HAPPY TIMES!

Enjoy the holiday. Back in a week or less. Sporadic posting until Jan 5.

One part silly, one part spooky...

from the AP (this seems to be true...):

Deborah Campbell, 25, said she phoned in her order last week to the ShopRite. When she told the bakery department she wanted her son's name [Adolf Hitler Campbell] spelled out, she was told to talk to a supervisor, who denied the request.

Karen Meleta, a spokeswoman for ShopRite, said the Campbells had similar requests denied at the same store the last two years and said Heath Campbell previously had asked for a swastika to be included in the decoration.

"We reserve the right not to print anything on the cake that we deem to be inappropriate," Meleta said. "We considered this inappropriate."

The Campbells ultimately got their cake decorated at a Wal-Mart in Pennsylvania, Deborah Campbell said....

The Campbells' other two children also have unusual names: JoyceLynn Aryan Nation Campbell turns 2 in a few months and Honszlynn Hinler Jeannie Campbell will be 1 in April.

Heath Campbell said he named his son after Adolf Hitler because he liked the name and because "no one else in the world would have that name." He sounded surprised by all the controversy the dispute had generated....

SAFTEY ALERT: NO SCHOOL FRIDAY!

Yep, only a fool would try to have a school day tomorrow. Enjoy, and be a kid in the snow and sleet!

Here Comes Another One...

from today's New York Times:

The next edition of the Diagnostic and Statistical Manual is currently being put together. Each edition (I, II, III, IV, IV-revised) has grown larger and larger, as many more "syndromes" and "disorders" are added every time. The clinicians who contribute to the book- which, by the way, is a huge money maker for the American Psychology Association- vote on which disorders get put in and get taken out. Yes, that is right. They vote.

If you think that this means that the scientific basis for, say, a diagnosis of Bi-polar is shaky, well, then maybe you are right. After all, oncologists don't vote on cancer, do they?

Read the article.

And keep this in mind, also from the Times:

More than half of the task force members who will oversee the next edition of the American Psychiatric Association’s most important diagnostic handbook have ties to the drug industry, reports a consumer watchdog group.

The Web site for Integrity in Science, a project of the Center for Science in the Public Interest, highlights the link between the drug industry and the all-important psychiatric manual, called the Diagnostic and Statistical Manual of Mental Disorders. The handbook is the most-used guide for diagnosing mental disorders in the United States. The guide has gone through several revisions since it was first published, and the next version will be the D.S.M.-V, to be published in 2012.

The American Psychiatric Association’s Web site has posted the financial disclosure of most of the the 28 task force members who will oversee the revision of the D.S.M.

It’s not the first time the D.S.M. has been linked to the drug industry. Tufts University researchers in 2006 reported that 95 — or 56 percent — of 170 experts who worked on the 1994 edition of the manual had at least one monetary relationship with a drug maker in the years from 1989 to 2004. The percentage was higher — 100 percent in some cases — for experts who worked on sections of the manual devoted to severe mental illnesses, like schizophrenia, the study found. (For a Times story on that report, click here.)

The American Psychiatric Association allows members who work on the upcoming fifth edition of the handbook to accept money from drug firms. However, from the time of their appointment until the completion of the work, their annual individual income from industry sources cannot exceed $10,000. “We have made every effort to ensure that D.S.M.-V will be based on the best and latest scientific research, and to eliminate conflicts of interest in its development,” said Dr. Carolyn B. Robinowitz, president of the organization, in a press release.

The Integrity in Science group described the financial conflicts of interest by the task force members as ranging from “small to extensive,” including one member who over the past five years worked as a consultant for 13 drug companies, including Pfizer, Eli Lilly, Wyeth, Merck, AstraZeneca and Bristol-Myers Squibb.

Where is the Real Drug Problem?

Let me begin this post by stating that pharmaceuticals have a role in psychological treatment. But I will also state unequivocally that the role of drugs in psychological treatment has been totally distorted by the vast amounts of money made by big drug corporations, certain universities, and many, many individual clinicians. There is a big pharma-university-psychiatrist complex that makes a scientific basis for national mental health policy pretty much impossible at this point in time.

