…says “former liberal turned conservative” “columnist” (I think I’ll put that one in quotation marks) Cinnamon Stillwell, writing about a suicide bombing by a 21 year-old engineering student outside the packed football stadium of the University of Oklahoma on October 1. The powerful explosion killed only the bomber himself, and no one else was injured, although the power of the blast was considerable, according to onlookers.

Thanks to Seth for pointing me to this story; he shares Stillwell’s sense that officials’ rapid dismissals of the act as that of a ‘lone gunman’ with a history of mental instability smelled funny. But Stillwell draws heavily — almost exclusively — on wingnut sites who were the sole sources of conspiratorial conclusions drawn from the claims: that the bomber had a roommate of (gasp!) Pakistani descent; that he may have visited the campus Islamic Society center; that the explosive used in the bombing was the same substance so-called “shoe bomber” Richard Reid and the London Underground bombers used; and that the bomber’s apartment reportedly contained “a significant amount” of Jihadist literature (a claim which investigators have debunked… probably part of the coverup in progress, if you ask me).

Now we turn from the sublime to the ridiculous. The fact that he was a Westerner “would have come in handy for avoiding official scrutiny” — thus he must have been a terrorist — and the fact that he did not live at his fraternity house and that members of his frat did not know him as an Islamic convert somehow further suggest covert activity on his part. Similarly, the fact that these events did not attract serious mainstream press coverage suggests that there is a coverup going on. (BTW, search for ‘Joel Henry Hinrichs’ on Google News if you doubt that the issue is attracting any press coverage.) Believe it or not, he had a beard “too similar to those worn by newly observant Muslim men to be a mere coincidence”! And the fact that this occurred in the same state as the 1995 bombing of the Murragh Federal Building, by this perverse logic, suggests that both were Islamic plots.

This shrill, hysterical absurdity reminds me of nothing so much as the incident sometime last year (about which I wrote in FmH, although I cannot find the reference just now) by an alarmist and somewhat reactionary “writer” who believed she saw a group of Islamic men on her airline flight conspiring together but nobody would do anything about it! Then, as now, that was probably because there was nothing more to such fears than proof that people can see what they want to see. One of the most reprehensible aspects of reactions to the 1995 Oklahoma City bombing was the rush to assume that the Muslims were responsible. Incredibly, some are still holding on to that bigoted and ignorant sentiment. Stillwell’s concluding plaint is that “… if a terrorist attack in America’s heartland doesn’t jolt the country out of this fantasyland, what will?” Unfortunately, the only ‘fantasyland’ I see around here is the one she and others of similar ilk call their homeland.

Here you will find the more levelheaded Wikipedia entry on the incident.

…says “former liberal turned conservative” “columnist” (I think I’ll put that one in quotation marks) Cinnamon Stillwell, writing about a suicide bombing by a 21 year-old engineering student outside the packed football stadium of the University of Oklahoma on October 1. The powerful explosion killed only the bomber himself, and no one else was injured, although the power of the blast was considerable, according to onlookers.

Thanks to Seth for pointing me to this story; he shares Stillwell’s sense that officials’ rapid dismissals of the act as that of a ‘lone gunman’ with a history of mental instability smelled funny. But Stillwell draws heavily — almost exclusively — on wingnut sites who were the sole sources of conspiratorial conclusions drawn from the claims: that the bomber had a roommate of (gasp!) Pakistani descent; that he may have visited the campus Islamic Society center; that the explosive used in the bombing was the same substance so-called “shoe bomber” Richard Reid and the London Underground bombers used; and that the bomber’s apartment reportedly contained “a significant amount” of Jihadist literature (a claim which investigators have debunked… probably part of the coverup in progress, if you ask me).

Now we turn from the sublime to the ridiculous. The fact that he was a Westerner “would have come in handy for avoiding official scrutiny” — thus he must have been a terrorist — and the fact that he did not live at his fraternity house and that members of his frat did not know him as an Islamic convert somehow further suggest covert activity on his part. Similarly, the fact that these events did not attract serious mainstream press coverage suggests that there is a coverup going on. (BTW, search for ‘Joel Henry Hinrichs’ on Google News if you doubt that the issue is attracting any press coverage.) Believe it or not, he had a beard “too similar to those worn by newly observant Muslim men to be a mere coincidence”! And the fact that this occurred in the same state as the 1995 bombing of the Murragh Federal Building, by this perverse logic, suggests that both were Islamic plots.

