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. 

 

Health sites evolve as Boston.com and BostonGlobe.com split up property

ssNow that BostonGlobe.com and Boston.com have gotten divorced, don’t expect to see Globe bylines on Boston.com health page. The health blogs don’t seem to be over there anymore either. But, it’s a beta site and we hear they are still dividing the property.

Chelsea Conaboy, who did a nice job with both White Coat Notes and her reporting, has departed to Portland. She still lives on the page if you’ve bookmarked it, but it looks a tad neglected —  no links to it and last post was April 4.  And no sign over there of Daily Dose, which still lives on the Globe.com  Click on the old link and you get a empty page telling you it has moved. Find posts from Deborah Kotz here for now.

With the divorce, came a crack in the paywall. Non-subscribers can get 10 stores per month for free, where you can still read the Globe’s strong health and science reporting.  That is if you can find the health page. There is no link or crumb on the home page — click on “News”  to get to it.

All is still free on Boston.com, where you’ll find substantial wires stories mixed in with aggregation, links and listicles. It is what it is. We know much of this is temporary and evolving. We wish them well.

Along with a lot of meaty wire copy, here’s some of the lighter fare they are serving up today:

  • Do and don’t (grilling)  with a quiz – Which burger to eat, the red one or the brown one. Links to the Hearth Patio and Barbeque Association
  • Five simple ways (to be sane)  
  • 9 travel snacks
  • 2-time cancer survivor plans to run marathon. 
  • Tootht tattoos are real

 

 

Video: How to use national database to evaluate your doctor’s Medicare billing, treament patterns #hcr #doctors #costs

More from ProPublica:

Medicare recently released, for the first time, details on 2012 payments to individual doctors and other health professionals serving the 46 million seniors and disabled in its Part B program. Part B covers services as varied as office visits, ambulance mileage, lab tests, and the doctor’s fee for open-heart surgery. Use this tool to find and compare providers. | Related story »

Clover #food truck coming to #Longwood

 

A couple of reasons to be happy about this. CLover-Logo-Red-Early-20142

1) Chick pea fritters

2) Popovers

3) Egg and eggplant which sounds awful, but tastes great.

4) When they got shut down for salmonella last summer (see above)  they didn’t try to deny it. They paid their workers while they were closed and and fixed it.

 

From Clover Food Labs

 

Attention Beth Israel! Brigham and Women’s! Harvard Medical! Dana-Farber and Joslin and Children’s! Isabella Stewart Gardner and Emmanuel and Merck!
Clover is opening at 3 Blackfan Street this Wednesday, May 21. Clover serves just-cut, locally-sourced, seasonal breakfast and lunch, with prices anyone can afford, and speed that rivals McDonalds.

And for opening day only, come find us, show us a hospital, lab, museum, or university ID, and we’ll buy you a free side (choose from French Fries w/Rosemary, Spicy Roasted Tomato Soup, Carrot Lemonade, Lavender Lemonade, or Iced Coffee) with your Clover meal.

We’ve heard it’s going to be beautiful out, so spread the word, bring a group, and spend your lunch with us on Wednesday! 

Can’t wait to meet you all!
-Lucia, Mike, and the Clover LMA crew

5/21 MENU:

Breakfast 8am-11am, MWF
-$2 Popovers, made on board the truck, flaky, buttery pastry. Served with house-made orange marmalade
-$2 Muffins, bran w/fruit and nuts, baked on the truck
-$3 Breakfast Sandwich: whole wheat pita, Grafton cheddar, Chip-In Farm egg, salt, pepper
-$4 Granola w/Yogurt and Fruit: Sidehill Farm Yogurt, house granola, pear compote
-$3 Pourover Coffee (hot or iced), Barismo Roasters

