Andrew Parker of MI5, John Sawers of MI6, and Iain Lobban of GCHQ testifying before the Intelligence and Security Committee, Nov. 7, 2013.
Video still by UK Parliament via Reuters
In the months since Edward Snowden exposed mass surveillance by the National Security Agency, the U.S. Congress has grilled the agency, its overseers, and its intelligence-community partners in several open hearings. The British Parliament, however, has conducted no such interrogations, despite Snowden’s revelations of similar surveillance by the United Kingdom. Today, the chiefs of Britain’s top three intelligence agencies—MI5, MI6, and GCHQ (Government Communications Headquarters), testified together publicly for the first time before the parliament’s Intelligence and Security Committee. The session was a joke.
Will Saletan writes about politics, science, technology, and other stuff for Slate. He’s the author of Bearing Right. Follow him on Twitter.
I expected better. The Brits, after all, are the people who gave us Question Time, a daily ritual in which members of Parliament interrogate government ministers. Our public-affairs TV network, C-SPAN, treats this as a model of transparency, accountability, and lively debate. But in security matters, the U.K. has a long way to go. When the spy chiefs were asked in today’s committee session about domestic surveillance, they gave the same pat answers U.S. intelligence officials tried to peddle in early post-Snowden congressional hearings. They alluded to “safeguards,” “rigorous oversight,” and “internal rules.” The committee’s members failed to press for evidence or clarification.
The committee’s chairman, Sir Malcolm Rifkind, asked the spymasters why they had to monitor the entire public in order to catch evildoers. Sir Iain Lobban, the director of GCHQ, assured Rifkind that the government’s data harvesters don’t exceed what’s necessary and proper, since “there are very specific legal thresholds,” and “I don’t employ the type of people who would” spy on innocent civilians. “My people are motivated by saving lives,” Lobban sniffed.
In a congressional hearing, this is the kind of assertion that prompts somebody on the panel to ask for details. What legal thresholds? What internal rules? Instead, Rifkind thanked Lobban: “You’ve given a very full response.”
Ten minutes later, Rifkind asked Andrew Parker, the director general of MI5, for “specific examples” of damage done to British intelligence by the disclosure of surveillance methods. Parker offered to give the committee examples in closed session, but he assured Rifkind that thanks to GCHQ’s data collection, “there are real instances” of the government “finding terrorist plots that we would not otherwise find that we’re then able to thwart, which leads to lives being saved.” Again, this is the kind of assertion that often unravels under scrutiny in congressional hearings. But in the British forum, it went unchallenged.
Lobban claimed to have solid evidence. “What we have seen, over the last five months, is near daily discussion among some of our targets” showing damage from recent surveillance disclosures, he told the committee.
We’ve seen terrorist groups in the Middle East, in Afghanistan, and elsewhere in South Asia discussing the revelations in specific terms, in terms of the communications packages that they use, the communications packages that they wish to move to. … We have actually seen chat around specific terrorist groups, including close to home, discussing how to avoid what they now perceive to be vulnerable communications methods, or to how to select communications which they now perceive not to be exploitable.
At this point in an American hearing, you’d expect some congressman to ask the witness how we have such good intel on this “chat” if the bad guys have learned how to evade our surveillance. But nobody on the British panel raised that question.
Why was the interrogation so lame? I can imagine several reasons. The British spy agencies are only supporting actors in the surveillance story. The NSA is the main target, so Congress feels pressure to do something. Libertarianism and distrust of government are also less prevalent in the United Kingdom. One member of the British committee told the spy chiefs that in national polls, “about 60 percent of the public either think that you’ve got the right amount of powers, or indeed, some members of the public think you need more powers.” In addition, the Brits have a stronger faith in the decency of public servants. When NSA officials tell Congress that their employees are good people, we nod but persist. We want to know what laws and mechanisms are in place to prevent abuse.
Two other things about the hearing struck me as odd. One was this comment from Parker, the MI5 boss: “There have been times over the years when successive governments have offered my service greater powers and greater measures. And we’ve said they’re disproportionate and turned away from them.”
