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Sunday, April 28, 2002“In the coming debate, the battleground will shift to a 941-page book -- the American Psychiatric Association's Diagnostic and Statistical Manual, or DSM, a compendium of the diseases, disorders and distress that affect the human psyche. The primary issue is whether equal health benefits should be extended to every condition listed in the DSM or limited to the most serious disorders, such as schizophrenia, bipolar disorder and major depression.” Extending healthcare coverage to every diagnosis in the book would be fiscally disasterous. We have expanded the definition of illness so widely that just about anyone can be classified as psychologically impaired. Take, for example, the cause of autism, or “social phobia.” I took the self-test for social phobia at the Paxil® web-site and was told that I probably suffer from it, even though I indicated that my daily functioning was not impaired. (The questions, of course, are designed so that just about everyone would answer in the affirmative to some degree in the hopes that they’ll pressure their doctor in writing a prescription for Paxil.) Advocates of comlete coverage insist that having the diagnosis won’t mean the government will pay for it: “The American Psychiatric Association said critics were spreading misinformation about the validity of the group's manual. Jay Cutler, special counsel for the association, said that diagnosis and treatment were separate issues, and that clinicians would offer treatment only to those people whose disorders significantly interfered with their lives. "There would have to be clinically significant impairment" in order to be eligible for treatment, he said. "If I have a cold it would be covered, but should it be treated? If you only sneeze once, you are not going to get coverage."” The problem is that in practice it’s almost impossible to limit coverage based on severity of symptoms. Every doctor who has ever treated a cold knows that. We are constantly fighting off pressure for antibiotics from patients under just the same circumstances that Mr. Cutler describes. It’s even harder for mental health issues, because the severity of the symptoms is largely within the province of the patient’s perception. A patient who, for example, has taken the Paxil test can easily become convinced that he has a disorder even though he’s functioning just fine. It’s extremely difficult to disabuse people of this notion once they’ve seen their perfectly normal reactions classified as abnormal in the media, even if it's only in an advertisement. The result is that more and more people get referred and treated for what is nothing more than normal human behavior. Congress should consider this issue carefully before jumping on the full parity bandwagon. Such a move may have been feasible twenty years ago, but not today when almost everything is classified as a disease. posted by Sydney on 4/28/2002 06:04:00 AM 0 comments 0 Comments: |
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