Many are painting current events as the enactment of a grand struggle between the opposing forces of Light and Darkness. Of course, the archetypical such conflict, paleontologists are learning, was staged at the dawn of civilization between the Neanderthals and their eventual successors, the Cro-Magnon who would turn out to be forebears of modern humankind. Scientists have recently begun to appreciate that the two humanoid races coexisted in time and space across the European continent, and may have even intermarried to some extent, while vying for the supremacy of their respective ways of being sometimes by geopolitical positioning, sometimes frank combat. We may be considered to be in an analogous situation today. This Reuters wire photo, however, raises serious doubts about whether we’re the Neanderthals or the Cro-Magnon of the day. [thanks,Ted!]

Trading Cards: American Crusade 2001+: “President Bush tried his bestest to simplify the picture as Good vs. Evil, but it’s still a jumble! Who knew all those crazy Dorkistan countries even existed?! Now The Infinite Jest rides to the rescue with a set of educational trading cards.Fun to collect! Fun to trade! Fun to drain a box of inkjet cartridges!” Infinite Jest

Psychologists Get Prescription Pads and Furor Erupts

Psychologists are adept at diagnosing and treating mental illness. But unlike psychiatrists, who are medically trained, they have never been able to prescribe drugs for their suffering patients. As of July 1, however, psychologists in one state, New Mexico, will be authorized to pull out the prescription pad. A new law will grant prescribing privileges to licensed, doctoral-level psychologists who have completed an additional training and certification program. And though the specifics of the plan remain to be worked out, the law is already the focus of a bitter national debate. Proponents argue that the law will provide greater access to quality care at lower cost. Opponents contend that psychology should remain distinct from its medical cousin and they worry that the legislation may place vulnerable patients in danger. Most vehement in their objections are the representatives of organized psychiatry. “Most of the patients we see as psychiatrists have many other medical problems,” said Dr. Richard K. Harding, president of the American Psychiatric Association. “They have hypertension, diabetes, migraine headaches. And the interactions of the medicines we give for these other conditions are often extremely difficult and scary.” NY Times

This is a very very bad idea, in my opinion both as a psychiatrist and a consumer advocate for my patients. First off, let’s remember that most members of the public have only a hazy notion of the difference betwen a psychologist and a psychiatrist. “Are you a medical doctor too?”, I’m constantly asked. This makes me suspect that the quality of the public debate on the New Mexico law was sorely lacking. Moreover, the law requires far less training and supervision of the prescribing psychologists than the pilot study on whose successful results it is predicated. In the time-honored tradition of not even knowing enough to know how little you know, one of the psychologists first trained to prescribe says that the amount of knowledge necessary to prescribe has been overrated. Eminent psychiatrist Joel Yeager comments, “People are going to learn psychopharmacology for dummies. They will learn how to pass tests but will not really have a decent immersion in this material because they won’t have the background for it.”

On the other hand, the argument (above) by the psychiatrist president of the American Psychiatric Association — that most psychiatrically ill patients who require medication are also medically ill and require someone skilled in avoiding drug interactions to prevent disaster — is no more than the typical scare-tactic spin of a professional lobbyist. Far more pertinent than drug interactions or recognizing covert medical illness is the ease with mind-body integration and the familiarity with the rhythm of prescribing, assessing, adjusting that psychiatrists have come by over years of medical training, as Dr Yeager’s comment suggests. And since more of healing, even psychopharmacological, than we ever acknowledge depends on the patient’s unconsciously entering into the shared premise of the healing (a.k.a. the placebo response), treatment success depends too on ineffable qualities of charisma and directiveness that are the unspoken subtext learned in medical training. Needless to say this cannot be galvanized in this shortcut correspondence school approach to getting psychologists up to speed to prescribe. Not to mention that, whereas medical training is a clinical field from the get-go, although there is “clinical psychology” psychology is an academic and research-oriented field — quite a different mindset, and selecting for quite a different personality.

I know this diatribe may offend psychologist FmH readers, but I don’t mean to suggest their ability is lesser — only different. The obvious twin dangers inherent in psychiatrists, MDs, responding in this debate are that they will be tarred with the usual brush of being seen as arrogant and that they will be seen as trying to protect their eroding market share — which is the usual approach of the APA and the reason I no longer belong to that ol’ dinosaur of a lobbying group. Instead, I’m trying to suggest there’s an argument from quality of care as well, a Hippocratic one (“first, do no harm”) if you will. If you see MDs only as overpriced functionaries whose sole distinction is that they have prescribing privileges, then of course it makes sense to try to develop lower-priced alternatives. But you get what you pay for. Caveat emptor, not that the consumer is going to have any say in the matter, or even necessarily know what they are missing, the way modern healthcare is going.

I already find that most of my poor, disenfranchised patients with major mental illnesses, on public assistance, get second-rate prescribing from the nurse practitioners who are allowed to write prescriptions in my state. And, yes, I know that will unleash another firestorm of reproach from any readers who are RNs or sympathetic to them. But, from more than a decade of consulting to, supervising, hiring (and firing), and treating patients referred from nurse clinical specialists, I am comfortable with my conclusion that their lack of global preparation and experience for prescribing results in a job less well done by most of them than most physicians in equivalent clinical roles. And the same will be true with the new law (even more, since psychologists have no experience treating medically very ill patients in general). Of course there are anecdotal exceptions, if you compare a particularly gifted non-MD prescriber with a particularly clumsy MD prescriber — there are NPs to whom I would send a family member for psychopharmacological treatment, and there are MDs I would not, needless to say — but public policy should be based on aggregates, not anecdotes. Okay, I’ve got my asbestos suit on, let the flamewar begin. Actually looking forward to thoughtful disagreement on this issue, so close to my heart and passion…

Senator Helms as an AIDS Savior: ‘Writing in Sunday’s Washington Post, Senator Jesse Helms, long deemed public enemy No. 1 by AIDS advocates, said that he would ask for an extra $500 million to prevent mother-to-child transmission of AIDS overseas, contingent on matching funds from the private sector.

