The FCC crackdown on media indecency is fueled by a dramatic increase in public concern, right? The statistics would seem to say so, but apart from the public outcry after the Janet Jackson NFL debacle, more than 98% of indecency complaints to the FCC in the past two years have been from one advocacy group, the Parents’ Television Council. (Media Week) Should we let, essentially, 23 people dictate the ‘community decency standards’ by which the FCC is supposed to be governed?

The Rolling Stone list is here

This is a commentary in Roanoke VA’s newspaper by poet Colleen Redman, whose poem My President Bush Dream appeared here on FmH last month.

The author may be forgiven for her Proustian aspirations (or was the title the responsibility of her editor??); her article grapples with one of the unappreciated distressing issues of modern life, with which I have been struggling both professionally and personally.

A writer working on a book about mid-life memory and memory loss, she goes on to note that the embarrassment and inconvenience of these “senior moments” hide a more primitive emotion of fear that they are a portent of further memory loss to come, and of “decades of dependence, of life with a diminished mind trapped in a still vigorous body.” Now in my early fifties and having the same changes in my memory, I resonate with this. And as a psychiatrist caring for patients who have descended into the deep memory loss of Alzheimer’s and other dementias, I am even more spooked on a daily basis. Even though I can, intellectually, quote you the statistics, it is difficult not to be viscerally misled by the skewed sample of aging I see in my work. And so are my patients. Those who, even though not profoundly demented, are experiencing some memory difficulty inevitably ask me, “Doc, please tell me, is it Alzheimer’s?” (or, as one patient put it to me recently, “…Oldtimer’s?) But most of us do not even whisper these unspoken fears or, if we do, we frame them as humorous.

The author suggests that, in this ‘information age’, memory loss and lack of easy access to your own databank feel like more of a vulnerability than they were in the past. I find this dubious, however, since self-knowledge has always been the essential human attribute and awareness of its impairment likely to have been distressing since the origin of consciousness. However, the information we must coordinate and access in modern life may arguably be more diverse and voluminous than in ‘the old days.’ This may be in part the price we pay for the breakdown of community and family stability in the modern world — there is less of the routine, unchanging, the comfortably familiar to tether us. In that sense, experiences may tax memory more than they would have done for our forebears of one or two generations previous. What counterbalances this, however, is the evidence that mental activity ‘exercises’ memory and keeps it strong; that intellectually active individuals develop dementia at a lower rate than the intellectually stultified casualties of modernity. (Recall the research finding about aging nuns who do crossword puzzles?)

Another sense in which the information age is a hedge against memory loss, of course, is technological aids. Both in my professional and my personal life, there is less trivial data I have to remember as long as I can carry around my laptop or my PDA or access an internet search engine. I am reminded of a vignette in one of the Sherlock Holmes novels in which, if I remember it correctly (grin — forgive me! In an essay about memory loss, it is hard not to be self-referential!), he is annoyed that Watson has told him that the earth orbits the sun because the fact, useless to his daily life, takes up valuable space in his memory. Although there is no evidence that human memory has a fixed capacity that can get filled to the brim, this is an instinctual reaction, and one which is reinforced by the electronic memory metaphor. In this sense, I have at times sardonically referred to my PDA as a peripheral brain and think in terms of dumping off less essential data to this peripheral storage. This works better for some forms of data than others. For example, just considering the two most common functions of the PDA, no matter how completely my appointment schedule is entered into my PDA’s calendar, unless I am going to have alarms going off all the time I have to keep some notion of the shape of my day in mind. On the other hand, between the contact lists on my PDA and my cellphone, I no longer have more than a handful of phone numbers memorized. It sometimes seems that I am well on the way to the obsolescence of the ten-digit phone number (and why not? Who accesses websites by their IP addresses?). Of course, there is nothing unique about using a PDA for this purpose. I relied on my Daytimer for a decade or so before I got my first handheld (an HP 95LX, if memory serves). In a more recent and profound change, with the instant information access of the internet, my peripheral brain in a broader sense now be said to be embodied by a weblike network extending around the world. Could the legacy of the ‘information age’ be that memory is becoming a property of the hive mind instead of the individual?