This shrill, hysterical absurdity reminds me of nothing so much as the incident sometime last year (about which I wrote in FmH, although I cannot find the reference just now) by an alarmist and somewhat reactionary “writer” who believed she saw a group of Islamic men on her airline flight conspiring together but nobody would do anything about it! Then, as now, that was probably because there was nothing more to such fears than proof that people can see what they want to see. One of the most reprehensible aspects of reactions to the 1995 Oklahoma City bombing was the rush to assume that the Muslims were responsible. Incredibly, some are still holding on to that bigoted and ignorant sentiment. Stillwell’s concluding plaint is that “… if a terrorist attack in America’s heartland doesn’t jolt the country out of this fantasyland, what will?” Unfortunately, the only ‘fantasyland’ I see around here is the one she and others of similar ilk call their homeland.

Here you will find the more levelheaded Wikipedia entry on the incident.

Of course, fungi are everywhere, so I am not sure how concerned one ought to be. Researchers say you should buy feather pillows instead of synthetic, if this worries you.

My family and I escaped the sodden Northeast for a week in — where else? — the Pacific Northwest. I apologize, especially to several readers who wrote in alarm and withdrawal, for not posting my customary notice that I would be gone for awhile. It won’t happen again (the radio silence, I mean…). A belated happy new year to Jewish readers, an auspicious Ramadan to any Muslims who read this, and happy Thanksgiving to Canadian ones. [If you want to be prepared, I will be travelling again for several weeks in February…]

If you visit a Blogspot (Blogger’s web hosting vehicle) weblog which uses the Blogger navbar at the top, you now have the ability to flag its content as objectionable. Google (recall: the Blogger parent company now) reserves the right, if they agree that the content is potentially offensive (by whatever standards they wish to apply), to place a Content Warning Page in front of the weblog and to unlist it, although its content will still be available.

Some would argue that this is censorship, while others insist that because the content is not restricted this is reasonable. On FmH, in the weblogging world and in the web in general, it has seemed to me that pointing to content assumes an inherently more and more important role in proffering information and opinion. So it is arguable that removing pointers to something becomes perilously increasingly akin to restricting speech, which seems indefensible no matter how vile the speech is.

A great reason not to host with Blogspot, it would seem. On the other hand, the demands of any other weblogging platform will probably weed out many of the mindless dolts who promulgate hate speech and vulgarity, because it is so braindead-easy to do on Blogspot.

…as it is braindead-easy for the great unwashed masses who read weblogs to react with a click on the “flag” button to anything with which they disagree. Google is going to have its hands full investigating all the spiteful would-be stool pigeons (see story below). Perversely, it actually makes me wish I had a “flag” button here on FmH. After all, from its beginnings six years ago I have said you should let me know as soon as I offend you. After Steve Baum, “I like to keep track of those times when I get something right.”

Maybe I am preaching to the choir, but no matter how economical it is, you simply have no business doing business with a firm that does this. [via boing boing]

“…it’s how I live my life…” (glenrhodes.com)

Of course, fungi are everywhere, so I am not sure how concerned one ought to be. Researchers say you should buy feather pillows instead of synthetic, if this worries you.

Gizmodo is derisive about a pair of slippers with LEDs in them, saying most people are pretty familiar with where things are in their homes and can navigate in the dark. A commenter begs to differ, saying there will be a particular market for them among New York City apartment-dwellers, to keep the cockroaches away during those trips to the bathroom when you don’t want to turn on the lights and wake up fully.

George Will, with welcome audacity, in the Washington Post:

Merck claims its immunization against human papillomavirus strains which cause cervical cancer is overwhelmingly effective (New York Times ). There are more than a quarter of a million cervical cancer deaths a year worldwide, many of them in poorer countries where women do not have access to regular Pap smears that could detect the disease earlier. If this bears up, it could be a momentous health advance — enthusiasts say it could prevent at least 70% of cervical cancer deaths — although women would still need regular screening tests. Now, going beyond questions of clinical efficacy: what is Merck going to charge for the vaccine in the Third World? Would putting in the infrastructure for regular gynecological checkups be a less costly alternative to lining the pockets of Big Pharma? Is there the political will to do so?

Delight abounds at the recognition of the IAEA and Mohammed ElBaradei, which among other things is a reaffirmation of the role of diplomacy, a reinforcement of the urgent issue of nonproliferation facing the world, and a slap in the face to U.S. unilateralism in the Middle East and our undercutting of the United Nations.

Happy 74th birthday to the wry Desmond Tutu, who said: “When the missionaries came to Africa they had the Bible and we had the land. They said ‘Let us pray.’ We closed our eyes. When we opened them we had the Bible and they had the land.”