If you want to read an excellent, moving, and well written book that asserts some profound benefits of medication for people diagnosed with Bi-polar disorder try Kay Redfield Jamison's
An Unquiet Mind. If you would like to read up other sides of the issue, try this blogpost from Psychology Today or this good summary of a point of view that accepts the premise that psychological disorder have a "medical" reality, or this view that such a diagnosis is more socially driven than biological, or this rather convincing (to me) overview of the criticism leveled at the whole assumption that neurochemicals and behavior have a proven, causal relationship.

There is alot out there to read. Basically, the drugs are largely unproven and have dangerous side effects. But the behavior to be treated can be fantastically destructive of human potential and causes enormous suffering. Some drugs seem to work sometimes, but usually not much better than placebo. The universities, big corporations, publications, and clinicians that profit from the drugs are not honest brokers.

Now look at this (from Furious Seasons):

Many of you are already aware of the two-year-old lawsuit brought by the State of Texas against J&J/Janssen over allegations that the drugmaker worked to influence the Texas Medication Algorithm Project to favor its star atypical antipsychotic Risperdal and made payoffs to state officials, among other allegations. A similar children's medication project is under investigation by state officials.

Yesterday, the state amended its complaint to include allegations that the company gave out false marketing materials and used fake advocacy groups to get its then-expensive drug (which is now a generic) used in the state MedicAid program. Although the state isn't naming names in its complaint (who is the mysterious fake advocacy group?), the complaint is worth reading. You can download it from the Dallas Morning News' website.

I've read the complaint and it's the usual set of allegations that J&J/Janssen took a drug designed to treat schizophrenia--not a very efficacious drug at that--and pressed to have it used off-label in adults and children for a number of other indications. In the process, the company used state officials as pitchmen for its drug and somehow got its drug on the children's list--which was never implemented and was recently suspended altogether--eight years before it was approved for use in kids and teens by the FDA. Earlier this year it was revealed that Texas officials and researchers wanted to use McDonald's gift certificates as inducements to get kids on medication trials.

TWO HOUR DELAY TODAY

Classes begin at 11 am. Be safe.

Trouble with the phones

Please check back here for announcements of delays and cancellations due to weather.

Justice

Over the last year or so we have instituted a number of substantial, if subtle, changes around Tinicum Art and Science. Our Ass't Principal, Stephanie Kenney, oversees all academic issues, from scheduling to class content to teacher performance. We have developed two sets of procedures, one for holding staff accountable for good educational and therapeutic performance, another for holding administration responsible for setting the proper tone and for follow through on issues big and small.

The students now meditate four days a week in the morning, and have short periods of meditative silence just before lunch and at the very end of the day. We offer courses in yoga and meditation, as well as in a psychology class that is oriented towards well-being and self-observation.

We have also used a quirk in our current enrollment- that we have a large group of seniors and freshman, but little in the middle- to structure more deeply the orientation for the young students and the oversight for senior projects and college applications. We currently have one current student teaching study skills that she learned this past summer at Phillips Academy, and a recent graduate- a prolific and able writer- teaching an intro to writing course.

What is next? A more integrated music program. Also, building on the work we accomplished last year with getting students to evaluate and more forcefully shape the curriculum here. This will require a greater degree of self-knowledge on their part, and much clearer, more collaborative advocacy on ours.

Most heavily on my mind has been the role of social justice at school. There is a program nearby that helps families wracked by domestic violence. One of their difficulties has been getting presents together for their older children. Everyone donates the little kid stuff. So our students gave a hundred dollars of the money they have raised over the last couple of years, and raised another one hundred fifty more to fill that need. Efforts such as this are admirable, but they don't require an integrated view of the world. They address a problem without raising questions of justice.

Can social justice be addressed non-ideologically? Is it even desirable to try? At TAS we don't preach "buddhism". We teach certain techniques and emphasize few rituals. Students who wish to go deeper can, and do. They learn to treat each other justly because they are treated justly. But is that enough. Should we be instilling a stronger ethic, a broader awareness? Or do we plant a seed and let it be?

