ARTICLE-MENTAL HEALTH PARITY

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FWD:

This is the best anti-mental health parity article ever written.  Distribute

this far and wide and definitely acknowledge the reporter (short and concise 

please)  for such an incredible expose at <A

HREF= " mailto:komeara@... " >komeara@...</A>

 

Money and Madness: U.S. Surgeon General admits diagnoses of psychiatric

mental disorders is not science.

 

<A HREF= " http://www.insightmag.com/main.cfm?include=detail & storyid=254286 " >

http://www.insightmag.com/main.cfm?include=detail & storyid=254286</A>

Money and Madness

June 3, 2002

By O'Meara

A child who doesn't like doing math homework may be diagnosed with the

mental illness developmental-arithmetic disorder (No.315.4). A child who

argues with her parents may be diagnosed as having a mental illness called

oppositional-defiant disorder (No.313.8). And people critical of the

legislation now snaking through Congress that purports to " end

discrimination against patients seeking treatment for mental illness " may

find themselves labeled as being in denial and diagnosed with the mental

illness called noncompliance-with-treatment disorder (No.15.81).

The psychiatric diagnoses suggested above are no joke. They represent a few

of the more than 350 " mental disorders " listed in the American Psychiatric

Association's (APA) Diagnostic and Statistical Manual of Mental Disorders

(DSM-IV), the billing bible for mental disorders which commingles

neurological diseases with psychiatric diagnoses. (Click here to see more

examples of the mental disorders listed in the DSM-IV.) Whether the

described diagnoses are real diseases or subjective speculation, science is

at the heart of the debate about whether lawmakers will require employers

and insurers to cover mental illness on the same level as physical disease.

Advocates of the Mental Health Equitable Treatment Act of 2002 (S 543), and

its sister proposal in the House (HR 4066), are seeking to expand the 1996

" mental-health parity " legislation. It mandates employers with more than 50

employees and that offer mental-health coverage to provide insurance

benefits equal to those of standard health care, such as surgery and

physician visits.

The pending proposals would expand the 1996 legislation to require that

caps, or limitations on coverage, be the same for mental illnesses as those

provided for medical illnesses, in the name of so-called mental-health

parity. When it comes to " mental illness " and " medical illness " however,

there is no scientific parity between the two schools of thought. That is,

only one is based in physical science.

Proponents of mental-health parity believe, and have for the most part

successfully convinced lawmakers, that the mental illnesses described in the

DSM-IV are medical diseases. For example, obsessive-compulsive disorder

(OCD) is considered medically equivalent to, say, measles or anemia.

But critics patiently explain that the psychiatric " mental illness " as

described in the DSM-IV is a subjective diagnosis that lies in the eye of

the beholder rather than in proved medical science. How this issue is

decided, these critics say, likely will determine whether millions of

American families will be priced out of health insurance.

Fred Baughman, a San Diego neurologist and leading critic of the alleged

mental illness called attention-deficit/ hyperactivity disorder (ADHD) (see

picture profile, Feb. 18), tells Insight the question that must be answered

before a mental illness can qualify as a disease is this: " Where is the

macroscopic, microscopic or chemical abnormality in any living patient or at

death/autopsy? "

Baughman explains: " No one is justified in saying anyone is medically

abnormal/diseased until such time as they can adduce some such abnormality.

This, by the way, would apply to a person suspected of having diabetes or

cancer. "

The fact is, Baughman adds, " There is no psychiatric diagnosis for which any

part of this question can be answered in the affirmative. In other words: no

abnormality; no disease. There is no confirmation of abnormality in the

brain in life or at autopsy for any of the psychiatric diagnoses. And they

[in the psychiatric community] don't say this because it's part of the

propaganda campaign to make patients out of normal people. The findings at

autopsy would be very specific and would reveal whether it is a diseased

brain and, if so, which disease it is. There is no proof in life or at

autopsy of any of the alleged psychiatric mental illnesses, including

schizophrenia, psychosis, depression, OCD or ADHD. "

Here is Baughman, an internationally respected neurologist, denying there is

any such thing as an authentic diagnosis of psychiatric disease at precisely

the same time that Congress appears to be getting ready to mandate equal and

comparable coverage of psychiatric and medical diseases as the same thing.

Perhaps lawmakers haven't asked for the supporting science, or perhaps it

has just been withheld from them.