“Some may say that this initiative is not consistent with some of my earlier positions,” wrote Mr. Helms. But he continued, “in the end our conscience is answerable to God. Perhaps, in my 81st year, I am too mindful of soon meeting Him, but I know that, like the Samaritan traveling from Jerusalem to Jericho, we cannot turn away when we see our fellow man in need.” There are many in Congress who have talked about adding money to President Bush’s shamefully tight-fisted budget for combating AIDS overseas, but nothing can match the impact of these words from Senator Helms.’ New York Times editorial

Adminimizer Toolbar— if you’re weblogging with Blogger and IE6, you need this free tool! [If you’re not a weblogger yourself, you can probably stop reading here to prevent boredom; and if you’re a weblogger but not using IE6, to prevent envy…]

“So here is the deal. You see your blog in the browser. You want to add to or edit it so… You go to some other app or site to do your blogging. Does this make sense? No. You should be able to edit and save right there, in your browser, on your blog page, WYSIWYG style. No fuss, no muss, no fooling around.

How? Internet Explorer 6 has fabulous XML and text editing capabilities that are grossly underutilized by most people. The Adminimizer Toolbar makes it easy for you to take advantage of them when using your Blogger blog. All you need to do is install the Toolbar in your browser, add 2 lines of code and 2 span tags to your blogger template, and copy an XML file onto your site. You’ll be ready to edit in no time.”

Ever since Blogger’s “remote editing” capacity broke (a long time ago), I’ve been looking for a way to edit posts directly from the browser window without going to my “edit your blog” page at blogger.com. When you install the toolbar in your browser and click on it while you’re displaying your weblog, green lines surround all the editable posts; you just do WYSIWYG editing in situ! Drag-and-drop works too. Watch for the imminent disappearance of the little pencil icon at the end of every post, the old way I was doing it (imperfectly), as soon as the Adminimizer’s shakedown cruise is done..

It would be a perfect world, though, if Evan Williams would hurry up and write a Blogger Pro interface for Mozilla, and the Adminimizer programmers would do the same. I’m feeling abit guilty about my wholesale sellout to M$, but IE is just so much more functional right now.

Internet Sacred Text Archive — “This is a quiet place in cyberspace devoted to religious tolerance and scholarship…”

This week’s parlour game is to count up how many of these books you’ve read; needless to say, the movie adaptations don’t count. For extra credit, who would you promote and demote? I would have ranked several of the characters higher: Gulley Jimson, Molly Bloom, Geoffrey Firmin, Tom Ripley and George Smiley, off the top of my head. Oh yes, and Eeyore.

Volume Control Knob Turns Heads — This Wired item leads with, “Who but a jewelry designer could create a computer product that seems useless but is fast becoming a hit based on its good looks?” Read on, though, and it appears the PowerMate’s appeal is not, by a longshot, limited to its appearance.

“When elephants dance, it’s best to get out of the way. That’s exactly what’s happening now as the entertainment industry—the recording, publishing, and motion picture industries, mainly—attempts a worldwide intellectual property power grab with two distinct targets. Think of it: a coup and a lock on all published content in the same year, amazing isn’t it?” Proposes a simple fix — recognition of artists’ moral rights to their intellectual property; reversion of the term of copyright to fourteen years, immediately and retroactively; and prohibiting corporations from owning copyrights:

The basis of the problem is found in a single court ruling: Santa Clara County v. Southern Pacific Railroad. In this 1886 dispute, the U.S. Supreme Court found that a private corporation was a “natural person” under the Constitution and enjoyed the same protections as a citizen under the Bill of Rights. Corporations from that point forward were granted all of the rights and freedoms of a private citizen, yet none of the responsibilities. We made a mistake; hey, shit happens. It’s not too late to fix it.

Can it be done? The author points out how little it took in contributions for the media industry to ‘buy’ the Senate sponsors (Hollings et al) of the pending copy protection bill ( the Consumer Broadband and Digital Television Promotion Act, or CBDTPA) and predicts, knowing who is most awash in entertainment industry money in the House, who myght soinsor a companion bill there; could we buy back our rights? Ironically, he notes, since the bill would still have to be signed nto law, “installed President Bush just may be the fly in this particular ointment. Like most conservatives, he sees the entertainment industry as a liberal bastion, remember, and a political force that’s not necessarily aligned with his larger agenda.” Arts & Farces

Tests show no screening improvements post-Sept. 11: “In the months after Sept. 11, airport screeners confiscated record numbers of nail clippers and scissors. But nearly half the time, they failed to stop the guns, knives or simulated explosives carried past checkpoints by undercover investigators with the Transportation Department’s inspector general.

In fact, even as the Federal Aviation Administration evacuated terminals and pulled passengers from more than 600 planes because of security breaches, a confidential memo obtained by USA TODAY shows investigators noticed no discernable improvements by screeners in the period from November through early February, when the tests were conducted. “

‘Friendly Fire’ Deaths Traced to Dead Battery: “…the Air Force combat controller was using a Precision Lightweight GPS Receiver, known to soldiers as a plugger, to calculate the Taliban’s coordinates for a B-52 attack. The controller did not realize that after he changed the device’s battery, the machine was programmed to automatically come back on displaying coordinates for its own location, the official said.” Washington Post [And we want to start using battlefield nukes??!! –FmH]