A Soft Spot for Mollusks

It seems to most that the country faces more than a few problems in the near, middle, and long term. Short term: the economy. Middle term: our inability to set the agenda internationally. Long term: the environment. It is like waking up into a bad dream, or, having been sleepwalking, finding oneself standing in the middle lane of the interstate.
But I find myself moved most of all by the little details of our carelessness projected into the future. To wit:

(10:32 16 December 2008 by Catherine Brahic, New Scientist)

Swimming through warmer, more acidic oceans will feel like swimming through molasses for jumbo squid.

Jumbo squid (Dosidicus gigas), also known as Humboldt squid or red devils, are best known for their voracious appetite and for decimating fish stocks. But according to new research, climate change could make them sluggish - and turn the hunter into the hunted.

Rui Rosa of the University of Lisbon in Portugal and Brad Seibel of the University of Rhode Island, put jumbo squid in tanks that mimicked the warmer and more acidic ocean conditions expected for 2100 if industrial emissions of greenhouse gases are not curbed.

The team found that the squid's metabolic levels dropped by one third and the length of time the squid spent contracting their muscles dropped by almost half.

Jumbo squid blood carries very little oxygen - with each cycle through its body, the oxygen can be used up entirely. This means they must "recharge" constantly, and makes the animals very dependent on what oxygen is available in the water around them. Yet, the warmer water is, the smaller the amount of oxygen it can hold.

To make matters worse, the squid's blood cells are able to carry even less oxygen in acidic water. The bottom line is that jumbo squid in warm, acidic sea water are more lethargic, says Rosa. "They may become more susceptible to predators and less able to capture prey."

Last year, the first study to simultaneously track a predator and its prey suggested that sperm whales may take advantage of moments when jumbo squid slow down to catch them.

The tracking study also showed that jumbo squid undertake a daily migration between the surface and the deep ocean. Rosa and Seibel say in future, the range they are able to survive in will become narrower, possibly forcing them to find new habitats.

In fact, there are already signs that changes in the oceans are pushing jumbo squid into new waters.

Surveys carried out by the Monterey Bay Aquarium show that over the past 16 years, the squid have become permanent residents of Californian waters. It is believed that warmer temperatures have helped push them north of their usual hunting grounds off Mexico and Central America.

Squid are literally held into shape by the pressure of their environment. Darting, epic, and fleeting, they are masters of their strata. But on land, a sprawling gunk. More helpless than a fish. A bit like those soaring thoughts one has, that when spoken, flop helplessly to the ground.

Math and English

The study mentioned below is an ongoing one being conducted by Boston College (alma mater of the three people who got TAS off the ground). Turns out the language scores for the U.S. aren't too shabby either. We lost out to much of Canada, but beat England and France. Russia is on top. Go figure.
Scroll down to p. 37 of this for the distribution chart. Go here for the website of BC's International Study Center.

I can't help but wonder why the press seems to focus almost exclusively on the math and science scores. After all, don't it seem that the new economy is all about communication?

Maybe your average journalist is a little math-neurotic.

from the NY Times:

U.S. kids make math gains...

Sam Dillon

American fourth- and eighth-grade students made solid achievement gains in math in recent years and in two states showed spectacular progress, an international survey of student achievement released on Tuesday found. Science performance was flat.

The results showed that several Asian countries continued to outperform the United States greatly in science and math, subjects that are crucial to economic competitiveness and research.

The survey, the Trends in International Mathematics and Science Study, or Timss, found that fourth-grade students in Hong Kong and eighth-grade students in Taiwan were the world’s top scorers in math, while Singapore dominated in science at both grade levels.

“We were pleased to see improvements in math, and wished we’d seen more in science,” said Stuart Kerachsky, acting commissioner of the National Center for Education Statistics at the Education Department, which carried out an analysis of the performance of American students on the test.