FILE - In this Oct. 30, 2013, file photo, President Barack Obama speaks at Boston's historic Faneuil Hall about the federal health care law. Obama says he's sorry Americans are losing health insurance plans he repeatedly said they could keep under his signature health care law. But the president stopped short of apologizing for making those promises in the first place. "I am sorry that they are finding themselves in this situation based on assurances they got from me," he said in an interview Thursday, Nov. 7 with NBC News. (AP Photo/Stephan Savoia, File)
FILE - In this Oct. 30, 2013, file photo, President Barack Obama speaks at Boston's historic Faneuil Hall about the federal health care law. Obama says he's sorry Americans are losing health insurance plans he repeatedly said they could keep under his signature health care law. But the president stopped short of apologizing for making those promises in the first place. "I am sorry that they are finding themselves in this situation based on assurances they got from me," he said in an interview Thursday, Nov. 7 with NBC News. (AP Photo/Stephan Savoia, File)
WASHINGTON (AP) — Seeking to calm a growing furor, President Barack Obama said Thursday he's sorry Americans are losing health insurance plans he repeatedly said they could keep under his signature health care law. But the president stopped short of apologizing for making those promises in the first place.
"I am sorry that they are finding themselves in this situation based on assurances they got from me," he said in an interview with NBC News.
Signaling possible tweaks to the law, Obama said his administration was working to close "some of the holes and gaps" that were causing millions of Americans to get cancellation letters. Officials said he was referring to fixes the administration can make on its own, not legislative options some congressional lawmakers have proposed.
"We've got to work hard to make sure that they know we hear them, and we are going to do everything we can to deal with folks who find themselves in a tough position as a consequence of this," Obama said.
The president's apology comes as the White House tries to combat a cascade of troubles surrounding the rollout of the health care law often referred to as "Obamacare." The healthcare.gov website that was supposed to be an easy portal for Americans to purchase insurance has been riddled by technical issues. And with at least 3.5 million Americans receiving cancellation notices from their insurance companies, there's new scrutiny aimed at the way the president tried to sell the law to the public in the first place.
In Thursday's interview, Obama took broader responsibility for the health care woes than in his previous comments about the rollout, declaring that if the law isn't working "it's my job to get it fixed."
"When you've got a health care rollout that is as important to the country and to me as this is and it doesn't work like a charm, that's my fault," he said.
Some Republicans, who remain fierce opponents of the law three years after it won congressional approval, appeared unmoved by Obama's mea culpa.
"If the president is truly sorry for breaking his promises to the American people, he'll do more than just issue a half-hearted apology on TV," Senate Minority Leader Mitch McConnell, R-Ky., said in a statement.
In recent days, focus has intensified on the president's promise that Americans who liked their insurance coverage would be able to keep it. He repeated the line often, both as the bill was being debated in Congress and after it was signed into law.
But the health care law itself made that promise almost impossible to keep. It mandated that insurance coverage must meet certain standards and that policies falling short of those standards would no longer be valid unless they were grandfathered, meaning some policies were always expected to disappear.
The White House says under those guidelines, fewer than 5 percent of Americans will have to change their coverage. But in a nation of more than 300 million people, 5 percent is about 15 million people.
Officials argue that those forced to change plans will end up with better coverage and that subsidies offered by the government will help offset any increased costs.
"We weren't as clear as we needed to be in terms of the changes that were taking place," Obama told NBC. "And I want to do everything we can to make sure that people are finding themselves in a good position, a better position than they were before this law happened."
The president's critics have accused him of misleading the public about changes that were coming under the law, which remains unpopular with many Americans.
Obama dismissed those accusations, insisting the White House was operating in "good faith." He acknowledged that the administration "didn't do a good enough job in terms of how we crafted the law" but did not specify what changes the administration might make.
The White House has not formally taken a position on a variety of proposals from Congress to address issues that have arisen since the insurance sign-ups launched on Oct. 1.
Sen. Mary Landrieu, D-La., has proposed requiring insurance companies to reinstate canceled plans, and Sen. Joe Manchin, D-W.Va., is supporting a measure to delay for a year the penalties for going without insurance. Another Democrat, Sen. Jeanne Shaheen of New Hampshire, is asking Obama to extend the open enrollment period for insurance exchanges because of the widespread problems with the website.
On Wednesday, Obama met at the White House with Senate Democrats facing re-election next year to try to ease their concerns about the impact the rough health care rollout might have on their races. Many senators in the meeting asked for the enrollment period to be extended but the White House said it doesn't that that will be necessary.