The essayist interviews Oliver Sacks about why we are so bothered by memory lapses. Sacks points out that it also has much to do with our personality style. Someone who prides themselves on control and order may be less tolerant than someone more “easygoing”, he observes. I am certainly in the former category, so much dependent on my intellectual functions for my self-valuation that it is difficult for me to recognize that anyone could be “easygoing” about their mental capacities! (That may go a long ways in explaining why I have so much difficulty with George Bush…) For a moment, the essayist feels reassured, that her memory loss is normal, and all she has to do is get used to it.

The article makes some important stipulations about the multifaceted nature of memory function and dysfunction. Memory for names, words, facts, for procedural capabilities (“how-to memory”), prospective obligations, are all differently mediated and differentially susceptible to impairment. Perhaps because she is a writer, she pays far less attention to an entire other realm, nonverbal memory, equallly complex and in parallel with the verbal. I wonder — is the fact that I often find the face or the voice of someone I meet familiar because I have reached a point in fifty-plus years of encounters that everyone is virtually certain to remind me of someone else? or is it more that I can no longer retrieve the nonverbal memory behind the sensation of familiarity with as much precision as I once could?

The author goes on to describe her pursuit of a comprehensive neuropsycholigical evaluation of her memory difficulties which confirms that she has some deficits worse than those considered typical for her age range. One of the specialists she confers with pushes the hypothesis that such complaints often relate to mild traumatic brain injuries. She scoffs at first but realizes on reflection that, between childhood horseback riding and horseplay with her brother, she has certainly shaken her brain around abit. In reality, head trauma preferentially affects attentional processes, but the results are often mistaken for memory difficulty. Separate from memory function and equally complex, the machinery for attention is crucial. To recall something, one must not only store it effectively and access it efficiently on demand but must pay attention — which involves focusing, filtering out the competing and the extraneous, efficiently shifting when demanded, etc. etc. — to it sufficiently to acquire the memory in the first place. Looking back at my discussion above of the relationship between memory problems and the conditions of modernity, it is strikingly evident how susceptible attentional processes are to interference by the constant datastream overload to which modern life subjects us. Furthermore, there is some evidence that attentional processes are quite vulnerable to other erosions of our information-processing capacities by modern life which are more of a neurochemical, organic nature, e.g. due to accumulating environmental toxins and dietary effects. In this light, I have long felt that the attention deficit disorder concept — with which I have been clinically involved since it was recognized in its modern sense around two decades ago — is so overly broad as to be clinically meaningless. While there is a real entity of ADHD that involves physiological and neurochemical dysfunction in the brain’s attentional circuitry, most of the patients diagnosed with this disorder or ‘recognizing’ it in themselves are really just at sea with the information processing demands of their lives. (Not to mention those for whom it is merely a pretext, consciously or unconsciously, to earn a stimulant prescription — which, by the way, will help almost anyone feel and function better, ADHD or not, although in a self-fulfilling-prophecy manner, benefit from a stimulant will often ‘confirm’ the diagnosis in the mind of the patient or the prescribing clinician.)

The issue of head traumas is critical, in my opinion, and often neglected. Whenever I see the dramatic cognitive deficits that occur after serious head traumas — e.g. in a fall or a motor vehicle accident, or the even more dramatic entity of dementia pugilistica after the repeated blows to the head incurred in prizefighting — I wonder about the cumulative effects of more subtle, easily overlooked knocks to the head I would venture to say we all incur throughout life. Think about it; how many times have you hit your head, even without loss of consciousness or even “seeing stars”? There is a selection bias here; if a neuropsychologist presses you to recall childhood head trauma, memory will usually serve. This would be a very very difficult hypothesis for which to design a research protocol (since you cannot very well follow a population prospectively for the thirty or forty years necessary; and even if you had the will and the funding to do so, most mild head traumas go unnoticed and leave no telltale signs on imaging or lab studies) but I am convinced of the likelihood that cumulative mild head trauma is very important to deficits in cognitive functioning. I was knocked senseless at least a number of times during my youth playing touch football (no helmet), being body-checked or tackled during steal-the-flag or ring-o-levio [does anyone know what that is anymore?], taking a spill off my bicycle or while skiing (no helmet), or wrestling with my brother. Call me paranoid if you will, but I have told my children, for example, not to ‘head’ the ball when they play soccer. We are born with a fixed number of neurons, and conserving them is one of the unrecognized priorities of modern life, it seems to me. As the author’s consultant suggests, direct knocks to the head might not even be necessary to experience brain damage. Rapid acceleration-deceleration and rotational torque on the brain can also be injurious. Are we ‘moderns’ more frequently doing things to the CNS that outstrip its evolutionary protections? Think of the reports, for example, on the nasty G-shock to which the brain is subjected during roller coaster rides.