The latest Timss study, the world’s largest review of math and science achievement, involved testing a representative sample of students in each country in 2007, the first time the tests had been administered since 2003. The results included fourth-grade scores from 36 countries and eighth-grade scores from 48 countries. The tests cover subjects taught in all the participating countries, including algebra, chemistry, geometry and physics.

The study is directed by the International Study Center at Boston College.

Asia’s continuing dominance in math and science, first demonstrated in the 1990s, was especially apparent in the latest results, which showed rising percentages of high-scoring students there.

Nearly half of eighth graders scored at the advanced level in math in Taiwan, Korea and Singapore, compared with 6 percent of American students.

Comparing educational performance in the United States, a diverse country of 300 million people with 50 state educational systems, with city-states like Singapore and Hong Kong, which have populations of 4.5 million and 6.9 million people, respectively, is a bit of apples and oranges.

Still, experts said the Timss study again confirmed the tremendous gains those societies had made in just a few decades.

“It was good to see that the United States has made some progress in math,” said Ina V. S. Mullis, co-director of the Boston College center, “but I was surprised by the magnitude of the gap between us and the highest performing Asian countries, and that should cause us some concern.”

Students in Massachusetts and Minnesota, which participated in a special study that attributed a score to the states as if they were individual countries, also demonstrated stellar achievement, outperforming classmates in all but a handful of countries.

In eighth-grade science, for instance, Massachusetts students, on average, scored higher than or equal to students in all countries but Singapore and Taiwan.

And in Minnesota, which has worked to improve its math curriculum, the proportion of fourth-grade students performing at the advanced level jumped from 9 percent in 1995 to 18 percent in 2007, a gain that was one of the world’s largest.

But on average, the results showed several Asian countries increasing their dominance.

In the fourth-grade math survey, scores in Hong Kong, Singapore, Taiwan, Japan, Kazakhstan, Russia, England and Latvia were higher than in the United States.

Average scores were equal to the United States in the Netherlands, Lithuania, Germany and Denmark. Scores in 23 other countries were significantly lower.


I don't understand what is behind the constant drumbeat about Math and Science scores only. It seems pretty clear that language skills are not only inadequate among great swaths of the population, but that the nature of those skills now needed are changing. Yet, I rarely see much on that subject at all.
On the other hand, Bush bashers must admit that the Educator in chief can take some credit for this. Ironically, education reform and accountability was a major part of his original agenda until scuttled by his V.P.

Coming Soon...

A slightly different layout and a consistent posting schedule. By Monday....

I hope.

Oh Brother...

At the beginning of next week I will put together some reactions to the New York Times piece on children labeled as "bi-polar". Until then, perhaps we should chew on this interview with Dr. Nancy Andreasan in today's paper:

Q. WHY DO YOU THINK THIS IS HAPPENING (brain shrinkage in schizophrenics at a rate of about 1% a year)

A. Well, what exactly do these drugs do? They block basal ganglia activity. The prefrontal cortex doesn’t get the input it needs and is being shut down by drugs. That reduces the psychotic symptoms. It also causes the prefrontal cortex to slowly atrophy.

What is this? In a robust, soon to be published study, brains exposed to the new anti-psychotics are shown to shrink. Recently some pharmaceutical companies have been claiming that their drugs protect the brain, somehow.

The most distressing thing to me is this:

More and more children are being diagnosed as bi-polar.

The diagnosis is vague and highly overapplied.

These same anti-psychotics are being used on these children.

There are NO studies on their safety for children.

These drugs are not even approved by the FDA for use in Bi-polar diagnosis.

Yes, there are some children who are suffering inexplicably and they are tearing their families apart. And yes, emotional problems- whatever that means- are every bit as destructive and painful as physical illness and requires enormous resources to deal with.

And yes, medication might be one part of the solution. But it has to be approached empirically.

Abstract: Psychobiology of Mindfulness

This is dense, certainly. But worth taking a look at the biology behind the effectiveness of meditation.

