Government and Regulations

Admissions to publicly funded substance abuse treatment have declined slightly for alcohol abuse and markedly for cocaine use, according to a new report from the Substance Abuse and Mental Health Services Administration (SAMHSA).

The report’s findings, drawn from the 2013 Treatment Episode Data Set (TEDS), show that admissions dropped from 1,865,145 in 2003 to 1,683,451 in 2013. Alcohol use, although still responsible for the largest proportion of admissions, decreased from 42% to 38%. Cocaine (including crack) use declined dramatically from 14% to 6%. Marijuana use remained fairly steady over the past 10 years at 16% to 17%.

However, during the same period, heroin use admissions rose from 15% to 19%. And more than half of all patients admitted in 2013 reported abusing more than one substance.

Admissions to publicly funded substance abuse treatment have declined slightly for alcohol abuse and markedly for cocaine use, according to a new report from the Substance Abuse and Mental Health Services Administration (SAMHSA).

The report’s findings, drawn from the 2013 Treatment Episode Data Set (TEDS), show that admissions dropped from 1,865,145 in 2003 to 1,683,451 in 2013. Alcohol use, although still responsible for the largest proportion of admissions, decreased from 42% to 38%. Cocaine (including crack) use declined dramatically from 14% to 6%. Marijuana use remained fairly steady over the past 10 years at 16% to 17%.

However, during the same period, heroin use admissions rose from 15% to 19%. And more than half of all patients admitted in 2013 reported abusing more than one substance.

Admissions to publicly funded substance abuse treatment have declined slightly for alcohol abuse and markedly for cocaine use, according to a new report from the Substance Abuse and Mental Health Services Administration (SAMHSA).

The report’s findings, drawn from the 2013 Treatment Episode Data Set (TEDS), show that admissions dropped from 1,865,145 in 2003 to 1,683,451 in 2013. Alcohol use, although still responsible for the largest proportion of admissions, decreased from 42% to 38%. Cocaine (including crack) use declined dramatically from 14% to 6%. Marijuana use remained fairly steady over the past 10 years at 16% to 17%.

However, during the same period, heroin use admissions rose from 15% to 19%. And more than half of all patients admitted in 2013 reported abusing more than one substance.

According to a recent article jointly produced by ProPublica and NPR, privacy violations within the VA between 2011 and 2014 nearly doubled from 1,547 to 3,054. These violations are causing some veterans to question just how safe the VA keeps their medical data.

Well aware of privacy concerns, the VA released a statement that read in part, “inappropriate access of patient health records, either during or post treatment, is absolutely unacceptable and in violation of privacy laws and regulations, VA policies and procedures, and our principles,” according to the statement. “To protect against improper access and disclosure, VA’s VistA electronic health record, and other VA information systems, have built-in safeguards to ensure patient privacy.”

For example, whenever a VA employee pulls up an individual’s medical record, VIstA generates a Sensitive Patient Access Report that logs the viewer’s identity and the time of access. The VA also requires that all employees and contractors complete privacy and information security training annually, and more than 500,000 staff members must sign VA’s Rules of Behavior, which confirms that these users are aware of, and will comply with, safeguarding requirements for protecting veterans’ private medical information.

“The challenges VA is facing are similar to those experienced across public and private sectors, and we are continuously striving to better protect veteran data,” according to the VA statement. “VA is also transparent in its handling of privacy incidents, both by contacting veterans directly as provided by law, as well as posting monthly reports to the VA website containing a sampling of reported incidents.”

Despite the efforts, some veterans are not satisfied. “I don't trust them,” said veteran Anthony McCann in an interview with ProPublica. “They don't do what they say they're going to do.”

In 2014, McCann received a package containing more than 250 pages of medical information concerning another veteran’s mental health. At a town hall meeting with the director of the VA's Tennessee Valley Healthcare System in attendance, McCann alerted the director to the violation but refused to turn over the documents, citing his belief that the VA lacked the ability to keep this information private. Complicating matters, McCann also claimed that this was not the first time he had received another veteran's private medical records in the mail.

According to a recent article jointly produced by ProPublica and NPR, privacy violations within the VA between 2011 and 2014 nearly doubled from 1,547 to 3,054. These violations are causing some veterans to question just how safe the VA keeps their medical data.

Well aware of privacy concerns, the VA released a statement that read in part, “inappropriate access of patient health records, either during or post treatment, is absolutely unacceptable and in violation of privacy laws and regulations, VA policies and procedures, and our principles,” according to the statement. “To protect against improper access and disclosure, VA’s VistA electronic health record, and other VA information systems, have built-in safeguards to ensure patient privacy.”

For example, whenever a VA employee pulls up an individual’s medical record, VIstA generates a Sensitive Patient Access Report that logs the viewer’s identity and the time of access. The VA also requires that all employees and contractors complete privacy and information security training annually, and more than 500,000 staff members must sign VA’s Rules of Behavior, which confirms that these users are aware of, and will comply with, safeguarding requirements for protecting veterans’ private medical information.

“The challenges VA is facing are similar to those experienced across public and private sectors, and we are continuously striving to better protect veteran data,” according to the VA statement. “VA is also transparent in its handling of privacy incidents, both by contacting veterans directly as provided by law, as well as posting monthly reports to the VA website containing a sampling of reported incidents.”

Despite the efforts, some veterans are not satisfied. “I don't trust them,” said veteran Anthony McCann in an interview with ProPublica. “They don't do what they say they're going to do.”

In 2014, McCann received a package containing more than 250 pages of medical information concerning another veteran’s mental health. At a town hall meeting with the director of the VA's Tennessee Valley Healthcare System in attendance, McCann alerted the director to the violation but refused to turn over the documents, citing his belief that the VA lacked the ability to keep this information private. Complicating matters, McCann also claimed that this was not the first time he had received another veteran's private medical records in the mail.

According to a recent article jointly produced by ProPublica and NPR, privacy violations within the VA between 2011 and 2014 nearly doubled from 1,547 to 3,054. These violations are causing some veterans to question just how safe the VA keeps their medical data.

Well aware of privacy concerns, the VA released a statement that read in part, “inappropriate access of patient health records, either during or post treatment, is absolutely unacceptable and in violation of privacy laws and regulations, VA policies and procedures, and our principles,” according to the statement. “To protect against improper access and disclosure, VA’s VistA electronic health record, and other VA information systems, have built-in safeguards to ensure patient privacy.”

For example, whenever a VA employee pulls up an individual’s medical record, VIstA generates a Sensitive Patient Access Report that logs the viewer’s identity and the time of access. The VA also requires that all employees and contractors complete privacy and information security training annually, and more than 500,000 staff members must sign VA’s Rules of Behavior, which confirms that these users are aware of, and will comply with, safeguarding requirements for protecting veterans’ private medical information.

