More al-Qaida sleeper cells in U.S.? More wolf calls?

“Government agents have recently uncovered numerous calls from hard-to-track prepaid cell phones, Internet-based phone service, prepaid phone cards and public pay phones in the United States to known al-Qaida locations overseas, federal officials said. The calls are one piece of a growing body of evidence pointing to the presence of suspected members of terrorist sleeper cells operating on U.S. soil, and a growing sophistication on their part to keep their communications secret, the officials said.” MSNBC

A busy summer…

Ruling Roils Death Penalty Cases: “…(T)rying to untangle the consequences of the Supreme Court’s decision in Ring v. Arizona, which said juries rather than judges must make the crucial factual determinations that support the death penalty, (has made for a busy summer for) courts and legislatures in the nine states where juries do not make such findings, or render only advisory verdicts…” NY Times

What They Were Thinking

[City Lights, 1955]

City Lights, 1955. Lawrence Ferlinghetti (on the right, with, from left, Bob Donlin, Neal Cassady, Allen Ginsberg, and Robert LaVigne) recalls, ” When the picture was taken, I was thinking, ‘Are these the best minds of our generation?’ Howl starts with that phrase. I’d say it was a bit of a satirical question. I am the only one in the picture still alive, because I work out all the time. They didn’t work out except raising the elbow or rolling joints. I wasn’t part of the Beat Generation at all. I was really the last bohemian…” NY Times Magazine [Doesn’t it look as if the sign saying “Books” is a thought balloon emanating from LaVigne’s head, by the way? — FmH]

Dispatch from the Frontlines of the Psychopharmaceutical Wars:

FDA Issues Approvable Letter For Abilify. Another new ‘atypical’ antipsychotic medication reaches the marketplace; ‘Abilify’ is its brand name, and aripiprazole its generic moniker. The new generation of ‘atypical’ antipsychotics represents a revolution in increased tolerability and efficacy as compared to the older, ‘typical’ or first-generation antipsychotics. For psychiatrists like myself who treat psychotic illnesses such as schizophrenia, this is as exciting as the explosion in antidepressant development was a decade before. You don’t hear as much about this revolution because there is virtually no public constituency for schizophrenia. However, although you don’t think you have had much contact with the disease because those affected are largely socially shunned and segregated in a manner quite different from depressed patients (no TV ads for antipsychotics forthcoming!), you probably have had at least some indirect contact with its consequences given that it affects 1-3% of the population overall. So I think it’s worth my while wriitng about this development for a general audience of interested souls.

First, there’s its brand name. ‘Abilify’, although mercifully bucking the recent trend for new psychiatric medications to have a ‘z’, a ‘q’ or an ‘x’ in their name, is an extremely silly name, IMHO, and some Bristol-Myers Squibb representatives gearing up to market it to whom I recently spoke agree. [I hope there are no consequences for their disloyalty if any of their corporate superiors read this. — FmH]  We joked about the estimated $1 million fee some agency got to develop a name for this product. I offered the company that, from my vantage point in the psychiatric marketplace [yes, as FmH readers know, you should make no mistake about the fact that it is a marketplace!], I would create advantageous product names for half what they would pay anyone else, but for some reason they haven’t taken me up on my offer.

In any case, from my reading so far, aripiprazole (I try not to use brand names, as a matter of fact) does not seem a massive therapeutic advance over the other ‘atypical’ or ‘second-generation antipsychotics we have available already — clozapine (Clozaril), risperidone (Risperdal), olanzapine (Zyprexa &mdash ahhh, there’s that ‘x’ and that ‘z’!), quetiapine (Seroquel) and ziprasidone (Geodon). Predictably, sales efforts will soon begin to jockey for a share of the antipsychotic ‘market’ by spinning the clinical studies (often funded by Bristol-Myers Squibb money) to claim more rapid onset, better response, or improved tolerability. Even the explanations of mechanisms of action for these new molecules are ‘spins’, since the CNS is largely a black box and the molecular actions of these medications are opaque to us. (For those of you who are curious, what I’ve read so far indicates that while, like other atypical antipsychotics, aripiprazole has combined postsynaptic dopamine and serotonin activity, it is also supposed to be a presynaptic dopamine autoreceptor agonist. It remains to see if it is; if that is as distinct from the other atypicals as it is made out to be; and, if it is, how much of a contributor to its effectiveness that might be…)