The six-month sign-up window ends March 31. Unless Americans have enrolled in a plan by then, they'll face a penalty.
Obama said he remains confident that anyone who wants to buy insurance will be able to do so.
"Keep in mind that the open enrollment period, the period during which you can buy health insurance, is available all the way until March 31," he said. "And we're only five weeks into it."
Administration officials say they expect the website to be working for the vast majority of users by the end of November.
___
Associated Press writers Jim Kuhnhenn and Josh Lederman contributed to this report.
The editor of "Guns & Ammo" magazine has issued a lengthy apology to outraged readers for publishing an editorial that called for gun control.
"As editor of 'Guns & Ammo,' I owe each and every reader a personal apology," Jim Bequette wrote in a letter posted on the magazine's website late Wednesday. "No excuses, no backtracking. Dick Metcalf’s 'Backstop' column in the December issue has aroused unprecedented controversy. Readers are hopping mad about it, and some are questioning [our] commitment to the Second Amendment. I understand why."
In the column, Metcalf argued that gun owners can no longer hide behind the Second Amendment.
"Way too many gun owners still seem to believe that any regulation of the right to keep and bear arms is an infringement," contributing editor Dick Metcalf wrote in a column titled "Let's Talk Limits." "The fact is, all constitutional rights are regulated, always have been, and need to be."
"Our commitment to the Second Amendment is unwavering," Bequette wrote in his apology to readers. "It has been so since the beginning. Historically, our tradition in supporting the Second Amendment has been unflinching. No strings attached.
"In publishing Metcalf’s column, I was untrue to that tradition, and for that I apologize. His views do not represent mine — nor, most important, 'Guns & Ammo''s. It is very clear to me that they don’t reflect the views of our readership either."
Earlier this week, outraged readers flocked to the magazine's Facebook page, threatening to cancel their subscriptions and boycott the magazine's advertisers unless Metcalf was fired.
"I will NEVER read your magazine again," one reader wrote. "I will NEVER buy anything offered in your magazine. You can kiss my red blooded, white American ass!!!"
"If Dick Metcalf isn't given the boot, I will give the boot to my subscription," wrote another. "Stabbed in the back by one of our own. What a shame."
They got what they wanted.
"Dick Metcalf has had a long and distinguished career as a gunwriter, but his association with 'Guns & Ammo' has officially ended," Bequette wrote.
"I understand what our valued readers want. I understand what you believe in when it comes to gun rights, and I believe the same thing. I made a mistake by publishing the column. I thought it would generate a healthy exchange of ideas on gun rights. I miscalculated, pure and simple. I was wrong, and I ask your forgiveness."
Bequette, who was planning to step down as editor on Jan. 1, wrote that he would do so immediately.
He added: “'Guns & Ammo' will never fail to vigorously lead the struggle for our Second Amendment rights."
Everyone is already all over this whole 3D printing thing. But 3D painting? It's a much emptier field. GE is experimenting with such a technology called "cold spray" that slowly builds up layers of metal by spraying metal powder at extremely high velocities. Instead of recreating works of art, the process is used to repair worn metal components, adding years or potentially decades to their life span. Unlike 3D printing which is severely limited in the size of the objects it can create, 3D painting is only limited by the spread of its spray. That means it could potentially be used to create or repair large structures, and not just prototype scale models of them. In particular, the process is being looked at as a way to repair parts used in oil and gas drilling. It could even be done on the scene and, unlike welding, there's no heat involved -- so there's very little chance for a fire or explosion. (And who wouldn't like to make our gas and oil wells safer.) For a quick demo of the process, check out the video after the break.
Climate may play a role in the distribution and prevalence of trachoma
PUBLIC RELEASE DATE:
7-Nov-2013
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Contact: Katie Steels Katie.Steels@lshtm.ac.uk 44-207-927-2802 Public Library of Science
Call for investment in environmental strategies to eliminate the leading cause of preventable blindness
High temperatures and low rainfall are important factors which influence the occurrence and severity of the active stages of trachomathe most common cause of infectious blindnessaccording to a new study publishing November 7, 2013 in PLOS Neglected Tropical Diseases.