“The challenges VA is facing are similar to those experienced across public and private sectors, and we are continuously striving to better protect veteran data,” according to the VA statement. “VA is also transparent in its handling of privacy incidents, both by contacting veterans directly as provided by law, as well as posting monthly reports to the VA website containing a sampling of reported incidents.”

Despite the efforts, some veterans are not satisfied. “I don't trust them,” said veteran Anthony McCann in an interview with ProPublica. “They don't do what they say they're going to do.”

In 2014, McCann received a package containing more than 250 pages of medical information concerning another veteran’s mental health. At a town hall meeting with the director of the VA's Tennessee Valley Healthcare System in attendance, McCann alerted the director to the violation but refused to turn over the documents, citing his belief that the VA lacked the ability to keep this information private. Complicating matters, McCann also claimed that this was not the first time he had received another veteran's private medical records in the mail.

Can hip-hop help get minority youth to avoid smoking? The FDA is hoping so. Its “Fresh Empire” campaign is the FDA’s first public education campaign designed to reduce and prevent tobacco use among at-risk multicultural teens who “identify with the hip-hop culture.”

Related: Is Cigarette Smoking on the Decline?

According to the Office of Minority Health (OMH), more than 4 million minority youth smoke or experiment with smoking, and research suggests that those in the hip-hop crowd are more likely to smoke than are other young people. With the tagline “Keep It Fresh,” the campaign aims to associate living “tobacco free” with desirable hip-hop lifestyles. The goal is to keep the campaign “authentic through a peer-to-peer approach,” but the FDA is also encouraging public health organizations and interested adults to share the information about the campaign through the FDA’s social media channels, such as @FDATobacco (https://twitter.com/FDATobacco).

Related: E-Cigarettes and Tobacco Product Smoking

The campaign will complement the FDA’s general youth education campaign, “The Real Cost.”

Can hip-hop help get minority youth to avoid smoking? The FDA is hoping so. Its “Fresh Empire” campaign is the FDA’s first public education campaign designed to reduce and prevent tobacco use among at-risk multicultural teens who “identify with the hip-hop culture.”

Related: Is Cigarette Smoking on the Decline?

According to the Office of Minority Health (OMH), more than 4 million minority youth smoke or experiment with smoking, and research suggests that those in the hip-hop crowd are more likely to smoke than are other young people. With the tagline “Keep It Fresh,” the campaign aims to associate living “tobacco free” with desirable hip-hop lifestyles. The goal is to keep the campaign “authentic through a peer-to-peer approach,” but the FDA is also encouraging public health organizations and interested adults to share the information about the campaign through the FDA’s social media channels, such as @FDATobacco (https://twitter.com/FDATobacco).

Related: E-Cigarettes and Tobacco Product Smoking

The campaign will complement the FDA’s general youth education campaign, “The Real Cost.”

Can hip-hop help get minority youth to avoid smoking? The FDA is hoping so. Its “Fresh Empire” campaign is the FDA’s first public education campaign designed to reduce and prevent tobacco use among at-risk multicultural teens who “identify with the hip-hop culture.”

Related: Is Cigarette Smoking on the Decline?

According to the Office of Minority Health (OMH), more than 4 million minority youth smoke or experiment with smoking, and research suggests that those in the hip-hop crowd are more likely to smoke than are other young people. With the tagline “Keep It Fresh,” the campaign aims to associate living “tobacco free” with desirable hip-hop lifestyles. The goal is to keep the campaign “authentic through a peer-to-peer approach,” but the FDA is also encouraging public health organizations and interested adults to share the information about the campaign through the FDA’s social media channels, such as @FDATobacco (https://twitter.com/FDATobacco).

Related: E-Cigarettes and Tobacco Product Smoking

The campaign will complement the FDA’s general youth education campaign, “The Real Cost.”

Updated January 20, 2016

The Million Veteran Program may play an important role in the recently announced cancer "moon shot." President Barack Obama and Vice President Joe Biden are promising to marshal federal and private resources to battle against cancer. Beginning with a bold announcement at the President’s State of the Union address, delivered January 12, and followed up by a slightly more detailed plan put forth by Biden a day later, the White House is focused on battling cancer by breaking down silos and increasing both public and private resources.

“The goal of this initiative — this ‘Moonshot’ — is to seize this moment,” Biden explained in a blog post. “To accelerate our efforts to progress towards a cure, and to unleash new discoveries and breakthroughs for other deadly diseases.”

Noting advances in immunotherapy, genomics and combined therapies, Biden argued that great strides have been made in cancer research, but the results are not necessarily reaching patients. “The science, data, and research results are trapped in silos, preventing faster progress and greater reach to patients,” Biden insisted. “It’s not just about developing game-changing treatments — it’s about delivering them to those who need them.”

Biden pledged that the federal government “will do everything it possibly can— through funding, targeted incentives, and increased private-sector coordination — to support research and enable progress.” Unclear, however, is whether the VA or the Murtha Cancer Center at Walter Reed National Military Medical Center will be involved in the effort. Later this month Biden will meet with cabinet secretaries and heads of relevant agencies to discuss ways to improve federal investment and support of cancer research and treatment.

VA Secretary Bob McDonald recently toured a Million Veteran Program (MVP) repository in Boston and touted the potential role in could play in the cancer moon shot, according to Military.com. Veterans who participate in the program donate blood for DNA extraction, which is linked to their health records. Created in 2012, MVP was expected to take 5 to 7 years to reach 1 million participants and already has registered more than 400,000 participants.

According to Politico, Biden has already made significant progress. The White House has a detailed plan leveraging the work of the National Institutes of Health (NIH) and private organizations that can compress 10 years of work into 5. The NIH is one of the few agencies that has received more funding from Congress in the latest budgets.

Medical and cancer organizations met the announcement with widespread approval. The American Association for Cancer Research (AACR) applauded the commitment to curing cancer. “We have indeed reached an inflection point, where the number of discoveries that are being made at such an accelerated pace are saving lives and bringing enormous hope for cancer patients, even those with advanced disease,” Dr. José Baselga, AACR president, said in a statement. “Now is the time for a major new initiative in cancer science that supports and builds upon our basic science foundation while translating these exciting scientific discoveries into improved treatments for cancer patients, such as in the areas of genomics, precision medicine, and immuno-oncology.”

“Vice President Biden’s call to leading cancer centers to break down silos and reach unprecedented levels of cooperation to enhance the effectiveness of cancer treatment, and for the oncology community to improve communication so that the care provided to patients at the world’s best cancer centers is available to everyone who needs it, echoes the work and mission of NCCN and our Member Institutions,” said Robert W. Carlson, MD, chief executive officer of the National Comprehensive Cancer Network (NCCN). “NCCN stands with President Obama, Vice President Biden, and their Administration on this crucial initiative, and we look forward to working to advance the goals of the initiative. It is time that people stop dying of cancer.”

