Harvard Doc To Wikipedia: You’re Not Playing Fair On Alternative Trauma Therapy

By Dr. Eric Leskowitz, M.D.
Guest Contributor

Up until recently, I’ve thought of Wikipedia as one of the great breakthroughs of the Internet era — a gigantic encyclopedia of everything, right at our fingertips, with real-time updates in all spheres of human knowledge. I even consult it regularly for medical information as part of my work as a practicing psychiatrist.

But in the past few months, I’ve been reconsidering the venture. Why? In a nutshell, it appears that the folks at Wikipedia have a problem with a fairly new sort of therapy that I practice and find helpful for certain patients.

Here’s the backstory.

Dr. Eric Leskowitz, a Harvard psychiatrist, wonders why the founder of Wikipedia called practitioners of Energy Psychology "lunatic charlatans.'

Dr. Eric Leskowitz, a Harvard psychiatrist, wonders why the founder of Wikipedia called practitioners of Energy Psychology “lunatic charlatans.’

For several years now, I have increasingly deployed this new form of psychotherapy, called Energy Psychology (EP), in my work with chronic pain patients at Spaulding Rehabilitation Hospital’s outpatient clinic in Medford, Mass.

Energy Psychology uses a combination of exposure (intentionally re-experiencing the upleasant emotions surrounding a stressful situation) and desensitization (affirmations of self-acceptance despite the persistence of symptoms), along with a somatic component (tapping on one’s own acupressure points) to defuse the emotional charge of those upsetting memories.

Without getting into the details of how it might work, suffice it to say that Energy Psychology has helped many of my patients make great strides, especially when Post-Traumatic Stress Disorder (PTSD) is involved. (For example, when a frightening automobile accident triggered the disorder). For some patients, full recovery is possible. I’ve seen it.

A large body of research over the last 10 years shows just how effective Energy Therapy can be for a wide range of clinical problems, as described in this review article from the American Psychological Association’s journal, Review of General Psychology.

Energy Psychology has been particularly effective in treating PTSD in combat vets. And Energy Psychology has even gotten some fairly mainstream attention, from television’s Dr. Oz to The Huffington Post.

Jimmy Wales, founder of WIkipedia (Robert Huffstutter/flickr)

Jimmy Wales, founder of WIkipedia (Robert Huffstutter/flickr)

But you’d never know about any of this from consulting Wikipedia. Their entries use a range of emotionally loaded and downright pejorative terms to describe Energy Psychology and make no mention of promising new research published in the last ten years. Their article about the related topic of Energy Medicine, for example, only includes studies conducted prior to 2004 (though more recent critical reviews are cited).

Wikipedia’s entry on the most widely used Energy Psychology protocol (Emotional Freedom Techniques, or EFT) refers to the field of Energy Psychology as “pseudoscience” and relies on judgements rendered by a non-peer-reviewed blog whose name – Quackwatch – reveals just how objective it is(n’t).

To counter what we feel are gross misrepresentations, the international Energy Psychology community and members of the national Enerfy Psychology organization — the Association for Comprehensive Energy Psychology (ACEP) — attempted to add new research citations to the Energy Psychology article, in accord with Wikipedia’s promise to update their entries to include scientifically validated findings.

However, new entries supporting Energy Psychology appear to be scrubbed from the site. Fortunately, many of the details of this process are stored on the “Revision History” link of any Wikipedia article, so that much of the back-and-forth process can be tracked and the inconsistencies between policy and practice become evident. (Emotional Freedom Technique’s revision history is here).

Even studies from prestigious peer-reviewed journals like the Journal of Nervous and Mental Disease whose editor-in-chief is past president of the American Psychiatric Association, have not been cited by Wikipedia, nor has it been mentioned that the American Psychological Association now allows its approved Continuing Education providers to offer Energy Psychology training for Continuing Education Units, the result of a lengthy appeals process.

Because these obstacles persisted despite several years of good-faith effort in the face of repeated “scrubbing” of Energy Psychology-favorable information from the Wikipedia website, ACEP recently initiated a petition drive through change.org, asking Wikipedia to show fairness discussing newer holistic therapies. Over 11,300 supporters have signed, and, much to our surprise (and I say “our” because I am an active member of ACEP), the founder of Wikipedia – Jimmy Wales – responded personally to the petition. Here’s what he wrote on the change.org site:

No, you have to be kidding me. Every single person who signed this petition needs to go back to check their premises and think harder about what it means to be honest, factual, truthful.

