TagNEJM

Reading of the Week: Breaking the Stigma – Dr. Adam B. Hill on his Depression and Addiction

From the Editor

“My name is Adam. I am a human being, a husband, a father, a pediatric palliative care physician, and an associate residency director. I have a history of depression and suicidal ideation and am a recovering alcoholic.”

So begins this week’s selection, which is an essay written with remarkable candor and honesty.

1docDiscussing what we should discuss

In this Reading, Dr. Adam Hill writes in The New England Journal of Medicine about his struggle with mental illness.

It is moving and important.

DG Continue reading

Reading of the Week: The NEJM on “Our Struggle to Care for People with Serious Mental Illness”

From the Editor

What can we do for those with severe mental illness?

Homelessness: can we do better?

This week, we look at a series of excellent essays that have run on mental illness in The New England Journal of Medicine. They are well written and insightful. We particularly focus on the first of the three essays, which considers treatment and rights.

DG Continue reading

Reading of the Week: Do the Meds Work? Peter Kramer’s Essay, and More

From the Editor

Do the pills really work?

It’s a question that we clinicians are repeatedly asked. Antidepressants are widely prescribed, but often doubted – by our patients and by people in general.

This week, we look at an essay penned by Dr. Peter Kramer, an American psychiatrist. Dr. Kramer, you may recall, made a name for himself two decades ago by extolling the super-therapeutic powers of Prozac. Today, he has a more modest goal: explaining the role of antidepressants in the treatment of depression.

Then, looking to The New England Journal of Medicine, we consider a paper that discusses the rise and, perhaps, fall of randomized controlled trials as the “gold standard” of medical research.

DG Continue reading

Reading of the Week: The Good Life of Oliver Sacks, and More

From the Editor

Is the incidence of dementia falling?

What makes a good clinician?

This week, I’ve selected two Readings. We open with a NEJM paper suggesting a big trend: a decline in the incidence of dementia. That paper obviously has major implications for public policy. We then move on to a big and eloquent essay on a famous doctor, Oliver Sacks.

There isn’t much connecting these selections – except that both were suggested by readers, and they both raise big questions.

Enjoy.

DG Continue reading

Reading of the Week: A Father Mourns His Son, and More

Note from the Editor

In most Readings of the Week, a paper or essay is selected and then discussed in the commentary.

This week, we try something a bit different: a few pieces are selected and briefly discussed. We can cover more ground this way, and consider some pieces that may not have warranted a “full” Reading, but are still worthy of consideration.

DG

 

Selection 1: “How to Help Save the Mentally Ill From Themselves”

Norman J. Ornstein, The New York Times, 17 November 2015

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My older son, Matthew Ornstein, died at age 34 on Jan. 3 from carbon monoxide poisoning. It was accidental — he fell asleep in a tent with a propane lantern — but his death was shaped by a lack of judgment driven by a 10-year struggle with mental illness.

Continue reading

Reading of the Week: NEJM and Smoking Cessation

More than 50 years after the release of the first Surgeon General’s report on the harmful effects of smoking, national policies, behavioral programs, and pharmacologic approaches have helped reduce smoking rates in the United States. However, the need for new approaches is clear because smoking remains the leading cause of preventable illness and death.

So begins a big paper from The New England Journal with a simple aim: getting people to butt out. It raises two important questions: If we are serious about promoting smoking cessation, are we willing to put ‘our money where our mouth is’ – literally? And how could we do this?

“Randomized Trial of Four Financial-Incentive Programs for Smoking Cessation” by Dr. Scott D. Halpern et al. is this week’s Reading; it has just been published.

Though other papers have been written on this topic, the Halpern et al. paper is clever and interesting – and the results are surprising.

And, don’t tell the editors of The New England Journal of Medicine: the results are also disappointing. Continue reading

Reading of the Week: The Kids are Alright – The New England Journal of Medicine and Childhood Mental Health Disorders

The rate of severe mental illness among children and adolescents has dropped substantially in the past generation, researchers reported Wednesday, in an analysis that defies public perceptions of trends in youngsters’ mental health.

So begins The New York Times’ front-section coverage of a big paper in a big journal with a big result.

This paper, just published by The New England Journal of Medicine, considers the rate and treatment of childhood mental health impairment. In contrast to other surveys, this paper didn’t find a rise in the rate of mental illness. (Contrast this finding with the comment of a former president of the American Psychiatric Association that such illnesses are “an epidemic hidden in plain view” – that is, obviously there but underreported historically.)

Explains the lead author, Dr. Mark Olfson:

The finding is robust and real and challenges the prevailing stereotype that young people are somehow more vulnerable to mental problems.

Dr. Mark Olfson

How common is mental impairment among children and adolescents? How has this changed in recent years? How are patients being treated? Are we prescribing more than in the past? Olfson et al. seek answers to these important questions in “Trends in Mental Health Care among Children and Adolescents” – this week’s Reading. Continue reading