The American Society of Clinical Oncology (ASCO) concurred. “With nearly 1.7 million people in the United States diagnosed with cancer each year, and the incidence of cancer expected to rise to 2.3 million cases per year by 2030, it is imperative that we do all we can to bring more effective treatments from the laboratory bench to the patient’s bedside as quickly as possible,”  Richard L. Schilsky, MD, ASCO chief medical officer, said in a statement. “We must recommit to vastly speeding the discovery of new cancer treatments and enabling the possibility of precision medicine for every individual with cancer.”

Updated January 20, 2016

The Million Veteran Program may play an important role in the recently announced cancer "moon shot." President Barack Obama and Vice President Joe Biden are promising to marshal federal and private resources to battle against cancer. Beginning with a bold announcement at the President’s State of the Union address, delivered January 12, and followed up by a slightly more detailed plan put forth by Biden a day later, the White House is focused on battling cancer by breaking down silos and increasing both public and private resources.

“The goal of this initiative — this ‘Moonshot’ — is to seize this moment,” Biden explained in a blog post. “To accelerate our efforts to progress towards a cure, and to unleash new discoveries and breakthroughs for other deadly diseases.”

Noting advances in immunotherapy, genomics and combined therapies, Biden argued that great strides have been made in cancer research, but the results are not necessarily reaching patients. “The science, data, and research results are trapped in silos, preventing faster progress and greater reach to patients,” Biden insisted. “It’s not just about developing game-changing treatments — it’s about delivering them to those who need them.”

Biden pledged that the federal government “will do everything it possibly can— through funding, targeted incentives, and increased private-sector coordination — to support research and enable progress.” Unclear, however, is whether the VA or the Murtha Cancer Center at Walter Reed National Military Medical Center will be involved in the effort. Later this month Biden will meet with cabinet secretaries and heads of relevant agencies to discuss ways to improve federal investment and support of cancer research and treatment.

VA Secretary Bob McDonald recently toured a Million Veteran Program (MVP) repository in Boston and touted the potential role in could play in the cancer moon shot, according to Military.com. Veterans who participate in the program donate blood for DNA extraction, which is linked to their health records. Created in 2012, MVP was expected to take 5 to 7 years to reach 1 million participants and already has registered more than 400,000 participants.

According to Politico, Biden has already made significant progress. The White House has a detailed plan leveraging the work of the National Institutes of Health (NIH) and private organizations that can compress 10 years of work into 5. The NIH is one of the few agencies that has received more funding from Congress in the latest budgets.

Medical and cancer organizations met the announcement with widespread approval. The American Association for Cancer Research (AACR) applauded the commitment to curing cancer. “We have indeed reached an inflection point, where the number of discoveries that are being made at such an accelerated pace are saving lives and bringing enormous hope for cancer patients, even those with advanced disease,” Dr. José Baselga, AACR president, said in a statement. “Now is the time for a major new initiative in cancer science that supports and builds upon our basic science foundation while translating these exciting scientific discoveries into improved treatments for cancer patients, such as in the areas of genomics, precision medicine, and immuno-oncology.”

“Vice President Biden’s call to leading cancer centers to break down silos and reach unprecedented levels of cooperation to enhance the effectiveness of cancer treatment, and for the oncology community to improve communication so that the care provided to patients at the world’s best cancer centers is available to everyone who needs it, echoes the work and mission of NCCN and our Member Institutions,” said Robert W. Carlson, MD, chief executive officer of the National Comprehensive Cancer Network (NCCN). “NCCN stands with President Obama, Vice President Biden, and their Administration on this crucial initiative, and we look forward to working to advance the goals of the initiative. It is time that people stop dying of cancer.”

The American Society of Clinical Oncology (ASCO) concurred. “With nearly 1.7 million people in the United States diagnosed with cancer each year, and the incidence of cancer expected to rise to 2.3 million cases per year by 2030, it is imperative that we do all we can to bring more effective treatments from the laboratory bench to the patient’s bedside as quickly as possible,”  Richard L. Schilsky, MD, ASCO chief medical officer, said in a statement. “We must recommit to vastly speeding the discovery of new cancer treatments and enabling the possibility of precision medicine for every individual with cancer.”

Updated January 20, 2016

The Million Veteran Program may play an important role in the recently announced cancer "moon shot." President Barack Obama and Vice President Joe Biden are promising to marshal federal and private resources to battle against cancer. Beginning with a bold announcement at the President’s State of the Union address, delivered January 12, and followed up by a slightly more detailed plan put forth by Biden a day later, the White House is focused on battling cancer by breaking down silos and increasing both public and private resources.

“The goal of this initiative — this ‘Moonshot’ — is to seize this moment,” Biden explained in a blog post. “To accelerate our efforts to progress towards a cure, and to unleash new discoveries and breakthroughs for other deadly diseases.”

Noting advances in immunotherapy, genomics and combined therapies, Biden argued that great strides have been made in cancer research, but the results are not necessarily reaching patients. “The science, data, and research results are trapped in silos, preventing faster progress and greater reach to patients,” Biden insisted. “It’s not just about developing game-changing treatments — it’s about delivering them to those who need them.”

Biden pledged that the federal government “will do everything it possibly can— through funding, targeted incentives, and increased private-sector coordination — to support research and enable progress.” Unclear, however, is whether the VA or the Murtha Cancer Center at Walter Reed National Military Medical Center will be involved in the effort. Later this month Biden will meet with cabinet secretaries and heads of relevant agencies to discuss ways to improve federal investment and support of cancer research and treatment.

VA Secretary Bob McDonald recently toured a Million Veteran Program (MVP) repository in Boston and touted the potential role in could play in the cancer moon shot, according to Military.com. Veterans who participate in the program donate blood for DNA extraction, which is linked to their health records. Created in 2012, MVP was expected to take 5 to 7 years to reach 1 million participants and already has registered more than 400,000 participants.

According to Politico, Biden has already made significant progress. The White House has a detailed plan leveraging the work of the National Institutes of Health (NIH) and private organizations that can compress 10 years of work into 5. The NIH is one of the few agencies that has received more funding from Congress in the latest budgets.

Medical and cancer organizations met the announcement with widespread approval. The American Association for Cancer Research (AACR) applauded the commitment to curing cancer. “We have indeed reached an inflection point, where the number of discoveries that are being made at such an accelerated pace are saving lives and bringing enormous hope for cancer patients, even those with advanced disease,” Dr. José Baselga, AACR president, said in a statement. “Now is the time for a major new initiative in cancer science that supports and builds upon our basic science foundation while translating these exciting scientific discoveries into improved treatments for cancer patients, such as in the areas of genomics, precision medicine, and immuno-oncology.”