Also pointed to by the null device: one of the best medical webloggers, Dr. Charles, writes a doctor’s fictitious journal entry about the avian flu pandemic to come. Scroll down for some advice from one of his readers on preparing for it:

“1) It has recently been determined that most pulmonary illnesses are spread by hand contamination, not coughing or sneezing as previously believed. If you are out in public or around those who are during an outbreak, using alcohol-based hand sanitizer six times a day will reduce your chance of catching flu by 80%. If there is obvious contamination, use soap and water. Antiseptic soap is not significantly more effective than ordinary soap in this regard. Consciously force yourself not to touch your face in public until you have sanitized your hands.

2) The worst public sources for air and surface contamination are public restrooms and restaurants. Avoid them. Sanitize telephone handsets and often touched surfaces in work areas, especially doorknobs. Parts of automobile interiors can also be cleaned.

3) There are several known effective OTC anti-virals, and several more that may help. Some non-toxic metals are powerful antiseptics and can be used for decontamination, such as the calcium found in grapefruit seed extract (available in health food stores). A few drops can disinfect a quart of water. A tablespoon can also be added to a humidifier for an air and room surface disinfectant. Larger amounts could be added to a swamp cooler to help sanitize an entire house.

4) Other metals are not directly anti-viral, but inhibit viral reproduction in some circumstances. Silver and zinc in the proper form and place can have this effect in the human body. Colloidal silver in a nasal spray, for one, and Cold-Eeze brand throat lozenges for zinc. Cold-Eeze is unique in this way, as its patented form of zinc is readily uptaken into the mucous membranes, unlike most zinc supplements. With FDA approval, it can state that it lessens severity and duration of colds and flu. Perhaps it can do more.

5) Most colds and flus reproduce in the sinuses and trachea, so it is important to keep them a less friendly environment for viruses. The use of ordinary saline nasal spray to reduce large build ups of mucous removes breeding medium. NOTE: avian flu is different, in that it can reproduce in several other organs, including the liver.

6) Another newly discovered trick that may work is ordinary store-bought cranberry juice, which has been determined to inhibit cellular adhesion by several viruses, in quantity. It is unknown if it would work for avian flu, but drinking copious amounts as a possible prophalaxis should not be too much an inconvenience, if that is all you’ve got to protect yourself with.

7) There will undoubtedly be shortages of several items once an outbreak has occurred. Surgical masks, protective glasses, latex gloves, sanitary wipes and rubbing alcohol may all become scarce, so it is not unreasonable to stock up now.

8) The vaccination priority that we are used to has been changed because of the severity of this illness. Instead of giving injections to the elderly, infirm and very young, the emphasis will be on school-aged children (the largest human vector of the disease), and in outbreak areas. It would be wise to familiarize yourself with traditional quarantine measures, as they can be unexpectedly harsh. In time of an epidemic, the Health Department can be authoritarian.

9) The avian flu also has a large number of animal vectors, and until these are determined for certain, it would be wise to avoid large assemblages of animals and birds, even dogs and cats. Already, some birds have been identified that can carry the disease for great distances without immediately dying.

10) Flu vaccine takes from several days to two weeks for optimum immunity. This immunity may last perhaps six months or more in a healthy, young adult, and as little as two to three months in the elderly. A severe flu epidemic usually appears in two waves, and can last from one to two years.

11) Symptomology of avian flu so far seems to indicate that death occurs very quickly, perhaps within 72 hours, and is often from blood and fluid build-up in the lungs. Though this sounds morbid, some people may die in public and it is important not to touch the body. An incapacitated person may spew large amounts of infectious fluids about.

12) Traditionally, government has been slow to react to epidemics, often waiting too long before instituting strong restrictions on the public. However, this can be deadly serious, even if ineffective. There may be circumstances where armed guards are used, and response to public panic may be severe.”

Related: Brainblog rounds up resources for pandemic awareness.

Sex-selection technique lets farmers choose sex of breeding offspring in advance. Antibodies have been developed that are selective for the sex-specific proteins in a collection of sperm, removing whichever sex is not wanted. Obvious implications… (Globe and Mail)

Ed Fitzgerald writes at unfutz:

Leonardo da Vinci and the ancient astronomical riddle of Earthshine. (NASA)

I was reminded of the ongoing allure of Danvers State Hospital, here in eastern Massachusetts where I make my home, by this story of three “would-be ghost-busters” who were arraigned today on trespassing charges after taking a video camera onto the grounds of the asylum, which opened in 1878 and closed in 1992 amidst allegations of overcrowding, abuse and neglect of its wards. At their court appearance, the chastened men each admitted their fascination with ghosts and the legends that the hospital grounds are haunted.

