New Edition of the Diagnostic and Statistical Manual of Mental Disorders Likely to Change Autism Diagnosis

Epidemiologists, sociologists, , medical anthropologists, psychologists, psychiatrists, and all manner of other experts have long been aware of the extent to which statistics about incidence and prevalence of disorders are very much a function of how those disorders are defined.

A change in definition can drastically affect statistics and give the public — unaware of what might have been either a  change in wording or the combining of  two categories into one — the sense that a disorder is becoming either more or less of a problem.

This has always been an issue  in autism statistics, and I wanted to call to your attention to the latest debate over how autism will be defined in the next version of the Diagnostic and Statistical Manual of Mental Disorders.

Lancet Retracts Fatigue Syndrome Paper

Our deep  impulse to seek closure, certainty, and finality — especially in the realm of health and science – is extremely powerful.

To live for an extended period without these things means inhabiting that insecure mental terrain where questions remain unanswered, where solutions are partial, where  causation is rarely proven with complete certainty, and where one day’s “truth” can quickly disappear with the emergence of  some new revelation.

Truth, in short, is a process, not a sacrament.

And so it is  that today  we learn about a development in scientific research that requires us, yet again,  to confront the fluid and constantly evolving nature of scientific truth.

What was “true” may no longer be “true.”

Wouldn’t this  be as good a time as any to finally accept the transitory nature of  scientific inquiry and recognize that real scientific literacy requires a tolerance and acceptance of this uncertainty?

New York. The un-Michigan. The un-Wisconsin. Why not?

With Michigan and Wisconsin “leading” the way, we now seem to live in a culture where — rather than confront the realities of  poverty, hunger, income inequality, worker’s rights, the right to basic health care — it is infinitely simpler to focus on the alleged greed of unionized workers who — this line of nonsense goes — are the cause of everything from a bad economy to the seasonal flu.

Just thought I’d mention that New Yorkers now have a chance to show the nation a different way, to stop the demonizing of workers, to reject the union busting, and to show support for  professionals who have chosen to dedicate their lives to the quality of our lives.

I am absolutely serious: The New York State Nurses’ Association,  properly outraged by a system that seeks their sacrifice while continuing to raise executive compensation, is at a crossroads that very well might lead to a strike that they have already voted to authorize.

This really is a chance to show the country a different path.

Why don’t we all — patients, future patients, health care professionals, citizens  – stun a nation caught in an epidemic of victim-blaming and support workers who aren’t afraid to take a courageous stand for fairness and equity.

Think about it. We could stand proudly as the un-Michigan, the un-Wisconsin, as the one of the first places to stop the scapegoating and stand by those who have stood by us.

I kind of like the sound of it:

New York. The un-Michigan. The un-Wisconsin.

New York. The state that had a simple and different answer:

Enough.

2.5 Million Young People Now Have Health Insurance; Republicans Prepare to Argue That Healthy 24 Year-Olds Are Actually “Job-Killing”

It long ago became clear that the primary Republican strategy for dealing with President Obama was 1) to quickly and completely denigrate or deny any alleged accomplishment of his administration and 2) to obstruct any possible accomplishment, regardless of who might be affected by that obstruction. President Obama was — at every opportunity — to be branded as a failure.

As both a student and veteran of electoral politics, I immediately realized that I was witnessing something that was actually quite unusual. This wasn’t going to be your average, run of the mill, “sabotaging-the-opposition-at-every-turn-but-ultimately coming-up-with-some-uneasy-compromise” strategy.

Rather, the Republicans were going to engage in a version of “total war” with no compromise, no goodwill, no prisoners and no acknowledgement whatsoever that any action by the President might have been successful.

In fact (and only next year will we learn if this strategy was successful) they chose not even to fake collegiality or compromise. Rather, they have been completely open about obstructing any proposal made by the President and pooh-poohing any supposed accomplishment.

But this isn’t about my disgust with the Republican leadership.

It’s about the latest data revealing the extraordinary impact of the President’s landmark health care reform bill, the bill that Republican legislators — following the precise language provided by consultants like Frank Luntz – called the “job-killing” health care bill.  (You may have noticed that anything the President does, up to and including taking Sasha and Malia out to Five Guys for a burger, is “job-killing.”)

Yesterday, the Department of Health and Human Services released new data from the National Center for Health Statistics at the Centers for Disease Control and Prevention (CDC) illustrating that the Affordable Care Act helped 2.5 million additional young adults get health insurance. I strongly recommend a post by my colleague Barbara Glickstein at Hunter College’s Center for Health, Media and Policy that both explains the new data and reveals the extent to which it actually is a shot in the arm for young “job-growing” entrepreneurs. Check it out.

Now all we have to do is wait and watch. The Republican playbook requires that this now be positioned as roughly comparable to either a drug-resistant infection or a chronic rash.  So let’s see the twisted language or logic they come up with to convince the parents or guardians of these 2.5 million young adults that health insurance is a bad thing.

Let’s see exactly what they say to the mother of a recent college graduate who has been able to rejoin her family’s health plan for a year or two while she finds her place in an uncertain economy.

Let’s watch as they argue  that we are  all worse off — that jobs have been killed — because that woman’s 23 year-old daughter can now have a routine gynecological exam without taking out a second mortgage.

Go ahead, tell her.  Make my day.

Why I Have Avoided Steven Soderbergh’s Film “Contagion.”

It took me a while to figure out why I have been so reluctant to see Steven Soderbergh’s film Contagion.  Then I wrote this fictional “memo” to him on the web site of Hunter College’s Center for Health, Media and Policy.

Now I am ready to watch it.

