Tom D’Antoni: Thank you, Ann Coulter : “Big Annie is a national treasure. She has helped define Republicans as cruel bigots, haters whose evil is unsurpassed in American life. It’s not something I made up. It’s something she brays and sprays every time she opens her mouth.”

Chris Durang: Ann Coulter – Tipping Point?

Russell Shaw: Ann Coulter, “Bitch” Is Too Kind a Word For You

Kathy Griffin To Al Roker: “I’d Like To Go After Ann Coulter, I Saw That Nut-Bag On The Show”… (HuffPo)

Here is a summary table of the features of a dozen of these critters.

A blogger alliance formed to promote Torture Awareness Month, June 2006.

Should you remove ‘quakers’ before grinding your coffee beans? (bookofjoe)

The quest for a bigger and better high has led to the addition of fentanyl, a potent synthetic opiate painkiller, to street heroin. Dealers are giving it out for free to show how potent it is, leaving scores of their customers overdosed and dead in several American cities where it has been reported, notably Detroit and Chicago. Police are conflicted about warning addicts about the dangerous combination for fear of providing free advertising for the dealers. No one knows how the fentanyl has hit the streets or where it comes from. (Washington Post)

…He Jumps Into Cage And Declares “God Will Save Me, If He Exists”…

“The Pentagon’s move to omit a ban on prisoner humiliation from the basic guide to soldier conduct faces strong State Dept. opposition.” (LA Times) And we’ve seen how potent State Dept. opposition can be!

“After a 40-year virtual ban on research involving psychedelic drugs, scientists look anew at their potential in treating pain and anxiety“. This Boston Globe piece highlights the resurgent interest in psychedelics for therapeutic purposes. Current research includes claims that the powerful South American hallucinogen ibogaine is a quick fix for addictions and that MDMA (Ecstasy) can ease a fearful and pain-ridden dying.

The occasion for the Globe‘s interest is a research grant awarded to Harvard psychiatrist John Halpern, which the article observes

“…represents a chance to reduce the stigma hanging over the field. Back in the 1960s, Harvard professor Timothy Leary helped spur the backlash against psychedelic drugs with ethically questionable experiments and by advocating recreational LSD use to ”turn on, tune in, drop out.” Halpern, by contrast, is a respected researcher…”

This in my opinion is an irresponsible attack on Harvard faculty colleagues Leary and Richard Alpert, who were interested in systematic disciplined use of LSD as a learning tool. Mind expansion with psychedelics was never promoted as “recreational” as much as profoundly exploratory and revelatory. It is absurd to blame the victims — who were drummed out of academia — for the prejudicial backlash against hallucinogenic drugs, given the fundamental challenge they represented to the dominant paradigms.

It is no surprise, either, that psychedelic research got quickly assimilated to the social change movement which was simultaneously mounting equally profound challenges in areas including sexuality, peace, freedom and social structure. It really was a long time ago, and perhaps younger observers can be forgiven if some of the more dramatic manifestations of change in the ’60’s and early ’70’s are seen only as foolish and absurd when decontextualized as they so often are. Forget the times and you forget the real reasons no one is talking about changing society through psychedelics today. Some would say that the backlash has been utterly successfully in making us forget and decontextualize. As I wrote in the despairing days after Bush was returned to the White House for a second term in 2004, the only effective way I could see to speak truth to that obscene power was to create a fullscale countercultural backlash again, not a challenge narrowly confined to the political process.

It would be interesting to know if it is the Globe reporter’s take, or Dr. Halpern’s political attempt to distance himself from his forebears. An organization that closely and responsibly tracks these issues is the Multidisciplinary Association for Psychedelic Studies, or MAPS. In this article, MAPS founder Rick Doblin similarly distances himself from Leary’s position that psychedelic use will change society. I suppose that, in the Age of Bush, it would be hard enough getting dispassionate research funded without appearing to be an advocate. So Leary ends up being a convenient straw man.

