Duty to Warn: Ethics and Social Consequence

The past two years have been filled with anger, conflict, and stark political splits in the Culture. That these trickle down into the consultation room is doubtless.

You are invited to a series of panels and discussions on the challenging roles and responsibilities of mental health professionals in the current political climate. Panels will look at the potential dilemma between a clinician’s Duty to Warn (As mandated by the Tarasoff ruling) and the Goldwater Rule which limits clinical discussion of public figures.

What this is not. This meeting is not a partisan rally and moderators will be charged to maintain a collegial atmosphere of sharing and mutual exploration.

Book Chat: Sense and Nonsense of Alternative Medicine

By Hannah Lee

Americans are avid consumers of over-the-counter pills and capsules. Parents of patients being treated at the Children’s Hospital of Philadelphia (CHOP) often ask to continue their non-prescription regime of herbs and other dietary supplements. What most of us don’t know is that the Food and Drug Administration (FDA) has no authority to regulate them, so these products do not have to be tested for efficacy or purity before they’re marketed.

Sometimes supplements are later tested by the National Center for Complementary and Alternative Medicine (NCCAM), a part of the National Institutes of Health, but their test results are published in scientific journals. It does not have the clout of the FDA for product recalls or warning labels. People shopping at their local supermarket or drugstore do not know if the labels are false or misleading.

In a recent groundbreaking policy ruling, CHOP took most dietary supplements off its formulary, its list of approved medications. It is the first hospital to no longer administer dietary supplements unless the manufacturer provides a third-party written guarantee that the product is made under the F.D.A.’s “good manufacturing practice” conditions, as well as a Certificate of Analysis assuring that what is written on the label is what’s in the bottle. Parents can sign a waiver, which states “Use of an agent for which there are no reliable data on toxicity and drug interactions makes it impossible to adequately monitor the patient’s acute condition or safely administer medications.”  
Dr. Paul Offit, chief of the division of infectious diseases at CHOP and chair of the Therapeutic Standards Committee which approved the new policy, said that they found a few vitamins and other supplements which meet this standard. One is melatonin which has been shown to affect sleep cycles and has a record of safety, and they have identified a product that met manufacturing and labeling standards. Around 90 percent of the companies they contacted for verification never responded.

People seeking supplements on their own are advised to look for the label, “USP-verified,” meaning they meet standards set by the U.S. Pharmacopeial Convention for ensuring the strength, quality, and purity of a product. One such brand is Nature Made and it’s readily available in local stores.

In his new book, “Do You Believe in Magic?  The Sense and Nonsense of Alternative Medicine,” Offit writes about man’s quest for therapeutic cures and the chicanery of individuals who fool the public with sham remedies. The term, quack, comes from the sixteenth-century Dutch term, kwakzalver, which means one who quacks like a duck while promoting salves and ointments. This became the English quacksilver, later shortened to quack. While the term implies intent, it is not necessarily so. We may laugh at the popularity of erstwhile products such as Wendell’s Ambition Pills, Hamlin’s Wizard Oil, or Becket’s Sovereign Restorative Drops for Barrenness, but we are not immune to new and contemporary marketing.

One chapter is on Linus Pauling and how he upended his stellar scientific career, including a Nobel Prize in Chemistry (and a Nobel Peace Prize for his activism leading to the Nuclear Test Ban Treaty), in his dogged endorsement of massive doses of vitamin C: 3,000 mg or about 50 times the U.S. government’s Recommended Dietary Allowance. Pauling initially proposed the use of vitamin C to treat the common cold, then as a cure for cancer, and later in conjunction with massive doses of vitamin A, vitamin E, and other “antioxidant” supplements which neutralize DNA-damaging free radicals could treat virtually every disease known to man. Since 1994, multiple large studies conducted at the National Cancer Institute, the Fred Hutchinson Cancer Research Center in Seattle, and elsewhere have found that people taking such large doses of vitamins and supplements, in fact, had higher rates of death.  However, studies have not affected sales.  In 2010, the vitamin industry grossed $28 billion in sales.