Researchers from the London School of Hygiene & Tropical Medicine and Sightsavers carried out the first systematic review to explore links between climate and trachoma. They found temperature and rainfall appear to influence the transmission of the infection in Africa, possibly because the eye-seeking flies which spread trachoma are more active at higher temperatures and are more abundant in areas with low rainfall.
Trachoma affects more than 40 million people, but it is estimated that 1.2 billion people worldwide live in areas where trachoma is found and are at risk of going blind. The bacterial infection is either passed from person to person by contact with infected secretions from the eyes or nose on hands and clothing, or by flies that land around children's eyes. Repeated infection in childhood can lead to blindness later in life.
The World Health Organization has resolved to eliminate blinding trachoma by 2020 and is working with governments and partners to roll out the SAFE strategy*, which includes surgery to distorted eyelids, antibiotics for active infection, facial cleanliness and environmental improvement to reduce the spread of the infection.
However to ensure the disease can be eliminated on schedule, a greater understanding of all factors that affect the incidence of the disease is needed. This study brings together the evidence on the role climate factors have to play for the first time.
Study co-author Dr Sari Kovats, Senior Lecturer at the London School of Hygiene & Tropical Medicine, said: "Our findings will assist international efforts to map where trachoma occurs as we now have a clearer understanding of the role that altitude, temperature and rainfall can play. We need to increase research on the environmental determinants of blinding trachoma in order to make control measures more effective now and in the future."
Dominic Haslam, Director of Policy at Sightsavers and co-author of the study, said: "This review underlines the urgent need for organizations such as Sightsavers to step-up global efforts to eliminate trachoma, before regional climate shifts make the current situation worse. The blinding disease already causes devastating suffering to millions around the world, and yet we know that by promoting face washing, better hygiene and sanitation, we can help manage the spread of trachoma in endemic communities."
The researchers stress the limitations of the study; only eight papers that were identified in the literature search met the standard for inclusion in the review and all these studies were undertaken in Africa (in Mali [2], Burkina Faso [1], Ethiopia [3], Tanzania [1] and South Sudan [1]), so the findings may not be generalizable to other areas. The study was co-funded by Sightsavers and Irish Aid.
###
* SAFE strategy: Surgery to upper eyelids, Antibiotics for active infection, Facial cleanliness, Environmental improvement, http://trachoma.org/safe-strategy
PLEASE ADD THE FOLLOWING LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002513
(Link will go live upon embargo lift)
Citation: Ramesh A, Kovats S, Haslam D, Schmidt E, Gilbert CE (2013) The Impact of Climatic Risk Factors on the Prevalence, Distribution, and Severity of Acute and Chronic Trachoma. PLoS Negl Trop Dis 7(11): e2513. doi:10.1371/journal.pntd.0002513
For any questions relating to the article, please contact:
Katie Steels
Media Manager
London School of Hygiene & Tropical Medicine
Katie.Steels@lshtm.ac.uk
+44(0)207 927 2802
Sarah Nelson
Senior Media & PR Officer
Sightsavers
snelson@sightsavers.org
+44(0)144 444 6637
Media Permissions
PLOS Journals publish under a Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.5/), which permits free reuse of all materials published with the article, so long as the work is cited (e.g., Kaltenbach LS et al. (2007) Huntington Interacting Proteins Are Genetic Modifiers of Neurodegeneration. PLOS Genet 3(5): e82. doi:10.1371/journal.pgen.0030082). No prior permission is required from the authors or publisher. For queries about the license, please contact the relative journal contact indicated here: http://www.plos.org/journals/embargopolicy.php
About the London School of Hygiene and Tropical Medicine
The London School of Hygiene & Tropical Medicine is a world-leading centre for research and postgraduate education in public and global health, with 3,500 students and more than 1,000 staff working in over 100 countries. The School is one of the highest-rated research institutions in the UK, and was recently cited as one of the world's top universities for collaborative research. The School's mission is to improve health and health equity in the UK and worldwide; working in partnership to achieve excellence in public and global health research, education and translation of knowledge into policy and practice. http://www.lshtm.ac.uk
About Sightsavers
Sightsavers is a registered UK charity (Registered charity numbers 207544 and SC038110) that works in more than 30 developing countries to prevent blindness, restore sight and advocate for social inclusion and equal rights for people with disabilities. http://www.sightsavers.org
About Irish Aid
Irish Aid is the Irish Government's programme for overseas development. It is managed by the Development Cooperation Division of the Department of Foreign Affairs and Trade. http://www.irishaid.ie
About PLOS Neglected Tropical Diseases
PLOS Neglected Tropical Diseases is a peer-reviewed, open-access journal devoted to the pathology, epidemiology, prevention, treatment, and control of the neglected tropical diseases, as well as public policy relevant to this group of diseases. All works published in PLOS Neglected Tropical Diseases are open access, which means that everything is immediately and freely available subject only to the condition that the original authorship and source are properly attributed. The Public Library of Science uses the Creative Commons Attribution License, and copyright is retained by the authors.