Danvers’ imposing Gothic architecture (it inhabits a place in the National Register of Historic Sites) is one of the most overwhelming of the grand state psychiatric hospitals in Massachusetts, the majority of which — with their monumental edifices, their sprawling grounds, and their treatment of those in the state most tortured by severe mental illness — were closed in the deinstitutionalization mania of the ’90’s from which the mentally ill of Massacusetts and their caregivers have yet to recover. (Institutionalized treatment in massive and remote asylums was supposed to be replaced by community-based outpatient supports when the institutions were closed, but the budget-makers of the state conveniently forgot about that small detail.)

Danvers State occupies a unique place in the psychogeography of this region, like a scratch you cannot reach to itch. It has its own Wikipedia entry, which mentions urban legends that former patients have come back to the closed facility in hopes of finding a place to live, become squatters, and terrorized teenage joyriders who trespass on the grounds. It sounds like a cheap horror flick. Indeed area film director Brad Anderson set his haunting 2001 horror film Session 9, which has been described as “an homage to Stanley Kubrick’s The Shining, with the modern feel of The Blair Witch Project…,”.on the grounds. “It’s the scariest building in North America,” actor David Caruso, who starred in the movie, told AboutFilm.com. “It was always scary, and you could really feel the pain of the people that were at Danvers.”

A real estate developer, in what is becoming a trend at abandoned asylums throughout the continent, is planning to turn Danvers State into an upscale condo development. The developer maintains that the project will be a ‘showcase for attractive and respectful reuse.’ No doubt there will be no accommodations for those peripatetic squatter ex-patients… A group of advocates and former patients are pressuring the group to include a museum to the hospital’s history in their scheme. There are also ongoing moves for the rehabilitation of the cemeteries on the state hospital grounds, in which hundreds of institutionalized patients were buried in graves marked by their medical record numbers. After the 1992 closure of the facility, advocates accessed the archived records to identify the graves and put up headstones where possible.

I have written before in FmH about the infiltration movement and its eponymous webzine, about “going places you’re not supposed to go”. Danvers has been an object of veneration for infiltrators in the decade-plus since its closure. (The three trespassers would have done well to study the ethos and methods of serious infiltrators before their escapade, especially because Danvers State is across the street from the State Police barracks!) Here is a site on the infiltration of another venerable old Massachusetts state hospital, Metropolitan State in Belmont and Waltham, where I myself trained and later worked in the ’80’s treating patients devastatingly ill with schizophrenia, and which has been closed for more than a decade as well.

Opacity, a site by the pseudonymous Motts, who started out being photographically interested in ‘urban ruins’ but grew increasingly fascinated with the act of exploring itself, has a photo essay about the eerie grandeur of the abandoned Danvers State as well as a number of other facilities in Massachusetts and elsewhere.

None has been as obsessed with the closed asylum as Michael Ramseur, author of the reverent website, The Castle on the Hill as well as Haunted Palace, a 260-page history of the facility and The Eye of Danvers, an 88-page art history.

Danvers is just a stone’s throw from Salem, the center of Massachusetts witchery, and interest in the asylum overflows from those preoccupied with the Witch City. Some claim that the hospital was the inspiration for H.P. Lovecraft’s Arkham Asylum, which in itself leads Goths to urge its preservation. Who knows what unmentionable horrors lie in wait in the decades to come for those who remain to be seduced by its terrifying summons?

Titilllating idea starts out as a joke but becomes ‘bona fide bosom buddy’ to breast cancer research:

Bandwidth-intensive information can now be streamed live from remote locations, over ultra-fast optical networks, as demonstrated at this week’s iGrid conference in San Diego:

Do not fail to zoom in as far as you can go.

I am amazed that, even at this point more than thirty years after I graduated, anyone would want to treat me like a Harvard alumnus (and I try to make that clear to the alumni fund solicitors!). Yes, I went there, and I do not hang my head in shame and mumble unintelligibly when anyone asks me where I went to school, although I am certainly familiar with that behavior from my own past. But I have not gone to a reunion of my class since the 10th and the tales I swap convivially are from times and places far from there. I no longer even know from what college most of those in my social circle graduated, and I keep up with those of my college-mates with whom I do not because of where they went to school but what sort of a life they have gotten for themselves since. And, it goes without saying, there are far worthier charities to which I target my charitable giving than the crucible of the ruling class.

From that introduction, you would think the article does not flinch in the face of such words. Nevertheless, a number of those discussed are asterisked out.

Dubner and Levitt float a unique solution that, at first, sounds quite Rube-Goldberg-esque, but bears thinking about. Very entertaining having them as Times columnists.

Thanks to walker for alerting me to this phenomenon and, more properly, to the fact that it has a name. Dhimmi is the Sharia (Islamic law) term for the status of a non-Muslim in a Muslim state. While some emphasize the official toleration of non-Muslims as a virtue of Islamic society, others focus on the restrictions that apply.

