NYTimes Magazine: Recalling the debate over repressed memories

ssThis weekend’s profile of Boston Dr. Bessel van der Kolk brought up some bad memories of the debate over what is clinically known as “dissociative amnesia.” The story profiles van der Kolk’s approach to treating Post Traumatic Stress Disorder, known as psychomotor therapy.  

“Trauma has nothing whatsoever to do with cognition,” he says. “It has to do with your body being reset to interpret the world as a dangerous place.” That reset begins in the deep recesses of the brain with its most primitive structures, regions that, he says, no cognitive therapy can access. “It’s not something you can talk yourself out of.” That view places him on the fringes of the psychiatric mainstream.

Not the first time, the story notes, as it recalls the doctor’s past support of repressed memories – a much debated concept that came into play when charges of sexual assault were levied against day care workers and priests in the ‘80s and ‘90s. Dr. van der Kolk’s Harvard colleague, psychologist Richard McNally, called the concept “the worst catastrophe to befall the mental-health field since the lobotomy era.”

From the Times:

For a time, judges and juries were persuaded by the testimony of van der Kolk and others. It made intuitive sense to them that the mind would find a way to shield itself from such deeply traumatic experiences. But as the claims grew more outlandish — alien abductions and secret satanic cults — support for the concept waned. Most research psychologists argued that it was much more likely for so-called repressed memories to have been implanted by suggestive questioning from overzealous doctors and therapists than to have been spontaneously recalled. In time, it became clear that innocent people had been wrongfully persecuted. Families, careers and, in some cases, entire lives were destroyed.

After the dust settled in what was dubbed “the memory wars,” van der Kolk found himself among the casualties. By the end of the decade, his lab at Massachusetts General Hospital was shuttered, and he lost his affiliation with Harvard Medical School. The official reason was a lack of funding, but van der Kolk and his allies believed that the true motives were political.

Not clear what the story means by “political,” but the implication is that he was banished for promoting an unpopular concept.

It didn’t help critics of repressed memory that the concept was being used in cases against alleged pedophiles. Most notoriously, lawyers defending defrocked priest Paul Shanley,  who was convicted of raping a young boy, used doubts about the concept to discredit the grown-up victim who testified that he had repressed memories of abuse. Shanley — who was the subject of numerous complaints to the church —  was found guilty in 2005. His lawyers filed an appeal, again based on the shakiness of the repressed memory concept.

From a Times story on the appeal

You have prominent scientists, psychologists and psychiatrists saying this is not generally accepted. So why allow it in a court of law in a criminal proceeding?” Mr. Stanley’s lawyer, Robert F. Shaw Jr., asked the state’s highest court Thursday.

The debate over repressed memory — the idea that some memories, particularly traumatic ones, can be inaccessible for years — has simmered since the 1980s, when some patients in therapy described long-past scenes of sexual abuse. Some of those experiences turned into high-profile legal cases. The scientific controversy boiled over in the 1990s — as experts raised questions about many claims — and then died down.

Recently, scientists have begun to spar again over the theory. New studies suggest, and many scientists argue, that what people call repression may just be ordinary forgetting; memory is not “blocked.” Others say the process is more complex and may involve a desire to forget.

“My impression is there continues to be a few scientists who honestly believe that it is actually possible for someone to be involved in a traumatic event and not be able to remember it at all,” said Dr. Harrison G. Pope Jr., a professor of psychiatry at Harvard. “But you cannot possibly argue that it’s generally accepted, which is the criteria for it to be admissible from a legal standpoint.”

In 2010, The Globe reported that the request for a new trial was thrown out

Jan 16, 2010: “In sum, the judge’s finding that the lack of scientific testing did not make unreliable the theory that an individual may experience dissociative amnesia was supported in the record, not only by expert testimony but by a wide collection of clinical observations and a survey of academic literature,” Justice Robert Cordy wrote for the SJC.

Shanley, now in his late 70s, was originally prosecuted by Martha Coakley, who is now attorney general and a Democratic candidate for US Senate. Her successor, Middlesex District Attorney Gerard T. Leone Jr., whose prosecutors defended the conviction before the SJC, applauded the ruling.

“As the SJC recognized, repressed memories of abuse is a legitimate phenomenon and provided a valid basis for the jury to find that the victim, a child at the time of the assaults, repressed memories of the years of abuse he suffered at the hands of Paul Shanley, someone who was in a significant position of authority and trust,” Leone said.

But Shanley’s appellate attorney, Robert F. Shaw Jr. of Cambridge, said the SJC had made a grievous mistake. Shaw, who argued in court papers that recovered memory was “junk science,” said Shanley deserved a new trial.

