Author Archives: FmH

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About FmH

70-something psychiatrist, counterculturalist, autodidact, and unrepentent contrarian.

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.

People Are Human-Bacteria Hybrid

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“Most of the cells in your body are not your own, nor are they even human. They are bacterial. From the invisible strands of fungi waiting to sprout between our toes, to the kilogram of bacterial matter in our guts, we are best viewed as walking ‘superorganisms,’ highly complex conglomerations of human cells, bacteria, fungi and viruses.

That’s the view of scientists at Imperial College London who published a paper in Nature Biotechnology Oct. 6 describing how these microbes interact with the body. Understanding the workings of the superorganism, they say, is crucial to the development of personalized medicine and health care in the future because individuals can have very different responses to drugs, depending on their microbial fauna.” (Wired News)

How quantum physicists ‘review’ the ‘Bleep’ movie

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The film What the Bleep Do We Know?! does a reasonable job of presenting some of the weird manifestations of quantum physics, researchers say. But they add that the film shows quantum mysteries selectively to shore up metaphysical points. Those points suggest that quantum-derived ‘possibilities’ affect the wider world, that human thought is the ultimate arbiter of physical reality, and that by manipulating thought properly, people can achieve harmony and even shape the structure of matter.” (Christian Science Monitor)

Boston vs. Austin

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“For half a century, Texas and Massachusetts have dominated the nation’s politics. Is there something in the water? …(T)he so-called ‘Boston-Austin axis’ (is) a quasi-mythical connection that has defined political power in the United States for half a century. Sometimes in alliance, sometimes at odds, the two states have provided more national candidates and more congressional leaders than any others. And the power generated by the states’ vibrant political cultures has fueled the national debate.

‘Massachusetts and Texas are the two centers of dynastic politics in the United States,’ said James Shannon, former Massachusetts attorney general and congressman. ‘I don’t mean just family dynasties — I mean that people feel when they get elected to higher office they’re part of a larger tradition in national politics.'” (Boston Globe)

Nurse, Where Do We Keep the Chicken Wire and Lamp Cord?

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I am quite enjoying this recent New York Times series of columns by medical professionals called ‘Cases’. This one is a depiction of quaint medical ingenuity, 1956-style. Of course, for my money, it does not hold a candle to the best stories of medical ingenuity, Burton Roueché’s Annals of Medical Detection from the New Yorker of decades past. I was surprised to learn that one of the most memorable of Roueché’s stories, “Eleven Blue Men” had been resurrected (poorly) as the basis for that new medical investigation series CSI clone on network television (I didn’t watch it…).

Quantum quirk may give objects mass

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“If you thought that quantum entanglement – the weird effect that allows two particles to behave as one, no matter how far apart they are – is too subtle to affect your daily life, think again. The phenomenon could be responsible for something as significant as the mass of everyday objects, yourself included, and could finally explain why the fundamental particles of matter have the mass they do.” (New Scientist)

Election 2004 and the law of unintended consequences

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“Whatever the outcome of the 2004 presidential election, there are bound to be unforeseen consequences…” — Alex Beam (Boston Globe)

And, on a more serious note: What if Bush Wins, a forum by 16 ‘experts’ (David Greenberg, James K. Galbraith, Grover Norquist, Kevin Drum, Gideon Rose, Cass R. Sunstein, Paul Begala, Mickey Edwards & Nancy Sinnott Dwight, Todd Gitlin, Sebastian Mallaby, Gregg Easterbrook, Christopher Buckley, Elaine Kamarck, E.J. Dionne and Jeff Greenfield). (Washington Monthly)

The New Yorker endorses Kerry,

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the first editorial position it has taken on a presidential race in its 80-year history. This is a wide-ranging and breathtaking indictment of the Bush record and a sober appraisal of the hopes invested in Kerry.

“But the challenger has more to offer than the fact that he is not George W. Bush. In every crucial area of concern to Americans (the economy, health care, the environment, Social Security, the judiciary, national security, foreign policy, the war in Iraq, the fight against terrorism), Kerry offers a clear, corrective alternative to Bush’s curious blend of smugness, radicalism, and demagoguery. Pollsters like to ask voters which candidate they’d most like to have a beer with, and on that metric Bush always wins. We prefer to ask which candidate is better suited to the governance of our nation.”

Any thinking person who reads this could only vote one way. A pity many aren’t, and won’t.

Royal Cockup

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“This is the stuff the bad guys have been using to kill our troops, so you can’t ignore the political implications of this, and you would be correct to suspect that politics, or the fear of politics, played a major role in delaying the release of this information.” [quoted in Talking Points Memo] Marshall quite rightly points out that this story perfectly weds the misadministrations incompetence and its dishonesty; the Americans have known for the year-and-a-half since the occupation that this enormous amount of high-potency explosives had gone missing and had not revealed it, and took great pains that the story not emerge after supposedly ceding power back to the Iraqi transional authority. But what I am dying to hear more about, and what Marshall does not discuss, is how the Bush cabal lost control of this desperately necessary coverup at just the wrong time. Whoever in the Iraqi regime reported the theft to the IAEA just two weeks before Nov. 2 obviously knew the potential implications it would have for the Bush reelection re-defeat effort.

And So It Begins…

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U.S. Chief Justice Undergoes Surgery for Thyroid Cancer (New York Times ). The Court is aging; only one justice is under 65 years of age. (Unfortunately, the youngest justice with the likely longest Supreme Court career ahead of him is the worst, Clarence Thomas, at 56, but what will he do after Rehnquist is no longer on the Bench, since he seems to ape Rehnquist’s position in the preponderance of cases?) There has not been a new appointment to the Bench in ten years. It is serendipitous that the news about Rehnquist breaks now, in the final run-up to the election, alerting the electorate as it does to the expected opportunity for one or more likely several appointments to the Court during the administration of whoever wins next week. Arguably, the upcoming Supreme Court appointments will be the most lasting legacy of the next president. That alone is reason to defeat the smirking chimp.

Rehnquist’s cancer appears to be advanced, to judge from the fact that he had a tracheostomy. Yet the Chief Justice says he will continue to work. There would be nothing to be gained from his resignation now even if he does want to hand an appointment to Bush before he leaves. A lame duck Bush appointment would be blocked by outraged Senate Democrats… one would hope.

R.I.P. Jack Shea, 1948-2004

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Freak accident kills filmmaker. Jack and his partner, painter and journalist Yvonne Baginsky, have been my close friends and hosts during my frequent trips to Scotland going back more than twenty years. Jack was a mercurial and passionate filmmaker and as gifted and gentle soul as I have ever met. I am going to miss the quiet glint in his eye and the impish grin across the kitchen table where on any given night he and Yvonne hosted a motley assortment of their transatlantic friends, many of them artists and musicians. I wish Yvonne and their daughters the strength to go on and, one day, thrive without this larger-than-life companion.

Jack’s recently completed film, Who Owns Jack Kerouac?, details the ugly contest over Kerouac’s literary estate; Jack had been unable to find a distributor for this film. And I am sorry I’ll never get to see what he would have made of the Khumb Mela footage he was editing at the time of his death.