Wikipedia’s policies around this kind of thing are exactly spot-on and correct. If you can get your work published in respectable scientific journals – that is to say, if you can produce evidence through replicable scientific experiments, then Wikipedia will cover it appropriately. What we won’t do is pretend that the work of lunatic charlatans is the equivalent of “true scientific discourse”. It isn’t.

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Instead Of Therapy, Put A Little Thanksgiving Into Regular Family Dinners

Mark's postcards from Beloit/flickr

Mark’s postcards from Beloit/flickr

Anne K. Fishel, Ph.D.
Guest Contributor

When a colleague recently told me about her Thanksgiving tradition, it got me thinking about family dinners — a topic I consider every night around 7 pm and with every patient I see in family therapy.

Indeed, as a mental health provider, I sometimes feel I’d go out of business if families had regular dinners with one another. Truly. There are dozens of research studies that show that frequent family dinners promote kids’ mental and emotional well being — by lowering rates of depression, anxiety, eating disorders and substance abuse, for starters. Family meals also strengthen children’s resilience, self-esteem and sense of connectedness to their parents. Isn’t that exactly the goal of therapy?

It’s no wonder that I often have to stifle the urge to say, ‘Stop wasting your time here. Go home and eat dinner together.’

But, I’m well aware of how hard it is for busy, harried families to find time to sit down to dinner, and I’m always looking for new ways to unlock the benefits without adding any guilt or pressure. So, that is why my colleagues remarks sparked my interest. Here’s what she said:

“My sisters and I love Thanksgiving so much that our father makes a Thanksgiving-like meal throughout the year that he dubs ‘Harvest Dinner.’ We just can’t get enough of his mashed potatoes!”

I love the idea of bringing the special quality and spirit of Thanksgiving dinner to everyday meals. Two elements could easily translate to everyday dinners: sharing the workload, and focusing on more than just food. Continue reading

Brain Science, Dangerous? Not So Fast, Says Poverty Expert

Back in June, we wrote about a novel program in Boston that seeks to lift women and their families from poverty, in part by using the latest research in neuroscience. Specifically, the program (developed by the nonprofit Crittenton Women’s Union) takes into account recent studies that reveal how trauma, and poverty, can rewire the brain and potentially undermine executive function.

In an Op-Talk piece in this week’s New York Times headlined “Can Brain Science Be Dangerous?” writer Anna North cites our story, and then goes on to question whether this type of approach might be problematic. In the article, North refers to sociologist Susan Sered:

Dr. Sered…says that applying neuroscience to problems like poverty can sometimes lead to trouble: “Studies showing that trauma and poverty change people’s brains can too easily be read as scientific proof that poor people (albeit through no fault of their own) have inferior brains or that women who have been raped are now brain-damaged.”

She worries that neuroscience could be used to discount people’s experiences: “In settings where medical experts have a monopoly on determining and corroborating claims of abuse, what would happen when a brain scan doesn’t show the expected markers of trauma? Does that make the sufferer into a liar?”

We asked Elisabeth Babock, president and chief executive officer of Crittenten Women’s Union, to respond to the Times piece. Here, lightly edited, is what she wrote:

Moving out of poverty in the U.S. today is an extremely complicated and challenging process. It involves trying to maintain a roof over your head when the minimum wage doesn’t cover the minimum rent; and trying to get a better paying job when almost all those jobs require education beyond high-school and the costs of that education, in both money and time, are well beyond the means of most low-wage workers. It involves trying to care for a family while filling in the gaps in what the minimum wage will buy with increasingly-frayed public supports. It involves a lot of juggling.

We at Crittenton Women’s Union (CWU) understand this process all too well because we work with hundreds of people trying to navigate their way out of poverty every day: homeless families living in our transitional housing and domestic violence shelters, and people who are living on the edge of homelessness, struggling to make ends meet. What we at CWU see is that the stress of this everyday struggle creates an additional set of monumental challenges for those we serve.

Our families often describe themselves as feeling “swamped” by their problems to the point that they can only think about how to deal with the crisis of the moment. And in those moments, they may not have the mental bandwidth to strategize about how to change their current circumstances or help them get ahead.

One of the most valuable things brain science research does for this struggle is that it validates what our families share about the way being in poverty affects them. Instead of saying that stress leaves people “irrevocably debilitated”, or worse still, that people should somehow rise above this crippling stress to “just move on” the science actually suggests something much more important. It calls upon all of us to understand that poverty, trauma, and discrimination are experiences whose cumulative effects impact our health, decision-making, and well-being in tangible and predictable ways, and because of this, we as a society can and must do our best to remediate it. Continue reading

Quadruple Amputee Gains New Arms, From Donor Who ‘Gave Best Hugs’

Will Lautzenheiser looked down at his rosy, fleshy new arm at a Brigham and Women’s Hospital news conference this week and exclaimed, “It’s the most beautiful arm!”

