Daily Archives: 26 Oct 04

Allawi Faults U.S.-Led Forces on Execution of Iraqi Soldiers

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“Prime Minister Ayad Allawi partly blamed the American-led military forces on Tuesday for the massacre by insurgents of 49 freshly trained Iraqi soldiers on Saturday, saying the military had shown ‘major negligence’.

…Prime Minister Allawi’s razor words before the National Assembly marked the first time he has publicly criticized the American-led forces, and revealed his profound frustration at the assault and quite possibly at the deteriorating security situation in the country.” (New York Times)

Coming on the heels of the Iraqi administration letting the cat out of the bag last week about the missing explosives, one has to wonder about the impact of Allawi’s seeming disaffection with the US. This could be yet another blow to Bush’s reelection effort (if the American public is listening). US officials reportedly could not believe Allawi would be critical at first, and thought there had been a mistranslation of his remarks. (Wake up and smell the coffee…) It is a sort of fitting symmetry that, having turned on the man the misadministration originally built up to run the post-invasion Iraqi puppet regime, Ahmed Chalabi, his successor Allawi turns on them.

Addendum: Kevin Drum asks,

“Am I the only one wondering why the Iraqi government suddenly seems to be so eager to release information that’s obviously harmful to George Bush’s reelection prospects? Has Ayad Allawi had a sudden change of heart about who he’d like to see in the White House next year?”

No, you’re not alone, Kevin. Great minds think alike, I guess.

Also: Drum has what is probably the definitive post about the ludicrous Republican efforts to squirm out of the implications of the missing 380 tons. Ah, schadenfreude is sweet.

A nice cup of tea could hold back Alzheimer’s, scientists say

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“Laboratory tests found that regular cups of green and black tea inhibit the activity of certain enzymes in the brain which bring on Alzheimer’s, a form of generative dementia that affects an estimated 10 million people worldwide.” (Yahoo! News) Essentially, tea is an acetylcholinesterase inhibitor, acting in the same way as (albeit more weakly than) the anti-Alzheimer’s prescription drugs donepezil (Aricept), rivastigmine (Exelon) and galantamine (Reminyl). It is abit inaccurate to say that the enzyme they inhibit, acetylcholinesterase (ACh-ase), brings on Alzheimer’s disease. It degrades the neurotransmitter acetylcholine in the brain, and Alzheimer’s is characterized by a drop in brain acetylcholine, but this is not thought to be due to abnormal activity of the enzyme. Nevertheless, inhibiting ACh-ase can compensate for some of the effects of the illness.

Sarah Kane’s Second Life

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“…Ms. Kane had written only five plays. On the strength of those alone, however, she had been hailed by some critics and writers as a potential heir to dark, existentially minded playwrights like Samuel Beckett and Edward Bond, with a brilliant career ahead of her. But Ms. Kane’s life came to a sudden, violent halt in February 1999, when she hanged herself in a London hospital where she was being treated after swallowing a handful of sleeping pills. She was 28.

A through-the-night writer with a history of depression that shared time with an often vivacious spirit, Ms. Kane had written up to the time of her death. In retrospect, Psychosis seems too sadly prescient to bear; set in a netherworld populated by characters without set identities, the play ends with a chorus that suggests imminent death: ‘Watch me vanish, watch me vanish, watch me, watch me, watch.’

That line proved prophetic in a different way, too. Now five years after her suicide, Ms. Kane is one of the most watched playwrights around, a proposition that is either made more or less likely, depending on how you look at it, by the coincidence of her youthful promise and premature death.” (New York Times)

Silent Lament for a Japan Still Scarred by the War

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“…Shomei Tomatsu’s astonishing retrospective at the Japan Society …should come as a revelation to many people. Japan’s pre-eminent photographer of the postwar era, Mr. Tomatsu is a master of a kind of redolent ambiguity that speaks both to his subject, which is life in Japan, and also to the nature of photography, which always shows tantalizingly more than it can explain. As photographers like William Klein, Garry Winogrand and Robert Frank defined their era in America, Mr. Tomatsu has defined his in Japan, but the work does something more than that, too.” (New York Times)

How to think about prescription drugs:

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Malcolm Gladwell writes in The New Yorker: “Angell’s book and almost every other account of the prescription-drug crisis take it for granted that cost increases are evidence of how we’ve been cheated by the industry. In fact, drug expenditures are rising rapidly in the United States not so much because we’re being charged more for prescription drugs but because more people are taking more medications in more expensive combinations. It’s not price that matters; it’s volume.

This is a critical fact, and it ought to fundamentally change the way we think about the problem of drug costs. Last year, hospital expenditures rose by the same amount as drug expenditures—nine per cent. Yet almost all of that (eight percentage points) was due to inflation. That’s something to be upset about: when it comes to hospital services, we’re spending more and getting less. When it comes to drugs, though, we’re spending more and we’re getting more, and that makes the question of how we ought to respond to rising drug costs a little more ambiguous.

…The fact that volume matters more than price also means that the emphasis of the prescription-drug debate is all wrong. We’ve been focussed on the drug manufacturers. But decisions about prevalence, therapeutic mix, and intensity aren’t made by the producers of drugs. They’re made by the consumers of drugs.

…The core problem in bringing drug spending under control, in other words, is persuading the users and buyers and prescribers of drugs to behave rationally, and the reason we’re in the mess we’re in is that, so far, we simply haven’t done a very good job of that.”

As a physician, I am thinking very hard about how to be a part of the solution rather than a part of the problem. Psychiatry, my field, is plagued by sloppy diagnosis, polypharmacy, the more-is-better and newer-is-better styles of prescribing, and lack of clarity in planning the mix of acute treatment and prophylactic medicating. Educating consumers is important, but more important is countering the effects of sloppy prescribing by unthoughtful clinicians out there.