Some see in particular “an ongoing initiative by some Muslims to force British society to conform to Islamic standards.” Here is a website that exists solely to chronicle the supposedly stunningly rapid advancement of the “mentality of dhimmi servitude” in the West. In particular, there have been ongoing battles over the offense taken by the displays of pig-related items including toys, piggy banks and images of Winnie the Pooh’s friend Piglet.British schools have removed or restricted access to “anti-Muslim” children’s books including The Three Little Pigs, Charlotte’s Web, the Olivia and Babe series. Animal Farm, of course, offends as well. Supposedly, an employee of an Orlando, FL Muslim-owned business was fired for eating a BLT sandwich. And one commenter warns that depictions of dogs are more offensive than those of pigs..

In evaluating all this, however, we should take a hint from the fact that much of this alarm emanates from the righthand side of the weblog world, not exactly bastions of tolerance. This is in the mold of the longstanding tendency of the right to lampoon the excesses of political correctness as if they make a mockery of all of free speech and tolerance. Especially in the wake of the London bombings in the UK, one can expect an incidence of fearful misjudgments and overreactions from some British magistrates and civil authorities. String together the most egregious examples, throw in a sprinkling of US parallels, ignore all counterexamples, and you can thoroughly obscure the distinctions between toleration of Muslims in a multicultural society and encouragement of intolerant extremism. This all smacks of Dubya’s fatuous insistence that “they hate us because we are free.” Radical Islamists stand far less of a chance of bringing down Western freedoms (such as they are) than these anti-Muslim jihadists; we’re doing it for them. In general, we in the West have much more to fear from anti-Muslim totalitarianism than the ugly spectre of the Muslim kind these writers depict.

Was there a biological attack on the Mall protesters in Washington last weekend? Quite a coincidence that the sensors detected low levels of tularemia just at that time and place. The route of infection is by inhalation, and it is treatable with antibiotics but can be fatal if not recognized. (Washington Post; thanks, Uncle $cam)

Dubner and Levitt float a unique solution that, at first, sounds quite Rube-Goldberg-esque, but bears thinking about. Very entertaining having them as Times columnists.

If liars have more white matter (not clear if it is cause or effect), do honest people succumb more often to the various neurological diseases that involve the CNS’ white matter? It seems to me, thinking back,. that the patients I have known with multiple sclerosis were all really good people. Someone should do the research…

A psychiatrist in Boston with whom I am fortunate to be acquainted, Ron Pies, writes about What Kafka’s “Hunger Artist” Teaches Us About Terrorists:

Neil Gaiman’s new book is out. It is set in the same universe as American Gods, in which the American ‘melting pot’ is also the melting pot for all the deprecated deities of our immigrant ancestors, living in exile and ‘retirement’ among us. Reading the blurbs about Anansi Boys, I am prepared to be disappointed and it will not leap to the head of the queue of books waiting to be read here, unlike what happens with the release of the latest book by many of my favorite authors. But then again, I was prepared to be disappointed by American Gods and didn’t buy it for a long time after its release, yet I ended up finding it an engrossing read some of whose images and conceits have stuck with me since. I am a follower of the trickster mythos (and related themes like the holy fool); perhaps Anansi Boys will please after all. Alas, I worry that Gaiman peaked with Neverwhere.

The buck stops here: Military jury convicts Lynndie England of six of seven counts in Abu Ghraib abuse case (Boston Globe)

Related:

From Ed Fitzgerald’s unfutz I learned that:

• Michael Brown, who recently resigned as FEMA head in ignomy, has been rehired as a consultant to the organization to assess the disaster response. Ed comments, “Now, in the abstract, this is not a bad idea, making sure you get the value of an employee’s experience before they leave to go elsewhere. In this particular instance, though, one has to think What experience? ” If I am not mistaken, this is what is usually called a ‘golden parachute.’ However, in this case, it is not gold but excrement-brown.
• The bus which caught fire killing twenty-three nursing home evacuees during the Houston evacuation was from a company which had had numerous difficulties with regulatory authorities in Texas and, according to a whistle blower, more serious problems with meintenance of its vehicles. “The bus, run by Global Limo of McAllen, Texas, was taken out of service in July after its registration expired. It was allowed back on the road because of a waiver signed last week by Gov. Rick Perry intended to make available as many commercial vehicles as possible for the hurricane evacuation.” Ed places this rightly in the broader context of Republican officials’ eagerness to set aside regulatory restrictions on business at any opportunity, which may be a bit of a reach here.