How useful it is to me and other psychiatrists treating psychotic illnesses, other than those who accept funding from Bristol-Myers Squibb and have already reached their conclusions [grin], will only be clear over time. I may not begin to prescribe it until its track record is better-defined. As a hospital-based psychiatrist who sees patients who have ‘fallen apart’ in the community, I have the following unique opportunity to gauge its efficacy and tolerability quite rapidly, as a matter of fact. Every time a new antipsychotic medication emerges, there is a rush of psychiatrists who adopt it immediately and even take previously stable patients off their existing stabilizing medications in the interest of using the newest and greatest thing. (Being cynical, I assume these are the practitioners who get most of their current ‘continuing medical education’ from manufacturers’ representatives or drug-company-funded symposia, rather than reading independent refereed medical journals and being able to read betwen the lines…) This phenomenon often prompts an epidemic of fresh relapses among patients with major mental illnesses, and the extent to which I start to see admissions of patients who fell apart after being switched to aripiprazole will be one of my indicators of whether it seems to be a worthwhile medication.

The magnitude of that phenomenon when the previous-but-one new antipsychotic, quetiapine (Seroquel), was introduced several years ago has made me avoid that drug in most instances, much to the chagrin of the hardworking manufacturers’ representatives trying to persuade me to use more of it. (The drug companies these days have detailed databases of exactly how many prescriptions of their products, and their competitors’, I prescribe every month. I’d love to find a way to fight a battle about this fact on the privacy front — mine or my patients’…). Quetiapine was a particularly egregious case in point, because it was marketed largely around how superior it is in reducing side effects. True, true; it is much more tolerable, but it is probably in that class of ‘white elephant’ drugs which don’t produce side effects because… well, because they largely don’t produce any effects at all, including therapeutic ones! Actually, quetiapine is a pretty good sedative, but that’s different from having antipsychotic activity. I’m noticing a small number of psychiatrists are starting to notice that ‘the emperor has no clothes’ and question the consensus by writing about its lack of efficacy in major psychotic conditions. The company’s response is to say that they just haven’t been using high enough doses.

What we really need by way of the next advance in antipsychotic psychopharmacology is a long-acting injectible atypical antipsychotic. Many patients who are too disorganized to take daily medication, or who are so dangerous when they are off medication that they are under court compulsion to take it (unwillingly), benefit from receiving their antipsychotic treatment in the form of a deep intramuscular injection of a “depot” preparation of a medication whose effect last between ten and thirty days before another injection is necessary. So far, however, the only medications available in such depot preparations in North America are haloperidol (Haldol) and fluphenazine (Prolixin), both of which are first-generation antipsychotics with the full gamut of undesireable side effects which one would like to spare one’s patients, particularly the uncomprehending ones who have not consented willingly to such a price for their stability. Several European countries have a depot version of risperidone, but it is probably several years off in the US, and olanzapine or ziprasidone would be more preferable still.

Hoping these dispatches from the war zone are of interest; I certainly enjoy venting my spleen about my own profession! So, if anyone is interested, I’ll keep you posted on aripiprazole.

Fate of the WTC Businesses

Year of Struggle and Change:

When the World Trade Center towers fell, they took more with them than human lives. A huge segment of the downtown economy collapsed with the falling steel and concrete, and the disaster encompassed far more than the large financial firms that are most often identified with the Sept. 11 attacks.

The trade center was home to hundreds of diverse companies, a polyglot village spanning everything from Asian food importers to graphic designers to dentists. Many had inhabited the towers for decades.

Those companies, more than half of which had fewer than 20 employees, became refugees on Sept. 11. Some have folded, overwhelmed by the deaths of owners or employees or undone by a lack of cash. Others have eked out a living in kitchens and basements. Some have relocated to Florida or Texas, while others have insisted on staying within a few blocks of ground zero. Some, miraculously, have flourished, growing even as the local economy foundered.

The New York Times set out to chronicle the fate of the complex’s tenants as they struggled to re-establish themselves over the past year. After compiling lists of tenants from several sources, The Times estimates that about 700 companies and organizations occupied the trade center buildings. Defining a more precise number, however, is difficult because so many of the companies were subtenants whose occupancy did not appear on official lists.

