Adult “Selective Eating Disorder” to be included in DSM-V?

Via John Goodman comes a story at LA Weekly reporting that the next released edition of the Diagnostic and Statistical Manual of Mental Disorders might include picky eating, or “Selective Eating Disorder.”  One of the lead researchers into the “causes and severity of the disorder” explains it thusly:

She went on to explain that these finicky eaters often reject food not because of taste, but rather because they find the look or smell unappealing or have negative physical or emotional childhood associations with food.

I know I’m only one-eighth of the way to being a medical professional and so might be missing out on something here, but it seems to me that what she’s saying is that sometimes people base their eating decisions on subjective personal preferences about the food in question.

Heaven forfend!

The implication seems to be that if you don’t like a given food for reasons other than taste, you may have a mental illness.  I wonder if that covers my avoidance of foods like deep-fried Twinkies for the sake of my health.

Around the Mediverse: July 8, 2010

Fun tidbits, health-related and otherwise, from around the ‘tubes:

• OpenTable for physicians?  It does exist, apparently.  Be sure to click the link for HelloHealth to find out how that firm is bringing the power of the Internet to enhance patient care.

• As debates about research enter the public consciousness more and more often these days, Megan McArdle gives us a timely reminder of what “peer review” of publications means, and more importantly, what it doesn’t mean.  In a similar vein, Dr. Rich tries to get at the real reason for some of the outcry directed at the results of the recent JUPITER trial (statins for primary prevention in healthy adults).
  

• Some questions have emerged about Supreme Court nominee Elena Kagan.  Reason asks if she would ban books.  Bloggers at the Volokh Conspiracy touch on what is arguably Kagan’s political manipulation of a medical specialty society’s statement on abortion.  It should be said that the American College of Obstetrics and Gynecology comes out looking worse than the nominee.

• New York State voted to outlaw short-term housing rentals, dealing a blow to those seeking cheap Manhattan accommodations.  Prior to the vote, this situation prompted a Reason blogger to note wryly that owning property seems to be “a mug’s game.”  Relatedly, one of his colleagues argues that property rights have more importance than is often ascribed to them.

• How the response to the Gulf spill has been hampered by protectionism and inflexible environmental regulation:  the saga of the skimming Dutchmen.

• Though the response to the Deepwater Horizon spill has arguably been insufficiently aggressive, here are two commentators who argue that children should be taught to better express and receive aggression.

• What is a “scientific consensus?”  Reason’s Ronald Bailey takes on this issue.  Along the way, we stumble onto this gem of a web page explaining the relationship between animal models of carcinogenic toxicity and the actual exposure of humans to those substances.  Much more non-technical than I made it sound.  Do give it a read if only to attenuate your own “cancer panic” over some of those chemicals.

• Greg Mankiw asks what will happen to markets for life insurance and annuities given new advances in genetic testing and identification of markers for longevity.  Genetic discrimination?  An adverse selection death spiral?  Or something in between?

• As befits someone with an economics degree and a medical school acceptance agreement, I want to showcase some recent commentary on doctors and dollars.  A contrarian voice at Slate argues that drug companies should be allowed to buy physicians’ lunches.  The comments section of that article is surprisingly informative and thought-provoking.  An excerpt from the recent documentary The Vanishing Oath shows that many people think that doctors are in the profession ‘just for the money.’  Shadowfax argues that under some circumstances, fee-for-service is exactly the right way to pay physicians, whereas Dr. Wes thinks they should be paid by time, like lawyers (though I don’t know if he knows that there’s a movement among some lawyers towards flat fee payment structures).  He also presents pro and con arguments for what he terms “the corporate practice of medicine.”  Whatever choice you make, however, don’t make a mistake!  You will be crushed by a giant green Tyrannosaurus Rex.
  

• David Williams at the Health Business Blog reminds everyone that hospital visits should be BYOMD.

• Via Mark Perry comes this essay on wealth, wealth creation, the “rich,” and entrepreneurialism.  A similar theme is expressed more bluntly at The Volokh Conspiracy, discussing Ayn Rand. Coyote asks why government seems so hell-bent on putting more obstacles in front of entrepreneurs, in the context of tightened restrictions on “angel investments” in startups.

• Two recent guest posts at KevinMD point out that the concept of the patient-centered medical home is probably way overhyped, given the current evidence “for” it.

• Here are three articles on a lighter note to close out this week’s edition:  Foreign Policy seems to overreach in calling this next century “the Canadian Century;” The Economist takes on job-title inflation; finally, Hit & Run looks at San Francisco’s recent ban on soft drinks in municipal vending machines, and compares Coke to the alternatives.
  