“Vice President Biden’s call to leading cancer centers to break down silos and reach unprecedented levels of cooperation to enhance the effectiveness of cancer treatment, and for the oncology community to improve communication so that the care provided to patients at the world’s best cancer centers is available to everyone who needs it, echoes the work and mission of NCCN and our Member Institutions,” said Robert W. Carlson, MD, chief executive officer of the National Comprehensive Cancer Network (NCCN). “NCCN stands with President Obama, Vice President Biden, and their Administration on this crucial initiative, and we look forward to working to advance the goals of the initiative. It is time that people stop dying of cancer.”

The American Society of Clinical Oncology (ASCO) concurred. “With nearly 1.7 million people in the United States diagnosed with cancer each year, and the incidence of cancer expected to rise to 2.3 million cases per year by 2030, it is imperative that we do all we can to bring more effective treatments from the laboratory bench to the patient’s bedside as quickly as possible,”  Richard L. Schilsky, MD, ASCO chief medical officer, said in a statement. “We must recommit to vastly speeding the discovery of new cancer treatments and enabling the possibility of precision medicine for every individual with cancer.”

The Community Preventive Services Task Force (www.thecommunityguide.org), which includes subject matter experts from the CDC, has released new online reports on interventions to prevent cardiovascular disease (CVD).

One report, Clinical Decision Support Systems to Improve Provider Practices, recommends clinical decision support systems (CDSSs). A systematic review of 45 studies provided sufficient evidence that CDSSs help improve screening for CVD risk factors and other CVD-related preventive care services, clinical tests, and treatments.

The Task Force adds that most of the available evidence on effectiveness is from studies of CDSSs that are implemented alone rather than as part of a coordinated service delivery effort. The report also found “evidence gaps,” such as a lack of evidence regarding the impact of CDSSs on CVD risk factor outcomes, including systolic and diastolic blood pressure, lipids, diabetes, and CVD-related morbidity and mortality, as well as patient-centered outcomes and processes.

The report includes full-text articles on the studies published in the American Journal of Preventive Medicine.

The Community Preventive Services Task Force (www.thecommunityguide.org), which includes subject matter experts from the CDC, has released new online reports on interventions to prevent cardiovascular disease (CVD).

One report, Clinical Decision Support Systems to Improve Provider Practices, recommends clinical decision support systems (CDSSs). A systematic review of 45 studies provided sufficient evidence that CDSSs help improve screening for CVD risk factors and other CVD-related preventive care services, clinical tests, and treatments.

The Task Force adds that most of the available evidence on effectiveness is from studies of CDSSs that are implemented alone rather than as part of a coordinated service delivery effort. The report also found “evidence gaps,” such as a lack of evidence regarding the impact of CDSSs on CVD risk factor outcomes, including systolic and diastolic blood pressure, lipids, diabetes, and CVD-related morbidity and mortality, as well as patient-centered outcomes and processes.

The report includes full-text articles on the studies published in the American Journal of Preventive Medicine.

The Community Preventive Services Task Force (www.thecommunityguide.org), which includes subject matter experts from the CDC, has released new online reports on interventions to prevent cardiovascular disease (CVD).

One report, Clinical Decision Support Systems to Improve Provider Practices, recommends clinical decision support systems (CDSSs). A systematic review of 45 studies provided sufficient evidence that CDSSs help improve screening for CVD risk factors and other CVD-related preventive care services, clinical tests, and treatments.

The Task Force adds that most of the available evidence on effectiveness is from studies of CDSSs that are implemented alone rather than as part of a coordinated service delivery effort. The report also found “evidence gaps,” such as a lack of evidence regarding the impact of CDSSs on CVD risk factor outcomes, including systolic and diastolic blood pressure, lipids, diabetes, and CVD-related morbidity and mortality, as well as patient-centered outcomes and processes.

The report includes full-text articles on the studies published in the American Journal of Preventive Medicine.

In a 2015 study appearing in Annals of Epidemiology, VA associated researchers examined the risk of suicide among active-duty, National Guard, and Reserve veterans who were deployed in Operation Enduring Freedom and Operation Iraqi Freedom, and were separated from duty between 2002 and 2011. Looking at the data of veterans who were 7 years past active-duty service, researchers found a difference in rates by gender. To approximate the suicide risk over time, researchers used a hazard rate, which calculates the deaths by suicide per 100,000 veterans alive for each year that they have been away from service.

Although researchers found the overall suicide risk to be higher among male veterans (1,491 suicides out of 1,237,049) than that for female veterans (62 out of 164,333), the percentage of suicides among males has been decreasing by 6.1%, on average, per year. The percentage of suicides for female veterans varied through the years with a hazard rate of 9.1 in the first year after service, 15.0 in the fourth year, and 9.9 in the seventh year.  

Another 2015 study, also appearing in Annals of Epidemiology, showed rates of suicide differed in gender among deployed and nondeployed veterans during the same wars between 2001 and 2007. Researchers found out of 68 female and 1,582 male deployed deaths there were 15 deployed suicides among females and 336 suicides among males. The numbers for nondeployed suicides were higher than deployed suicides. Among 738 nondeployed female deaths, 109 were suicides, and of 6,965 nondeployed deaths among males, 1,408 were suicides.

To help decrease the suicide rate among veterans, the VA provides a Veterans Crisis Line to assist veterans and their families and friends. The crisis line is open 24/7 and can be reached by calling 1-800-8255, option 1, or by visiting https://www.veteranscrisisline.net.

In a 2015 study appearing in Annals of Epidemiology, VA associated researchers examined the risk of suicide among active-duty, National Guard, and Reserve veterans who were deployed in Operation Enduring Freedom and Operation Iraqi Freedom, and were separated from duty between 2002 and 2011. Looking at the data of veterans who were 7 years past active-duty service, researchers found a difference in rates by gender. To approximate the suicide risk over time, researchers used a hazard rate, which calculates the deaths by suicide per 100,000 veterans alive for each year that they have been away from service.

Although researchers found the overall suicide risk to be higher among male veterans (1,491 suicides out of 1,237,049) than that for female veterans (62 out of 164,333), the percentage of suicides among males has been decreasing by 6.1%, on average, per year. The percentage of suicides for female veterans varied through the years with a hazard rate of 9.1 in the first year after service, 15.0 in the fourth year, and 9.9 in the seventh year.  

Another 2015 study, also appearing in Annals of Epidemiology, showed rates of suicide differed in gender among deployed and nondeployed veterans during the same wars between 2001 and 2007. Researchers found out of 68 female and 1,582 male deployed deaths there were 15 deployed suicides among females and 336 suicides among males. The numbers for nondeployed suicides were higher than deployed suicides. Among 738 nondeployed female deaths, 109 were suicides, and of 6,965 nondeployed deaths among males, 1,408 were suicides.