The author does a good job of reconciling herself to the alarming reality of her memory difficulties and why their onset and recognition took the course they did. She shares the experience that my wife and many of the women friends with whom she has compared notes have had, in noticing some cognitive derangement dating from pregnancy and childbirth. This is likely due to the combination of hormonal effects on the brain during pregnancy and the novel demands on attention caused by the life-changing arrival of an infant. The author was prescribed stimulant medication, and she considers in a sophisticated way the costs one pays both personally and more existentially for treating such ‘deficits’.. Ultimately, she is challenged to ask whether one can do other than pathologize and attempt to remediate age-related changes in memory function:

Perspective, insight, acceptance, wisdom with age — perhaps one of the other things we have lost with the erosion of the social, community and family fabric in the 20th century has been a place for these.

Related?

Lost time reclaimed, indeed. Syncronistically, while I was posting this piece about the loss of one’s past, Mark Wood was linking here to this piece that reminds us about the flipside of timelessness in psychopathology, the loss of one’s future:

Intriguing as this suggestion to use psychedelic time dilatation properties to address this futurelessness, the conception is not new. Freud’s dictum a century ago that the goal of psychoanalysis was not to turn unhappiness to happiness but rather to turn neurotic unhappiness to normal everyday unhappiness largely rested upon restoring a patient’s future to them. A teacher of mine, the late, consummate psychologist John Perry, put it only slightly differently when he described the alleviation of suffering achieved in psychotherapy as largely being to persuade a suffering patient that s/he is not in Hell but merely Purgatory. The fires burn just as hot in Purgatory, he would say, the only distinction being whether you know your stay there is time-limited and not eternal damnation.

Nothing you didn’t already realize.

Related:

A dwarf known as al Qaeda

I have long felt that the threat presented by al Qaeda is specious and that, moreover, the organization does not exist in any real sense except in the minds of the terror-obsessed Bush administration, which is interested in a perpetual Orwellian war against an illusory opponent. Al Qaeda is now a franchise brand name many unaffiliated or, at best, informally connected disgruntled groups or individuals use to add cachet to the threats they are interested in advertising.

Not to mention Marion Jones and all the rest of them, although there will be the most anguish about the sullying of the Great American Pastime. The author points out that the steroid scandal is really about denial. Readers of FmH know that my diffidence about spectator sports may disqualify me as an expert commentator on this issue, but these are my sentiments exactly. And, to further place things in a broader context:

“The United States brushed aside a call from 144 countries party to an international treaty banning landmines to join the deal, saying its military responsibilities prevented such a step.

Instead, the State Department defended Washington’s record as a leading supporter of global demining initiatives and efforts to promote the use of so-called ‘smart mines’ which deactivate themselves after a period of time to prevent them from causing permanent danger.” (Yahoo! News)

An update on a chilling effect [via walker]

Wonkette loves Hardball‘s Chris Matthews puttin’ the screws to Jerry Falwell:

Although I also find it delicious to catch someone in the logical fallacy of their bigotry, the sad truth is that making coherent sense is not important to this type of thinking.

Stop wondering whether civil war will erupt in Iraq. It already has. Yglesias:

“The use of misleading information as a military tool sparks debate in the Pentagon. Critics say the practice puts credibility at stake,” says the LA Times And what credibility, pray tell, does the US have left to lose?

Of course, while some will see this as an argument for massive increases in defense spending, it is much more an indictment of the Bush cabal’s military adventurism. The emphasis on the ‘deferred or cancelled procurement’ of the previous decade, which is intended to castigate the Clinton administration, made sense in a world where, for a brief period, capping the insanity of continued Pentagon spending became policy.

“The 20 Best North American Districts, Downtowns, and Neighborhoods” (Project for Public Spaces (PPS))

Fimoculous gears up for its usual effort compiling best-of-the-year lists. Readers of FmH will recall that I love these lists, but it does not appear necessary to duplicate his effort.