Workshops and Open House Tuesday Sept 23nd

We have a day off this Monday for the Equinox (3:44pm) and workshops for students all day on Tuesday. Tuesday night is our Open House.

Here is Tuesday's schedule:

09:30 am to 10:25 Learning Styles and Strategies with Chris Briggs


10:35 am to 11:25 Our Assistant Principal Stephanie Kenney and student Madeline Rublee will be training students in fundamental study skills. Madeline attended a very tough and enlightening summer academic program at Phillips Academy this past summer and is currently taking two classes at Bucks County Community College.

11:35 am to 12:25 Robby Garza and Sherry Beers will be showing the students how to clean the dishes, the kitchen, and the bathrooms properly. They will also teach the students proper hygiene.

1:30 pm to 02:30 Seniors will have their first meeting with Will Palmieri and Stephanie regarding their graduation projects.

Photos for ID's will be taken during this time. The rest of the students will be tending the garden and sprucing up the landscape for fall.

2:45 pm to 03:45 Chrissy Chase will host a feedback forum for the students regarding this and later workshop days.


The Open House begins at 5:00. You are welcome to bring food and drinks, and there will be plenty.

At 5:30, Pete Ryan (Principal) and Stephanie will be speaking about the school year, the growing role of mindfulness practice during the school day, and our academics. The talk will last about forty-five minutes.

Afterwards there will be plenty of time to talk to the teachers and see what is going on around school.

Open House ends at 7:00.

No Post Thursdays...

Too busy...

What's Going On

The school has begun. Auspiciously, I would say. We had a fairly thorough orientation for the younger students on Thursday and Friday, and for all the students on Monday and Tuesday. We had the first of our workshop series on Tuesday. Doctors Chris Caffery and Lauren Caffery presented some material on the relationship between breathing, posture, and cortex functioning. They are neuro-chiropractors, or more accurately, "Functional Neurologists" who approach rehabilitation as a brain function more than as the failure of a particular part of the body. Most of the students seemed to find it interesting. We will be posting material related to this later on.

Over the course of the school year we will be conducting workshops on hygiene, nutrition, sleep, brain function, emotional and physical development and, of course, study skills. This Friday our Ass't Principal and one of our senior students, Madeline Rublee (who was in an intensive program at Phillips Academy this summer) will be presenting that very subject to our students.

Stay tuned for news on the Parent's night, our full day of student workshops, and an overview of classes this term.

Proscribing Any Drug for Anything, Part Four Hundred Sixty

Oh boy. Here we go again. A study published online ahead of print at the Journal of Clinical Psychiatry notes that among Oregon Medicaid patients who received a prescription for an atypical antipsychotic:

• 52% had a depression diagnosis
• 34% had an anxiety diagnosis
• 15% had a PTSD diagnosis

But only 15% had a schizophrenia diagnosis and 27% had a bipolar diagnosis. So... the majority of atypical scripts were written off-label. Seroquel was the most frequently prescribed atypical, followed by Zyprexa, then Risperdal.

Doses less than what are typically given to treat schizhophrenia or bipolar disorder (subtherapeutic dosing) were quite common. As in 86% of Seroquel scripts were subtherapeutic, 59% of of Risperdal scripts, and 48% of Zyprexa prescriptions. Wait, am I calling for higher doses of these drugs? That doesn't sound like me at all, right? Don't worry, I haven't lost my mind (I think).

Here's the deal. The authors suspect that a lot of these low-dose prescriptions are being written to manage agitation and as sleep aids. The authors note that there are likely less expensive/more effective medications for such conditions. Not to sound too cavalier, but one could also recommend behavioral treatment to help with sleep as well. Nah, that's crazy talk -- not enough money to be made in that.

Primary care docs were more likely than psychiatrists to dish out low-dose antipsychotics. I guess that the Viva Zyprexa marketing blitz was a success after all. Thanks to Daniel Hartung and collagues for their study, which provides another insight into the wonderful world of atypical antipsychotics as a treatment for everything imaginable. Sorry to beat a dead horse with my zillionth post about the topic of atypicals, but isn't this getting just a teeny bit out of control?

