In mid-August the Bush administration issued final regulations governing the privacy of computerized medical records. In issuing the new rules, Health and Human Services Secretary Tommy G. Thompson said that they "strike a common sense balance" between protecting the confidentiality of patient records and creating barriers to receiving health care.

However, the American Psychiatric Association (APA) and other consumer advocates, who have long sought stronger protections, disagreed with this assessment, pointing out that several of the rules tip the balance in favor of health plans, insurance companies, and the pharmaceutical industry. APA President Paul S. Appelbaum, M.D., stated that the APA is "deeply disappointed" with the rules and that "in their ultimate form, the privacy rules have abandoned patients' fundamental right of prior consent to the disclosure of personal medical information."

Since 1996, when Congress recognized the need for national patient privacy standards, the debate on prior consent has pitted consumer advocates against the health care industry, including many physicians, insurers, health maintenance organizations, and other health plans. The final regulations did not include a requirement that patients' written informed consent be obtained before their medical information can be released to insurance plans, hospitals, pharmacies, and medical personnel. Such a requirement was contained in the draft regulations and in privacy regulations issued in the final months of the Clinton administration, the implementation of which was postponed by the incoming administration.

Bush administration officials and representatives of the health care industry have argued that requiring written informed consent would make it difficult for doctors, hospitals, pharmacies, and insurance plans to share patient information and provide care effectively and economically. The American Medical Association strongly opposed the requirement for written consent. Instead of written consent, the regulations require entities that handle patient records to provide patients with a written notice of their privacy practices and patients' privacy rights. Patients will not be required to provide written acknowledgment of their receipt of this information from treatment providers

In his statement, Dr. Appelbaum pointed out that under the new rules "patients no longer have control over who has access to their medical records," and that as a result patients may be discouraged from revealing information to their physicians that is necessary for their treatment. He also noted that physicians may be reluctant to record important but potentially embarrassing information in their patients' medical charts.

Critics have also focused on the regulations that govern the use of medical information for marketing products such as prescription drugs. Dr. Appelbaum called this aspect of the regulations "troublesome." He further stated that "According to the Bush administration's own account, they have created a loophole whereby a pharmaceutical company will be permitted to pay a pharmacy to recommend to patients that they switch from one medication to another, and there will be no requirement to disclose this arrangement to patients. Moreover, patients will be unable to decline to receive such solicitations. This unwarranted interference with the patient-physician relationship is not justified by any benefit to patients, but is motivated solely by the economic interests of the pharmaceutical industry."

Dr. Appelbaum also pointed out positive aspects of the rules, including some restrictions on the sale of patients' medical information and expanded rights of patients to see and correct errors in their records. In addition, the final regulation requires for specific patient authorization for release of psychotherapy notes, with limited exceptions. "But, he said, "the value of these positive measures is seriously compromised by the retreat on patients' rights to determine what happens to their records and to prevent their information from being used for commercial purposes."

The regulations will override any weaker state laws governing the privacy of records but will not interfere with more stringent policies that states have adopted. Most providers and health plans have until April 14, 2003, to comply with the regulations. To help people prepare for compliance, the Office for Civil Rights of the U.S. Health and Human Services Department (HHS) will develop and disseminate technical assistance materials, such as fact sheets, handbooks, and lists of frequently asked questions. HHS will also hold national educational conferences in the fall to address issues related to key parts of the regulations. Technical assistance materials will be posted on the Web at http://www.hhs.gov/ocr/hipaa/.

On any given day, approximately 1 million people are receiving treatment for drug or alcohol addiction, according to the 2000 National Survey of Substance Abuse Treatment Services released by the Substance Abuse and Mental Health Services Administration (SAMHSA). The large majority—89 percent—were enrolled in some type of outpatient care in 2000. Of the remainder, 9 percent were in residential rehabilitation. Three other categories—residential detoxification, inpatient hospital rehabilitation, and inpatient detoxification—accounted for the other 2 percent. Forty-eight percent of all clients were in treatment for both alcohol and drug abuse, and 23 percent were in treatment for alcohol abuse only.

The purpose of the annual national survey is to collect data on the location, characteristics, and use of alcohol and drug treatment facilities and services in the 50 states, the District of Columbia, and other U.S. jurisdictions. In 2000 a total of 13,428 facilities, or 94 percent of eligible facilities, participated in the survey.