Other chapters report on the success of Suzanne Somers (touting biodentical hormones for menopause and an extensive anti-aging regimen), Rashid Buttar (anti-autism cream), Deepak Chopra, and Mehmet Oz.  The latter two are especially prolific and vocal in advocating for alternative remedies that have not been tested in scientific trials.

A riveting chapter is on the placebo effect and the powerful ways that it is manifested, such as for acupuncture and pain relief.  The book reads easily and the 36 pages of notes and extensive bibliography allow the committed reader to learn further.

Offit cites the Hippocratic oath of physicians to first do no harm.  When a prominent individual endorses faith healing, how many children would come to harm because their parents choose to rely solely on prayer instead of antibiotics, insulin, or chemotherapy? Steve Jobs was diagnosed with pancreatic cancer, but it was a rare neuroendocrine tumor that was amenable to early treatment; surgery offered a good prognosis.  Jobs eschewed standard therapy in favor of herbal remedies, bowel cleansings, and diet. By the time he had surgery nine months later, the cancer had spread. Ultimately, Offit writes, Jobs died of a treatable disease.

Magical thinking, writes Offit, is how alternative healers cross the line into quackery.  “Encouragement of scientific illiteracy- or, beyond that, scientific denialism- can have a corrosive effect on patients’ perceptions of disease, leaving them susceptible to the worst kinds of quackery.”

AABGU Sponsors Update for Israel’s Health System‏

(from left) AABGU national vice-president and Philadelphia Chapter board member Dr. Al Sutnick, AABGU Philadelphia vice-chair and Health Sciences committee co-chair Dr. Rob Zipkin, and Dr. Jay Bloch

A discussion of health and social justice in Israel was just what the doctor ordered at a reception in Jenkintown, sponsored by the American Associates, Ben-Gurion University of the Negev (AABGU). BGU Professor Nadav Davidovitch spoke about Israel’s public and private healthcare systems and compared them to proposed changes in the United States under President Obama’s new initiatives. In addition to Israel’s four major public health consortiums, there is also a growing private sector for those who can afford the cost of treatment. Joining Prof. Davidovitch on the program was Prof. Michael Yudell, director of Drexel University’s new program in Public Health ethics and a collaborator with Prof. Davidovitch on a NIH-sponsored study on autism, ethics and history. Prof. Yudell also writes the blog “The Public’s Health” for the Philadelphia Inquirer.

More details after the jump.

(from left) Drexel University Professor Michael Yudell; BGU Professor Nadav Davidovitch; AABGU Philadelphia Chapter board member and host Shirley Tauber; BGU researcher Uri Schwed; and Dr. Rob Zipkin

American Associates, Ben-Gurion University of the Negev (AABGU) aims for sustaining David Ben-Gurion’s vision, creating a world-class institution of education and research in the Israeli desert, nurturing the Negev community and sharing the University’s expertise locally and around the globe. With some 20,000 students on campuses in Beer-Sheva, Sede Boqer and Eilat in Israel’s southern desert, BGU considers itself a university with a conscience, where the highest academic standards are integrated with community involvement, committed to sustainable development of the Negev.

Is Your Child Suffering From Hearing Loss?

— by Melissa K. Rodriguez, BC-HIS

A parent’s responsibility while raising children is a never-ending task. From their health to their education from their social skills to providing a nurturing and safe environment, there is so much to do!

One issue that is so often overlooked is how our children hear. Our hearing connects us to the world around us and it is only through the ears of a child that they learn how to speak and how to listen, develop social skills, and build relationships. At school, what they hear and what they listen to can propel them to a brilliant career or a life of manual labor.

More after the jump.
The earlier hearing loss is diagnosed and treated the more chance the child has of successfully adapting to amplification and developing good speech and language skills as well as having healthy social relationships.