Around the Mediverse: June 28, 2010

The unusual delay since the last edition of “Around the Mediverse” means that this one features a higher-than-normal number of…

Fun tidbits, health-related and otherwise, from around the ‘tubes:

• SBM gives us a peek behind the curtain of how the FDA decides whether drugs should be available over-the-counter instead of by prescription only.

• Hit & Run, on the other hand, shows us what vendors have to do in order to have their brownies approved by the Pentagon.  I honestly thought it was a joke… I was wrong.  This is the sort of thing that the OSS recommended to those agents infiltrating enemy governments.  Seriously.

• David Williams at the Health Business Blog talks about the PPACA’s mental health parity requirement, and how it might end up driving evidence-based managed-care from insurers.  InsureBlog points out, though, that the regulations mean that mental health “parity” is actually anything but.  Insurers may well be forced to treat mental health care more generously than other covered services.

• On the subject of evidence, Hit & Run discusses scientific denialism of both left- and right-wing political flavours.

• Edwin Leap tells a tale of government/regulatory burdens to hiring by a small business… specifically, his medical practice.

• Richard Posner discusses whether asset-price bubbles, like the housing bubble of the mid-2000s, can be explained by rational behaviour on the part of market participants.

• The Placebo Journal Blog points out that government programs that enlist others to root out physician wrongdoing promise monetary rewards and bounties, whereas a new program that enlists physicians to root out drug company wrongdoing promises to pay whistleblowers… well, you’ll see.

• With so much of California’s fiscal situation being driven by out-of-control public sector pensions, you’d think that they would be focused on getting the best money managers to get them the best possible return on the pension fund instead of worrying about how many CalPERS money managers are women or minorities.

• Can anti-market regulation be harnessed for a pro-market climate change response?  A modest proposal in that vein.

• Greg Mankiw reports that some Japanese men are too sexy for their equities, too sexy for commodities, too sexy for corporates… oh yeah…

• Buy your own journalist!  Well, not really.  More like targeted micro-charity for investigative reporting.  I like this model better than the FTC’s.

• A series of side-splitting Marxist-Socialist jokes.

• What would “Around the Mediverse” be without a tale of ridiculous litigation?  The propofol litigation, however, could have real adverse consequences for those patients needing anesthesia now that one of its manufacturers has withdrawn from the US market.  See Great Zs, Overlawyered, and Skeptical OB for details.

• Dr. Wes discusses some of the often-overlooked biases inherent to the way medical research is conducted, and what it might mean for the wide applicability of results.

• What do patients think of evidence-based medicine?  More importantly, what does government think about it… forget “Mammogate,” let’s talk pseudo-science and quackery in the health reform bill!

• Jason Shafrin points out that when measures of income inequality are adjusted to include health insurance benefits, the standard narrative about widening inequality changes.

• MLRs, what are they good for?  David Williams and Reason have interesting, unorthodox takes on the question.

• Rounding out this week’s selection, Dr. Rich has an unorthodox take on a hot-button issue… this one being the appropriate nature of the relationship between physicians and pharmaceutical companies.  It’s a perspective that I haven’t seen well-elucidated elsewhere, so it’s well worth reading the full thing.

Around the Mediverse: April 21, 2010

Fun tidbits, health-related and otherwise, from around the ‘tubes:

• Dinosaur, at her new blog, has another post explaining her position that palliative care need not be a subspecialty operating the way it does now.

• The econoblogs might offer this as an example of “markets in everything:”  publicly funded programs in WA have to compete for funds. (via Reason’s Hit & Run blog)

• Over the past couple of weeks I’ve been following a fascinating debate on the policy implications of behavioural economics over at the Volokh Conspiracy.  Here’s the article that started it all, a post at Volokh on libertarian paternalism more generally, a bit about regulators, and a discussion of Richard Thaler’s response to the criticism.  The collection of links here is one-sided, but if you haven’t already read Nudge, do so to get the other point of view (and more generally, you should just read the book).

• Also from Volokh is an intelligent take on the constitutionality (or lack thereof) of the personal health insurance mandate (there’s also video!)

• A Croatian patient wakes from a coma speaking fluent German.

• In discussing American wage stagnation, Richard Posner makes some excellent points about money-based vs. standard-of-living based approaches to measuring economic wellbeing.  He also proposes an interesting rationale for why an economic conservative/libertarian may want to pragmatically support government-led reductions in wage inequality.  Relatedly, Jeff Miron takes on the question of libertarian-friendly anti-poverty spending programs.

• Edwin Leap discusses one of the frequently ignored drivers of Emergency Department use:  other physicians.  To be fair, most of those other physicians would probably cite liability concerns, and most of those could do so legitimately.   Still, it’s something to keep in mind when looking at ED utilization patterns.

• Megan McArdle and the WSJ Health Blog discuss the recent moves by some health insurers to reclassify expenses to satisfy new rules requiring minimum medical-loss ratios.  In my view, things like nursing hotlines and wellness programs are “medical” expenses moreso than “administrative,” but reasonable people disagree.