I would say so. About six years ago one of our students was having a lot of difficulty sleeping. His mother took him to a psychiatrist. After a ten or fifteen minute "evaluation" the doctor proscribed Risperdal, which is a pretty big time anti-psychotic, and at that time, not often used for teenagers. When the mother told me this, I was astounded that such a powerful drug, that had been subjected to no safety studies regarding children, would even be considered.

This boy was a heavy smoker, a heavy pot smoker, lived in a emotionally chaotic home, ate terribly, and drank lots of soda. The good doctor apparently knew none of this. Or cared.

An Epidemic

I spent much of last night digesting a huge chunk of a procedure manual for the DSM-IV-tr, the "bible", as it were, of psychiatry. It was interesting, in an intellectual history sort of way, and some of it actually made some sense. Fortunately I am in the middle of a gigantic Erik Satie binge- hours and hours of that mad Frenchman's marvelous music- so that formed the soundtrack. Dark chocolate gave me the requisite umfph for gliding though "caffeine disorders" at about 1 in the morning. Then, distracted, I stumbled on this:

http://www.youtube.com/watch?v=RoppJOtRLe4

A parody, true. But not far from the state of things....

Ah, Numbers...

So...how many home runs have been hit in Major League Baseball as of about 10pm last night? Let's see, 120 odd years, 10 then 20 then 30 teams over that span, 150 or so games per year per team.

Did you guess 250,000? Nicely done. Yep, the cranky and determined Gary Sheffield hit numbers 249,999 and 250,000.

Now this:

If you think you're just "not a numbers person", you might be correct. It seems that some people are born with a naturally better sense of numbers than others - although that doesn't mean education can't improve your mathematical abilities.

Being good at maths is thought to depend on two factors: the inherent sense of numbers that children, and some animals, possess from a very young age, and the formal education they receive at school. How these factors relate to one another and how much this inherent "number sense" varies between individuals had not been investigated, until now.

Justin Halberda at Johns Hopkins University in Baltimore, Maryland, and his colleagues examined the performance of 64 14-year-olds on a test of approximate number system (ANS) – the ability to estimate numbers without counting them precisely. The children had also received standard maths tests every year between the ages of 5 and 11 years.

Teenagers with the highest ANS scores also tended to have the best scores in maths tests all the way back to the age of 5, even after measurements of IQ and visual-spatial reasoning skills were taken into account. "There are vast individual differences in the acuity of this number sense in 14-year-olds," says Halberda.

While it seems likely that ANS can be shaped by education to some degree, previous studies have shown that ANS scores in an Amazonian tribe that receives no maths education are similar to those in an educated French population, suggesting that the effects of education are likely to be subtle. All of the children in the current study received the same maths education.

Halberda cautions against thinking success or failure in school mathematics is entirely genetic and therefore immutable. "ANS is powerful, but it certainly isn't predicting 100% of the variance [in mathematical ability]," he says.

Halberda is currently testing whether ANS can be strengthened by specific training.

Here's the link

The First Day of School

We are back in business. News and updates coming soon.

Lower the Drinking Age?

This from the AP:

College presidents from about 100 of the nation's best-known universities, including Duke, Dartmouth and Ohio State, are calling on lawmakers to consider lowering the drinking age from 21 to 18, saying current laws actually encourage dangerous binge drinking on campus.

Lower the Drinking Age?

This from the AP:

College presidents from about 100 of the nation's best-known universities, including Duke, Dartmouth and Ohio State, are calling on lawmakers to consider lowering the drinking age from 21 to 18, saying current laws actually encourage dangerous binge drinking on campus.

Privacy and the SAT's

from the Times, yesterday:

The Princeton Review, the test-preparatory firm, accidentally published the personal data and standardized test scores of tens of thousands of Florida students on its Web site, where they were available for seven weeks.

A flaw in configuring the site allowed anyone to type in a relatively simple Web address and have unfettered access to hundreds of files on the company’s computer network, including educational materials and internal communications.