Conservative British psychiatrist and curmudgeon Theodore Dalrymple (which I have just learned is the pseudonym of Anthony Daniels (Wikipedia )) writes in the Wall Street Journal that he is not impressed about the difficulties of withdrawing from narcotics:

I largely agree that withdrawal from opiates is highly overrated, and that addicts have a hard time being honest with those of us to whom they come for assistance. However, I am not sure, except for sampling errors introduced by the fact that Dalrymple works in the penal system, how he quickly makes the leap from their histrionics, manipulativeness and inadequacy to any conclusions about criminality. It is probably what stops him from being more compassionate toward these unfortunate individuals who have so little in the way of coping mechanisms that they have reduced all the diversity of life’s challenges to one — copping their drug and feeding their jones — and, correspondingly, pitifully, all life’s distress to one mind-numbing feeling of unrequited craving.

“Emotions, Like Germs, Are Easily Transmissible. The Trick Is Passing and Receiving the Right Ones” (Washington Post). Emotional contagion occurs in milliseconds, entirely beyond our awareness. We unconsciously mimic the facial expressions, posture and gestures — body language — to which we are exposed; the phenomenon can be gauged experimentally by measuring the tone of the muscles of facial expression, for example. Incremental changes in these muscles may help trigger the associated emotion in the bearer. Modulation of speech tone is also matched and mimicked. Of course, some people are better than others at infecting those around them with their moods, and others are more sensitive to people’s emotions. The article does not mention the mirror neuron concept, one of the darling new paradigms of neuropsychology (which I have followed and written about here for several years), which almost certainly underlies and shapes this emotional contagion. It makes sense that a mechanism for emotional contagion developed, given the adaptive value of the role it plays in social cohesion. This also bears a relationship to why it is largely unconscious and automatic, and why it operates most strongly in our most intimate social contexts. That does not mean, of course, that those aware of the infectious nature of their moods cannot attempt to exercise some control. (However, beware the new light this casts on Machiavelli’s dictum that, if you cannot both be loved and feared, it is better to be feared than loved.)

On the surface of it, despite the need for Bush to appeal to his base as his ratings plummet, it is an odd time for a renewed stand on the sanctity of marriage, just when speculation is mounting about marital tension in the White House over his supposed affair with Condoleezza Rice. But, since the man does not understand the meaning of the word hypocrisy, he may feel that now is a particularly good time for that very reason…

I am using the latest Windows version of iTunes (6.042) under WinXP SP2. Apart from those of you who are going to advise me to deal with my frustration by moving to Linux or MacOS, I am interested on feedback on the following scenario.

My iTunes library is around 6000 songs. Recently, I found a wonderful program that satisfied my obsessional needs to attach album art to each and every cut in my collection. The latest version of this program, iArt, has the added ability to go through my library and build a list of those songs which have multiple pieces of artwork attached to them, which is an annoying problem with iTunes that needlessly increases the storage space of the songs both on my desktop computer and on my iPod. So I went through that list and deleted the extraneous duplicate artwork. It turns out that 1800 of my songs had had multiple pictures attached to them (!), so I ended up saving between 2-3 gigs of space on both my hard drive and my iPod.

And that was where the problem began. I have my iPod set to auto-synchronize every time it is plugged into its cradle. But despite numerous attempts, with reboots of both the desktop and the iPod, the attempt to update more than 1800 songs would crash somewhere around the 700th file, giving me a message along the lines of, “The instruction at xxxxxx referenced memory at yyyyyy. The memory could not be ‘read’.” One of the problems was that, with the synchronization process crashing, those 1800 songs were erased from my iPod (or at least their index entries were) and, no matter how I tried, could not be resynch’ed onto the iPod.

To jump to the punchline, I finally solved this by changing the synchronization method from automatic to manual; building four or five playlists of around 400 songs each from the group of 1800 (fortunately, you can sort your iTunes library by last modified, so all the songs whose artwork I had modified last night were grouped together at the top of the sort), and synchronizing the missing songs by dragging these smaller playlists onto the iPod one by one.

So the problem was solved (the only abiding annoyance being that, after I changed back to automatic synchronization, the blinking “do not disconnect” message on the iPod screen now never goes away, even when synchronization has completed, until I reboot the iPod), but it leaves me with three questions. (1) what would someone have done who knows less than I do how to problem-solve such a scenario? I wouldn’t even bother calling Apple phone support (or any other phone support, for that matter), since I know all they would have told me would be to uninstall and reinstall iTunes; wipe the iPod clean and start from scratch; and finally, if that didn’t work, to reinstall Windows XP. I was worried about wiping the iPod and starting from scratch because it seemed that this was an issue of iTunes’ synchronization system choking on a certain volume of data, and of course I would expect it to choke around 700 songs if it were trying to transfer my entire library. One can never get access to anyone by calling tech support who really knows the innards of the program and can talk as intelligently as an intelligent and curious consumer would like, it seems to me.