To help decrease the suicide rate among veterans, the VA provides a Veterans Crisis Line to assist veterans and their families and friends. The crisis line is open 24/7 and can be reached by calling 1-800-8255, option 1, or by visiting https://www.veteranscrisisline.net.

In a 2015 study appearing in Annals of Epidemiology, VA associated researchers examined the risk of suicide among active-duty, National Guard, and Reserve veterans who were deployed in Operation Enduring Freedom and Operation Iraqi Freedom, and were separated from duty between 2002 and 2011. Looking at the data of veterans who were 7 years past active-duty service, researchers found a difference in rates by gender. To approximate the suicide risk over time, researchers used a hazard rate, which calculates the deaths by suicide per 100,000 veterans alive for each year that they have been away from service.

Although researchers found the overall suicide risk to be higher among male veterans (1,491 suicides out of 1,237,049) than that for female veterans (62 out of 164,333), the percentage of suicides among males has been decreasing by 6.1%, on average, per year. The percentage of suicides for female veterans varied through the years with a hazard rate of 9.1 in the first year after service, 15.0 in the fourth year, and 9.9 in the seventh year.  

Another 2015 study, also appearing in Annals of Epidemiology, showed rates of suicide differed in gender among deployed and nondeployed veterans during the same wars between 2001 and 2007. Researchers found out of 68 female and 1,582 male deployed deaths there were 15 deployed suicides among females and 336 suicides among males. The numbers for nondeployed suicides were higher than deployed suicides. Among 738 nondeployed female deaths, 109 were suicides, and of 6,965 nondeployed deaths among males, 1,408 were suicides.

To help decrease the suicide rate among veterans, the VA provides a Veterans Crisis Line to assist veterans and their families and friends. The crisis line is open 24/7 and can be reached by calling 1-800-8255, option 1, or by visiting https://www.veteranscrisisline.net.

Meaningful use is on its way out.

Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services, told investors attending the annual J.P. Morgan Healthcare Conference that CMS is pulling back from the health care IT incentive program in the coming months.

“The meaningful use program as it has existed will now be effectively over and replaced with something better,” Mr. Slavitt said.*

“We have to get the hearts and minds of physicians back. I think we’ve lost them,” Mr. Slavitt said. He noted that, when the meaningful use incentive program began, few physicians and practices used electronic health records and concerns were that many would not willingly embrace information technology. Now that “virtually everywhere care is delivered has a computer,” it’s time to make health care technology serve beneficiaries and the physicians who serve them, Mr. Slavitt said.

The cost, however, was too high, Mr. Slavitt said. “As any physician will tell you, physician burden and frustration levels are real. Programs that are designed to improve often distract. Done poorly, measures are divorced from how physicians practice and add to the cynicism that the people who build these programs just don’t get it.”

Soon, CMS will no longer reward health care providers for using technology, but will instead focus on patient outcomes through the merit-based incentive pay systems created by last year’s Medicare Access and CHIP Reauthorization Act (MACRA) legislation. In addition to asking physicians to work with health care IT innovators to create systems that work best according to their practice’s respective needs, CMS is calling on the private sector to create apps and analytic tools that will keep data secure while fostering true and widespread interoperability.

Anyone seeking to block data transfer will find CMS is not their friend. Mr. Slavitt said. “We’re deadly serious about interoperability. Technology companies that look for ways to practice data blocking in opposition to new regulations will find that it will not be tolerated.”

Dr. James L. Madara, CEO of the American Medical Association, echoed Mr. Slavitt’s comments on the current, negative impact of EHRs on physicians’ practices. He noted that many physicians are spending at least 2 hours each workday using their EHR and may click up to 4,000 times per 8-hour shift.

Dr. Madara outlined three AMA goals to help restore the physician-patient relationship. The first is to restructure the medical school curriculum, which he said essentially is the same as it has been for 100 years. New generations of physicians should be taught how to deliver collaborative care that includes telemedicine, more ambulatory care, and home care. Community-based partnerships, he said, would become key to treating chronic diseases like diabetes and would have to be factored into reimbursement models. The AMA also seeks to improve health outcomes and ensure thriving physician practices.

Central to the AMA’s plan for the future: Helping physicians restructure practice via technology. He announced that the AMA is a founding partner in the Silicon Valley (Calif.) based Health2047, a company focused on supporting health IT and other entrepreneurs in their efforts to provide physicians with digital tools that improve patient outcomes, among other innovations.

With MACRA set to go into full effect in 2019, Dr. Madara said that a “daunting” level of change is about to take place. Citing the successful shift to ICD-10, he said he was optimistic there would be positive changes, largely brought about through incentives to the private marketplace and by dropping meaningful use.

Although having metrics in health care delivery is important, Dr. Madara said that, up to this point, “We kinda got it wrong” with quality measures that are more processed based, rather than evidence based. “It was really great to hear about the move from meaningful use to a more aggregated program.”

*Correction, 1/12/2016: A previous version of this story included an incorrect start-up date for meaningful use changes.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

Meaningful use is on its way out.

Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services, told investors attending the annual J.P. Morgan Healthcare Conference that CMS is pulling back from the health care IT incentive program in the coming months.

“The meaningful use program as it has existed will now be effectively over and replaced with something better,” Mr. Slavitt said.*

“We have to get the hearts and minds of physicians back. I think we’ve lost them,” Mr. Slavitt said. He noted that, when the meaningful use incentive program began, few physicians and practices used electronic health records and concerns were that many would not willingly embrace information technology. Now that “virtually everywhere care is delivered has a computer,” it’s time to make health care technology serve beneficiaries and the physicians who serve them, Mr. Slavitt said.

The cost, however, was too high, Mr. Slavitt said. “As any physician will tell you, physician burden and frustration levels are real. Programs that are designed to improve often distract. Done poorly, measures are divorced from how physicians practice and add to the cynicism that the people who build these programs just don’t get it.”

Soon, CMS will no longer reward health care providers for using technology, but will instead focus on patient outcomes through the merit-based incentive pay systems created by last year’s Medicare Access and CHIP Reauthorization Act (MACRA) legislation. In addition to asking physicians to work with health care IT innovators to create systems that work best according to their practice’s respective needs, CMS is calling on the private sector to create apps and analytic tools that will keep data secure while fostering true and widespread interoperability.

Anyone seeking to block data transfer will find CMS is not their friend. Mr. Slavitt said. “We’re deadly serious about interoperability. Technology companies that look for ways to practice data blocking in opposition to new regulations will find that it will not be tolerated.”

Dr. James L. Madara, CEO of the American Medical Association, echoed Mr. Slavitt’s comments on the current, negative impact of EHRs on physicians’ practices. He noted that many physicians are spending at least 2 hours each workday using their EHR and may click up to 4,000 times per 8-hour shift.