Some warning signs of hearing loss that parents can look out for are:

Birth – 2 years old

  • Chronic ear infections
  • Constant pulling or tugging at the ears
  • Not responding to loud noises around them

2 – 5 years old

  • Delayed speech development
  • Speech that is mushy and unclear
  • No response to being called by name
  • Excessively loud speech

5 – 12 years old

  • Slurring of speech
  • Excessive volume on TV or radio
  • Difficulty hearing in the car
  • Declining grades at school


  • Excessive volume levels in TV or speaking
  • Declining grades in school
  • Increased social isolation
  • Aggression

Any of the above red flags or a failed hearing test at school indicates the need for an in depth hearing exam. The hearing exam should include pure tone testing (hear the beep, hit the button) as well as speech testing. These tests can be performed by an audiologist or hearing aid specialist. Children under the age of 5 require specialized equipment and should be seen by a pediatric specialist.

Once a child has been diagnosed with hearing loss there are many questions that need to be answered. First, it is important to understand what type of hearing loss your child has. The two types are conductive and sensorineural.

Conductive hearing loss is a problem with the mechanics of the ear and may be temporary. For example, too much ear wax in the ear canal can block the sound from getting to the eardrum causing some hearing loss. Most conductive losses can be treated through an office procedure, medication or an operation.

Sensorineural hearing loss is permanent and happens in the inner ear in the cochlea. Each cochlea has thousands of hair cells that send the hearing signal to the brain. If these hair cells are damaged or never form, there is no way for the sound waves to be transmitted (in part or in whole) to the brain. A Sensorineural loss will most often be treated with hearing aids. Hearing aids should be worn all waking hours and it will only take a couple of weeks for your child to adapt to this improved hearing. They will need you to cheer them on in their new sense of hearing as it will be different and difficult in the beginning. Once they have adapted to hearing they will appreciate the ease of hearing they receive from their devices.

In the case of deafness (no measure of hearing), cochlear implants and lip reading classes will be top on the list of treatments.

If your child has good hearing, it is important to keep their hearing healthy and to help them develop good listening habits. Ear level devices like I-Pods or MP3 players when used with headphones can be very detrimental to your child’s long-term hearing health. Teach the 60/60 rule: all ear level devices should be used at no more than 60% of the available volume for no more than 60 minutes. Never allow your child to sleep with devices in their ears.

Because of the wide spread use of social media and texting, more children than ever before are not developing good listening and communication skills. Consider having technology blackout periods in your home where communication is achieved verbally. It is unhealthy for all humans, even more so for the developing brain of a child to spend a large amount of time listening to recorded auditory signals. This has become known as schizophonia, it is a dislocation between what we hear and what we see.  This is leading to a culture disconnected from the immediate world around them. Depression, anxiety and poor communication skills can be the result. Model good listening skills to your children and teach them to listen to the world around them.

Finally, teach your children about hearing loss. Currently 5% of teenagers entering college have permanent hearing loss. This number is up significantly in the last decade, meaning that more and more people are wearing hearing aids all the time. Whether it is a classmate, a family member or a future boss, someone wearing hearing aids is invested in communicating with the world around them and should be respected for this effort. Hearing aids don’t restore hearing to perfect so it helps to understand how to best communicate with a hearing aid wearer. Try to talk to them face to face, don’t cover your face with your hand and try to talk distinctly. You don’t have to talk louder; the hearing aid is already amplifying your voice. If a grandparent wears hearing aids, let your children know that as we age our brains ability to process speech slows down so slowing down the rate at which we talk can be helpful.  

Your child’s development both socially and academically is dependent on healthy hearing. Take time today to listen together to the world around you.