For those of you who watch Jeopardy! (I don’t, and could care less about gameshows, although throughout my life people have urged me to try to get to be a contestant on one of these things), I guess it is big news that Ken Jennings finally loses tonight and, as this Washington Post story puts it, loses on some rather mundane questions. But it is equally big news, it seems, that the news was leaked. kottke even had an audio clip of the crucial segment of the show, although he has taken it down under a cease-and-desist order. And, finally, it is also news how much of a relief it appears to be to Jeopardy!‘s host Alex Trebek that the mighty is fallen and he gets to be the star again.

“Net users are getting the chance to fight back against spam websites. Internet portal Lycos has made a screensaver that endlessly requests data from sites that sell the goods and services mentioned in spam e-mail. Lycos hopes it will make the monthly bandwidth bills of spammers soar by keeping their servers running flat out. The net firm estimates that if enough people sign up and download the tool, spammers could end up paying to send out terabytes of data.

…The list of sites that the screensaver will target is taken from real-time blacklists generated by organisations such as Spamcop. To limit the chance of mistakes being made, Lycos is using people to ensure that the sites are selling spam goods.

As these sites rarely use advertising to offset hosting costs, the burden of high-bandwidth bills could make spam too expensive…” (BBC) In other words, a DDoS attack on spammer sites…

Thill is Salon‘s columnist on independent publishing. He starts a recent column with this wrap-up of the post-election state of affairs in Bushland, which strikes me as a concise summary statement for anyone who has had their head buried under the pillows for the past month:

[Oxymoron: medical skepticism about a profitable procedure?]

With all the furor last month about the size of Dick Cheney’s organ, is Junior now trying to horn in on the act? In this photo, by the way, crafty Vladimir Putin appears to see what is going on…

Also coverage from the Boston Globe and The Australian.

I have never travelled to China. When I dropped out and vagabonded around the world in the early ’70’s, I applied for visas to enter China at every consulate in every Asian country I passed through, but since I was hitchhiking and could not afford an organized tour they never gave me a second glance… More recently, especially as a member of the adoption community, a disproportionate number of my friends have travelled there. Still, it is hard to disabuse oneself of the stereotype of a primitive country full of throngs of bicycle riders in Mao jackets, struggling to modernize with the thinnest of veneers of glitz thrown over the poverty.

From one perspective at least, not so. These are ten small innovations in daily life the author, who I gather is a Toronto business writer, loved. (Globe and Mail via workopolis via Electrolite) Many of them exploit the technological advances of the ‘information age’ we find mundane and ineluctable in the West but which in China are implemented in ways whose thoughtfulness is arresting… and seemingly easy to do.

I know the constraints imposed by the newspaper column format, but I was left hankering for more than ten examples, and for some deeper implications. Given the less incremental — ‘leapfrogging’ is the term always used to describe the Chinese process — manner in which information processing and communications technology are being introduced in China, I wonder to what extent there is central planning of technology adoption, sort of like an official Media Lab for the country? (It strikes me it would be a fun job to have…) In the West, it is harder to see us implementing such simple exploits in convenience when they offer no competitive advantages to the profiteers who run our lives.

Also, shouldn’t China be considered a laboratory for observing the impact of rapid technological change on social structure? A goodly number of the items on Jan Wong’s list are particularly conveniences for the more urban and urbane, the traveller, the foreign visitor, shopping, attending cultural events, eating out, navigating the big cities by car. How do they impact the run-of-the-mill Chinese in day-to-day life? And how will they spread to the provinces, as cellphone coverage has?

With all the furor last month about the size of Dick Cheney’s organ, is Junior now trying to horn in on the act? In this photo, by the way, crafty Vladimir Putin appears to see what is going on…

Never mind that the judge ruled in favor of the doctor, and seems to be crassly playing on Harrison’s memory for personal glory just as the doctor had done.

“On January 20th, George Bush will pledge to uphold the Constitution. Our goal is to recruit 100,000 new ACLU supporters by that day to proclaim ‘I refuse to surrender my freedom‘ by taking this simple pledge:

‘I pledge to join with over 400,000 ACLU members and supporters to help ensure that the President, his administration, and our leaders in Congress fulfill their duty to preserve, protect, and defend our Constitution.

By reaffirming my commitment to the American values of justice and liberty for all, I am enlisting in a powerful movement to defend our freedoms against assaults on our civil liberties.'”