Dr. Madara outlined three AMA goals to help restore the physician-patient relationship. The first is to restructure the medical school curriculum, which he said essentially is the same as it has been for 100 years. New generations of physicians should be taught how to deliver collaborative care that includes telemedicine, more ambulatory care, and home care. Community-based partnerships, he said, would become key to treating chronic diseases like diabetes and would have to be factored into reimbursement models. The AMA also seeks to improve health outcomes and ensure thriving physician practices.

Central to the AMA’s plan for the future: Helping physicians restructure practice via technology. He announced that the AMA is a founding partner in the Silicon Valley (Calif.) based Health2047, a company focused on supporting health IT and other entrepreneurs in their efforts to provide physicians with digital tools that improve patient outcomes, among other innovations.

With MACRA set to go into full effect in 2019, Dr. Madara said that a “daunting” level of change is about to take place. Citing the successful shift to ICD-10, he said he was optimistic there would be positive changes, largely brought about through incentives to the private marketplace and by dropping meaningful use.

Although having metrics in health care delivery is important, Dr. Madara said that, up to this point, “We kinda got it wrong” with quality measures that are more processed based, rather than evidence based. “It was really great to hear about the move from meaningful use to a more aggregated program.”

*Correction, 1/12/2016: A previous version of this story included an incorrect start-up date for meaningful use changes.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

Meaningful use is on its way out.

Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services, told investors attending the annual J.P. Morgan Healthcare Conference that CMS is pulling back from the health care IT incentive program in the coming months.

“The meaningful use program as it has existed will now be effectively over and replaced with something better,” Mr. Slavitt said.*

“We have to get the hearts and minds of physicians back. I think we’ve lost them,” Mr. Slavitt said. He noted that, when the meaningful use incentive program began, few physicians and practices used electronic health records and concerns were that many would not willingly embrace information technology. Now that “virtually everywhere care is delivered has a computer,” it’s time to make health care technology serve beneficiaries and the physicians who serve them, Mr. Slavitt said.

The cost, however, was too high, Mr. Slavitt said. “As any physician will tell you, physician burden and frustration levels are real. Programs that are designed to improve often distract. Done poorly, measures are divorced from how physicians practice and add to the cynicism that the people who build these programs just don’t get it.”

Soon, CMS will no longer reward health care providers for using technology, but will instead focus on patient outcomes through the merit-based incentive pay systems created by last year’s Medicare Access and CHIP Reauthorization Act (MACRA) legislation. In addition to asking physicians to work with health care IT innovators to create systems that work best according to their practice’s respective needs, CMS is calling on the private sector to create apps and analytic tools that will keep data secure while fostering true and widespread interoperability.

Anyone seeking to block data transfer will find CMS is not their friend. Mr. Slavitt said. “We’re deadly serious about interoperability. Technology companies that look for ways to practice data blocking in opposition to new regulations will find that it will not be tolerated.”

Dr. James L. Madara, CEO of the American Medical Association, echoed Mr. Slavitt’s comments on the current, negative impact of EHRs on physicians’ practices. He noted that many physicians are spending at least 2 hours each workday using their EHR and may click up to 4,000 times per 8-hour shift.

Dr. Madara outlined three AMA goals to help restore the physician-patient relationship. The first is to restructure the medical school curriculum, which he said essentially is the same as it has been for 100 years. New generations of physicians should be taught how to deliver collaborative care that includes telemedicine, more ambulatory care, and home care. Community-based partnerships, he said, would become key to treating chronic diseases like diabetes and would have to be factored into reimbursement models. The AMA also seeks to improve health outcomes and ensure thriving physician practices.

Central to the AMA’s plan for the future: Helping physicians restructure practice via technology. He announced that the AMA is a founding partner in the Silicon Valley (Calif.) based Health2047, a company focused on supporting health IT and other entrepreneurs in their efforts to provide physicians with digital tools that improve patient outcomes, among other innovations.

With MACRA set to go into full effect in 2019, Dr. Madara said that a “daunting” level of change is about to take place. Citing the successful shift to ICD-10, he said he was optimistic there would be positive changes, largely brought about through incentives to the private marketplace and by dropping meaningful use.

Although having metrics in health care delivery is important, Dr. Madara said that, up to this point, “We kinda got it wrong” with quality measures that are more processed based, rather than evidence based. “It was really great to hear about the move from meaningful use to a more aggregated program.”

*Correction, 1/12/2016: A previous version of this story included an incorrect start-up date for meaningful use changes.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

The Air Force Medical Service offers 3 mobile applications designed to encourage health and well-being: the Pregnancy Mobile  App, the Center of Excellence for Medical Multimedia (CEMM) Virtual Medical Center App, and the Wingman Toolkit App.

The Pregnancy Mobile App includes tools such as a pregnancy journal, an appointment manager, and kick and contraction counters. The user can also track health stats, such as biometrics, vitals, labs, ultrasounds, screenings, and vaccinations/immunizations.

The CEMM Virtual Medical Center App has patient education tools, such as a 3D Medical Animation library, Rx drug listing and reminder, adult and childhood immunization lists, and CEMM library. It also provides TRICARE tools, including military treatment facility locator, news feed, and Plan finder.

The Wingman Toolkit App was based on Master Resilience Training to help users “bounce back and recover when facing a difficult issue.” The toolkit also provides just-in-time resources such as quick access to the National Suicide Prevention Lifeline, the DoD Safe Helpline, and the user’s Wingman. Interactive tools include PT test requirements and workout reminders.

For more information on these apps, visit www.airforcemedicine.af.mil/healthy-living/mobile-apps.

The Air Force Medical Service offers 3 mobile applications designed to encourage health and well-being: the Pregnancy Mobile  App, the Center of Excellence for Medical Multimedia (CEMM) Virtual Medical Center App, and the Wingman Toolkit App.

The Pregnancy Mobile App includes tools such as a pregnancy journal, an appointment manager, and kick and contraction counters. The user can also track health stats, such as biometrics, vitals, labs, ultrasounds, screenings, and vaccinations/immunizations.

The CEMM Virtual Medical Center App has patient education tools, such as a 3D Medical Animation library, Rx drug listing and reminder, adult and childhood immunization lists, and CEMM library. It also provides TRICARE tools, including military treatment facility locator, news feed, and Plan finder.

The Wingman Toolkit App was based on Master Resilience Training to help users “bounce back and recover when facing a difficult issue.” The toolkit also provides just-in-time resources such as quick access to the National Suicide Prevention Lifeline, the DoD Safe Helpline, and the user’s Wingman. Interactive tools include PT test requirements and workout reminders.

For more information on these apps, visit www.airforcemedicine.af.mil/healthy-living/mobile-apps.

