Anesthesiologists Outraged Over New Policy. A change in Medicare regulations will now allow nurse anaesthetists to administer anaesthesia during surgery without being under the supervision of an anaesthesiologist or other medical doctor. Nurses argue that this is good policy for underserved areas where no anaesthesiologists are available; the MDs counter that in such areas the nurse should be supervised by the surgeon performing the surgery (whom Medicare hasn’t yet ofund a way to do away with). The rhetoric about serving the underserved just doesn’t hold up to scrutiny, and this smacks of more meddling with lives to save an almighty dollar. Besides, who thinks it is going to remain restricted to medically underserved areas?

The closest I come to having seen anything like this in my own specialty of psychiatry is the growing encroachment of cheaper “nurse clinical specialists” managing psychiatric outpatients’ medications in place of psychiatrists. Unfortunately, I have rarely seen one who has the breadth and depth of perspective to do justice to sorting out the complicated patients, often the sickest in the mental health arena, they tend to treat, since they usually appear to be hired by the public sector mental health clinics that are under the tightest budgets. Being at the receiving end of the fruits of their difficulties managing their patients in the community, I can attest to the fact that patients simply do not od as well under their care as under the care of a physician, and end up requiring psychiatric hospitalization at a far greater rate than patients who have psychiatrists. And that’s just expensive hospital bills; in the realm of anaesthesia, we’ re talking about mortality. WCVB Boston

Is ANDi a miracle or a monster?

Readers will remember the dark eyes of ANDi, the world’s first
genetically modified monkey, gazing up at them from this
newspaper recently.

After several failed attempts to insert jellyfish genes into rhesus
monkeys, ANDi – “inserted DNA” in reverse – was created at the
Oregon Regional Primate Research Center in America. ANDi’s
case has attracted worldwide interest because of its implications
for the manufacture of “designer babies”: genetically modified
humans, created from a shopping list of desirable
characteristics. Other GM animals already exist, but the
modification of primates brings the possibility of similar
experiments on humans much closer.

Ever since Aldous Huxley’s Brave New World appeared nearly 70
years ago, thoughtful people have been haunted by his vision of
a dystopian society of laboratory-bred human robots. Until the
Nazis gave eugenics a bad name, many intellectuals in Britain and
America supported the idea. Now the genetic revolution has
made eugenics respectable again. Scientists at the cutting edge
of genetic research are often invited to defend their work, but
we hear less often from philosophers. Theirs, however, is the
task of assessing the meaning of such research.

The Telegraph asked seven of the world’s leading philosophers a
number of questions arising from the ANDi case.

The Telegraph

“Making it hard to go on eating fast food in blissful ignorance”: a review of Eric Schlosser’s Fast Food Nation: “The aim of his
book, developed from articles written for Rolling Stone, is
to force his readers to stop and consider the consequences
of McDonald’s and its ilk having become inescapable features
of the American (and, increasingly, global) landscape — to
contemplate ”the dark side of the all-American meal.”

This sounds kind of frivolous. After all, practically everyone
in the country has at least dabbled in fast food at one time
or another. So what’s the big deal? Readers who have grown
weary of attempts to locate the DNA of the contemporary
American soul within the history of video games or tennis
shoes or whatever might also feel a wave of fatigue when
Schlosser announces his interest in fast food ”as a metaphor.”

But the good news is that
this isn’t a frivolous book at
all.” New York Times via Looka! I previously pointed to Schlosser’s Atlantic article on “the flavor industry”.

Too Clever by Half: Metafiler pointed to this transcript of Bill Maher’s Jan. 11th Politically Incorrect show in which he crosses the line in demeaning the less able. That’s guest Martin Short concluding that Maher is a “hideous, cold person.” Excerpts:

Bill: What? Dogs are like retarded children.

Jay: The show is living up to its name.

[ Scattered boos]

Sarah: Boo.

Bill: But they’re not a regular person.

Sarah: Well, they are regular people.
They have a heart and a soul.

Cynthia: Limitations.

Bill: They have a heart and a soul and a brain that’s
retarded.
That’s a fact, people! Excuse me!

Sarah: No, because you can’t say that.
Do you know their brain is retarded —
this word retarded? They could just be lacking in the
ability.

Bill: That’s what we call retarded.

[ Laughter ]

I mean, people, are you all retarded? I mean —

[ Laughter ]

That’s a fact.

Martin: I’m not gonna comment.
You’re a hideous, cold person.

Bill: I’m a truthful person.