About the Public Library of Science
The Public Library of Science (PLOS) is a non-profit organization of scientists and physicians committed to making the world's scientific and medical literature a freely available public resource. For more information, visit http://www.plos.org.
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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Climate may play a role in the distribution and prevalence of trachoma
PUBLIC RELEASE DATE:
7-Nov-2013
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]
Share
Contact: Katie Steels Katie.Steels@lshtm.ac.uk 44-207-927-2802 Public Library of Science
Call for investment in environmental strategies to eliminate the leading cause of preventable blindness
High temperatures and low rainfall are important factors which influence the occurrence and severity of the active stages of trachomathe most common cause of infectious blindnessaccording to a new study publishing November 7, 2013 in PLOS Neglected Tropical Diseases.
Researchers from the London School of Hygiene & Tropical Medicine and Sightsavers carried out the first systematic review to explore links between climate and trachoma. They found temperature and rainfall appear to influence the transmission of the infection in Africa, possibly because the eye-seeking flies which spread trachoma are more active at higher temperatures and are more abundant in areas with low rainfall.
Trachoma affects more than 40 million people, but it is estimated that 1.2 billion people worldwide live in areas where trachoma is found and are at risk of going blind. The bacterial infection is either passed from person to person by contact with infected secretions from the eyes or nose on hands and clothing, or by flies that land around children's eyes. Repeated infection in childhood can lead to blindness later in life.
The World Health Organization has resolved to eliminate blinding trachoma by 2020 and is working with governments and partners to roll out the SAFE strategy*, which includes surgery to distorted eyelids, antibiotics for active infection, facial cleanliness and environmental improvement to reduce the spread of the infection.
However to ensure the disease can be eliminated on schedule, a greater understanding of all factors that affect the incidence of the disease is needed. This study brings together the evidence on the role climate factors have to play for the first time.
Study co-author Dr Sari Kovats, Senior Lecturer at the London School of Hygiene & Tropical Medicine, said: "Our findings will assist international efforts to map where trachoma occurs as we now have a clearer understanding of the role that altitude, temperature and rainfall can play. We need to increase research on the environmental determinants of blinding trachoma in order to make control measures more effective now and in the future."
Dominic Haslam, Director of Policy at Sightsavers and co-author of the study, said: "This review underlines the urgent need for organizations such as Sightsavers to step-up global efforts to eliminate trachoma, before regional climate shifts make the current situation worse. The blinding disease already causes devastating suffering to millions around the world, and yet we know that by promoting face washing, better hygiene and sanitation, we can help manage the spread of trachoma in endemic communities."
The researchers stress the limitations of the study; only eight papers that were identified in the literature search met the standard for inclusion in the review and all these studies were undertaken in Africa (in Mali [2], Burkina Faso [1], Ethiopia [3], Tanzania [1] and South Sudan [1]), so the findings may not be generalizable to other areas. The study was co-funded by Sightsavers and Irish Aid.
