer symptoms of depression, including thinking about suicide and attempting it.” That said, he likened population-based studies—both observational studies such as this one and randomized controlled trials of medications—to “circumstantial evidence” about what happens to individual patients.

Like other psychiatrists, Dr. Simon has seen a few depressed patients start having suicidal thoughts while taking antidepressant medication despite never having thought about suicide before then. He hypothesizes that subgroups of people may be vulnerable to becoming more agitated or suicidal after taking these drugs. “We hope to learn how to identify these people in advance,” he says.

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Newsweek Cover: Failing Our Wounded

Recent revelations about the decay and mismanagement at Walter Reed Army Medical Center in Washington, D.C., were especially shocking because it is one of the most prestigious U.S. military hospitals. But a Newsweek investigation--which focused not on one facility but on the services of the Department of Veterans Affairs, a sprawling 235,000-person bureaucracy--found that the VA system is unprepared for the scope of the task at hand and ahead.

Around 50,000 service members so far have been banged up or burned, lost limbs or sacrificed something less tangible inside them in the wars in Iraq and Afghanistan. And a new study projects that at least 700,000 moreveterans from the global war on terror will flood the system in the coming years. In the March 5 cover story, "Failing Our Wounded" (on newsstands Monday, February 26), national security correspondent Dan Ephron and Assistant Editor Sarah Childress paint a grim portrait of an overloaded bureaucracy cluttered with red tape; veterans having to wait weeks or months for mental-health care and other appointments; families sliding into debt as VA case managers study disability claims over many months, and the seriously wounded requiring help from outside experts just to understand the VA's arcane system of rights and benefits.

Tonia Sargent, whose husband, Kenneth--a Marine master sergeant who had been in the corps for nearly 18 years--nearly died in a sniper attack in Najaf in 2004, says no one ever sat her down and explained the benefits and how to access them. Her husband's brain injury made him often incapable of understanding his own care. Key decisions fell to her alone. It's a "don'task, don't tell system," she says. The Sargent's story, and the stories of many other veterans, is raising concerns that the United States is failing to meet its most basic obligations to those who fight its wars, Newsweek says.

"In no way do I diminish the fact that there are veterans out there who are coming in who require treatment and maybe are not getting the treatment they need," White House Deputy Press Secretary Tony Fratto tells Newsweek. "It's real and it exists."

Dr. Michael Kussman, the VA's acting under secretary for health tells Newsweek that the department is trying to reach veterans earlier, as they approach their date of discharge, and that he does not believe Iraq and Afghanistan are straining resources severely.

"The impact on the VA so far has been relatively small," Kussman says. "It has not kicked the system over in our budget and in our ability to absorb it."

But the number of veterans has to grow and critics worry the VA is in a state of denial. In a broad sense, Newsweek reports, the situation at the VA seems to mirror the overall lack of planning for the war. "We know the VA doesn't have the capacity to process a large number of disability claims at the same time," says Linda Bilmes, a Harvard public-finance professor who last month released a 34-page study on the long-term cost of caring for veterans from Iraq and Afghanistan.

Veterans' support groups and even some former and current VA insiders believe there's a reluctance in the Bush administration to deal openly with the long-term costs of the war, Newsweek says.

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A New Target for the Treatment of Breast Cancer

The active ingredient in a drug currently being tested to treat rheumatoid arthritis might also one day serve as an effective means of treating one of the deadliest forms of breast cancer.

Researchers with the U.S. Department of Energy’s Lawrence Berkeley National Laboratory have demonstrated that inhibiting the activity of the protease enzyme known as TACE can deprive tumor cells of a key factor needed for their proliferation. TACE is strongly present in a form of breast cancer which responds poorly to current therapies

“We have shown that inhibition of the TACE protease in breast cancer cells blocks the shedding of two critical growth factor proteins and results in an inhibition of a key signaling pathway that controls cell division,” says Paraic Kenny, a post-doctoral cell biologist with the research group of Mina Bissell in Berkeley Lab’s Life Sciences Division. “Based on analysis of cells grown in three-dimensional cultures, the inhibition of this protease results in the reversion of the malignant phenotype of these breast cancer cells and switches their behavior back to a phenotype very reminiscent of non-malignant breast epithelial cells.”

Kenny is the co-author along with Bissell of a paper published in the Journal of Clinical Investigation titled: "Targeting TACE-Dependent EGFR-ligand Shedding in Breast Cancer." This paper presents the latest experimental results from an on-going investigation led by Bissell into the ecology of tumors.

It has long been Bissell’s contention that “no tumor is an island.” Tumor cells, she maintains, exist in the same microenvironment as healthy cells and must therefore appropriate normal physiological processes to facilitate their growth and spread. As she and her colleagues have repeatedly demonstrated, this idea can open up potential new avenues and targets for diagnostic and therapeutic applications.

For this latest paper, Kenny and Bissell looked into the pathway by which the EGFR signal is carried. EGFR, which stands for Epidermal Growth Factor Receptor, is the protein on the outer surface of a cell that is activated by EGF and related growth factors and signals for the cell to divide. Given that one of the hallmarks of cancer is cell division run amok, the reduction of high levels of EGFR activity has long been a primary target for anti-cancer drug development. So far, however, drugs aimed at directly inhibiting EGFR activity have met with only limited success in the cancer clinic, primarily in a small number of lung cancers.

“Because of this, we turned our attention to the processes that regulate the production of the ligands which bind and activate EGFR,” Kenny says. “We reasoned that this binding and activation is essential for EGFR activation and that finding a way to block this interaction might prove to be an important additional approach to explore for inhibition of this pathway.”

Kenny stresses that the importance of EGFR to so many different tumor types, including lung, head and neck, bladder, colorectal and kidney, makes it likely that “TACE inhibition has the potential to be an effective means of stopping tumor growth for EGFR-dependent cancers outside the breast as well.”

<---We all know someone or are some one who has or have had cancer. The most common for women is breast cancer. Slow progress is made in the battle. A new vaccine prevents a virus that causes cervical cancer. Still cancer has no vaccine, nor cure. Scary too is the rise in cases of prostate cancer in men 18-37.--->

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