Thanks to Dan Hartung at Lake Effect for pointing to this update on the health of Dr. Jerri Nielsen, the scientist whose drama (as she was stranded at the South Pole with a breast cancer diagnosis) we watched unfolding last year. She’s doing fine, it appears.

Constantine’s Sword, by James Carroll, argues that the Church’s relationship with Jews has not only been a problem but, in a sense, the problem throughout its two thousand year history.

The Church’s failure to protest the Holocaust — the infamous
“silence” of Pius XII — is only part of the story: the death
camps, Carroll shows, are the culmination of a long,
entrenched tradition of anti-Judaism. From Gospel accounts
of the death of Jesus on the cross, to Constantine’s
transformation of the cross into a sword, to the rise of blood
libels, scapegoating, and modern antisemitism, Carroll
reconstructs the dramatic story of the Church’s conflict not
only with Jews but with itself.

As a troubled practicing Catholic himself, Carroll calls for Vatican III to address the problem in a multifold way: (a) a reexamination of and distancing from anti-Semitic thought in the New Testament, in essence turning it on its head as exemplary of how not to be a good Christian; (b) grappling earnestly and openly with the way in which power has corrupted the message of the Gospels; (c) [this is the conceptually challenging suggestion, IMHO] a subtle shift in portraying Jesus’ role which would recast the concept of the Jewish God against whom he ‘plays’ — from a vengeful, wrathful one (which Carroll feels inherently fuels and reflects anti-Semitism) against whom Jesus has to interpose himself as salvator, toward a more benificent and merciful one, of which nature Jesus’ role was more as the revelator; and (d) an attitude of repentance for the wrongs done to the Jews in the name of the Church through the ages, starting with the silence of the Holocaust. Carroll recognizes, of course, that the doctrine of Infallibility has to fall for this to occur, but argues that understanding the two-thousand-year arc of this troubling history makes that contingent.

Here’s a Drug Czar for Bush. ‘Before he appoints a drug czar, President-elect Bush should reflect on
the legacy of President Clinton and current czar Barry McCaffrey’s drug
policy… He
should remember the official goal of our drug
policy — “educate and enable America’s
youth to reject illegal drugs as well as alcohol
and tobacco” — when he selects his drug
czar.’ Tompaine.com

”You can’t blur the lines between fact and fiction if you don’t
have fact,” and a new computer game does just that. Majestic, named for the supposed shadowy covert group headed by Truman in the ’50’s, collects real-life information from participants then later begins blurring the boundaries between fact and fiction, intruding into their lives with, for example, threatening telephone calls. It will inevitably draw comparisons to the film of several years ago, The Game, in which Michael Douglas is driven crazy by the incursion of a similar live-action game, in which he had been enrolled as a birthday present, into his life. Boston Globe

Girl Scouts curbed protesters at the inaugural ceremonies. They cordoned off a group of demonstrators who had occupied a large set of bleachers along the parade route. By the way, what do you make of the by-line on this article? Boston Globe

The Foibles of Leadership: A New York Times editorial holds up to our examination A German Metamorphosis: “Despite the publication of photos of
him beating up a policeman at a 1973
demonstration, Foreign Minister
Joschka Fischer of Germany should be
allowed to continue serving his
country.” And a New York Times op-ed piece suggests that Moral Leaders Need Not Be Flawless. “Mr. Jackson’s situation illustrates the need to acknowledge
that our leaders will occasionally disappoint themselves and
us. If we demand that they be perfect, we risk
disillusionment when their shortcomings surface. The
underlying flaw of our unwritten compact with leaders is the
desperate need to believe that they must be pure to be
effective. The best leaders concede their flawed humanity
even as they aspire to lofty goals.

” This does not mean that we should not hold leaders
accountable for their actions. To his credit, Mr. Jackson
acknowledged his failure, sought the forgiveness of his
family and followers, and provided for his infant daughter.
He is willing to practice the same moral accountability he
preaches.” The author, Michael Eric Dyson, a professor of religious studies at
DePaul University, wrote the controversial I May Not Get There With
You: The True Martin Luther King Jr.
, in which he chose not to shy away from discussing King’s moral flaws.

The New York Times reviewer of Nega Mezlekia’s Notes From the Hyena’s Belly extolls “the author’s fine storytelling
instincts and the value of getting these stories told,” calling it “the most riveting book about Ethiopia since
Ryszard Kapuscinski’s literary allegory The Emperor and the
most distinguished African literary memoir since Soyinka’s
Ake appeared 20 years ago”. The review does not mention the controversy brewing around a Canadian government investigation of Mezlekia’s alleged plot to kill his former thesis advisor and other faculty of his doctoral program in Canada, to which I blinked several months ago.