Tagnudge

Reading of the Week: Does COVID Affect Outcomes? Also, Depression & Behavioural Economics (JAMA Psych), and Crawford on Virtual Care (Walrus)

From the Editor

As we head into the second wave, are there lessons from the spring?

This week, we have three selections.

In the first, published in The Lancet Psychiatry, Dr. Seung Won Lee (of the Sejong University College of Software Convergence) and co-authors look at mental illness and COVID-19 in South Korea. Doing a cohort study, drawing on national databases, they wonder about diagnosis and clinical outcomes for those with mental illness. “Diagnosis of a mental illness was not associated with increased likelihood of testing positive for SARS-CoV-2.” It’s a big finding – but is it relevant on this side of the Pacific?

wave-1

Can we nudge patients with depression to take medications? In the second selection, we look at a new JAMA Psychiatry research letter. Steven C. Marcus (of the University of Pennsylvania) and his co-authors offer financial incentives for medication compliance. They conclude: “In this pilot study, escalating incentives for daily antidepressant adherence significantly improved adherence compared with a control group during the critical first 6 weeks of treatment.”

Finally, in our third selection, we consider an essay by Dr. Allison Crawford (of the University of Toronto) from The Walrus. She writes about the change in mental health care with COVID-19, as virtual care has become the norm. “I take off my shoes so that I can enter softly and with an open heart. My patients can’t see my bare feet.”

DG

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Reading of the Week: How to Cope With a Patient’s Suicide? What to do When Nudges Don’t Work? Can Technology Bring Physicians Together?

From the Editor

“We talk about the toll suicide takes on families… We talk about the tragedy for the people who’ve died… What we don’t openly talk about is suicide’s toll on the doctors who have treated these patients.”

So writes Dr. Dinah Miller, a psychiatrist affiliated with Johns Hopkins Medicine. She discusses the death of a patient and the impact on her life.

Dr. Miller’s essay is one of three selections in this week’s Reading.

The papers are different and look at different issues. The one common thread: they were all published in The New England Journal of Medicine.

And they all ask important, thought-provoking questions:

How to cope with a patient’s suicide?

What to do when nudges don’t work?

Can technology bring physicians together?

p17Dr. Dinah Miller

Enjoy.

DG

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Reading of the Week: Smoking Cessation & Incentives – the NEJM Paper

From the Editor

“So to put it simply, forcing people to choose is not always wise, and remaining neutral is not always possible.” University of Chicago economist Richard H. Thaler and Harvard Law School Professor Cass R. Sunstein write this comment in their widely-read book Nudge: Improving Decisions about Health, Wealth and Happiness. They argue that people could be nudged in a certain direction, improving outcomes. Among the book’s fans: former UK Prime Minister David Cameron and former US President Barack Obama.

Thaler and Sunstein write about shaping basic decisions, like encouraging people to choose among their company’s pension plans. Retirement planning can significantly help people with their finances in their twilight years. But what about substance use? The stakes seem higher: smoking cessation can prevent major health problems long before retirement.

This week, we look at a new paper by University of Pennsylvania Perelman School of Medicine’s Dr. Scott D. Halpern and his co-authors. Published in The New England Journal of Medicine, they consider smoking cessation and find “financial incentives added to free cessation aids resulted in a higher rate of sustained smoking abstinence than free cessation aids alone…”

file-20170804-6503-18ujgw6Nudging people to butt out?

In this week’s Reading, we consider the paper and its implications. (There is, however, no financial incentive offered here.)

DG

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Reading of the Week: “Is Cognitive Behavioral Therapy the Gold Standard for Psychotherapy?” JAMA on Psychotherapy

From the Editor

Is CBT overrated? The authors of a new JAMA paper raise this question in a cutting Viewpoint.

In this two-part Reading of the Week series, we look at two papers, both published in JAMA. These Viewpoint pieces make interesting, provocative arguments.

Last week, we looked at conversational agents.

This week, we ask: is CBT really the gold standard for psychotherapy?

University of Giessen’s Falk Leichsenring and Medical School Berlin’s Christiane Steinert consider CBT and the research that has been done in the area. “CBT is usually considered the gold standard for the psychotherapeutic treatment of many or even most mental disorders.” But should it be? Leichsenring and Steinert argue no.

beck_aaron_t-_112798Aaron Beck: Great bowtie, but is his CBT really so great?

In this Reading, we review their paper, and consider their argument.

DG

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