(2) What woudl someone have done who knows more than I do how to problem-solve such a scenario? Some of you readers out there must have some thoughts, or even some similar experiences.

(3) Why does this particular Microsoft error message put the word “read” in quotation marks? What exactly is so ironic about the concept of trying to ‘read’ memory??

“Prime Minister Nuri Kamal al-Maliki lashed out at the American military on Thursday, denouncing what he characterized as habitual attacks by troops against Iraqi civilians.” (New York Times ) The tip of the iceberg turned out to be just the tip of the tip. First we had isolated torture of enemy combatants by rogue underlings, then it was a persistent pattern of torture of detainees around the globe, then an isolated massacre of civilians by rogue troops, finally a habitual pattern of gratuitous violence. Little else should have been expected given the xenophobic contemptuous arrogant imperialist culture of the American projection of force in dealing with Iraq and the Mideast. It is shaped by and emanates from the top. My country, ’tis of thy people, you’re dying.

Addendum: Robert Fisk echoes my theme: “Could Haditha be just the tip of the mass grave?… [P]art of the problem is that we never really cared about Iraqis.”

And retired Army General John Batiste, on CNN, insists that Haditha, Abu Ghraib etc. arise from Rumsfeld’s bad judgment in managing the war effort in 2003-04. A Pulitzer Prize winning former Toledo Blade reporter and co-author of Tiger Force, discussing parallels between Haditha and My Lai, tells Der Spiegel that “I hope the investigation goes up the food chain.” An increasing number of politicians are clamoring for the investigation of the massacre to go all the way to the top.

In other words, Bush is inept at getting his story straight with his new spokesperson in important regards. Snow reported that the new treasury secretary was hired five days before Bush had stopped denying rumors that the old one was going. And even more serious discrepancies exist about the ‘party line’ on when Bush knew of the massacre at Haditha.

The only results anyone is going to see from wearing these tights is their marketers laughing all the way to the bank. Not only is caffeine not a weight loss agent (if it were, I would be carrying far fewer kilos by now); not only is the transdermal absorption claim dubious; but, if so, I don’t think the metabolic effects would be localized to the thighs.

True this is a widespread and growing problem, but there is another far more common internet contribution to drug abuse. As a physician used to the considerations that go into prescribing a controlled substance for a patient, it took me a long while to wrap my head around the new reality — quite simply, the lack of a prescription is no longer a barrier to obtaining virtually any controlled substance, as you might suspect from the spam mail that fills your inboxes. It has reached the point where the only substance abusers coming into our emergency room for detox who need to buy their drugs on the street are the ones unresourceful enough not to have an internet connection and a credit card to order by mail.

Although this piece in The Boston Herald, this city’s conservative tabloid daily, has a bemused, if not derisive tone about the Brookline decision, this is the thing that small towns throughout the country need to start doing. In a curious sidelight, the local media has reported that Barney Frank, our congressional representative and no progressive slouch, had responded by saying (to paraphrase the reportage) that this is not an issue that should be decided by public opinion. Of course that is exactly how we are supposed to be governed. Frank was being taken sloppily out of context; he was responding to the impotence of the Congress to act, frustrated that public opinion alone does not seem to be making a difference in countering the reign of terror from the Oval Office. In fact, he himself called long ago for an impeachment investigation.

Related: Same theme of growing rage against the war and repudiation of our dysadministration. Massive volatile antiwar protests against Iraq-bound war supplies shipments escalate at the Port of Olympia, Washington State, as described in this coverage from The Olympian of an underreported event. As I have commented before, we need to highlight these upwellings wherever they occur, to hasten our arrival at the popular sentiment tipping point.