This is doing the rounds:

[Feel free to copy this, paste into a blank email message, and send here.]

is an incredible 3D animated creation myth being entirely created by solo animation and sound artist Andy Murdock (a longtime FmH reader) at home. A new LOR Quicktime and DVD release is out; it can be viewed only several clicks away from the page at this link. LOR, a work in progress, will eventually be a feature length film. Unfortunately, I found viewing it a work in progress as well. With a DSL connection, I could get neither part I or part II to play all the way through without freezing (using the Quicktime plug-in in either IE6 or Mozilla). It would be better if Andy would let us download the .mov files and play them offline.

Here is an interview with Andy Murdock.

Addendum: Here, courtesy of Andy, is a link to download the film if you are having trouble with streaming.

Sometimes Reality Has the Last Laugh. (The Specious Report [via walker])

Think your job is bad? Try these. (But they probably don’t want to do what you do any more than you want to do what they do.) (Popular Science)

Think again, says Edward Champion:

What do you want to talk about?

Literary Luddites Unite! “A computer program known as Brutus.1 is generating brief outbursts of fiction that are probably superior to what many humans could turn out.”

(New York Times )

I said this last week in my response to FDA officer David Graham’s criticisms of the agency.

Negotiators Add Abortion Clause to Spending Bill. The language buried deep inside the new piece of legislation expands various protections to doctors and healthcare institutions which refuse to give patients access to abortion counselling or abortion procedures.

Senate majority leader Frist, interviewed today, gave lip service to being outraged someone had slipped this into the omnibus spending package, but pleaded ignorance about who could have made the edit. Given the way legislators approach their jobs, it could very well have gone unnoticed until the bill is passed. Sen. Barbara Boxer (D.-Cal.) vowed to use ‘procedural tactics’ to slow Senate business to a crawl if the clause was not removed from the bill.

And:

Lest you think this was an isolated transgression of legislative ethics, there’s this:

Josh Marshall is all over the story of who’s trying to pull the wool over our eyes on this one.

In an open letter on his weblog, Kevin Sites agonizes over his videotaping of the Marine killing of the wounded Iraqi in the mosque:

The pistachio problem is solved: “A new gadget uses the distinctive pings made by bouncing nuts to sort the open shells from the uncrackable closed ones.” (New Scientist)

Q: So, has success changed you?

A: Yeah, it’s changed me. You know how when you’re eating pistachios and you find one that’s hard to get the shell open? Well, I don’t bother with them anymore.

— Bob Weir [thanks, Paul]

Enforcement of Civil Rights Law Declined Since ’99, Study Finds (New York Times)

Today, from a distance, I saw you

walking away, and without a sound

the glittering face of a glacier

slid into the sea. An ancient oak

fell in the Cumberlands, holding only

a handful of leaves, and an old woman

scattering corn to her chickens looked up

for an instant. At the other side

of the galaxy, a star thirty-five times

the size of our own sun exploded

and vanished, leaving a small green spot

on the astronomer’s retina

as he stood on the great open dome

of my heart with no one to tell.

— Ted Kooser

These are difficult to believe but they are real. Read more about them here and here. [thanks to rebecca blood]

“The Book Review recently asked a handful of poets and critics to respond to this question: What book of poetry, published in the last 25 years, has meant the most to you personally — the book you have found yourself returning to again and again? We asked them not to select reissues, or volumes of a poet’s ”selected” or ”collected” work. Here are their responses…” (New York Times [thanks to wood s lot])

While, as my posts reacting to the election defeat indicate, I agree that this is a time for, figuratively if not literally, street-fighting, I hope that stridency like this does not herald a return to the rhetoric of certain segments of the ’60’s movement who were intent on being radicaler-than-thou and dismissive of anyone who did not conform their activities to their notion of what was to be done. I personally think, in contradistinction to the lead-in above, that writing a weblog is a valid part of ‘taking action on the pressing issues of our day’ and may even qualify as ‘street fighting.’ Of course, it can also be simply intellectual masturbation. The danger is that empty lip service to being a change agent may actually help bolster the status quo. Please help me to maintain an honest distinction.

“BloggerCorps matches bloggers with activists and non-profit groups who want to blog and need help getting started….