For three years, Lautzenheiser — a quadruple amputee in the wake of a virulent bacterial infection in 2011 — had lived without arms. Now, he and his Brigham and Women’s Hospital transplant team have just revealed, he has two new ones, the gifts of an anonymous donor. A medical team of 35, including 13 surgeons, operated on him for nine hours last month to attach them.

Lautzenheiser, 40, spoke with us last year in the video above about his “sit-down” comedy career: “Did You Hear The One About The Comedian With No Arms And Legs?” That armless footage is now outdated.

It will take months for the new arms and hands to gain sensation and function, but Lautzenheiser, a former film professor at Boston University, says he’s already putting them to good use, hugging his partner, Angel Gonzalez. “To be able to hold my love in my arms again is really the best,” he said.

Arm transplant recipient Will Lautzenheiser uses his new arms to hug his partner, Angel Gonzalez, at a Brigham and Women's Hospital press conference. (Photo courtesy BWH)

Arm transplant recipient Will Lautzenheiser uses his new arms to hug his partner, Angel Gonzalez, at a Brigham and Women’s Hospital press conference. (Photo courtesy BWH)

The late donor put those arms to similar use, as described in a message from his family that New England Organ Bank President Richard Luskin read aloud to Lautzenheiser: “Our son gave the best hugs. We pray that you make a wonderful recovery and that your loved ones will be able to enjoy your warm embrace.”

Thus far, Lautzenheiser says, his new arms have little sensation, mainly just a bit of feeling in the skin right below where they’re joined to his own body. As for moving them, “If I really focus, I can occasionally move my thumb just a little bit, a few millimeters. It bends. I can pronate and supinate my wrist on my right arm. I have a little bit of wrist motion, a little bit of forearm motion.” Continue reading

‘Vladimir Pootin’ To Poop Pills: Saga Of First Stool Bank Goes On

Bottles of frozen human stool for fecal transplants at the nation's first stool bank, OpenBiome, in this file photo (Gabrielle Emanuel/WBUR)

Bottles of frozen human stool for fecal transplants at the nation’s first stool bank, OpenBiome, in this file photo (Gabrielle Emanuel/WBUR)

Coming up in the next issue of The New Yorker: “The Excrement Experiment,” a sweeping disquisition on the history of fecal transplants for treating intestinal ills. It includes the delightful tidbit that at the nation’s first stool bank, begun in an MIT lab and now located in Medford, donors are given nicknames like “Winnie the Poo” and “Vladimir Pootin.”

We posted the back-story of the stool bank, by Gabrielle Emanuel, here in April: “MIT Lab Hosts Nation’s First Stool Bank, But Will It Survive?

The existential threat to the stool bank loomed from the FDA, which said it considered stool to be a drug, and thus potentially subject to regulations rigorous enough to send the costs of fecal transplants soaring and probably kill the bank. More recently, the agency has seemed to signal that it will allow some fecal transplants — at least for now.

The New Yorker story reports that orders for OpenBiome’s stool supplies have been growing at 18 percent a month for the last year, spurring complaints from companies that are working on competing products — pills and enemas.

The prospects for poop pill prospects are looking promising, The New Yorker reports, and the stool bank is involved in those efforts as well:

Even if OpenBiome were to stop shipping stool to hospitals, it could presumably continue to operate as a resource for researchers. When I visited in October, there was a tray of shiny white capsules on [co-founder Mark] Smith’s desk—“poop pills that we’ve been working on,” he explained. Doctors at Massachusetts General Hospital had just announced the results of a study showing that capsules were as effective as colonoscopes for treating C. difficile, and the field was abuzz with the news, since, as Smith pointed out, “everyone would rather swallow a pill.” He had hit on a way to improve on the doctors’ methods: lining capsules with cocoa butter, which is solid at room temperature, thus insuring that they won’t disintegrate prematurely—on the shelf or in someone’s mouth.

Meanwhile, for Boston-area residents interested in becoming the next Vladimir Pootin, boston.com reported last month that the bank, which now ships to fecal samples to 122 hospitals, is paying $40 “per dump:”

Are you under 50 years old, willing to make daily trips to Medford, and have regular bowel movements? You, my friend, could be earning $40 a day—just for pooping.