A Postscript to a Hasty Judgement: On Remembering the Complexity of Human Interactions

Because I was so quick to tell you the story — reported so ably in the New York Times by Richard Perez-Pena – of a student with a stuttering problem  at a New Jersey college who had been asked by the Professor not to speak in class, I need to add a postscript.

While the full details of the story may remain murky, Perez-Pena — in the admirable journalistic tradition of careful follow-up when new details are revealed – – wrote a subsequent story with the instructor’s version of events.

Without claiming that I now have a firm handle on the truth in this complex situation, I do feel obligated to state the following:

Virtually every complex human interaction imaginable defies easy description. First-rate writers and researchers can try, and perhaps come close, but it is inevitable that different parties and witnesses to an interaction will see things differently.  Perez-Pena, a skilled and distinguished  professional,  was forced — given the initial choice of the professor not to comment — to write the first  story without her version. Only days later, when she did agree to speak, Perez-Pena immediately wrote a follow-up.

The speed with which I angrily chastised the instructor and the institution for this incident, while born of a deep anger and sensitivity to discrimination against people with disabilities, clearly should have awaited a fuller  account including the professor’s version. I still may not fully agree with what I now know was  the professor’s judgement, but the point is that my reaction preceded my even having any idea what that  judgement was.

The fault was allowing my indignation about discrimination  (an indignation that is alive, well, and still white-hot) to lead me to temporarily reject even the possibility of an alternate version of events.  I should have thought more carefully before allowing anger to trump caution.

Isn’t it just like complexity to come along and ruin certainty and clarity?

The Highly Legitimate, Infinitely Respected, and Ever So Weird Laboratory of Dr. Rudolph Witthaus

This brief post I wrote — The Highly Legitimate, Infinitely Respected, and Ever So Weird Laboratory of Dr. Rudolph Witthaus – appears on the blog of the Center for Health Media and Policy.

The post draws on a fascinating new book by Paul Collins that I read recently – The  Murder of the Century:  The Gilded Age Crime That Scandalized the City and Sparked the Tabloid Wars — that, in addition to telling the story of the Hearst/Pulitzer tabloid wars – describes the world of forensic criminology and pathology in the late 19th century.

It’s a great read.

Findings Reported in Scholarly Journals Are Invitations to Debate, Not Settled and Received Wisdom

We can never forget that the imprimatur of a prestigious medical
journal does not exempt any article within from the rigorous scrutiny that
serious science deserves.

Of course, we should listen carefully when findings are reported
in JAMA or Lancet or the American Journal of Nursing or any other top-shelf
publication. But these publications are not sacred texts. Indeed, the
appearance of an article in a prestigious journal is an invitation for other
scientists to critically engage with the reported research and findings.

This blog post by epidemiologist Phil Alcabes – focusing on a
reported connection between HIV risk and hormonal contraceptive use – is an
excellent example of a scientist showing how the widely publicized findings reported  in a prestigious journal can be significantly more complex and problematic than the headline treatment they may have received in media accounts.

My main point? Public literacy about science health and medicine
will require a wider understanding of the scientific enterprise itself, including
the means by which research is conducted, conclusions reached, and findings published.

The wider public simply has to get a better understanding of the
fact that the publication of even the most authoritative findings does not
signal the end of debate.   Journal articles in all disciplines are contributions
to long, ongoing conversations. They are invitations to engage and question and
to continue to struggle toward truth.

Journals should be seen as sites of rigorous argument in a vital
public sphere, not as vehicles to transmit “signed, sealed, and delivered” wisdom.

College Instructor Tells Stutterer Not to Speak in Class. I’m Serious.

Those of us who hunger for more complex, helpful, and nuanced coverage of  health issues might want to take a look at a story in today’s New York Times by  Richard Perez-Pena. The story is about the atrocious treatment received by a student with a stuttering problem at a college in New Jersey.

The story itself is a remarkable and painful account of just how much one thoughtless institution can botch what should have been the routine accommodation provided  to a student with a disability. Having been a higher education administrator,  eminently capable of my own occasional botch, I promise you that the treatment of one Philip Garber Jr. at The County College of Morris rises to a  mega-botch surpassing very few epic mistakes that I can recall.

Beyond the specific story, though, is what this reveals  about the importance of maintaining relationships with reporters whose beats  might not have any  obvious connection to health.  Richard recently took on the higher education beat for The Times.  Yet this was the vantage point from which he  chose to write an uncommonly thoughtful story about a health/wellness issue  that can only benefit from more visibility and public awareness.

Richard is not new to health issues. A  remarkable, continuing series he did on diabetes was one of the best I have  ever seen in any medium.

My point is that there is probably no news beat that is not a potentially fruitful domain for a provocative and informative story about  health-related issues.

The Misuse of ADHD as a Metaphor

You might want to check out this very thoughtful article in today’s New York Times about ADHD. Dr Klass tries to cut through all the overuse and misuse of the term “ADHD” and focus on what we do and do not  know about the science.

Article’s money point: The use of ADHD as a metaphor for the general problems of focus in a multi-tasking,  digital age even further obscures the actual disorder and the science.

I also admit a bias for any article about almost any subject that includes the sentence: “There is much we don’t know.” 

There are moments when I think that the task of communicating clear, useful information about health issues will require that all participants in the process — communicators, scientists, health care professionals, and audience – be able to openly and fully acknowledge what is not known about a topic.

Unfortunately, this simple admission turns out not to be so simple in professional cultures built on foundations  of what is known, what can be known, or what will be known.

Wisdom might require that we more fully embrace and understand the meaning of the null finding, the dead end, the confounding intervening variable, the contradiction, the messy nuance, and even what might — for a moment – seem to be complete hopelessness. 

To acknowledge being lost is not to settle for a permanent wilderness. It is the necessary,  honest confrontation with the world that begins an authentic, unflinching  journey  to truth.