The authors (a wide-ranging group comprised mainly of bloggers, activists, and tech organizations who work with non-profits) will post announcements on behalf of organizations who need help starting blogs or building blogging communities. The posts will be categorized according to the organization’s geographical location, and in some cases its main focus issue. Bloggers interested in helping that particular organization can express their interest in the comments section attached to that post. The organization will then decide which of the volunteers it wants to follow up with. All arrangements will be made directly between organizations and bloggers. Bloggercorps will not mediate. We are not raising money to put people on planes so in most cases the idea is to match organizations located in a particular place with bloggers living in the same place. If situations arise in which organizations cannot find volunteers living in their area, we may be able to point them to foundations or philanthropic organizations who might be in a position to help fund travel for blogger-volunteers. But we won’t do your fundraising work for you.

Sounds like a wonderful idea; count me in. Although FmH is primitive from a coding standpoint, I have been doing this for long enough to understand the mechanics.

I still wonder why there has been no serious discussion of the possibility that the tape was a Bush administration concoction given its convenient timing, its anonymous origins, and its congruence with the Republican fear-based campaign techniques. I raised the possibility that it was the often-touted ‘October surprise’ in my initial reactions to its appearance.

Oliver Willis’ Brand Democrat project

“Scientific experiments claiming that distant intercessory prayer produces salubrious effects are deeply flawed…” — Michael Shermer (Scientific American) Whenever I link to one of Shermer’s profoundly skeptical observations, I get at least several angry responses from readers who dismiss my thinking as being hopelessly limited. I don’t mind; I think that this is an especially important time to subject faith to reasonable examination. Readers of FmH will know that I hardly limit myself to what is “scientifically” proven; I think scientific knowlege is a socially conditioned belief system like any other, producing important distortions and limitations in our understanding of reality. There are many sources of light that project the flickering shadows on the wall of the cave.

I tend to believe most paranormal phenomena involve a balance of a basis in fact and a basis in human credulousness. I agree with Shermer that distance prayer is one of the more in-credible claims from a scientific perspective, but also with the claims of adherents that such phenomena may not be amenable to scientific examination. However, I think most paranormal phenomena are ultimately comprehensible as manifestations of intuition. We have ways of knowing things about which we know very little, yet they are ultimately comprehensible mental faculties. Empathic resonance and mind-body connectivity go a long way to understanding “extrasensory” perceptions. My difficulty with fitting distance healing into this perspective is that the recipient does not know s/he has been prayed for. I have the same difficulty with the studies several decades ago that claimed to show that therapeutic touch made a difference to plant growth.

And, as a reader commented to me in a private email (entitled “not an angry response”), distance prayer may be more beneficial for the sender than the recipient, but that it is nothing to scoff at because it increases the sender’s compassion. Most of the most meaningful spiritual practice is dedicated to cultivating compassion, no matter in which system it is embedded. And that, by the way, is why Bush’s brand of faith-based evangelism is not by any stretch of the imagingation a valid spiritual position.

“Will the inevitable decrease in prescriptions ultimately lead to more teenage suicides?” asks The New York Times Magazine. Readers of FmH know I have covered the controversy over antidepressants and suicide in detail. I won’t belabor the points I have already made, except to summarize that, even though they do sometimes make their users more uncomfortable, any excess suicidality in users of the antidepressants should not be attributed to the drugs but to the way they are prescribed. Part of the art of prescribing is monitoring and managing side effects; we do not restrict ourselves only to medications that are trouble-free, but weigh the relative risks and benefits with our patients in making the decision to prescribe a given medication and following the patient once they are taking it. All well and good, if everyone has access to accurate data on the effects of a medication, but drug company minimization and concealing adverse information from both consumers and prescribers has made that impossible. The pharmaceutical manufacturers sitting on top of this cash cow have marketed the drugs as trouble-free and persuaded prescribers that little care was necessary to follow those taking the drugs under their supervision. Over the past two decades, this marketing strategy succeeded by shifting the bulk of SSRI prescribing from the psychiatrists who have traditionally followed depressed patients, have the training to assess the subtleties of antidepressant side effects and the subtleties of assessing suicidality, and the time to do so in their patient visits, to generalists, internists and primary care clinicians who have none of those assets.

