In Practice

What does it mean when a patient responds to a very low dose of a drug? Building on his recent posting on gene testing as an aid to prescribing, Peter D.Kramer looks back to a less contentious time, when doctors talked quietly among themselves about the art of prescribing. Read More

How important can a mediocre scientific study be? Extraordinarily important, even decisive — if it appears in the right place.

JAMA, the lead scientific outlet of the American Medical Association, has just published an overview of the "Effectiveness of Long-term Psychodynamic Psychotherapy." It concludes that for a variety of what it calls complex mental disorders — including personality disorders, eating disorders, and chronic anxiety and depression — long-term pscyhodynamic psychotherapy (LTPP), is a much more effective treatment than short-term psychotherapy.

Will health insurance once again pay for long-term, psychodynamic psychotherapy? On October 3, President Bush signed the financial bailout bill, which is also the Mental Health Parity and Equity Act. Two days earlier, the prestigious journal JAMA published an analysis that found extended individual therapy, with a minimum duration of one year or 50 sessions, to be an especially effective treatment for chronic mental illnesses, including personality disorders and mood disorders. In one study in the survey, patients with treatment-refractory depression and anxiety were seen for a mean of 310 sessions over three-and-a-half years. So: are we there yet? Read More

When the Senate passed the multi-hundred-billion-dollar bailout, the Emergency Economic Stabilization Act of 2008, you may have wondered: How does that work? The Constitution specifies that "All bills for raising Revenue shall originate in the House of Representatives." Clearly, the proposed act includes revenue measures; its sweeteners restrict the alternative minimum tax and extend exemptions for businesses.

The answer is that the drafters used parliamentary legerdemain. They stuffed the emergency legislation into . . . the Mental Health Parity Act!