Melissa Kay Rodriguez, BC-HIS, literally grew up in the hearing aid business. The daughter of a Beltone dispenser, she obtained her license to fit hearing aids soon after graduating from high school. She earned her National Board Certification in 1995. Currently, she is owner of Hear On Earth Hearing Care Center in El Paso, TX. Rodriguez has been a member of the board of the Texas Hearing Aid Association and served a six-year term on the Texas Governing Board, which regulates the fitting and dispensing of hearing aids in her state. She is an active volunteer with the Starkey Hearing Foundation and has gone on numerous humanitarian missions to fit hearing aids in Juarez and Mexico City, Mexico, and in Peru, among other locations. She is a member of the International Hearing Society, the Texas Hearing Aid Association, and eWomenNetwork. She is the author of the new book, Hear Your Life: Inspiring Stories and Honest Advice for Overcoming Hearing Loss.

Health Care Might Not Be A Laughing Matter, But It Is A Comic Book

  • You won’t have to worry about going broke if you get sick.
  • We will start to bring the costs of health care under control.
  • And we will do all this while reducing the federal deficit.

That is the promise of the Affordable Care Act. But from the moment President Obama signed the bill into law in 2010, a steady and mounting avalanche of misinformation about the ACA has left a growing majority of Americans confused about what it is, why it’s necessary, and how it works. If you’re one of them, buy Jonathan Gruber’s new book Health Care Reform: What It Is, Why It’s Necessary, How It Works for yourself. (Perhaps get extra copies to give as Hanukkah gifts). From how to tame the twin threats of rising costs and the increasing number of uninsured to why an insurance mandate is good for your health, Health Care Reform dispels false fears by arming you with facts.

The author was interviewed by WBUR:

I think Mitt Romney is the hero of this story. But I want to make clear that the way he’s portrayed in this book has nothing to do with his presidential campaign. Mitt Romney is the single person most responsible for health care reform in this country: Without his leadership we don’t get reform in Massachusetts, and without Massachusetts reform we don’t get national reform.

Sample page from book and JSPAN’s resolution regarding ACA after the jump.
At its meeting on August 2, 2011, the JSPAN Board adopted the following resolution:

JSPAN, in keeping with the Biblical injunction that we are each others’ keepers, supports the availability of quality, affordable health care for all Americans. We support the Patient Protection and Affordable Care Act of 2010 as a critical step in achieving such availability. As the “mandate” section of the legislation, requiring all Americans to have health insurance, is essential for the Act to succeed and appears constitutionally valid as a federal power to regulate interstate commerce and assure the well being of the American people, JSPAN should investigate serving as an amicus in support of the defense of the Act in cases currently being heard by federal appellate courts and expected to be heard by the U.S. Supreme Court.

House Repeals Health Reform

Mark Pelavin, Director of the Religious Action Center of Reform Judaism:

Healthcare supporters are sending this form to Republican Congressmen (all of whom voted to repeal Health Reform) with the message: “Dear Represenative, After your vote to repeal affordable healthcare for 32 million Americans, you should practice what you preach, and cancel your own heavily subsidized federal healthcare, too. For your convenience, the form to do this is below. Thank you.”

We are deeply disappointed, though not surprised, by the outcome of yesterday’s House vote to repeal last year’s landmark health reform law.  It is simply incomprehensible that a majority of House members would advocate a complete repeal of the law that saves the government money while extending health insurance to 32 million  previously uninsured Americans, prevents insurers from kicking individuals off their coverage when they fall ill, closes the Medicare donut hole, and allows young adults to remain on their parents’ insurance plan until age 26.

Maimonides’ admonition that every community’s most important responsibility is to provide health care to its citizens continues to inspire us today.  While we are pleased that the Senate is unlikely to consider this legislation, we nonetheless call on all Members of Congress to focus on legislative priorities that reflect our nation’s commitment to life, liberty and happiness – none of which are possible without ensuring the health and well being of every citizen.

David Harris, President of the National Jewish Democratic Council:

The Affordable Care Act made dramatic improvements to our health insurance system — from expanding access to coverage, to lowering costs and preventing discrimination based on pre-existing conditions — which will benefit millions of Americans across the country. Today, the Republican-led House of Representatives took a politically-fueled step in the wrong direction by voting to repeal the legislation for which we all fought so hard. But we can’t stop the forward march of progress now.