The ‘black box’ warning about suicide risk in pediatric use of these medications was premature and unwarranted. Most data shows that antidepressants not only do not enhance suicide risk but that they decrease it. Here is a Google Scholar search into whose citations you can drill down if you have further interest. One of the effects of the cavalier attitude about prescribing the new generation of antidepressants has been a tremendous expansion of the indications for which they are used and a lowering of the threshold for using them, especially in children. Many speculate that the adverse publicity will make many parents skittish about having their children on antidepressants. With any luck, this reluctance will take its toll primarily on the more dubious uses of the medications and not on the most severe childhood depressions for which the medications remain urgently necessary, justifying any added risk if used carefully, and without which use there would be an expansion of childhood and teenage suicides. While I am not a child psychiatrist, given my strong interest in this issue I have had many conversations with my child-psychiatrist colleagues, including some of the most authoritative and well-respected pediatric psychopharmacologists in the Boston area, with whom I am privileged to collaborate at times. The good news is that they are not seeing the feared chilling effect; parents seem no more reluctant to approve antidepressant therapy for their children in need than before the furor began. Of course, they may not be a representative sample of antidepressant prescribers. By and large, the child psychiatrists I have queried are not the ones who would be prone to prescribe in a cavalier manner, with inadequate followup, or for dubious indications. But the premise of the Times Magazine‘s article — that there will inevitably be a decline in antidepressant prescribing since the FDA warnings — is not at all a given, as I see it.

“Will the inevitable decrease in prescriptions ultimately lead to more teenage suicides?” asks The New York Times Magazine. Readers of FmH know I have covered the controversy over antidepressants and suicide in detail. I won’t belabor the points I have already made, except to summarize that, even though they do sometimes make their users more uncomfortable, any excess suicidality in users of the antidepressants should not be attributed to the drugs but to the way they are prescribed. Part of the art of prescribing is monitoring and managing side effects; we do not restrict ourselves only to medications that are trouble-free, but weigh the relative risks and benefits with our patients in making the decision to prescribe a given medication and following the patient once they are taking it. All well and good, if everyone has access to accurate data on the effects of a medication, but drug company minimization and concealing adverse information from both consumers and prescribers has made that impossible. The pharmaceutical manufacturers sitting on top of this cash cow have marketed the drugs as trouble-free and persuaded prescribers that little care was necessary to follow those taking the drugs under their supervision. Over the past two decades, this marketing strategy succeeded by shifting the bulk of SSRI prescribing from the psychiatrists who have traditionally followed depressed patients, have the training to assess the subtleties of antidepressant side effects and the subtleties of assessing suicidality, and the time to do so in their patient visits, to generalists, internists and primary care clinicians who have none of those assets.

The ‘black box’ warning about suicide risk in pediatric use of these medications was premature and unwarranted. Most data shows that antidepressants not only do not enhance suicide risk but that they decrease it. Here is a Google Scholar search into whose citations you can drill down if you have further interest. One of the effects of the cavalier attitude about prescribing the new generation of antidepressants has been a tremendous expansion of the indications for which they are used and a lowering of the threshold for using them, especially in children. Many speculate that the adverse publicity will make many parents skittish about having their children on antidepressants. With any luck, this reluctance will take its toll primarily on the more dubious uses of the medications and not on the most severe childhood depressions for which the medications remain urgently necessary, justifying any added risk if used carefully, and without which use there would be an expansion of childhood and teenage suicides. While I am not a child psychiatrist, given my strong interest in this issue I have had many conversations with my child-psychiatrist colleagues, including some of the most authoritative and well-respected pediatric psychopharmacologists in the Boston area, with whom I am privileged to collaborate at times. The good news is that they are not seeing the feared chilling effect; parents seem no more reluctant to approve antidepressant therapy for their children in need than before the furor began. Of course, they may not be a representative sample of antidepressant prescribers. By and large, the child psychiatrists I have queried are not the ones who would be prone to prescribe in a cavalier manner, with inadequate followup, or for dubious indications. But the premise of the Times Magazine‘s article — that there will inevitably be a decline in antidepressant prescribing since the FDA warnings — is not at all a given, as I see it.

This is from a gossip rag — unsubstantiated but comforting? The Bush twins and their secret service escorts were apparently turned away from a popular NYC restaurant with the news that no tables would be available… for the next four years. A rousing cheer went up from the patrons of the eatery. (Gawker)

Joni Mitchell interviewed by Elvis Costello, with reverence, in Vanity Fair.

The USA Patriot Act makes it illegal for a library to tell its users if their browsing, surfing, etc. habits are being monitored. But it doesn’t, technically, make it illegal for you to tell them they are not being watched. (I would love to watch the sophistry on both sides if there is ever a test case of this one in the courts…) Here is a collection of signs to post, or to keep you posted. From celebrated Rutland VT librarian Jessamyn West, one of my heroes. The signs have been provided to libraries throughout her state. Perhaps you should take copies to your local librarian…

This would just be another curiosity, the grounds for some horror flick or the like, if they weren’t another canary-in-the-cage species, a harbinger of massive environmental change.