###
* SAFE strategy: Surgery to upper eyelids, Antibiotics for active infection, Facial cleanliness, Environmental improvement, http://trachoma.org/safe-strategy
PLEASE ADD THE FOLLOWING LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002513
(Link will go live upon embargo lift)
Citation: Ramesh A, Kovats S, Haslam D, Schmidt E, Gilbert CE (2013) The Impact of Climatic Risk Factors on the Prevalence, Distribution, and Severity of Acute and Chronic Trachoma. PLoS Negl Trop Dis 7(11): e2513. doi:10.1371/journal.pntd.0002513
For any questions relating to the article, please contact:
Katie Steels
Media Manager
London School of Hygiene & Tropical Medicine
Katie.Steels@lshtm.ac.uk
+44(0)207 927 2802
Sarah Nelson
Senior Media & PR Officer
Sightsavers
snelson@sightsavers.org
+44(0)144 444 6637
Media Permissions
PLOS Journals publish under a Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.5/), which permits free reuse of all materials published with the article, so long as the work is cited (e.g., Kaltenbach LS et al. (2007) Huntington Interacting Proteins Are Genetic Modifiers of Neurodegeneration. PLOS Genet 3(5): e82. doi:10.1371/journal.pgen.0030082). No prior permission is required from the authors or publisher. For queries about the license, please contact the relative journal contact indicated here: http://www.plos.org/journals/embargopolicy.php
About the London School of Hygiene and Tropical Medicine
The London School of Hygiene & Tropical Medicine is a world-leading centre for research and postgraduate education in public and global health, with 3,500 students and more than 1,000 staff working in over 100 countries. The School is one of the highest-rated research institutions in the UK, and was recently cited as one of the world's top universities for collaborative research. The School's mission is to improve health and health equity in the UK and worldwide; working in partnership to achieve excellence in public and global health research, education and translation of knowledge into policy and practice. http://www.lshtm.ac.uk
About Sightsavers
Sightsavers is a registered UK charity (Registered charity numbers 207544 and SC038110) that works in more than 30 developing countries to prevent blindness, restore sight and advocate for social inclusion and equal rights for people with disabilities. http://www.sightsavers.org
About Irish Aid
Irish Aid is the Irish Government's programme for overseas development. It is managed by the Development Cooperation Division of the Department of Foreign Affairs and Trade. http://www.irishaid.ie
About PLOS Neglected Tropical Diseases
PLOS Neglected Tropical Diseases is a peer-reviewed, open-access journal devoted to the pathology, epidemiology, prevention, treatment, and control of the neglected tropical diseases, as well as public policy relevant to this group of diseases. All works published in PLOS Neglected Tropical Diseases are open access, which means that everything is immediately and freely available subject only to the condition that the original authorship and source are properly attributed. The Public Library of Science uses the Creative Commons Attribution License, and copyright is retained by the authors.
About the Public Library of Science
The Public Library of Science (PLOS) is a non-profit organization of scientists and physicians committed to making the world's scientific and medical literature a freely available public resource. For more information, visit http://www.plos.org.
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Facebook's known for testing new features with a limited group before a broader rollout, and it's latest one could have some real implications for both businesses and individual users of the social network alike. As TechCrunch reports, Facebook is now testing a new five star rating system that's ...
Contact: David Orenstein david_orenstein@brown.edu 401-863-1862 Brown University
Racial disparity evident
PROVIDENCE, R.I. [Brown University] A new study by Brown University psychiatry researchers found that seven in 10 primary care patients with anxiety disorders eventually received potentially adequate medication or psychotherapy, but for many it took years to happen and it was considerably less likely for minorities.
In the five-year study of 534 people published online Nov. 4 in the journal Depression and Anxiety, researchers found that 28 percent of them were receiving "potentially adequate" medication (19 percent) or psychotherapy (14 percent) or both when first recruited into the study from one of 15 primary care sites in four New England states. By year five of follow-up, 69 percent had received either or both appropriate medication (60 percent) or psychosocial treatment, such as cognitive behavioral therapy (36 percent).
"The good news here was that eventually, most patients got some good treatment," said study lead author Risa Weisberg, associate professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University. "The bad news is that pharmacotherapy wasn't sustained for long periods of time, that cognitive-behavioral therapy was rarely received even over the longer time period, and that ethno-racial minorities were less likely to get good care."
Most studies of anxiety treatment adequacy have only looked at one time point and have therefore found very low levels of care. But anxiety disorders are often chronic and primary care providers typically have an ongoing relationship with patients, Weisberg said. This study looked at a longer term.
Another key feature of the study was that it measured the provision of "potentially adequate" therapy. In the case of medication, that meant a drug had to have known efficacy and be taken at an adequate dose for enough time. For psychotherapy, the authors defined cognitive therapy or behavioral therapy as potentially adequate based on the method having empirical support and on meeting basic benchmarks such as identifying problematic patterns in thinking and recommending a course to change them or asking patients to conduct exposure exercises in which they attempt to engage in feared behaviors.