And for the more altruistically motivated:

“These donors may seem very mild-mannered and think going to the bathroom is a humble thing,” said Smith, “but each sample they bring in can treat four or five patients.”

Baker Taps Marylou Sudders To Lead Health And Human Services Department

Gov.-elect Charlie Baker is choosing someone he worked with in the Weld administration to lead the largest agency in the state — the Department of Health and Human Services. Baker said Friday he tapped Marylou Sudders for the post in part because of her collaborative spirit.

Marylou Sudders (Jesse Costa/WBUR)

Marylou Sudders (Jesse Costa/WBUR)

Several groups are praising his choice, citing Sudders’ work as the former state mental health commissioner and former head of the Massachusetts Society for the Prevention of Cruelty to Children.

WBUR’s Deborah Becker spoke with Sudders and started by asking her why she wants to take over an agency facing several challenges. Their lightly edited conversation is below.

——

Marylou Sudders: I’m a public servant at heart. In many ways I feel like my entire professional career has been preparing me for a position such as secretary of Health and Human Services. I believe in the tremendous opportunities in the commonwealth. I’ve never shied away from challenges and I have tremendous faith in really good people fixing these problems.

Deborah Becker: Let’s talk about some of those problems, some of which were raised in a recent survey from the National Alliance for Mental Illness. They want to know what the Baker administration will do about hospital emergency rooms holding patients with a mental illness because they can’t find beds in treatment facilities, or over incarcerating folks with mental illness. Are those your priorities?

These are issues I’m very familiar with. I have every confidence that this administration will be looking at the full health needs, and health will be defined as both the physical and behavioral health needs in this administration.

With the many challenges in this field, what do you hope to accomplish?

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Parent Dilemma: When A Kid’s Concussion Lingers On

When Eli Davis was 15, his ski popped off in the middle of a steep, bumpy slope and he went suddenly airborne, then landed hard, the back of his head slamming down against unyielding ice. That was his first concussion.

A few months later, at soccer camp, he was defending the goal when a breakaway player took a shot from just five feet away and it rocketed right into his face. He finished the game, but he remembers thinking, “Oh…That was not a normal hit.” Another concussion, a worse one.

So far, so familiar. Efforts to expand awareness about the risks of concussion have exploded in the last few years, changing youth sports that had long been more cavalier about hits to the head. Coaches and parents take courses on identifying and treating concussion. Most know to err on the side of caution with head injuries — “When in doubt, sit ‘em out” — and watch for the telltale symptoms that may follow, from dizziness to headache to brain fog.

What fewer know, however, is that while most concussions clear within several days or weeks, a small minority of cases last much longer — like Eli’s.

“He looked at the two of us and said, ‘I don’t care about soccer. I care about the rest of my life.'”
– Al Davis, about his son, Eli

For months after the soccer injury, he suffered a mild headache that would not subside; grogginess and fatigue; sensitivity to light and noise; an inability to think hard that made learning impossible. He found himself stuck on the couch at home, feeling ever more “cabin sick,” when he wanted desperately to be back at school and on the soccer field.

“You can only watch so many seasons of ‘Lost,’ ” he says.

Dr. Neal McGrath, a neuropsychologist and nationally known expert on concussion, estimates very roughly that perhaps 10 to 15 percent of kids with concussions have “longer, tougher recoveries,” often when they’ve accumulated too many concussions, or their injuries have come too close together. That probably amounts to thousands of American children living through prolonged concussion recoveries each year, he says.

Now, Eli’s parents, Robin Friedman and Al Davis of Brookline, Massachusetts, are creating an online venue where those kids and their families can connect, learn from each other and from authorities like Dr. McGrath, and gain support for the long haul they may face.

Professional Web and video content creators who specialize in patient education sites, Friedman and Davis are in the midst of shooting videos like the one above and the others in this post for a site they’ll call Connect2Concussion. They’re trying to fill a void they found as parents groping their own way through post-concussion recovery and all the dilemmas it entails.

Though Eli is thriving now as a sophomore at the University of Massachusetts, his parents still vividly remember how frightening and confusing his condition was in high school. They were worried at first by each day of school Eli had to miss, Friedman says, then scared by how long his symptoms lasted.

“We just didn’t get it,” she says. “With a broken bone or a sprain, you can take an X-ray and you can see it’s healed, and then you know what to do,” she says. “With concussion, they just send you home. It could really be two days or it could be two years, and everything in between, because every child is different, every injury is different and every recovery is different.”