The Air Force Medical Service offers 3 mobile applications designed to encourage health and well-being: the Pregnancy Mobile  App, the Center of Excellence for Medical Multimedia (CEMM) Virtual Medical Center App, and the Wingman Toolkit App.

The Pregnancy Mobile App includes tools such as a pregnancy journal, an appointment manager, and kick and contraction counters. The user can also track health stats, such as biometrics, vitals, labs, ultrasounds, screenings, and vaccinations/immunizations.

The CEMM Virtual Medical Center App has patient education tools, such as a 3D Medical Animation library, Rx drug listing and reminder, adult and childhood immunization lists, and CEMM library. It also provides TRICARE tools, including military treatment facility locator, news feed, and Plan finder.

The Wingman Toolkit App was based on Master Resilience Training to help users “bounce back and recover when facing a difficult issue.” The toolkit also provides just-in-time resources such as quick access to the National Suicide Prevention Lifeline, the DoD Safe Helpline, and the user’s Wingman. Interactive tools include PT test requirements and workout reminders.

For more information on these apps, visit www.airforcemedicine.af.mil/healthy-living/mobile-apps.

Native American veterans have the highest rate of posttraumatic stress disorder (PTSD) of any ethnic group and often face significant barriers to care, such as living in rural and remote areas. To help overcome those barriers, the Office of Rural Health (ORH) established its Native Domain, a national resource on health care issues for rural Native veterans.

The Native Domain’s Telemental Health Services provides ongoing mental health care—including medication management, case management, and individual, group, and family psychotherapy—via videoconferencing to veterans who live on or near rural American Indian reservations in Montana, Wyoming, and South Dakota.

This “unique service within the VA system” demonstrates an “innovative model,” according to the ORH. Studies have suggested that telemental health is as effective as face-to-face services. For example, a 2010 study of 125 veterans with PTSD found videoconferencing an “effective and feasible” way to increase access to evidence-based care.

Clinic staff include VA-employed Tribal Outreach Workers (TOWs), who are usually military veterans and members of the tribes they serve. Their varied duties range from helping Native veterans enroll in the clinic programs, showing patients how to use the videoconferencing equipment, troubleshooting clinic telecommunications equipment, to coordinating emergency crisis management. The TOWs also work closely with the remote clinicians and provide guidance on cultural and community issues that may be relevant to the patient’s care or treatment.

The American Indian Telemental Health video (www.ruralhealth.va.gov/media/american-indian-telemental-health.asx) is an overview of a series of clinics that use videoconferencing. More information on the telemental health clinics is available at www.ruralhealth.va.gov/native/programs/telemental-services.asp.

Native American veterans have the highest rate of posttraumatic stress disorder (PTSD) of any ethnic group and often face significant barriers to care, such as living in rural and remote areas. To help overcome those barriers, the Office of Rural Health (ORH) established its Native Domain, a national resource on health care issues for rural Native veterans.

The Native Domain’s Telemental Health Services provides ongoing mental health care—including medication management, case management, and individual, group, and family psychotherapy—via videoconferencing to veterans who live on or near rural American Indian reservations in Montana, Wyoming, and South Dakota.

This “unique service within the VA system” demonstrates an “innovative model,” according to the ORH. Studies have suggested that telemental health is as effective as face-to-face services. For example, a 2010 study of 125 veterans with PTSD found videoconferencing an “effective and feasible” way to increase access to evidence-based care.

Clinic staff include VA-employed Tribal Outreach Workers (TOWs), who are usually military veterans and members of the tribes they serve. Their varied duties range from helping Native veterans enroll in the clinic programs, showing patients how to use the videoconferencing equipment, troubleshooting clinic telecommunications equipment, to coordinating emergency crisis management. The TOWs also work closely with the remote clinicians and provide guidance on cultural and community issues that may be relevant to the patient’s care or treatment.

The American Indian Telemental Health video (www.ruralhealth.va.gov/media/american-indian-telemental-health.asx) is an overview of a series of clinics that use videoconferencing. More information on the telemental health clinics is available at www.ruralhealth.va.gov/native/programs/telemental-services.asp.

Native American veterans have the highest rate of posttraumatic stress disorder (PTSD) of any ethnic group and often face significant barriers to care, such as living in rural and remote areas. To help overcome those barriers, the Office of Rural Health (ORH) established its Native Domain, a national resource on health care issues for rural Native veterans.

The Native Domain’s Telemental Health Services provides ongoing mental health care—including medication management, case management, and individual, group, and family psychotherapy—via videoconferencing to veterans who live on or near rural American Indian reservations in Montana, Wyoming, and South Dakota.

This “unique service within the VA system” demonstrates an “innovative model,” according to the ORH. Studies have suggested that telemental health is as effective as face-to-face services. For example, a 2010 study of 125 veterans with PTSD found videoconferencing an “effective and feasible” way to increase access to evidence-based care.

Clinic staff include VA-employed Tribal Outreach Workers (TOWs), who are usually military veterans and members of the tribes they serve. Their varied duties range from helping Native veterans enroll in the clinic programs, showing patients how to use the videoconferencing equipment, troubleshooting clinic telecommunications equipment, to coordinating emergency crisis management. The TOWs also work closely with the remote clinicians and provide guidance on cultural and community issues that may be relevant to the patient’s care or treatment.

The American Indian Telemental Health video (www.ruralhealth.va.gov/media/american-indian-telemental-health.asx) is an overview of a series of clinics that use videoconferencing. More information on the telemental health clinics is available at www.ruralhealth.va.gov/native/programs/telemental-services.asp.

Medical ethics of the DoD and Central Intelligence Agency (CIA) concerning military detainees deteriorated after 9/11 according to evidence presented in a medical essay by researchers Leonard S. Rubenstein, Scott A. Allen, and Phyllis A. Guze.

The Institute on Medicine as a Profession assembled an independent task force composed of 20 experts in military medicine, human rights, and bioethics to review the conduct of medical personnel in detention facilities. The report found that the DoD and CIA required physicians, psychologists, and other health care providers to act against their professional obligations,  by approving and monitoring torturous methods of interrogation, setting disruptive conditions of confinement, and force-feeding hunger strikers.  

Outraged medical groups responded with further clarification of their ethical obligations and reinforced that physicians have no legitimate role in monitoring interrogations or participating in pain-causing acts for nonclinical reasons. According to the Defense Health Board, military medical personnel’s first loyalty is to the patient. Ethically, a physician can only assess whether the patient is on a hunger strike, determine their capacity to make rational health decisions, counsel on the risks and benefits of certain decisions, and provide medical care to the patient with their consent.

In January 2013, the Under Secretary of Defense to the Defense Health Board sent a formal request to investigate how military medical personnel balance their dual roles as military officers and health care providers and how much leeway can be given to personnel for excusal from military operations with which they have ethical reservations.