Although over the course of five years many patients eventually received care, some patients were less likely to receive it. Minorities, for example, were less than half as likely to receive "potentially adequate" treatment for anxiety either at the beginning of the five-year study period or by the end. People of any race or ethnicity with a college education, on the other hand, were almost twice as likely to receive care.
The patients were recruited through via the Primary Care Anxiety Project and were tracked through a follow-up period that ran from 2002 to 2007.
Weisberg said it is possible that rates of referral to potentially adequate care have categorically increased since then, but there was no evidence in the study data that the rates were systematically increasing during the study's five-year period.
Instead, she said, patients may take a while to eventually get potentially adequate care because primary care physicians often employ a strategy of "watchful waiting" to see if symptoms will improve. Weisberg and her co-authors noted in the study that patients with more severe anxiety symptoms were more likely to get potentially adequate care.
In a future work, Weisberg said, she hopes to study explicitly what triggers the start of anxiety therapy for primary care patients.
###
In addition to Weisberg, other authors on the paper are Courtney Beard, Ethan Moitra, Ingrid Dyck and Martin Keller.
Pfizer Inc. funded the study.
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Anxiety help comes, eventually, via primary care
PUBLIC RELEASE DATE:
7-Nov-2013
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Contact: David Orenstein david_orenstein@brown.edu 401-863-1862 Brown University
Racial disparity evident
PROVIDENCE, R.I. [Brown University] A new study by Brown University psychiatry researchers found that seven in 10 primary care patients with anxiety disorders eventually received potentially adequate medication or psychotherapy, but for many it took years to happen and it was considerably less likely for minorities.
In the five-year study of 534 people published online Nov. 4 in the journal Depression and Anxiety, researchers found that 28 percent of them were receiving "potentially adequate" medication (19 percent) or psychotherapy (14 percent) or both when first recruited into the study from one of 15 primary care sites in four New England states. By year five of follow-up, 69 percent had received either or both appropriate medication (60 percent) or psychosocial treatment, such as cognitive behavioral therapy (36 percent).
"The good news here was that eventually, most patients got some good treatment," said study lead author Risa Weisberg, associate professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University. "The bad news is that pharmacotherapy wasn't sustained for long periods of time, that cognitive-behavioral therapy was rarely received even over the longer time period, and that ethno-racial minorities were less likely to get good care."
Most studies of anxiety treatment adequacy have only looked at one time point and have therefore found very low levels of care. But anxiety disorders are often chronic and primary care providers typically have an ongoing relationship with patients, Weisberg said. This study looked at a longer term.
Another key feature of the study was that it measured the provision of "potentially adequate" therapy. In the case of medication, that meant a drug had to have known efficacy and be taken at an adequate dose for enough time. For psychotherapy, the authors defined cognitive therapy or behavioral therapy as potentially adequate based on the method having empirical support and on meeting basic benchmarks such as identifying problematic patterns in thinking and recommending a course to change them or asking patients to conduct exposure exercises in which they attempt to engage in feared behaviors.
Although over the course of five years many patients eventually received care, some patients were less likely to receive it. Minorities, for example, were less than half as likely to receive "potentially adequate" treatment for anxiety either at the beginning of the five-year study period or by the end. People of any race or ethnicity with a college education, on the other hand, were almost twice as likely to receive care.
The patients were recruited through via the Primary Care Anxiety Project and were tracked through a follow-up period that ran from 2002 to 2007.
Weisberg said it is possible that rates of referral to potentially adequate care have categorically increased since then, but there was no evidence in the study data that the rates were systematically increasing during the study's five-year period.
Instead, she said, patients may take a while to eventually get potentially adequate care because primary care physicians often employ a strategy of "watchful waiting" to see if symptoms will improve. Weisberg and her co-authors noted in the study that patients with more severe anxiety symptoms were more likely to get potentially adequate care.
In a future work, Weisberg said, she hopes to study explicitly what triggers the start of anxiety therapy for primary care patients.
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In addition to Weisberg, other authors on the paper are Courtney Beard, Ethan Moitra, Ingrid Dyck and Martin Keller.
Pfizer Inc. funded the study.
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