There have been 270% the average number of intense storms expected by this date in the hurricane season, but it is certainly rash to draw conclusions from a given year. The formation of tropical storms over the Atlantic runs in phases, and we are in the midst of a several-decade active phase. However, we are almost certainly seeing an effect, from the warming of the average surface water temperature in the Gulf of Mexico, on the storms that cross the Gulf.

“There is a genuine intensity in the suffering of Frida Kahlo. Yet there is something vaguely repulsive in the adulation she receives. Victimhood, after all, is not beatitude…” (The New Criterion)

The robotic exploration of Mars is coming up with so many features to name that scientists go wild:

The New York Times writes about all the old dinosaur bands resurrecting themselves with new lead singers these days. The focus of the article seems to be whether, with such a profound change, a band is justified in continuing under the same name. The more profound issue is why so few acts let themselves die a dignified death anymore. One needs to wonder what it is about rock musicianship that prevents members of dinosaur bands from ever evolving any new chops and moving on and what it is about rock consumers’ sensibilities that encourages the musicians to do the same old things over and over again ad nauseum. And why in the world the New York TImes covers the phenomenon in an equally shallow manner.

The absurdity of the fact that there was no provision to ensure gasoline supplies to motorists along the clogged evacuation routes was just the tip of the iceberg. It is not a matter of individuals’ panic or ill-will but partly the lack of centralized planning and partly just the nature of things. Large cities are located at unique geographic points — that is why their precursor settlements were sited there in the first place — which often translate into bottlenecks even in a normal rush hour, not to mention a mass evacuation.

Prepearedness is not the issue. In fact, if anything, it appears to me that part of the problem in the Texas evacuation resulted from overpreparedness. Not only was there several days’ notice of where Rita was headed and approximately how strong it would be but people were more obedient than they would otherwise be to directives to evacuate because of the memory of Katrina. In most of the disasters that will call for mass evacuation, even with disaster authorites operating effectively, that combination of circumstances is not likely to recur.

The robotic exploration of Mars is coming up with so many features to name that scientists go wild:

A collaborative writing experiment in which readers are writing a novel. Given two sentences, you insert a sentence between them, so the whole think expands outward from the middle.

(So it is not just in cases where the oilpan cap requires alot of torque to remove??)

Of course, this essay appears at the website of a health insurance company, which has a vested interest in consumers not being prescribed the latest (and most expensive) new medications. But I largely agree, and I both regularly educate my patients and have written here at FmH in the past about the opposite trend, prescribers whose only source of information about the medications they prescribe is the manufacturers who profit from their use, and the questions you should ask your prescriber when s/he proposes a change to a newer medication because it is supposedly “better.”

I sit on the pharmacy and therapeutics committee of my hospital, where decisions about what medications the hospital will have in its formulary are made. This week, we discussed in exasperation the growing pressure from patients and families who demand to be treated with a new asthma medication they have seen advertised on television, which is 7-10 times more expensive than the standard of care, and according to the scientific literature is no more effective and no more tolerable. It is not only credulous doctors you have to worry about, but consumer-driven prescribing pressures.

People should be aware of one particular pharmaceutical industry scam which is increasingly widespread and insidious. Many medicinal copmounds have molecules with chirality, i.e. they are asymmetrical and thus exist in several different isomers which differ only in which way the bonds within the molecules twist. Often, the different isomers differ in biological activity. Thus, for example, 20 mg. of an antidepressant might contain around 10 mg of the leftward-twisting (levo- or L-, also referred to as S-) version of the molecule and around 10 mg of the dextro- or D-isomer. One of them is biologically active and the other is essentially an inert ingredient. So a company figures out how to efficiently separate the two isomers and patentsa a new medication consisting of one of the stereospecific forms. It is easy to see that 10 mg of the new medication is for all intents and purposes equivalent to 20 mg of the old one (and will probably be a pill of about the same size, by the way!), yet it will be marketed as new and improved, as more effective or more side-effect-free. It obviously sounds like a more powerful drug to a lay person, because 10 mg does what it took 20 mg of the old drug to do. And it costs some multiple of the cost of the old drug, as well as being protected by patent rights for many more years while the older drug enters the public domain where generic versions can be offered. One example of this is the antidepressant Lexapro, which is escitalopram (“S-citalopram”), the S-isomer of citalopram, which is the older antidepressant Celexa. Lexapro has been around for a few years now and is shaping up to have no advantages over Celexa, except in profit margin to the manufacturer.

It seems to me that the trend of capturing and maintaining market share with stereoisomeric forms of older medications is all the rage in Big Pharma these days; in fact, that is the case with the asthma medication we discussed in P&T this week. And I am sure we should believe the manufacturers’ claims in some instances that the ‘inert’ ingredient in the mixed version was not inert at all, but contributed to side effects or changes in the metabolism of the drug in comparison to the stereospecific form. But the literature, when you can get an unbiased study not paid for by the interested industry party, often says otherwise.