Killing Monsters:

A review of Killing Monsters: Why Children Need Fantasy, Super Heroes, and Make-Believe Violence by Gerard Jones: ‘In fact, everything in Killing Monsters works, placing it in sharp contrast to the endless sky-is-falling rhetoric of the last few decades, which seems designed for no other purpose than make us fear both the media and our own children. When Bob Dole is on the election stump railing about Quentin Tarentino movies he’s never seen, when school officials are tossing kids for simply expressing themselves, when Steven Spielberg is pixel-editing guns out of the hands of the FBI in his re-release of E.T. so that perhaps children will be unaware that law-enforcement officers use guns, and when lawsuits which contend that students will be turned into slavering terrorists if they even look at the Qu’ran are being taken seriously, it’s high time we stop listening to the “experts” and start paying closer attention to our kids. They seem to be the only ones with a clue.’ PopMatters

[Nessie?]

New Nessie pictures spark debate: “Instead of the usual fleeting glimpse afforded her followers, Nessie stayed above the surface long enough for retired printer Roy Johnston to take at least four photographs showing the suspiciously snake-like Nessie arching out of the water and returning to it with a splash. The new photographs, printed in yesterday’s Daily Mail, prompted an immediate debate as to whether they are genuine. ” The Scotsman

Top 10 Signs Your Neighbor is Brainwashed:

For example —

3) “We have to defend ourselves, and the war on terrorism is the only way to do that.”

Anyone who believes this war is simply a drive to eradicate terrorism must be brainwashed. The U.S. has been building military bases along proposed oil pipeline routes, and has its eye on the oil and gas reserves in the Caspian Sea region. All anyone need do is read Zbigniew Brzezinski’s “The Grand Chessboard” or brush up on the Wolfowitz Doctrine to understand the not-so-hidden agenda behind U.S foreign policy. In a recent appearance on Crossfire, Insight Magazine’s Jamie Dettmer deftly addressed America’s aim to control the oil fields in Iraq. “Nobody has suggested the United States is going into Iraq to control the oil,” Tucker Carlson asserted, leaving some to wonder if Tucker’s bow tie isn’t too tight. “Let’s not be unsophisticated about this,” Dettmer replied, warning that, “in the end, if America doesn’t restrain itself, [it’s] going to provoke groupings of countries which will restrain America instead.” Buzzflash

Warren Ellis writes in DiePunyHumans that Turkish chlamydia sufferers rape dogs, believing it cures their disease. [Ahh, the endless varieties of human ignorance and depravity! — FmH]  However, the report suffers a credibility gap, being from a Kurdish media source. [I’m not casting aspersions on Kurdish journalism, mind you — I don’t know enough about it to do so — but rather suggesting that they have more than enough reason to portray Turks in a depraved light…]

Where is the damned beef ? NY Times and Washington Post

U.S. Ready to Go It Alone on Iraq: “President Bush made clear on Saturday he would act against Iraqi leader Saddam Hussein with or without world support, and was said to be ready to strike within four or five months.” Yahoo! News – Most-emailed Content

Saddam Hussein Trained Al Qaeda Fighters – Report: “British Prime Minister Tony Blair’s promised dossier on Iraq is to reveal that Saddam Hussein trained some of Osama bin Laden’s key lieutenants, The Sunday Telegraph reported.” Yahoo! News – Most-emailed Content

Arab leaders appeal to Iraq: Let inspectors in: “Arab League nations are appealing to Iraq to allow UN weapons inspectors in, to avert a confrontation that could inflame the Middle East.” Ananova: News

Straw: UN backs Bush on Iraq : “Mr Straw says there is overwhelming support in the UN for President Bush’s stance on Iraq.” Ananova: News

UN fears Iraq anarchy. World Press Review: Breaking News

Arab League Urges Iraqi Inspections: “Under pressure from Arab nations to allow U.N. weapons inspectors back, Iraq’s foreign minister said late Saturday he hoped the crisis could be resolved without a new U.N. resolution that could threaten serious consequences.” AP World News

War Could Unshackle Oil in Iraq: “A U.S.-led ouster of Iraqi President Saddam Hussein could open a bonanza for American oil companies long banished from Iraq, scuttling oil deals between Baghdad and Russia, France and other countries, and reshuffling world petroleum markets, according to industry officials and leaders of the Iraqi opposition.” Washington Post: Front Page

UN Wants Arms Inspectors in Iraq in Weeks – Downer. Reuters World News

War Talk Hits Its First Target: The Pivotal Ally: “After years of antagonizing, criticizing and disdaining the U.S., there are strong signs that France is groping for a more openly cooperative relationship.” New York Times: International News

White House dismisses Iraqi offer. CNN – World

Action Against Iraq Possible in January – Italy. Reuters World News