The SJC noted – literally in a footnote – that repressed memories alone may not be enough to convict a defendant. From the Globe:

The court also said that it may decide in the future to throw out a conviction where the only evidence is based on recovered memories.

“We do not consider whether there could be circumstances where testimony based on the repressed or recovered memory of a victim, standing alone, would not be sufficient as a matter of law to support a conviction,” Cordy wrote in a footnote.

But, the debate goes on. A review in the current issue of the American Psychological Association’s journal Psychiatric Bulletin, tries the put the issue to rest. Harvard’s McNally is one of the authors.  The article is in response to a 2012 paper in the same journal supporting the concept of repressed memories.

 (Although) a key assumption of the TM (Trauma model) is dissociative amnesia, the notion that people can encode traumatic experiences without being able to recall them lacks strong empirical support. Accordingly, we conclude that the field should now abandon the simple trauma–dissociation model and embrace multifactorial models that accommodate the diversity of causes of dissociation and dissociative disorder. 

 

Storify: The Boston skinny on fat

ss

Over-treatment? There’s an app for that

ss accCritics have knocked the recently updated guidelines  on statins for patients at risk of heart disease. While some heart specialist spent years putting together advice for the high risk, others said the guidelines will result in massive overtreament.

Still, health monitoring apps are hot,. The American College of Cardiology is now offering an iPhone/ iPad risk calculator,  the Globe’s Daily Dose reports. This paragraph from the Boston.com post was cut off the print version of the story.

The app does instruct doctors to have a discussion about the risks and benefits of statins and to consider patient preferences; whether busy primary care providers will make the time to have that discussion, rather than simply prescribing the drugs, remains to be seen. 

The headlines were different as well. 

Print: App Calculates Heart Disease

Boston.com: Heart disease risk app may increase statin prescriptions

Don’t like the ACC app? There are already a handful of others.

Another study questions benefit of mammograms, via Globe, Times

The Globe isn’t sharing much with Boston.com these days. But, you can still access most of the blogs.

Mom, post breast cancer

Mom, post breast cancer

Today’s Daily Dose is on the mammography debate. We all thought early detection was key. For breast cancer, maybe not. 

In a research finding that will add to doubts about the value of breast cancer screening, Canadian researchers determined that women ages 40 to 59 who had yearly mammograms enjoyed no added survival benefit up to 25 years later compared with those who skipped the screening X-rays….

The latest finding, published Tuesday in the British Medical Journal, confirms earlier results from the Canadian trial, which first came out two decades ago and is unlikely to discourage many doctors from recommending screening…

But the researchers also determined that 22 percent of breast cancers initially detected on mammograms in the early 1980s were “over-diagnosed”—meaning they never would have been found otherwise and would not have become life-threatening. Most of these women had surgery to remove these tumors which, in hindsight, was unnecessary…

Such findings haven’t, though, swayed the opinions of most women and doctors, who remain more concerned about a life-threatening cancer going undetected than a harmless one being over-treated

Two local docs defend the procedure:

“Mammography is an imperfect test at best, but at this point, it’s the best test we have,” said Dr. Ann Partridge, a breast oncologist at Dana-Farber Cancer Institute. She and others highlighted some potential methodological flaws of the Canadian study.

For example, Partridge said, technology has improved significantly over the past 30 years with X-ray machines and digitized film that yield clearer images….

Some radiologists have sharply attacked the study investigators, accusing them of having a bias against mammography by designing a study in which the control group of women in their 50s received breast exams performed by skilled nurses every year instead of mammograms.

“The principal investigator set out to prove that all you needed to do was a physical examination,” said Dr. Daniel Kopans, director of breast imaging at Massachusetts General Hospital, in an e-mail responding to the new study finding. “The nurse examiners were highly trained while the radiologists and technologists [who performed the mammograms] had no training.”

Not everyone is sticking with mammography. The advocates at Breast Cancer Action have long questioned its usefulness.

And, the New York Times story offered this telling quote:

“It will make women uncomfortable, and they should be uncomfortable,” said Dr. Russell P. Harris, a screening expert and professor of medicine at the University of North Carolina, Chapel Hill, who was not involved in the study. “The decision to have a mammogram should not be a slam dunk.”

Press (blue) button; get health records — Hacking health this weekend in Boston

ssThe Blue Button “is a simple concept: give patients’ access to their own data. The U.S. Department of Veterans Affairs (VA) first used the Blue Button logo on its patient portal in 2010 ,By clicking on the button, individuals could download their medical records in digital form.

Since then, millions of Veterans have logged onto the tool to download their personal health information, and many of the country’s largest data holders, including federal agencies such as the Centers for Medicare & Medicaid Services (CMS) and the Department of Defense (DoD) and private health plans such as United HealthCare and Aetna, have embraced Blue Button as a way to make health care data readily available to their beneficiaries.”