To try to find out which, Insight sent carefully prepared questions about

mental illness to the APA and the National Institute of Mental Health

(NIMH), the two leading advocates of mental-health parity. Here are those

questions:

How many disorders that are listed in the DSM-IV are curable?

What documentable, confirmatory, diagnostic, physical abnormality is found

in schizophrenia, ADHD and depression?

What confirmatory, diagnostic tests are available and currently utilized to

detect a chemical imbalance?

The APA would not respond to the questions and the NIMH, which claimed not

to get involved in policy issues, deferred to a psychiatrist who refused to

speak on the record. Both groups did, however, suggest reviewing the 1999

Surgeon General's Report on Mental Health, which Insight promptly read. The

report contained the remarkable statement that, " in the United States,

mental disorders collectively account for more than 15 percent of the

overall burden of disease from all causes and slightly more than the burden

associated with all forms of cancer. "

But nowhere in the surgeon general's report was there any reference to a

single confirmatory, diagnostic test that proves any physical abnormality in

any psychiatric diagnosis. More importantly, several chapters into the

report the surgeon general admits what Baughman and other neurologists have

been saying for years: " The diagnosis of mental disorders is often believed

to be more difficult than diagnosis of somatic or general medical disorders

since there is no definitive lesion, laboratory test or abnormality in brain

tissue that can identify the illness " [emphasis added].

Naturally, one might assume, it would be difficult to diagnose a mental

illness if there were no confirming physical evidence that one exists. And

one might even ask the surgeon general how he could make the statement that

" mental disorders collectively account for more than 15 percent of the

overall burden of disease " when he admits later in the report that there is

no physical proof thus far of mental disease in any of the psychiatric

diagnoses.

More important, critics say, is his honest admission that there is no proof

of any physical abnormality that causes any psychiatric mental disorder.

This begs the question: If there is no way to prove that a single

psychiatric mental illness exists in life or death, how does one diagnose

something that doesn't exist and then require insurance companies to pay for

treatment?

While the observations of the nation's top medicine man seem crystal clear -

and are, in fact, a carbon copy of what critics such as Baughman long have

been saying about mental disorders - apparently the sponsors of the pending

legislation missed the surgeon general's report. According to

Dobson, communications director for Sen. Wellstone (D-Minn.), a

cosponsor of the Senate bill, " We know that mental illness is valid based on

the volumes of science that have been presented to the senator. The mental

illness thing has pretty much been proved by science. "

Sen. Pete Domenici (R-N.M.), the biggest cheerleader for requiring

mental-health parity, didn't respond to Insight's calls. But Zamora,

the policy adviser for Rep. Kennedy (D-R.I.), a cosponsor of the

House parity legislation, tells Insight: " We've had a number of specialists

from NIMH who have talked about what they're doing. While they don't have

any diagnostic criteria developed yet, they are making advances and starting

to document the linkages between the physical and mental. But they haven't

necessarily been able to establish yet exactly how these are working. "

Indeed, says Kennedy's spokesman, " I'm pretty confident and trusting that

the science base of the National Institute of Health, the surgeon general

and Nobel laureates have researched this stuff when they say there is a

science base behind mental illness. I know that the congressman is confident

that the surgeon general and our premier medical-research facility, NIMH, is

not full of quacks. "

But that's not the issue, critics say. It's whether as-yet medically proved

illness ought to be paid for by insurance companies, employers and patients

at the same levels as diseases science physically has confirmed.

Neither former surgeon general Satcher (author of the 1999 Surgeon

General's Report on Mental Health) nor former NIMH director Hyman

would agree to an interview to discuss these matters. Given the official

admission by former surgeon general Satcher it is tempting to speculate why

the interviews were denied. What is unclear is why lawmakers continue to

push for mental-health parity with medical disease when, to date, there is

no physical proof that any of the psychiatric mental disorders can be

confirmed as abnormalities of the brain.

As recently as late May sponsors of the House parity legislation, Marge

Roukema (R-N.J.) and Kennedy, continued the push to " end discrimination

against patients seeking treatment for mental illness. " In a " Dear

Colleague " letter to members of the House of Representatives entitled " The

Truth About The Impact of Mental Health Parity, " Roukema and Kennedy

attempted to " eliminate any confusion about the DSM. " The authors sought to

give credence to the APA's diagnostic manual, explaining that, " for 50

years, DSM has been widely recognized as the 'international standard' system

for classifying mental disorders, " and the " DSM is the state of the art of

the knowledge base. "

The " Dear Colleague " advocacy letter closed by observing: " There will always

be those who oppose ending insurance discrimination. . While we strongly

disagree with them, we look forward to a debate on the facts. " Perhaps so.