Was he a modern human with microcephaly instead? (New Scientist)

A team of scientists at Cold Spring Harbor Laboratories on Long Island claims that fluoxetine (Prozac) works by stimulating the proliferation of progenitor nerve cells in a part of the brain called the dentate gyrus. (BBC) Discovering that the medication has this action is a long way, however, from proving that that is how it treats depression. Psychiatric medications cause many brain changes and it is difficult to pinpoint which cause their clinical benefits, which are epiphenomena, and which are consequences of the fact that the patient gets better. The article alludes to a very important fact — for this to be an explanation of how antidepressants cure depression, it would have to be shown to be a mechanism of action common to all medications that have similar antidepressant efficacy. That research remains to be done. The consensus is, however, moving away from a neurotransmitter theory of depression and of how antidepressants work to one based on, essentially, tissue repair, as we appreciate that episodes of depression actually cause physical damage to the brain from, among other things, its exposure to chronically high levels of stress hormones.

…myself among them.

Publius understands the political and social preferences of white social conservatives on a host of issues in terms of a fundamental cognitive or cultural difference from their opponents:

Coincidentally enough, an FmH reader just posted a comment to my item on the National Reviews rock’n’roll list wondering about the seemingly fundamental Republican trait of “insisting that everything and everyone is really just like they are but won’t admit it.” How would I diagnose that, the commenter asked. Parochialism frames the answer succinctly, as Publius typified it.

Actually, this strikes me as similar to something I have been saying for awhile now about the essential Republican appeal to tribalism, which I find is an ingrained or, one might even say, innate human predilection. Here is what I said in August, 2005:

In other words, progressives rise against their base, reptilian, parochial tribal insticts, while conservatives indulge in them… and cannot conceive of the possibility of not doing so.

As suggested by Ed Fitzgerald at unfutz, you should check this list of medical doctors who do not believe in Darwinism. Finding your practitioner on the list should probably be grounds to start looking for someone new to take care of your medical needs. Funny, I was just talking to one of my colleagues on the medical staff of my hospital about a renowned specialist on our staff who guiltily shares with trusted confidantes that he is a non-Darwinist believer in ‘intelligent design.’ We were wondering whether he could really do a good job weighing the benefits of antibiotic treatment of his patients against the risk of breeding resistant strains.After all, it takes a conviction in natural selection, competitive fitness, etc…

The egg really came first! (Times of London)

At Least 16 Civilians Are Killed by US Airstrikes In Afghan Fighting (Washington Post)

The National Review offers up the top fifty conservative rock’n’roll songs of all time (New York Times via abby). Rock critic Dave Marsh, asked about the list, found it a desperate attempt by the right to co-opt rock music. Seems to me a classic example of how much mileage you can get out of taking things out of context. To say, for example, that the Who are counterrevolutionaries for singing, “Meet the new boss, same as the old boss,” (no. 1 on the list of fifty) ignores both the radical anti-authoritarianism of the overall theme of the song and the cultural iconoclasm of their cultural presence as a whole.

Michael Long, the list compiler, writes in National Review this week about the number two song, the Beatles’ “Taxman”, and announces that he will unveil the entire list of fifty on Friday, complete with iTunes links. But you can bet there will be no anti-capitalist links to free downloads of the tunes from Long!

Update: Here is the entire list courtesy of Left of the Dial.

“On May 16, the USPS expanded its year-old customized postage program to allow businesses the rights to place their logos on U.S. postage. The decision reverses a Civil War-era law that prevented businesses from placing advertising on any type of currency – including postage. The 1872 Mail Fraud Statute was adopted to establish the consolidated authority of the federal Post Office and to prevent schemes involving mailed materials.” From a Hewlett Packard press release; HP trumpets that it is the first corporation to take advantage of the new arrangements.

Related: Nothing is sacred: an off-Broadway performance of Stomp is preceded by the cast performing a live three-minute theatrical commercial. “They’re a captive audience. They can’t switch channels or change over or walk out once the thing is started.” (New York Times )

Incredible video close-up of a deep underwater volcanic eruption taken by a small remote-control submersible. Here’s more.

And news coverage:

Adam Gaffen at The Boston Globe ‘blog log’ took note today of my post about dental care for the indigent (scroll down to ‘The Root of the Problem’).