So…not so fast.

PS: the P&T committee voted to add the new asthma medication because the pulmonologists swear they would not be able to handle the P.R. fallout from not meeting patient requests for it, and don’t have the time or the inclination to better educate the public about its lack of advantages over the older medication it is meant to supplant. Supposedly, patients will have to jump through hoops, such as nonresponse to other measures and prior approval by a ‘gatekeeper’ specialist, to get the new drug. We’ll see how firm and how long the gates stand…

…too late that, in addition to wishing my readers a happy fall equinox as I did, it was also the spring equinox for half the world. On the other hand, I might have no readers in the Southern Hemisphere.

North Korean Deputy Foreign Minister announces N. Korea will stop accepting food aid at the end of this year, both because its food production has increased adn because the US is politicizing the process by linking aid to human rights issues. UN Emergency Relief Coordinator Jan Egeland asserts that 7% of North Korea’s population of 22.5 million are starving and 37% chronically malnourished. “According to U.N. statistics, 40 percent of North Korea’s children suffer from stunted growth, 20 percent are underweight for their age and 8 percent are wasted, meaning their weight is too low for their height. The average boy of 7 is 7 inches shorter and 20 pounds (9 kgs) lighter than the average 7-year-old in South Korea, the world body said.” (Yahoo! News)

You know, of course, that the letters after his name stand for “Doctor of Veterinary Medicine.” And FDA stands for “Food and Drug Administration.” That’s human food and drugs. He was as qualified for his position as, say, Michael Brown, in case you were wondering wehther there is a pattern here.

The Fundamentalist Shadow of George W. Bush (Scoop)

Scroll down the page abit further and you will also see a photo of a morgue full of Katrina victims’ corpses wickedly labelled “Bush’s Vacation Photo Album”, by the way. I love it.

Saudi Minister Warns U.S. Iraq May Face Disintegration: “The Saudi foreign minister said that the lack of a dynamic pulling Iraq together could drag the region into war.” (New York Times )

It is the birthday of both John Coltrane (September 23, 1926 – July 17, 1967) and Ray Charles (September 23, 1930 – June 10, 2004).

Gareth Branwyn et al have finally ported the classic 1991 Hypercard stack to the web.

“The Find-a-Human database is a collection of touch-tone recipes that get you through big companies’ voice-jail systems and through to a live operator.” [via boing boing]

“Find the perfect name for your business or product: Think all the quality domains are taken? Far from it – creativity produces quality results.

Let us know what you’re looking for in a name. Complete as much as you like of the form below, in any combination – no choice excludes another.

We’ll find the best available domains – all dot coms with no hyphens or numbers. We are experts at finding short, brandable names, business names, dictionary words, descriptive names, misspellings and more. We do NOT just combine keywords – as you can see from our For Sale domains and those RECENTLY FOUND.”

In a story on NPR’s Morning Edition on 9/15, reporter Cory Flintoff noted that “some extremist groups say (the July 7 London subway bombings) were a response to the U.S. and British military presence in Iraq.” NPR has repeatedly featured Tony Blair’s characterization of such reasoning as “obscene.” Now, FAIR (Fairness & Accuracy in Reporting is asking you to complain to NPR about the patently absurd suggestion that you would have to be an extremist to believe there was a link between the bombings and British participation in the Iraqi invasion. In fact, a majority of the public in the U.S. and the U.K. see the link, as well as a number of respected foreign affairs analysts. The extremist position, in reality, is that of Blair and Flintoff…

“In case of alien abduction these dog tags may save your life. The crucial data an alien will need to get you back to Earth is die stamped into these dog tags.” [via robot wisdom]

Hundreds of photographers converge on Yosemite’s Glacier Point fifty-seven years to the day later, as the conditions of Ansel Adams’ famous “Autumn Moon” photograph recur. (Sky and Telescope)

“What’s been so surprising about the U.S. news media’s coverage of George W. Bush’s Katrina debacle is that leading journalists finally have broken with a five-year pattern of protecting both Bush and his presidency.” — Robert Parry (consortium news)

This is how the Nazi Pope thinks the Church can rebound from the clergy abuse scandal (New York Times ). In reality, of course, this will simply drive gay clergy deeper into the closet (if they were ever out), which will increase the prevalence of exploitative illicit solutions to sexual repression. At least, so far, there will not be a witchhunt for gays already wearing the cloth. While the Church insists this does not represent a change in doctrinal position, it is clearly a move from policing behaviors to thoughts and feelings. In explaining why those entering the priesthood will be targeted, a spokesman explains it is because of the unique temptation posed by the seminaries, even for those who are celibate, because one is surrounded exclusively by men. (So here’s an idea; solve the problem by admitting women to the priesthood…)

