This study, supported by the National Institute on Drug Abuse (NIDA) and published in the Archives of General Psychiatry, found that individuals attaining high levels of an anti-cocaine antibody had significantly more cocaine free urine samples than those with lower antibody levels or those taking a placebo.  Unlike the antibodies produced by other vaccines, which destroy or disable the disease-causing agent, the cocaine antibodies prevent the drug from passing through the blood brain barrier to inhibit the drugs euphoric effects.   The study found that the proportion of subjects having a 50 percent reduction in use was significantly greater in those attaining higher antibody levels than those with lower levels.  However, only 38 percent vaccinated subjects attained the high antibody levels and significant effects of the vaccine only lasted 2 months.

Martell, B. A., Orson, F. M., Poling, J. et al. (2009). Cocaine vaccine for the treatment of cocaine dependence in methadone-maintained patients. Archives of General Psychiatry, 66(10), 1116-1123. http://archpsyc.ama-assn.org/cgi/content/abstract/66/10/1116

Authors: Bridget A. Martell, Frank M. Orson, James Poling, Ellen Mitchell, Roger D. Rossen, Tracie Gardner, Thomas R. Kosten.

This study uses data from August 2006 to July 2007 to determine the distribution of psychotropic drug prescriptions by medical specialty.  The authors find that 59 percent of psychotropic prescriptions were written by general practitioners, 23 percent by psychiatrists and 19 percent by other physicians. 

Mark, T. L., Levit, K. R., Buck, J. A. (2009). Psychotropic Drug Prescriptions by Medical Specialty. Psychiatric Services, 60, 1167. DOI: 10.1176/appi.ps.60.9.1167 http://psychservices.psychiatryonline.org/cgi/pdf_extract/60/9/1167 

Authors: Tami L. Mark, Katharine R. Levit, Jeffrey A. Buck.

This article examines recent changes to Medicaid and their effects on mental health services, noting that one group of changes will further limit mental health funding flexibility while increasing provider accountability and  state authority.  The author contends that another group changes will promote "person-centered" treatment and community-based care. 

Buck, J. A. (2009). Recent changes in Medicaid policy and their possible effects on mental health services. Psychiatric Services, 60, 1504-1509. DOI: 10.1176/appi.ps.60.11.1504 http://ps.psychiatryonline.org/cgi/content/abstract/60/11/1504

Authors: Jeffery A. Buck.

This article discusses the implications of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial for private and public payers.  The STAR*D trial found that, for second- and third-line treatment, no second-generation antidepressant was superior to another in terms of effectiveness or of the overall incidence of harmful effects.  The authors conclude that the findings have allowed payers to construct coverage rules with greater confidence.

Little, A., Hansen, R. A., Gartlehner, G. (2009). Impact of the STAR*D trial from the perspective of the payer. Psychiatric Services, 60, 1463-1465. DOI: 10.1176/appi.ps.60.11.1463 http://ps.psychiatryonline.org/cgi/content/abstract/60/11/1463 

Authors: Alison Little, Richard A. Hansen, Gerald Gartlehner, Carrie Gray. 

This article, published in the New England Journal of Medicine (NEJM), considers the complexities surrounding linking provider payments and quality of care and health outcomes, noting that, among other issues,  reimbursement must be adjusted for patients' coexisting conditions to prevent hospitals for treating only low-risk patients to achieve high quality ratings. 

Wang, C. J., Conroy, K. N., Zuckerman, B. (2009). Payment reform for safety-net institutions—improving quality and outcomes. NEJM, 361(19), 1821-1823.

Authors: C. Jason Wang, Kathleen N. Conroy, Barry Zuckerman.

This article from the New England Journal of Medicine (NEJM) explores the possibility that health care costs will decrease without health care reform. 

Cutler, D. M. (2009). Will the cost curve bend, even without reform? NEJM, 361(15), 1424-1425.

*Note: The New England Journal of Medicine (NEJM) policies preclude us from providing an article abstract or linking to the NEJM website; however, this article is available in full via the NEJM website.   

Authors: David M. Cutler.