The Globe has now contributed to my conspicuousness by highlighting things this “Brookline psychiatrist” has written several times. Even people I know around town with no idea what a ‘blog’ is read the Sunday papers. Doctors are taught to write their notes in medical records as if the patient about whom they are writing is going to read the chart (which, often enough of course, they do). If Globe item keep popping up, I might have to start to write my FmH posts as if my colleagues in the medical community are going to catch wind of some of the things I say. I didn’t want my comment about having to beg favors for the care of my patients from area dentists to be construed as casting aspersions on the generosity the local dental community shows to the dentally needy!

I don’t know why in the world they don’t join the 21st century; ironically this Globe column covering online phenomena has neither (in the print version) the URLs of the weblogs to which it refers nor (in the online version) any clickable links. Instead, they direct readers to the gathered links at www.universalhub.com/0521.html.

And finally, Adam, as long as I am quibbling, wasn’t the Morgellons post more interesting than the dental one this week?? (Got more comments…)

Addendum: Adam forwarded me some feedback he got regarding his column, which will obviously be of maximal interest to Boston-area readers:

This MetaFilter query prompted a reader (thanks, Stan) to ask my opinion about the controversial medical condition referred to as Morgellons Disease, written about on only one academic paper by Savely, Leitao and Stricker in the American Journal of Clinical Dermatology in 2006. When I read the abstract —

— I was struck by several details. ‘First described more than 300 years ago’ but obviously not developing much of a medical following; an outlandish and medically implausible lead symptom; the assertion that it is ‘confused’ with delusional parasitosis (but is not delusional parasitosis per se), an ‘association’ with Lyme Disease, which, although a real illness, attracts a large number of wannabees hoping to explain diverse symptoms, many of them in the emotional or psychiatric spheres; and the dramatic language about ‘unlocking the mystery’ — all of these combine to spell ‘histrionic’.

The ‘disease’ has its own foundation, the Morgellons Research Foundation, which keeps a tally of the number of ‘registered households’ (3492 as I write this). Its website expands on the attributes of the condition, citing cardinal features of “disturbing crawling, stinging, and biting sensations”, non-healing skin lesions, and associated, striking fiber-like or filamentous projections as well as “seed-like granules and black speck-like material associated with their skin.” The website features a 10x magnified photo of the lip of an affected 3 year-old boy and an “object from the same lip” at 60x. The pictures make discussants of the condition on MetaFilter squirm, the only consensus emerging from the message thread there.

In noting that “the most significant element of the infection appears to be the effect on the central nervous system”, the web site notes that concentration and memory problems are nearly universal, that mood disorders are very common, and that the majority of affected children have “ADHD, ODD, mood disorders or autism”. Only one direction of causality is considered — that the supposed infection has CNS effects. But it seemed more likely to me that the causal flow is in the opposite direction — from the emotional to the (imagined) physical. So many of the attributes of this condition smack of the other controversial syndromes of which I have written which patients adopt as explanations for their distress and dysfunction, with implausible and inconsistent core sympotoms and definitions. Although many of these conditions have a medical reality at their core, diagnostic criteria are applied loosely and diffusely by wannabee sufferers and unrigorous clinicians swept up in the bandwagon effect. Interest in and information about them (much of it inaccurate and imprecise) is spread largely by the media and particularly the internet. An everchanging constellation of trendy syndromes or ‘diseases’ serve these roles. La plus ca change, la plus c’est la meme chose, as the saying goes…

Although searching academic resources such as Medline or Google Scholar for ‘Morgellons Disease’, as proponents dub it, yields only these few resources, a search on ‘Morgellons’ alone is more revealing. Weeding out the sensationalistic and the partisan, the best overview of the status of Morgellons is the Wikipedia article here. Lo and behold, modern interest in Morgellons is largely the product of one evangelist, the aforementioned journal article author Mary Leitao, who coined the term in 2002 while investigating her son’s unexplained rash. Not a medical professional herself, she has a degree in biology and has worked as a chemist and electron microscope operator. Far from having a 300-year history, it is merely named after a condition described 300 years ago to which it is analogous but certainly not identical. Thus, it is a bit disingenuous to aspire to legitimacy by the claim to a legacy.

Leitao is the founder of the aforementioned Morgellons Research Foundation. It would be tempting to suggest that she seems to have a sense of mission about this condition and that it is somewhat self-serving now that nonprofit dollars and the preservation of her foundation are at stake. Most of the other Morgellons boosters are not medical doctors either. And, uh-oh, the sensationalism is fueled by one nurse practioner who claims to have identified and treated ‘the majority’ of these patients. Sure, you might argue that that is because she is a pioneer who recognizes a condition to which others are blind in a geographic area which for some inexplicable reason has a cluster of cases, but more likely it is because she sees what she wants to see in a self-fulfilling prophecy sort of way.

