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Physician's First Watch:
Medical News from Journal Watch

May 20, 2013

DSM-5 Debuts to a Scornful Review in Annals, Skepticism from NIMH

By Joe Elia

The new, fifth edition of the Diagnostic and Statistical Manual of Mental Disorders has been panned in an Annals of Internal Medicine commentary. The author, chair of the DSM-4 task force, advises that clinicians use it "cautiously, if at all."

Separately, the director of the National Institute of Mental Health says that "patients with mental disorders deserve better." Late last month he wrote that the institute will be "re-orienting its research away from DSM categories" to focus on biomarkers of mental disease rather than clusters of symptoms.

The Annals commentator seems especially disappointed with the proliferation of diagnoses "at the fuzzy boundary with normality." He says the result "will probably lead to substantial false-positive rates and unnecessary treatment." Perhaps most damning is his charge that the American Psychiatric Association has a financial conflict of interest driven by DSM revenues (the new edition costs about $200), which led to "premature publication of an incompletely tested and poorly edited product."

LINK(S):

DSM-5 website (Free)

Annals of Internal Medicine comment (Free)

National Institute of Mental Health director's blog (Free)

Published in Physician's First Watch May 20, 2013

Would You Like a Shot with That Shot? A New Venue for Vaccinating MSM Against Invasive Meningococcal Disease

By Amy Orciari Herman

The rise of invasive serogroup C Neisseria meningitidis disease among men who have sex with men (MSM) in New York City has at least one doctor taking a creative approach to vaccination: offer the meningococcal shot to as many men as possible in gay bars and clubs in the city.

The New York Times details the mission of Dr. Demetre Daskalakis to confer herd immunity by setting up his own vaccination "clinics" in several after-hours hotspots. Dr. Daskalakis's efforts highlight concern over this deadly strain of meningitis, which has infected 22 MSM in New York City since 2010, killing seven of them. Twelve of those infected were also HIV-positive.

Asked to comment, Paul Sax of Journal Watch HIV/AIDS Clinical Care noted: "The practice of bringing preventive health interventions directly to those at greatest risk is highly desirable, and frequently must take healthcare providers outside of clinics, offices, and hospitals."

LINK(S):

New York Times story (Free)

Background: Journal Watch Infectious Diseases coverage of meningitis in MSM in New York City (Your Journal Watch subscription required)

Published in Physician's First Watch May 20, 2013

WHO: Yellow Fever Booster No Longer Necessary

By The Editors

The yellow fever booster shot, given 10 years after the initial vaccination, is no longer needed, the World Health Organization announced on Friday. Upon reviewing the recent evidence, the WHO's Strategic Advisory Group of Experts on immunization concluded that just one dose is enough to provide lifelong immunity against the disease.

LINK(S):

WHO news release (Free)

Published in Physician's First Watch May 20, 2013

Fries with That? Immigrants' Health Found to Deteriorate After Life in U.S.

By Joe Elia

For immigrants, the effects of life in the U.S. include greater income along with higher cardiovascular risks, researchers are concluding.

In a survey of the problem in the New York Times, it's reported that American-born children of immigrants tend to have shorter lifespans than their parents. American-style behaviors, such as eating high-calorie diets and not getting enough exercise, seem to be to blame.

One researcher has found that Hispanic immigrants live almost 3 years longer than American-born Hispanics.

LINK(S):

New York Times story (Free)

Published in Physician's First Watch May 20, 2013

Featured in Journal Watch: ID Learning Unit — Antibiotics with Excellent Absorption

By The Journal Watch Editors

Paul Sax shares a list that "all ID doctors have encoded deep in their genome": antibiotics that can be given orally in place of their IV counterparts, or even more importantly, substituted for something IV on discharge.

LINK(S):

HIV and ID Observations blog (Free)

Published in Physician's First Watch May 20, 2013

May 17, 2013

Wisdom on Flu Vaccination Questioned

By Joe Elia

Influenza has been oversold as a disease, and the most widely promoted preventive measure — vaccination — rests on shaky scientific foundations, according to a BMJ essay.

In an attack that could draw mention around water coolers, the author says much of the measured benefit of vaccination owes to "healthy user bias." That is, healthier people are most likely to get vaccinated. And, he says, the CDC acknowledges this bias in its guidelines document.

Scoffing at the idea that "now we are all 'at risk'" and needing to get vaccinated, the essayist notes that deaths due to influenza decreased rapidly in the U.S. starting in the mid-20th century, well before aggressive promotion of flu vaccination.

Asked to comment, Stephen Baum of Journal Watch Infectious Diseases wrote: "While the BMJ article raises questions about the relative efficacy of influenza vaccination, it seems clear that vaccination saves many lives. If I told you I could prevent even 20% of cases of a cancer with a nontoxic drug or vaccine, the world would be lining up to get it."

LINK(S):

BMJ article (Subscription required)

Published in Physician's First Watch May 17, 2013

CDC Issues Report on Children's Mental Health

By Cara Adler

The CDC has issued its first report tracking mental health and its indicators in children. Published as a supplement to MMWR, the report summarizes federal public health surveillance data from 2005 to 2011.

Highlights of the findings: Among children ages 3 to 17, ADHD was the most common mental disorder (estimated prevalence, 7%), followed by behavioral or conduct problems (4%), anxiety (3%), depression (2%), and autism spectrum disorders (1%). Among those aged 12 to 17, about 8% reported experiencing 14 or more "mentally unhealthy days" in the past month, and more than 4% reported illicit drug use or alcohol abuse disorders in the past year. The suicide rate among those aged 10 to 19 was 4.5 per 100,000 persons in 2010.

LINK(S):

MMWR article (Free)

Published in Physician's First Watch May 17, 2013

FDA Expands Indications for Simponi to Ulcerative Colitis

By The Editors

Golimumab (Simponi) has been approved to treat adults with moderate-to-severe ulcerative colitis that has not responded to other treatment or that requires ongoing steroid therapy, the FDA has announced. The injectable tumor necrosis factor blocker was previously approved for rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis.

LINK(S):

FDA news release (Free)

Background: Physician's First Watch coverage of previous Simponi approvals (Free)

Published in Physician's First Watch May 17, 2013

Featured in Journal Watch: 8 Tips to Get the Perfect Fellowship

By The Journal Watch Editors

Dr. Jonathan Schwartz offers tips that might ease the fellowship application process — and possibly even calm the nerves of anxious soon-to-be applicants.

LINK(S):

Insights on Residency Training blog (Free)

Published in Physician's First Watch May 17, 2013

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