…and it is not as simple as the race of the victim. [read on]

…when even The American Spectator has That Sinking Feeling:

Related:

Bush-Bashing in Aspen

“The Witches’ Thanksgiving and the second harvest. Day and night are of equal length, looking forward to the days’ shortening. The Autumn Equinox is the time of the descent of the Goddess into the Underworld. We also bid farewell to the Harvest Lord who was slain at Lammas. Welsh legend brings us the story of Mabon, who dwells, a happy captive, in Modron’s magickal Otherworld — his mother’s womb. Only in this way can he be reborn.”

The article lists all twenty-five recipients and their accomplishments.

Related:

Are the Macarthurs controversial at all in any quarters? I mean, for example, has anyone seen any anti-elitist or anti-intellectual backlash anywhere in the media about them, or are the award-winners just celebrated unambivalently?

Addendum: I found this critique of the Macarthur approach. (marginal Revolution)

Abstract:

One weblog commentator summarizes it thus:

Treating psychotic illnesses, especially schizophrenia, has been an important part of my career, so I have alot of thoughts about this. I hasten to add that I haven’t yet read the article, just the abstract, so some of my questions might otherwise have been answered. It is not clear how the pts. were recruited, what inclusion criteria (including what definition of schizophrenia) and exclusion criteria were used. It is also not clear how dosages of the antipsychotics were determined within the ranges defined for each drug in the study; it would make a difference whether pts were at the top end which, for many of those drugs is arguably an excessive and poorly tolerated dose. Random assignment of medications to subjects will lead to higher discontinuation rates because of intolerance than careful match between patient and medication.

It is not clear what the balance was in the study of discontinuation because of ineffectiveness as opposed to discontinuation becuase of intolerability. My first take on the fact that patients continued with olanzapine, aripiprazole and perphenazine longer than they did with quetiapine and risperidone relates to the fact that risperidone is more poorly tolerated at therapeutic doses and quetiapine is, simply, a less effective medication at controlling schizophrenic symptoms. Let us drill down further into this concept of “ineffectiveness.” This can mean one of several things because there are several different symptom domains in schizophrenia. Different theoreticians and researchers parse them differently, but concepts of the disease include some or all of the following realms — ‘positive’ symptoms, cognitive symptoms, ‘negative’ or ‘deficit’ symptoms, associated depression and other mood symptoms, and aggression/hostility. Only some of these symptom realms are considered to be responsive to antipsychotics. If medication fails to control the torture of active psychotic symptoms, patients will not remain engaged with treaters, will not organize their behavior and follow through with plans, etc. But most pts with this disease, even with effective medication control of florid psychotic symptoms, do not necessarily develop much insight — acceptance of their illness and need for treatment — or improvement in the cognitive domain. Associated depression may not respond to antipsychotics although we are beginning to think that it may be a core domain of the suffering in the disease, in contrast to the older outmoded notion thatt there are thought disorders and mood disorders and never the twain shall meet. So discontinuation of an antipsychotic may not have related to the drugs sucking as much as the illness sucking.

What treatment context and psychosocial supports were used during the lengthy trial? Follow me here — if the study design includes drug discontinuation (for how long — a missed dose? a day? a week?) as a data endpoint, the findings are not surprising at all. In realworld biopsychosocial treatment of patients with schizophrenia, there are lapses, fits and starts in treatment continuity almost as a matter of course. But in realworld treatment, they are not endpoints. Supportive interventions often result in the restoration of interrupted treatment, or seamless change to a different medication if the prior one was ineffective, without the pt spiralling down into a fullblown decompensation requiring psychiatric hospitalization.

I firmly believe that the newer, so-called atypical antipsychotic medications are a treatment advance over the older first-generation antipsychotics (Thorazine and Haldol and their derivatives). They are far more tolerable, but I do not in the least believe the contention that they cause less side effects. Rather, they cause different ones. Unless a patient experiences morbid weight gain, the side effects of the newer agents, in contrast to the older ones, are not irreversibly damaging or disfiguring. And the newer drugs may have more effects in the mood and cognitive spheres, and even that of impoverishment and ‘negative’ symptoms, than the older agents. But they are not curative. Schizophrenia is such a devastating illness that, if someone is normalized with treatment, it is likely they did not have schizophrenia. Yes, it sucks. But medication treatment does not deserve to be slandered by an out-of-context interpretation of a non-naturalistic study with little bearing on how we treat individuals with the illness in the real world, in a multidisciplinary model with psychosocial support.