The Wikipedia article notes the extent to which the condition embodies indicators of delusional parasitosis:

• The presentation of physical evidence such as skin scrapings and debris
• Obsessive cleaning and use of disinfectants and insecticides
• Rejection of the possibility of psychological or other explanations
• Emotional trauma, desperation, social isolation.
• Having seen numerous physicians, to no avail

While some clinicians report response of symptoms in several weeks with antipsychotic medication, I wonder whether it is necessary to invoke delusionality per se as an explanation. A delusion is a psychotic symptom representing a fixed disorder of thought not amenable to reasoning, and it is premature, even if one is debunking the disorder, to say that Morgellons sufferers are frankly delusional, rather than just insistent seekers of somatic explanations for emotional distress. Antipsychotics work in nonpsychotic conditions as well; most of them by the way are anti-pruritics, i.e. they have anti-itch properties. Using them in this condition, however, may be akin to using a sledgehammer to drive in a thumbtack.

This June, 2005 article in, of all places, Popular Mechanics, takes an expanded look at the phenomenon and ultimately shares my conclusion that sufferers convinced they have something real called Morgellons are leaping to conclusions. A number of doctors have sent samples from the skin lesions of affected patients to pathology labs and state health boards, standard practice in dermatological diagnosis. Investigations of samples uniformly fail to reveal any signs of infection or infectious organisms. Nevertheless, members of the Morgellons.org online community demand that the CDC investigate the condition as an infectious disease, a plaint recently taken up by Sens. Dianne Feinstein and Dick Durbin. Believers can write to Congress from the website.

Circumspect practitioners report that the nonhealing skin lesions go away if the affected area is casted for several weeks, preventing sufferers from scratching and picking at their sores, as our mothers taught us not to do when we were children. And what of the bizarre core symptom of the spinous or filamentous extrusions from the skin lesions? One Morgellons debunker found the photomicrographs touted by proponents to be almost identical to pictures at the same magnification of kleenex fibers stained with blood. It seems likely to me that most people would dab a weeping or oozing lesion with kleenex at least intermittently. I am tempted to elaborate that the absorptive properties of the fibers of kleenex would draw blood or serous secretions up and, as they dried, the fibers would stiffen. Probably the strands and fibers sufferers report are heterogeneous; perhaps some are fungal hyphae too, others clothing fibers and other adherent fiber fragments. The vehemence and histrionics with which the debunker’s explanation is dismissed in the comments by Morgellons proponents, unwilling to entertain any suggestion contradicting their fervent convictions, is quite telling. [See the same in the comments to this post. -FmH]

Morgellons is fascinating, but although certainly new medical syndromes are being discovered and/or codified all the time, it almost certainly does not belong among my occasional ‘Annals of Emerging Disease’ features here in FmH. Rather, I firmly believe it is of interest as a snapshot of medical sociology, illness subculture and the spread of trendy pseudodiagnosis in the age of the internet. Just as most fibromyalgia is chronic fatigue with muscle aches, this is chronic fatigue with skin lesions. And, although there may be a germ of truth (pun intended) at the core of all of these disorders, most sufferers have nothing very different than, yes, conditions described hundreds of years ago — neurasthenia, depression and hysteria.

Adam Gaffen at The Boston Globe ‘blog log’ took note today of my post about dental care for the indigent (scroll down to ‘The Root of the Problem’).

The Globe has now contributed to my conspicuousness by highlighting things this “Brookline psychiatrist” has written several times. Even people I know around town with no idea what a ‘blog’ is read the Sunday papers. Doctors are taught to write their notes in medical records as if the patient about whom they are writing is going to read the chart (which, often enough of course, they do). If Globe item keep popping up, I might have to start to write my FmH posts as if my colleagues in the medical community are going to catch wind of some of the things I say. I didn’t want my comment about having to beg favors for the care of my patients from area dentists to be construed as casting aspersions on the generosity the local dental community shows to the dentally needy!