In 2000, private nonprofit facilities made up the bulk of the system (60 percent), followed by private for-profit facilities (26 percent) and programs and facilities operated by state and local governments (11 percent). Nonintensive outpatient rehabilitation was the most widely available type of care—offered by 78 percent of the facilities. Intensive outpatient treatment was offered by 46 percent. Twenty-six percent of the facilities offered residential rehabilitation. Partial hospitalization programs were available at 16 percent of facilities and outpatient detoxification at 13 percent. Residential detoxification and hospital inpatient treatment—either detoxification or rehabilitation—were offered by 8 percent of all facilities.

Ninety-five percent of the facilities offered both alcohol and drug treatment, and most had at least one special treatment program. The programs were aimed at a variety of groups. Fifty percent of facilities had programs for persons with dual diagnoses, 30 percent for adolescents, and 22 percent for persons with HIV infection or AIDS. Programs for pregnant or postpartum women were offered by 21 percent of the facilities, and 38 percent had programs aimed at other groups of women. Programs for men only were available at 33 percent of facilities, and 18 percent had programs for older adults. Many facilities—38 percent—also offered treatment for persons in the criminal justice system. Special programs for those arrested while driving under the influence of alcohol or drugs or driving while intoxicated were available at 36 percent of the facilities.

Methadone or LAAM were dispensed at 9 percent of the facilities surveyed. Those most likely to offer this treatment were for-profit facilities (14 percent) and federal government facilities (12 percent), including those operated by the Department of Veterans Affairs (22 percent). Twelve percent of state-owned facilities dispensed methadone or LAAM.

The number of facilities that had managed care contracts continued to increase. Fifty-four percent had such contracts in 2000, compared with 42 percent in 1996.

The data from the survey are also used to update SAMHSA's Substance Abuse Treatment Facility Locator, available at http://findtreatment. samhsa.gov.

Study of those affected by September 11: The 9/11 United Services Group (USG) has released findings from its Ongoing Needs Study, a systematic evaluation that analyzes the overall economic and emotional effects of the World Trade Center attacks on various New York City populations, estimates the future needs of those affected, and assesses how much funding is still available to meet those needs. The study, conducted by McKinsey and Company, found that 45,000 of the 70,000 workers whose jobs were affected continue to suffer an income loss of more than 25 percent and that 28,000 are still unemployed. It concludes that the total cost of meeting the needs of everyone affected by the attacks will be $768 million over the next 12 months. Mental health counseling was predicted to be the greatest future service need for all affected groups, and the estimated cost of providing mental health services is $68 million over the next 12 months. The USG is a consortium of 13 charities in New York City that were instrumental in distributing aid in the immediate aftermath of the attacks. The full text of the study is available at http://www.9-11usg.org.

New psychiatrist-administrators: The committee on psychiatric administration and management of the American Psychiatric Association has released the names of 19 psychiatrists who have met the requirements for certification in psychiatric management and administration. They are Sanjay S. Chandragiri, M.D., of Throop, Pennsylvania; Richard L. Cruz, M.D., of Chads Ford, Pennsylvania; Kayla L. Fisher, M.D., of Roanoke, Virginia; Charles R. Freed, Jr., M.D., M.H.A., of Chattanooga, Tennessee; Steven P. Kouris, D.O., M.P.H., of Rockford, Illinois; Arthur Lazarus, M.D., M.B.A., of Prospect, Kentucky; Patricia Lifrak, M.D., M.B.A., C.P.E., of Hockessin, Delaware; D. Sreedharan Nair, M.D., of Bloomfield Hills, Michigan; Kenneth Clayton Nash, M.D., of Wexford, Pennsylvania; Paulo J. Negro Jr., M.D., Ph.D., of Columbia, Maryland; Peter N. Novalis, M.D., of Columbus, Georgia; Mark A. Putnam, M.D., of Chester Springs, Pennsylvania; Nadimpalli V. Raju, M.D., of West Bloomfield, Michigan; J. Mark Rowles, M.D., M.P.H., of Decatur, Georgia; Alan L. Schneider, M.D., of Sherman Oaks, California; Maurice Andrew Sprenger, M.D., of Decatur, Georgia; Ravindra P. Srivastava, M.D., of Albany, Georgia; Elizabeth M. Tully, M.D., of Boulder City, Nevada; and Martin K. Williams, M.D., of Goldsboro, North Carolina.