“It gets crazy,” Davis adds, “because every day that goes by, it’s like sand going through an hourglass. You have no idea. You don’t know if he’s going to be OK on Friday, next Monday or two months from now. And what we’ve learned subsequently is that two months from now is actually a reality for people. A year from now is a reality for people. Or it could be three days and everything is good to go.”

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Mystery Ills: Are Older Americans Sicker Than Those In Other Countries?

By Richard Knox

Americans over 65 are apparently sicker than their counterparts in 10 other developed countries, according to a new international comparison.

But this raises a big question. Are American elders really sicker than those in other rich nations? Or are their illnesses just more likely to be diagnosed (or over-diagnosed) than elsewhere?

The mystery is deepened by another fact: As a group, the rising demographic of Americans over 65 are younger on average than elderly populations in the other 10 countries. But they’re three times more likely to have two or more chronic conditions than those in the United Kingdom.

(Medisoft via Compfight/Flickr)

(Medisoft via Compfight/Flickr)

Also, American elders are 21 percent more likely to have multiple chronic diseases than those just across the border in Canada, and 40 percent more likely than Germans.

What gives?

“Fourteen percent of the U.S. population is over 65, versus 21 percent of the German population,” study author Donald Moulds says. “This is really quite a difference, So the fact that we have a younger population with more chronic conditions is particularly alarming.”

Alarming, he says, because of what it means for the future of Medicare, the federal program that pays medical bills for the elderly and disabled, as the U.S. population continues to age. Already, nearly half of Medicare’s $300 billion-plus budget is spent on the 14 percent of beneficiaries with six or more chronic conditions.

The new numbers come from a survey of nearly 16,000 over-65 citizens in 11 nations conducted by the Commonwealth Fund and published online Thursday by the journal Health Affairs. Other than the U.S., the U.K., Canada and Germany the countries studied are Australia, France, the Netherlands, Sweden, Norway, Switzerland and New Zealand.

Moulds says the study can’t answer why American elders report more chronic illness than those in other peer nations. Partly it may be due to the spotty access to medical care that many Americans have had before they turned 65 — and before the Affordable Care Act began to expand coverage.

“If you think about chronic conditions like diabetes and heart disease, these aren’t conditions that people wake up when they’re 65 and suddenly get them,” says Moulds, who is executive vice president of the New York-based Commonwealth Fund. “They develop over a lifetime.” Continue reading

Baker Names Sudders As His Health And Human Services Chief

Marylou Sudders is poised to be named Gov.-elect Charlie Baker’s new head of health and human services, a Baker aide has confirmed to WBUR.

Marylou Sudders (Jesse Costa/WBUR)

Marylou Sudders (Jesse Costa/WBUR)

Sudders is the state’s former mental health commissioner.

State House News Service reports:

Sudders, an associate professor of health and mental health at Boston College’s Graduate School of Social Work, was recruited by Baker to state government in the mid-1990s and served as commissioner of mental health under Republican Govs. William Weld, Paul Cellucci and Jane Swift from 1996 until 2003. She held a similar position in New Hampshire.

Health and human services is the state’s largest executive agency.

The formal appointment is expected later Friday.

12 Tips For Nurses And Doctors Treating Transgender Patients

Massachusetts is drafting rules that will define the transgender services insurers will be required to cover. The Association of American Medical Colleges (AAMC) has just released guidance on training doctors to treat lesbian, gay, transgender and gender nonconforming patients. And Boston University Medical School has what Dr. Joshua Safer, a professor there, says is the nation’s first transgender medicine curriculum focused on the biology of gender identity.

Dr. Joshua Safer and Dr. Jennifer Potter (Courtesy photos)

Dr. Joshua Safer and Dr. Jennifer Potter (Courtesy photos)

Like I said: brand new stuff. But what do all these new rules mean for the doctor or nurse, in an examination room, who meets their first transgender or gender-fluid patient?

Here’s some advice from Dr. Safer, associate professor of medicine at Boston University Medical School, and Dr. Jennifer Potter, associate professor of medicine at Harvard Medical School. (Dr. Potter is a co-author of the AAMC guidelines.)

1) When greeting a new patient, or one you haven’t seen for some time, you cannot assume anything about their gender identity based on the masculinity or femininity of their appearance or the timbre of their voice. To avoid making mistakes, ask each new patient how they identify, what name they prefer to be called and what pronouns they want you to use. Note: Pronouns may be male (he), female (she), they or another gender-neutral option. Continue reading