I don’t know why in the world they don’t join the 21st century; ironically this Globe column covering online phenomena has neither (in the print version) the URLs of the weblogs to which it refers nor (in the online version) any clickable links. Instead, they direct readers to the gathered links at www.universalhub.com/0521.html.

And finally, Adam, as long as I am quibbling, wasn’t the Morgellons post more interesting than the dental one this week?? (Got more comments…)

Addendum: Adam forwarded me some feedback he got regarding his column, which will obviously be of maximal interest to Boston-area readers:

Italian P.M., calling the Iraqi occupation ‘a grave error’, to pull its troops out of coalition. (Washington Post)

Shayana Kadidal, an attorney at New York’s Center for Constitutional Rights working on a major lawsuit against the NSA spying program, details The Case Against The Hayden Nomination (The Huffington Post) Kadidal is also a contributor to Articles of Impeachment Against George W. Bush, from Melville House Publishing (2006)

Apparently, this minor author I delight in reading is now proclaimed Britain’s reigning postmodernist! Newsday interviews David Mitchell.

The US Dept. of Agriculture official guide: “Hijacking is extremely rare, but it does happen. It is well to consider how you should react if you end up being in the wrong place at the wrong time…”

If this is true, Jason Leopold of truthout has a scoop, in reporting that Fitzgerald told Rove attorneys he had 24 hours to get his affairs in order. As of this posting, any other references on the web to a Rove indictment are just citing Leopold. If Rove is served, can a Presidential pardon be far behind?

Update, also from Leopold:

Rove informs White House He Will Be Indicted: “Karl Rove told President Bush and Chief of Staff Joshua Bolten, as well as a few other high level administration officials, within the last week that he will be indicted in the CIA leak case and will immediately resign his White House job when the special counsel publicly announces the charges against him, according to people knowledgeable about these discussions.” (truthout)

The Age [thanks to acm] takes an in-depth look at modafinil — the first eugeroic (“good wakefulness”) drug, which puts us on a new threshold in psychopharmacology. This drug promotes quiet wakefulness and seems to allow the body to get away with prolonged sleep deprivation seemingly without paying the price, and its enormous popularity makes the intended recipients — patients with medical conditions disturbing wakefulness, such as narcolepsy — a minute proportion of its actual users.

Although the ‘balance’ in the article consists of the comments of only one nay-sayer, I agree in finding it hard to understand how such a core biological necessity as restorative sleep, which has been rigidly conserved in evolution, can be cheated substantially without any biological or psychological consequences.

We think this medication is a dopamine reuptake blocker, but why it does not appear to induce the jangly tension that other dopaminergic stimulants such as the amphetamines do, why it does not induce tolerance (the need for larger and larger doses to produce the same effect over time) and dependency (a withdrawal reaction and rebound symptoms after it is stopped) with prolonged use, as do other dopaminergic drugs, is not at all clear. Of course, it has not been used long enough by a large enough number of people for us to be confident that its long term effects are already apparent. Yet, as the author puts it, we are too far down the path to the “24-hour society”, in which wakefulness is cool and sleep is not, to stop this juggernaut, its coming competitors and its flipside companions, the newer better sleep aids.

Targeting Myspace and social networking sites (CNET News ). Schools and libraries would have to render the sites inaccessible to minors under a new bill (backed by Dennis Hastert and so having a high likelihood of passage), the Deleting Online Predators Act. As Declan McCullagh points out, not only sites that let users create public “Web pages or profiles” but those that offer discussion boards, chat rooms or email services. It could target any weblog that allows public comments and discussion, for example.

Among other issues Hacking considers is why autism is being diagnosed more often; what it means for a diagnosis to be in vogue; and how autism might be a key to understanding the human mind. Is autism that one recovers from, or an autistic-spectrum disorder with preservation of intellect, somewhere in the spectrum of the same neurobiological condition, or something different?

“Grisly figures from the first systematic survey of early Neolithic British skulls reveal that life then was no rural idyll.” (New Scientist) Muggings were rife, deaths from assault-related head injuries a common cause of death. In and of itself this information is not telling, but it certainly does some harm to the myth of the Neolithic pastorale and the notion that scourges such as war and crime are products of the rise of the city-state, domestication and agriculture, and social class distinctions.