NJDC believes that every American deserves the right to have access to quality, affordable health care. The Republicans’ repeal efforts would greatly limit that access. As Senate Majority Leader Harry Reid pointed out, ‘Almost half of all Americans under 65 have pre-existing conditions insurance companies could use as excuses to deny coverage under Republican’ plan to repeal health care reform.’ This is an unacceptable outcome and one of the many reasons why such a large majority of American Jews refuse to stand with the Republican Party.

DADT Repeal is now Official

Today was filled with historic votes:

  • the 9/11 Health Bill was passed unanimously by the Senate,
  • the Senate ratified the New START Treaty 71-26, and
  • President Barack Obama signed into law the repeal of the United States Defense Department’s “Don’t Ask, Don’t Tell” policy.


“Many of you probably remember the exchange earlier this year when Lt. Dan Choi gave Harry Reid his West Point ring and said he wouldn’t take it back until DADT was repealed. Today, Reid gave him the ring back. Powerful video.” (John Marshall – Talking Point Memo)

Reaction by the David A. Harris (NJDC) to these three historic events follows the jump.

The Invocation at the DADT Repeal Signing was given by Rabbi Arnold E. Resnicoff.

Rabbi Arnold E. Resnicoff is a consultant on interfaith values and interreligious affairs; a former line officer who served in Vietnam’s Mekong Delta, followed by assignments with Naval Intelligence before attending rabbinical school; a retired Navy Chaplain who earned the Defense Superior Service Medal for his work with military and civilian leaders throughout Europe, Africa, and the Mid-East while serving as the Command Chaplain for the U.S. European Command;  and a former National Director of Interreligious Affairs for the American Jewish Committee.  From June 2005 to June 2006, he served as  Special Assistant (for Values and Vision) to the Secretary and Chief-of-Staff of the U.S. Air Force, with the equivalent military rank of Brigadier General.  Headquartered in the Pentagon, this appointment took him to Air Force bases in more than ten countries around the world, including those in Iraq, Qatar, and the United Arab Emirates.  On June 16, 2006, Secretary of the Air Force Michael Wynne presented him with the USAF Decoration for Exceptional Civilian Service–the highest award that the Air Force can present to a civilian. In addition to rabbinic ordination, he has three masters degrees, in International Relations, Strategic Studies and National Security Affairs, and Rabbinics, and a doctorate from The Jewish Theological Seminary of America.

Senator Susan Collins (R-ME) and Rep Todd Platts (R-PA) were the only Republican Congressmen in attendance.
— David A. Harris

Senate Passes 9/11 Health Bill

The Senate voted to pass a bill that would “cover the cost of medical care for rescue workers and others who became sick from breathing in toxic fumes, dust and smoke after the 2001 attacks on the World Trade Center.”

The New York Times reported:

The vote, passed by unanimous consent, came soon after a deal was reached between conservative Republicans and Senators Charles E. Schumer and Kirsten Gillibrand. The New York Democrats agreed to changes demanded by the conservative lawmakers, who raised concerns about the measure’s cost and prevented the bill from advancing in the Senate. After drawing criticism in recent days from Democrats and Republicans alike, the Republican senators backed down.

NJDC, alongside so many others in the American Jewish community, was a vocal advocate for health care reform in our country. We applaud the Senate for taking yet another step forward in improving our health care system and honoring the brave men and women who risked their lives to save the lives of others. NJDC also thanks Senators Schumer and Gillibrand for their unwavering commitment to see this important bill passed.

START Treaty

Today’s ratification of the New START treaty by the Senate is yet another step forward in securing our country and helping to stop Iran’s nuclear weapons ambitions. While the treaty’s effects on strengthening the U.S.-Russia relationship are significant and monumental in their own right, the New START treaty will ultimately bolster the ability of the United States and Russia to jointly confront Iran’s nuclear weapons program.