This weekend:

Tufts MedStart and MIT Hacking Medicine in collaboration with the ONC Present:

The Blue Button Boston Innovation Challenge

Tufts MedStart and MIT Hacking Medicine are excited to announce their collaboration with the Office of the National Coordinator for Health IT (ONC) on the January Blue Button Code-a-thon taking place from Friday, January 17th to Sunday, January 19th.  Blue Button is an international movement to engage patients in their health through access to their health data in both human and machine-readable formats. This fall, all providers using MU2 certified technology will be able to support patients viewing, downloading, and transmitting their clinical data to a consumer endpoint, like a personal health record, or provider through Blue Button + Direct.

This codeathon is an opportunity for providers, patients, and the developers of consumer facing technology to come together to learn about Blue Button, identify high priority use cases, and build exciting new products that are ready to receive Blue Button data. We hope this event will foster collaborations that exist long after the codeathon ends. The ONC recently sponsored a successful codeathon on device data and health financial data in San Francisco, and we are excited to work with a new community in Boston!

The event will focus on use cases that take advantage of patient clinical data liberated through Blue Button + Direct, a technology available in all Meaningful Use certified technology starting winter 2014. The event will open with patients and providers sharing their highest priority Blue Button use cases which will guide development over the weekend and judging criteria. Example ideas may include but are not limited to:

  • Co-designed applications that can improve communication between the health care provider and the patient. (ie. care plans and notes that both the patient and physician can contribute to)
  • Simplifying medical jargon, content, and diagnoses for patients. (ie. consumer friendly definitions of clinical terms)
  • Clinical health information visualizations. (ie. interactive lab results)
  • Population trend analysis. (ie. seasonal, location specific tracking of symptoms at an aggregate level)
  • Patient record matching to clinical trials.

 

Maybe they serve turkey burgers: Unfortunate timing on these tweets

The BHN local health Twitter list served up this last week:

ss eat

BPA linked to infertility? Until we know more, how to reduce exposure

cans

From Boston.com

A growing body of evidence suggests that women who have high urine levels of bisphenol-A—a chemical used in some hard plastics and to coat metal cans—are more likely to suffer from infertility, and now researchers have found a possible reason why. BPA may disrupt eggs from maturing properly, according to a study from Brigham and Women’s Hospital researchers.

“As many as 20 percent of infertile couples have unexplained infertility, and this might just shed a glimmer of light on a contributing factor that plays a role,” said study co-author Catherine Racowsky, director of the hospital’s assisted reproductive technologies laboratory.

So, what to do to reduce you BPA levels? The Silent Spring Institute, a Newton research program looking a the links between breast cancer and the environment,  did a study looking at just that in 2011. They found that by families that were willing to give up canned food, food packaged in plastic, and restaurant meals for three days. “When study families switched to the fresh food diet, their levels of the hormone disruptors BPA and DEHP dropped by half.”


More here from the FDA. 


T
ips from SSI on how to limit exposure to BPA

While scientists continue to study the health effects of these chemicals, here
are  simple steps to play it safe and reduce your exposure:

Fresh is best 
BPA and phthalates can migrate from the linings of cans and plastic 
packaging into food and drinks. While it’s not practical to avoid food 
packaging altogether, opt for fresh or frozen instead of canned food as 
much as possible.

Eat in
Studies have shown that people who eat more meals prepared outside 
the home have higher levels of BPA. To reduce your exposure, consider 
cooking more meals at home with fresh ingredients. When you do eat 
out, choose restaurants that use fresh ingredients.

Store it safe
Food and drinks stored in plastic can collect chemicals from the
containers, especially if the foods are fatty or acidic. Next time, try 
storing your leftovers in glass or stainless steel instead of plastic.
While scientists continue to study the health effects of these chemicals, here 

Don’t microwave in plastic
Warmer temperatures increase the rate of chemicals leaching into food and drinks. So use heat-resistant glass or ceramic containers when you microwave, or heat your food on the stove. The label “microwave safe” means safety for the container, not your health. 

Brew the old-fashioned way
Automatic coffee makers may have BPA and phthalates in their plastic containers and tubing. 
When you brew your coffee, consider using a French press to get your buzz without the BPA.

“Life and Death in Assisted Living”: A Frontline/ProPublica investigation

downloadDealing with the housing and care issues that come with aging and disability is, at best, discouraging. When assisted living came along, those who could afford a spot found a comfortable, dignified place to age. These homes look more like hotels than hospitals and offer care for those who need help, but don’t need a nursing home.

But, long-term care is a challenge for both residents and owners. And when the owner is an off-site corporation, efforts to contain costs can lead to poor care for residents.