The news broke after an anonymous source with direct knowledge of the arrangement tipped the press that the phone companies had been turning over the records to the NSA. Let us hope this is, at minimum, a “growing impediment” to Hayden’s confirmation, as Dianne Feinstein put it.

Jesse Kornbluth is not apologetic for being ‘shrill’ and ‘partisan’, as accusers complain:

My sentiments exactly.

“…[M]ost dolphins recognized names — their signature whistles — even when emitted without inflection or other vocal cues. More than that, two dolphins may refer to a third by the third animal’s name…” (Yahoo! News) That last fact, for me, crosses the line to convince me that these are true names rather than just learned behavioral cues to a specific other individual’s presence.

New study endorses medication’s efficacy. In a complex design in which it was compared with behavioral treatment/counseling and acamprosate, another medication marketed for relapse prevention in alcoholism, the opiate blocker Revia (naltrexone) gets the nod as helpful. I use this medication for this purpose but have always puzzled about various aspects of how it works if it does.

First of all, as an endogenous opiate blocker, it supposedly blocks some of the activity of the internal reward system and thus diminishes the satisfaction connected with alcohol abuse. But why does it not block most satisfaction in the person’s life if that is the case? There is nothing specific about the effects of alcohol on the endogenous reward system; it responds generically to rewards.

Secondly, addictive behaviors pretty quickly pass beyond the stage of being rewarding; most people persist in abusing addictive drugs because they would be sick or in distress if they stopped. How would a reward blocker matter in such a case? I know I am speaking pretty schematically here, but I need to have some conviction I understand how a medication is supposed to work on a neurochemical basis before I will recommend it to my patients. That is partly because I believe that any medication works less well, or not at all, if the user does not have a belief in its effectiveness. In psychiatric treatment, where most classes of medications were discovered serendipitously and explanations derived after the fact, that is a particular problem.

The effects of naltrexone are modest at best; several studies have found that, while as in this study it was better than acamprosate, the combination of the two is far better than either alone in reducing the frequency and severity of alcoholic relapses. And the benefits usually are more robust in more severe alcoholism.

“Britain’s state-financed dental service, …stretched beyond its limit, no longer serves everyone and no longer even pretends to try.” (New York Times )

And neither, for that matter, does the United States’! None of my MassHealth (the version of Medicaid here) patients have any dental benefits, and it is getting more and more difficult to find even emergency services for them. From time to time, the underlying reason why someone presents to me with a mental health problem such as despondency or suicidality, alcohol or drug abuse (which MassHealth still pays for) is agonizing dental disease. When I can arrange to treat the ‘root cause’ [pun intended], it is only because I have begged and pleaded, calling in a favor from a dentist or dental surgeon colleague. More often, regrettably, the patient leaves the psychiatric service in as much mouth pain as when they came in, my efforts to go beyond merely patching them up to no avail. But I guess that is no different from many of the insoluble socioeconomic problems that are the real foundations of some of the mental illnesses I try to treat.

Addendum: Walker pointed me toward a particularly apt quote from Malcolm Gladwell’s <a href=”http://www.gladwell.com/2005/2005_08_29_a_hazard.html
” title=””>”The Moral Hazard Myth”:

I can’t help thinking that part of the impetus to accept moderation instead of abstinence comes from the growing prominence of pharmacological approaches to addiction which either moderate the desire or reward; or substitute a ‘more benign’ addiction for a more destructive one.

While the article does not detail what those advances in the understanding of consciousness are, my guess is that they relate to functional brain imaging of conscious mental activity. Nevertheless, I doubt that we will see surgeons obtaining PET scans or fMRIs of patients under general anaesthesia on the operating room gurney anytime soon. Consciousness researchers and surgeons couldn’t be further apart in the medical realm, methinks…

Some procedures are done under ‘conscious sedation,’ either because they are painfree or because they can be done with regional anaesthesia such as a nerve block. In some neurosurgical procedures, it is necessary that the patient be able to carry out actions on command to make sure that the surgeons are not messing about with the wrong parts of the brain.

But to be immobilized, conscious and feeling the pain of the surgical incisions would be the ultimate torture, to my mind. I have never seen or heard an interview with a patient who has been through that, but thinking about it inspires the kind of visceral horror that I imagine motivated those who fought for the abolition of vivisection.