Lunch: 11am-2pm, MWF
-$5 Chickpea Fritter Sandwich (hummus, just-cut cucumber tomato salad, house falafel, fresh house-pickled cabbage, carrots, red onions, tahini sauce)
-$5 Asian Eggplant Sandwich (eggplant and ginger spread, lightly fried cauliflower, pickled red onions, fresh watercress)
-$5 BBQ Seitan Sandwich (lean wheat protein baked with Clover BBQ sauce, caramelized onions, Grafton cheddar, lettuce, tomato, mayo)
-$3 French Fries w/Rosemary (PEI potatoes, cut and fried on the truck)
-$3 Spicy Chilled Roasted Tomato Soup (Maine tomatoes, brown chipotle pepper, cilantro)
-$3 Seasonal Beverages (all house-made)

Investigative health reporting lives: Milking Medicare

The latest in health data reporting  from ProPublica:

downloadMedicare paid for more than 200 million office visits for established patients in 2012. Overall, health professionals classified only 4 percent as complex enough to command the most expensive rates. But 1,800 providers billed at the top level at least 90 percent of the time, a ProPublica analysis found. Experts question whether the charges are legitimate.

For more: Top Billing: Meet the Docs who Charge Medicare Top Dollar for Office Visits

For a more precise look at your own doc note:

Looking at raw numbers, though, can unfairly flag some doctors who have multiple providers billing under their IDs or who justifiably use expensive services. It can be more revealing to look at which procedures doctors are performing and how frequently, and how their billings compare with those of their peers. (ProPublica has created a tool called Treatment Tracker that allows users to do just that.)

More health reporting from the ProPublica archives:

More than 1 million patients suffer harm each year while being treated in the U.S. health care system. Even more receive substandard care or costly overtreatment. Our ongoing investigation of patient safety features in-depth reporting, discussion and tools for patients.

Never-before-released government prescription records shows that some doctors and other health professionals across the country prescribe large quantities of drugs known to be potentially harmful, disorienting or addictive for their patients. And officials have done little to detect or deter these hazardous prescribing patterns.

ProPublica is tracking the financial ties between doctors and medical companies.

In today’s Globe: Stem cells, retractions, cystic fibrosis and lung transplants.

Capture

Two items of note, including one from obit writer Bryan Marquard on a patient who survived Mass General’s first living-donor double-lung transplant  which was “so new that no one could venture odds for long-term survival.Mr. Bean was 20 that July day as he lay on the operating table, helping advance science as much as he hoped to extend his life. He was 38 when he died in Mass. General on April 14, several months after his body began to reject the transplanted lungs and complications set in.”

 

And from Carolyn Y. Johnson’s always solid but hard-to- find science blog. Read it inside the Monday business section. Good luck finding it online.  Here’s some help:

Retracted stem cell papers get public, private scrutiny

Something would turn out to be wrong with both papers. Where these two tales diverge is how these problems have been handled.

In the weeks since the paper describing the acid bath technique was published in the journal Nature, it has been thoroughly — and publicly — picked apart. Several of its Japanese authors have held press conferences. The president of the RIKEN research institution in Tokyo, where many of the authors work, has apologized to the scientific community, prefacing his public remarks with a deep bow. RIKEN has released detailed reports and been specific about what portions of the paper it was investigating and what was found. It publicly accused a young scientist named Haruko Obokata of fraud, a finding she is appealing.

The incident has sparked a national discussion about the state of science in Japan and the need to ensure high standards in order not to lose the world’s trust.

In contrast, the 2012 paper was withdrawn in April without fanfare: a barebones retraction notice posted by the journal Circulation stated an institutional review had found that the paper contains unspecified “compromised” data. No details were provided about what was wrong with the data.

Asking advertisers, journalists and politicians to back up claims #evidence #askforevidence

ssA class at Emerson is working to bring the UK’s “Ask for Evidence” program to the US. The program was highlighted last night at Cambridge Science Festival. (TR was on one of the panels)

The premise behind this project is simple: if politicians, companies, or commentators want us to vote for them, buy their products, or believe their claims, then we should take an active role as responsible citizens and consumers in asking for relevant evidence. This campaign seeks to involve the public, YOU, in your own defense against deceit, by encouraging you to question and investigate marketing, media, or policy assertions that you read or hear. At Emerson College, this project is being incorporated into various Marketing and Communication Sciences and Disorders courses in order to engage students in asking for evidence and to collect data on consumer awareness.

Check it out. 

 

 

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