That’s what the  investigative reporters at Frontline and ProPublica found when they started digging. The FRONTLINE series — starts tonight, Tuesday, and the ProPublica series is running this week on the group’s website. Here’s what they found:

imagesWith America’s population of seniors growing faster and living longer than ever before, more and more families are turning to assisted living facilities to help their loved ones age in comfort and safety.

But are some in the loosely regulated, multibillion-dollar assisted living industry putting the lives of those loved ones at risk?

From the Texas assisted living resident who froze to death on Christmas morning to the Hall of Fame football player who drank unsecured toxic dishwashing liquid and died 11 days later, this major investigation raises questions about fatal lapses in care and a quest for profits at one of America’s best known assisted living companies.

Here in Massachusetts, assisted living facilities have to be certified by the state Office of Elder Affairs. State law requires the homes to have:

  • One or two bedroom units with entry doors that lock
  • Private bathrooms for each unit in newly constructed ALRs
  • Private kitchenettes or access to cooking facilities
  • At least one meal a day
  • For all residents who need it, assistance with bathing, dressing, ambulation and supervision of or reminders to take prescribed medications.
  • 24 hour a day on-site staff
  • Emergency response systems to signal on-site staff
  • Individualized service plans
  • Residency agreements (lease/contract) which detail what the home will provide to the resident, including the rights and responsibilities of both the home and the resident.

The home staff members are not allowed to deliver medical care and the homes are barred from accepting residents who need “skilled nursing care” unless that care is provided by an “employee of a Certified Provider of Ancillary Health Services.  Those caregivers can include physician, pharmacist, restorative therapist, podiatrist  hospice and home health aides.

In other words, assisted living is housing, not health care. This series did not look at homes here. But a former aide at a Massachusetts assisted living program makes some serious charges in the comment section of the ProPublica story.

Is DCIS cancer? New National Cancer Institute panel says no, get “carcinoma” out of the name

download8/29: Globe weighs in on new new study on how women perceive the DCIS diagnosis 

Via JAMA  

This seems huge, although the questions about the overdiagnosis of cancer have been bubbling up for a while.

Here’s the NYTimes Well blog take on it.

A group of experts advising the nation’s premier cancer research institution has recommended sweeping changes in the approach to cancer detection and treatment, including changes in the very definition of cancer and eliminating the word entirely from some common diagnoses.

The recommendations, from a working group of the National Cancer Institute, were published on Monday in the Journal of the American Medical Association. They say, for instance, that some premalignant conditions, like one that affects the breast called ductal carcinoma in situ, which many doctors agree is not cancer, should be renamed to exclude the word carcinoma so that patients are less frightened and less likely to seek what may be unneeded and potentially harmful treatments that can include the surgical removal of the breast.

 

More here:

The “Susan G Komen for the Cure” take is quite a  bit different:

Ductal carcinoma in situ (DCIS) is a non-invasive breast cancer. In DCIS, abnormal cells are contained in the milk ducts. It is called “in situ” (which means “in place”) because the cells have not left the milk ducts to invade nearby breast tissue. …. You may also hear the terms “pre-invasive” or “pre-cancerous” to describe DCIS.

 

NU prof in NYTimes: Can meditation teach manners?

Update 7/18 :The folks at WGBH’s Boston Public Radio took calls after an interview with David DeSteno, the author of this meditation study. Note:  Jim Braude does not mediate: his co-host Margery Eagan does.

7/7: This piece in the NYTimes magazine, “The Morality of Meditation” is of interest for two reasons. It was written David DeSteno is a professor of psychology at Boston’s Northeastern University. And, this reporter has spent the past five weeks in a brace and on crutches with a fractured tibia plateau — top of the shin bone. Anecdotally, that 16 percent of people would give up a seat for a person on crutches seems about right.

bll-leg-pix-web Buddha: “I teach one thing and one only: that is, suffering and the end of suffering.” For Buddha, as for many modern spiritual leaders, the goal of meditation was as simple as that….

Here’s how they tested that concept:

When a participant entered the waiting area for our lab, he (or she) found three chairs, two of which were already occupied. Naturally, he sat in the remaining chair. As he waited, a fourth person, using crutches and wearing a boot for a broken foot, entered the room and audibly sighed in pain as she leaned uncomfortably against a wall. The other two people in the room — who, like the woman on crutches, secretly worked for us — ignored the woman, thus confronting the participant with a moral quandary. Would he act compassionately, giving up his chair for her, or selfishly ignore her plight?

The results were striking. Although only 16 percent of the nonmeditators gave up their seats — an admittedly disheartening fact — the proportion rose to 50 percent among those who had meditated.

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