Owen’s [ also not found in nature ] reached its fifth anniversary the same week FmH did, but with a very different outcome. I will miss you. R.I.P.

“A new vaccine could prevent the majority of cases of cervical cancer, suggest the results of a major trial. The vaccine protects against the virus that causes cervical cancer, which kills almost a quarter of a million women worldwide each year.” (New Scientist)

Kaplan describes how — in what should be starting to sound like a familiar pattern in light of Bush’s recent Cabinet choices — Goss “auditioned for his current job by doing political hackwork for the president”, as a hired gun to discredit Kerry and to scoff at the Valerie Plame scandal. Although ensconced bureaucrats always raise the hue and cry whenever an outsider takes control of their agency, rarely is it such a political hack. Kaplan finds it more worrisome that the directorate of the CIA is “a political arm of the Oval Office” than even at Justice or State, because of the CIA’s importance in providing the administration with ‘disinterested analysis.’

But we already have abundant evidence that that is not what Bush and Cheney are interested in, and Goss’ role will be one of refining their ability to live in la-la land for the next four years.

The French Paradox: “Despite a diet stuffed with cream, butter, cheese and meat, just 10 per cent of French adults are obese, compared with our 22 per cent, and America’s colossal 33 per cent. The French live longer too, and have lower death rates from coronary heart disease – in spite of those artery-clogging feasts of cholesterol and saturated fat. This curious observation, dubbed ‘the French paradox’, has baffled scientists for more than a decade. And it leaves us diet-obsessed …smarting.” (Guardian.UK)

The FDA is far too cozy with the drug companies, critics assert, and I tend to agree. It is only going to get worse under an emboldened second Bush administration, since the Republican strategy for American prosperity goes no further than removing regulatory barriers to untrammelled corporate profitability.

The problem is not that Vioxx, or any other drug, has risks — physicians customarily balance risks and benefits in collaborating with their patients on prescribing decisions — but that the process withholds data about the risks from both practitioners and the public. The recent furor over childhood antidepressant use and suicide is the same. One solution would be to separate the FDA’s drug approval machinery from its post-approval drug safety monitoring role, but the fist-in-glove relationship with the industry would likely contaminate the latter’s functioning as well. A better way to address the problem would be to develop a trustworthy independent review board on drug safety issues, beyond the reach of industry gladhanding, sort of like the Underwriters’ Laboratory for household appliances.

“The tool that lets viewers control the TV will soon sport ‘billboards’ and track viewing habits.” (LA Times)

“Not a single major voice has been raised in the American media against the ongoing destruction of Fallujah. While much of the world recognizes something horrifying has occurred, the US press does not bat an eye over the systematic leveling of a city of 300,000 people.” (World Socialist Web Site via Cursor)

Also: “Speaking on condition of anonymity for fear of U.S. military reprisal, a high-ranking official with the Red Cross in Baghdad told IPS that ”at least 800 civilians” have been killed in Fallujah so far.

His estimate is based on reports from Red Crescent aid workers stationed around the embattled city, from residents within the city and from refugees, he said.

…The official said that both Red Cross and Iraqi Red Crescent relief teams had asked the U.S. military in Fallujah to take in medical supplies to people trapped in the city, but their repeated requests had been turned down. ” (Inter Press Service News via Cursor)

“The UN has warned that Afghanistan could become a ‘narco-state’ after opium cultivation rose by two-thirds this year. A UN report released on Thursday urged the US and Nato forces to fight drugs as well as Taleban insurgents.” (BBC)

[Props to adam for sending me this piece by Mel Gillies, first posted at Mathew Gross’ weblog and worth reprinting in full. This will make most sense to anyone who has worked with, or tried to intervene with, victims of domestic abuse, but the analogy is important to the rest of us as well. There is enough focus on the pathology of the dysadministration to go around; this is an attempt to grapple with the pathology of those of us at its mercy. It neatly complements my insistence that the Democrats’ lost grip on the direction of American politics and social policy calls for a bolder, more distinctive assertion of its identity and potential, not the cowed regression toward the insipid and meaningless least common denominator that some Democrats advocate. — FmH]