The board’s Medical Ethics Subcommittee was charged with the investigation and found “the DoD does not have an enterprise-wide, formal integrated infrastructure to systematically build, support, sustain, and promote an evolving ethical culture with the military health care environment.” Along with its other findings, the subcommittee recommended establishing a code of conduct for military medical personnel. In addition to adopting all subcommittee’s recommendations, the board made its recommendations to help strengthen the framework of military medical ethics by providing more efficient training and support of health professionals, enforcing the tightening of standards of medical confidentiality, and enhancing the protection of medical personnel confronted by unethical demands from commanders.

The Secretary of Defense adopted and implemented these recommendations with the support of the medical community, but in 2015 an independent investigation showed that the American Psychological Association (APA) approved the participation of psychologists in counter-terrorism interrogations with the DoD. As a result, the APA changed its stance, and currently no professional organization finds ethical basis for participating in interrogations or reason to waiver their ethical standards, based on the professional’s role.

Rubenstein, Scott, and Guze urge all health professional organizations to adopt the Defense Health Board’s recommendations “as part of their task to stand for the moral values underlying health practice,” and encourage these groups to seek congressional oversight in the reform process to ensure the integrity of military medical ethics.

Source:
Rubenstein LS, Allen SA, Guze PA. Advancing Medical Professionalism in US Military Detainee Treatment. PLoS Med. 13(1):e1001930.
doi: 10.1371/journal.pmed.1001930.

Medical ethics of the DoD and Central Intelligence Agency (CIA) concerning military detainees deteriorated after 9/11 according to evidence presented in a medical essay by researchers Leonard S. Rubenstein, Scott A. Allen, and Phyllis A. Guze.

The Institute on Medicine as a Profession assembled an independent task force composed of 20 experts in military medicine, human rights, and bioethics to review the conduct of medical personnel in detention facilities. The report found that the DoD and CIA required physicians, psychologists, and other health care providers to act against their professional obligations,  by approving and monitoring torturous methods of interrogation, setting disruptive conditions of confinement, and force-feeding hunger strikers.  

Outraged medical groups responded with further clarification of their ethical obligations and reinforced that physicians have no legitimate role in monitoring interrogations or participating in pain-causing acts for nonclinical reasons. According to the Defense Health Board, military medical personnel’s first loyalty is to the patient. Ethically, a physician can only assess whether the patient is on a hunger strike, determine their capacity to make rational health decisions, counsel on the risks and benefits of certain decisions, and provide medical care to the patient with their consent.

In January 2013, the Under Secretary of Defense to the Defense Health Board sent a formal request to investigate how military medical personnel balance their dual roles as military officers and health care providers and how much leeway can be given to personnel for excusal from military operations with which they have ethical reservations.

The board’s Medical Ethics Subcommittee was charged with the investigation and found “the DoD does not have an enterprise-wide, formal integrated infrastructure to systematically build, support, sustain, and promote an evolving ethical culture with the military health care environment.” Along with its other findings, the subcommittee recommended establishing a code of conduct for military medical personnel. In addition to adopting all subcommittee’s recommendations, the board made its recommendations to help strengthen the framework of military medical ethics by providing more efficient training and support of health professionals, enforcing the tightening of standards of medical confidentiality, and enhancing the protection of medical personnel confronted by unethical demands from commanders.

The Secretary of Defense adopted and implemented these recommendations with the support of the medical community, but in 2015 an independent investigation showed that the American Psychological Association (APA) approved the participation of psychologists in counter-terrorism interrogations with the DoD. As a result, the APA changed its stance, and currently no professional organization finds ethical basis for participating in interrogations or reason to waiver their ethical standards, based on the professional’s role.

Rubenstein, Scott, and Guze urge all health professional organizations to adopt the Defense Health Board’s recommendations “as part of their task to stand for the moral values underlying health practice,” and encourage these groups to seek congressional oversight in the reform process to ensure the integrity of military medical ethics.

Source:
Rubenstein LS, Allen SA, Guze PA. Advancing Medical Professionalism in US Military Detainee Treatment. PLoS Med. 13(1):e1001930.
doi: 10.1371/journal.pmed.1001930.

Medical ethics of the DoD and Central Intelligence Agency (CIA) concerning military detainees deteriorated after 9/11 according to evidence presented in a medical essay by researchers Leonard S. Rubenstein, Scott A. Allen, and Phyllis A. Guze.

The Institute on Medicine as a Profession assembled an independent task force composed of 20 experts in military medicine, human rights, and bioethics to review the conduct of medical personnel in detention facilities. The report found that the DoD and CIA required physicians, psychologists, and other health care providers to act against their professional obligations,  by approving and monitoring torturous methods of interrogation, setting disruptive conditions of confinement, and force-feeding hunger strikers.  

Outraged medical groups responded with further clarification of their ethical obligations and reinforced that physicians have no legitimate role in monitoring interrogations or participating in pain-causing acts for nonclinical reasons. According to the Defense Health Board, military medical personnel’s first loyalty is to the patient. Ethically, a physician can only assess whether the patient is on a hunger strike, determine their capacity to make rational health decisions, counsel on the risks and benefits of certain decisions, and provide medical care to the patient with their consent.

In January 2013, the Under Secretary of Defense to the Defense Health Board sent a formal request to investigate how military medical personnel balance their dual roles as military officers and health care providers and how much leeway can be given to personnel for excusal from military operations with which they have ethical reservations.

The board’s Medical Ethics Subcommittee was charged with the investigation and found “the DoD does not have an enterprise-wide, formal integrated infrastructure to systematically build, support, sustain, and promote an evolving ethical culture with the military health care environment.” Along with its other findings, the subcommittee recommended establishing a code of conduct for military medical personnel. In addition to adopting all subcommittee’s recommendations, the board made its recommendations to help strengthen the framework of military medical ethics by providing more efficient training and support of health professionals, enforcing the tightening of standards of medical confidentiality, and enhancing the protection of medical personnel confronted by unethical demands from commanders.

The Secretary of Defense adopted and implemented these recommendations with the support of the medical community, but in 2015 an independent investigation showed that the American Psychological Association (APA) approved the participation of psychologists in counter-terrorism interrogations with the DoD. As a result, the APA changed its stance, and currently no professional organization finds ethical basis for participating in interrogations or reason to waiver their ethical standards, based on the professional’s role.

Rubenstein, Scott, and Guze urge all health professional organizations to adopt the Defense Health Board’s recommendations “as part of their task to stand for the moral values underlying health practice,” and encourage these groups to seek congressional oversight in the reform process to ensure the integrity of military medical ethics.

Source:
Rubenstein LS, Allen SA, Guze PA. Advancing Medical Professionalism in US Military Detainee Treatment. PLoS Med. 13(1):e1001930.
doi: 10.1371/journal.pmed.1001930.