• Dr. Grumpy keeps us abreast of the latest developments in psychoanalytic psychology.

• John Tierney gives us “7 New Rules to Live By” for Earth Day, demolishing pervasive myths about organic food, GMOs, and nuclear power.  I’ve been harping on about these for the last couple of years (especially the first two) to anyone who would listen, so it’s gratifying to see that my views on the issues aren’t completely crazy.

• Coyote brings us an example of a proponent for creating another of my least favourite types of “rights:”  positive rights to someone else’s goods or labour.  In this case, the “right” being bandied about is an alleged “positive right to travel.”  The comment was made at a conference with no direct policy implications, but the existence of that thought at the higher levels of EU is terrifying (but unsurprising).

• Of interest to anyone who may want to start a small medical practice in the next few decades, Overlawyered brings us information about proposed new restrictions on so-called “angel investors.”

• Hit & Run drills down a bit on something about last weeks maternal mortality statistics that didn’t get too much attention elsewhere (at least not in any of the newspapers or blogs that I follow):  some women’s health advocates tried to get the data held back for political reasons.

• Closing out this week’s edition is a post at InsureBlog that explains why the new health insurance exchanges might not work so well after all (via last week’s Health Wonk Review).

Also of note is the addition of Bittersweet Medicine, a relatively new addition to the mediverse, to the list of blogs that I follow and to the links over to your right.  Of immediate interest is the series on overrated medications (for instance, statins).  Hopefully there will be more of those in the future!

Around the Mediverse: April 14, 2010

Fun tidbits, health-related and otherwise, from around the ‘tubes:

• A letter to the editor of The Economist tells that “[t]he so-called precautionary principle is, in the words of risk-expert Bill Durodié, “an invitation to those without evidence, expertise or authority, to shape and influence political debates. It achieves that by introducing supposedly ethical or environmental elements into the process of scientific, corporate and governmental decision-making.”

• The Legal Satyricon asks if drunk driving (sans collision/fatality) is a victimless crime (via the New York Personal Injury Law blog)

• The propensity of the US Congress to spend time and resources “investigating” issues of little policy import (at least in my opinion) never ceases to amaze me.  First it was steroid use in Major League Baseball.  More recently we saw hearings to investigate the application of generally accepted accounting principles.  Now, we have investigations into an airline that has the temerity to charge passengers for carry-on baggage.

• Bob Centor points out that increasing medical school enrollment won’t be enough to solve projected future shortages of physicians, especially in primary care.  He looks at increasing the number of primary care residency slots and improving pay for primary care physicians and residents.  I would argue that this might not even go far enough:  if the slots are there, who’s to say they’ll be taken unless the job gets much better than it is now?

• Eugene Volokh tells of litigation that arose after an accident victim was mistaken as dead many, many, many times.  I’m not one to second-guess decisions made under tricky circumstances (well, maybe I am), and I’m all for reducing “unnecessary medical tests” (whatever those are), but can it really hurt to double-check the pulse?

• Economix explains the real reason for the original Boston Tea Party.  In a similar vein, Cracked.com recently featured an article on other little-known facts about the American independence movement.  As always, Cracked.com uses language not safe for work.

• An alternate take on schizophrenia from a behaviourist perspective, entitled “Schizophrenia Is Not An Illness.”  Provocative?  To someone like me with only limited exposure to “traditional” approaches to mental illness, yes.  The three-part series makes some interesting points and is well worth the read.

• In 1964, President Lyndon Johnson placed an order for new pants.  The tape and transcript of the phone call are … quite something.  Be warned that LBJ uses graphic language to describe the desired specifications of the pants being ordered.  He also belches without saying “excuse me,” and admits to carrying a knife to work.

• A lot of health care revolves around providing reassurance and peace of mind (kinda like real insurance is supposed to, but that’s another topic for another day).  Sometimes that’s for the patient’s benefit and sometimes for the physician’s.  Oftentimes, it’s for both.  Of course, peace of mind can be an expensive thing to come by.   This story from ACP Internist illustrates this perfectly.

• There exists a jurisdiction not too far from Florida that has recently imposed a health insurance mandate on some of the people present there.  Those subject to the mandate who don’t already have insurance will have to buy a product that doesn’t cover pre-existing conditions and features payout caps.  Guess where this is, I challenge you!

• Don’t believe everything you read online, even from a somewhat-reputable source.  This is especially true when it’s AOL recommending “medical tests that could save your life.”  Or not.

• Reason explains, in graphical form, a subject near and dear to my heart:  US immigration law.

• And finally for this week, hot off the presses internets, the Library of Congress announces that it will archive every public tweet, ever.