With Iran at the top of the pro-Israel agenda, NJDC was at the forefront of urging the American Jewish community to lend a voice to the debate over the treaty. In mid-November NJDC issued a statement to community leaders saying ‘The time has come for those in the American Jewish community who care deeply about confronting Iran to help pass START now. We can do no less, and we have no time to wait.’ We are proud that our communal effort helped to shine light on the importance of ratifying this crucial treaty.

We commend President Barack Obama and Vice President Joe Biden for their leadership in making New START a top priority, and we applaud the Democratic Senate leadership – working together with key Republicans, including Senator Richard Lugar – for pushing forward the effort to ratify the treaty despite opposition and excuses from a small Republican minority who defiantly stood against the recommendations of our military leadership. Ultimately, Senators on both sides of the aisle understood the importance of ratifying this treaty for our own security – and that it will help to continue our efforts to protect the global community from a nuclear-armed Iran.”

Don’t Ask, Don’t Tell Signing

With the East Room and other key real estate at the White House taken up with holiday decorations and tours, this morning’s presidential signing of the Don’t Ask, Don’t Tell Repeal Act of 2010 has been moved a few blocks away to the Sidney R. Yates Auditorium at the U.S. Department of the Interior. The auditorium is packed with a who’s-who of the leadership within the gay rights and civil rights communities, and a wide array of figures who were essential in bringing about this long, long overdue policy change-including many key members of the House and Senate. The moving opening invocation-delivered by Rabbi Arnold Resnicoff-reminded us all of the many who had served before who had to hide their identities. President Barack Obama received nothing short of a star welcome, replete with chants of “yes we can” and shouts of thanks from the gathered crowd. The President spoke about the critical and historic nature of this moment, and he praised at length all of those who helped to bring this moment about-including the leadership of our military, and especially Chairman of the Joint Chiefs of Staff Mike Mullen who was on hand for the signing. As the President said just before signing, we are not a nation that says “don’t ask, don’t tell”-we are a nation that believes all are created equal. And as he firmly declared to cheers as he completed his signature, “This is done.”

Much ink has been spilled about the state of relations between President Obama and the GLBT community-perhaps as much as has been used in writing about relations between the White House and the Jewish community. But this morning the President made good on yet another key campaign pledge, as he helped our nation make another significant stride forward in civil rights and equality. Before long, openly gay and lesbian service members who wish to stand in defense of their country will be able to do so-making this a good day indeed.

Today’s vote to repeal the ‘Don’t Ask, Don’t Tell’ policy that prohibited gay, lesbian and bisexual Americans from serving openly in our nation’s armed forces is truly historic. The repeal sends a clear message that any willing and able American can and should be allowed to proudly serve our country. As a world leader, it was appalling that we allowed legal and public discrimination to take place against some of the brave men and women who volunteered to serve their country on the field of battle. We applaud President Barack Obama for shining a bright light on this issue, and we commend the leadership of both the House and Senate for protecting the rights of gay, lesbian and bisexual Americans.

This legislative step was a demonstration that good policy-doing the right thing-can also make for good politics. Indeed, Saturday’s vote to repeal “don’t ask, don’t tell” is truly historic. This step sends a clear message that any willing and able American can and should be allowed to proudly serve our country. As a world leader, it was appalling that we allowed legal and public discrimination to take place against some of the brave men and women who volunteered to serve their country on the field of battle. President Obama-and the House and Senate leadership-are to be commended for shining a bright light on this issue, and for their leadership when it comes to protecting the rights of gay, lesbian and bisexual Americans. And when history looks back at the naysayers who tried to block the march of progress-those like Sen. John McCain, who would not accept the verdict of the top leaders of today’s military, let alone the voices of the clear majority of those serving both in and out of uniform-it will not be kind.