But nowhere did the letter so much as mention that none of the psychiatric

diagnoses in the DSM are based in physical science such as abnormalities of

the brain found in life or death.

Meanwhile, independent groups representing businesses and other insurers say

they are alarmed about the financial burden the proposed legislation is

certain to produce. It is widely estimated that nearly 45 million Americans

already are without health insurance and there is little doubt that

mandating expanded coverage of undefined " mental disease " will run up costs

and premiums still further. No one knows how much, but consider these

guesstimates:

In 2001 the Business Journal estimated the likely increase in costs would be

as high as 40 percent; the National Association of Health Underwriters

suggests insurance premiums likely would increase by 11.4 percent.

The National Federation of Independent Businesses (NFIB) conducted a study

among its 600,000 members that indicates even existing state benefit

mandates could increase premiums by as much as 30 percent.

An April 2002 Pricewaterhouses report estimates that government

mandates and regulations, which increased 25-fold from 1970 to1996, will add

$10 billion to the overall increase in health premiums.

N. Kahn III, president of the Health Insurance Association of

America (HIAA), testified before Congress in 1999 that coverage for

psychiatric hospital stays alone already had increased premiums by 12

percent.

In land, a 1992 Blue Cross/Blue Shield Association study documented " the

most expensive individual benefits were estimated to be substance-abuse and

mental-health-care services. " Outpatient mental-health-care visits increased

more than 78 percent once mandates were expanded - from 448,000 in 1983 to

800,000 in 1986.

The NFIB, the National Association of Manufacturers, the U.S. Chamber of

Commerce and the HIAA are among the many organizations opposed to the parity

legislation. According to Randy Clerihue, a spokesman for HIAA, " We don't

like this bill because it's going to raise the cost of health care. It's not

that we don't think mental-health services aren't important, but we don't

think government should be mandating the kind of insurance employers

purchase on behalf of their employees. The problem comes when you have a

mandate that forces everyone to pay for something whether they want it or

not. We're headed in the direction of mandating everyone out of health

insurance. "

Each of the many business and insurance groups with which Insight spoke

expressed similar sentiments and each was aware of a little-discussed fact:

While lawmakers seem prepared to force private insurers to pay for the

increase in insurance premiums for mental disorders, which then will be

passed along to employees in the form of higher costs and lost take-home

pay, the federal government itself is not included - neither Medicare nor

Medicaid are included in the mandate. Imagine the uproar if payments for

these had to be increased 40 percent or so!

Bruce Wiseman, U.S. national president of the Citizens Commission on Human

Rights, a nonprofit organization committed to ending abuses in psychiatry,

tells Insight: " The government won't include Medicare and Medicaid in parity

legislation because they know the taxpayers couldn't afford it - it would

break the bank. And even excluding those programs it will break the bank

because mental illness is subjective. "

According to Wiseman, " Numerous studies show psychiatrists tend strongly to

use health-insurance benefits up to the point that they are exhausted, at

which point the patient is declared cured. For instance, a person is found

to have anxiety disorder up to the insurance cap, whereupon the psychiatrist

tells them they no longer have it. This kind of diagnosing would milk the

system dry. In this legislation, the government is saying that if there's a

million-dollar cap on treating a patient's cancer then there has to be a

million-dollar cap on treating shyness when it is called social-anxiety

disorder. So once the person gets 'treated,' the bill reaches the cap and

they're pronounced cured. Such diagnoses will run insurance costs into the

stratosphere. Parity legislation is ripe for abuse if for no other reason

than bogus diagnosis. "

The former surgeon general, however, might put an end to the debate if he

were to testify before Congress about what he wrote in the 1999 report -

that there is no known abnormality in the brain as a marker for any of the

psychiatric diagnoses. Meanwhile, the critics say, they will continue to

insist that until a physical cause of mental disorder is identified it is

not comparable to medical disease and there should be no government mandate

that insurance companies treat them the same.

O'Meara is an investigative reporter for Insight magazine.

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