Another test-preparatory company said it stumbled on the files while doing competitive research. This company provided The New York Times with the Web address of the internal files on the condition that it not be named. The Times informed the Princeton Review of the problem on Monday, and the company promptly shut off access to that portion of its site.

One file on the site contained information on about 34,000 students in the public schools in Sarasota, Fla., where the Princeton Review was hired to build an online tool to help the county measure students’ academic progress. The file included the students’ birthdays and ethnicities, whether they had learning disabilities, whether English was their second language, and their level of performance on the Florida Comprehensive Assessment Test, which is given to students in grades 3 to 11.

Another folder contained dozens of files with names and birth dates for 74,000 students in the school system of Fairfax County, Va., which had hired the Princeton Review to measure and improve student performance.

The Princeton Review said the student information should have been protected by a password, but that the protection was most likely lost when the company moved its site to a new Internet provider in late June. The company said it was looking into how many people might have accessed the files, some of which could be found through search engines.

“As soon as I found out about this security issue we acted immediately to shut down any access to this information,” said Stephen C. Richards, the company’s chief operating officer. “The Princeton Review takes Internet privacy seriously, and we are currently conducting a review of all of our procedures.”

Several other companies have recently committed similar Internet blunders. The British mobile operator O2 misconfigured its cellphone photo service so that its customer’s private images were accessible to anyone using Google. And Facebook recently exposed the birth dates of some users who had wanted to keep them private.

Natalie Roca, executive director for research and testing at the Sarasota County public schools, said she was “surprised and troubled” by the release of the student data. She said the student information the county gave to the Princeton Review to build the testing tool was strictly confidential.

In addition to the information on students, the site contained the Princeton Review’s educational materials for the LSAT, PSAT and SAT exams, course schedules, an internal analysis of the effectiveness of the company’s instructors, and the entire texts of some Princeton Review books, like the 2008 edition of “Cracking the LSAT.”

One folder on the Web site gave unusual insight into how test preparation companies use older exams to prepare their practice tests. The folder contained digital scans of eight official SATs and six PSAT exams from 2005 through 2007. The tests are created by the Educational Testing Service, a nonprofit organization in Princeton, N.J.

An accompanying guide for Princeton Review exam writers, dated January 2008, said that the company’s “current SAT course diagnostic tests are not as reflective of the real E.T.S. tests as they should be.” It then described “spiraling,” or writing a new practice question based on an old question from the official test. The document instructs authors to avoid copyright infringement by obeying the “three word rule” — ensuring that no three consecutive words remain the same.

Ray Nicosia, the executive director of test security for the Educational Testing Service, said the company had retired the exams that were made available on the Princeton Review Web site and now sells them to tutorial companies. He said he would need more information to determine whether the Princeton Review had properly attained and used the exams.

The Web error indicates that the Princeton Review neglected several accepted online security practices.

In addition to failing to properly restrict access to the student information, the company combined confidential and innocuous files on the same computers — which security researchers say is never a good idea.

“In this case it would have made sense for the company to separate information such as the names of the students from their test scores and whatever confidential information the company had,” said Mike Haro, an analyst at Sophos, an Internet security firm. “But we are finding that companies today don’t change until they have experienced the pain of a data breach that is exposed to the public.”

Summer's Long Shadows

It is mid-August, and we are back. Stay tuned for a number of updates on our new student orientation, seminars for returning students, and various changes in the school building and schedule.

Summer has its own logic

There will be intermittent posts for the rest of July. Actually, I'm trying to stay away from the internet and get a bunch of work done, while relaxing. Blogging is contrary to this spirit.

I plan to begin posting school business, news, and ed/psych matters several times a week in mid-August.

A Return to Posting

Early this morning I was still a bit off from a brief but encapsulating little virus- not so off that I couldn't enjoy the silence of my attic and my desk, but just weakened enough to give into a habit I am trying to escape: The Internet In the Morning.

Every morning I awake with the same thought. No Internet. A tidal pull manifests itself, and a quick swirl of rationalizations lead me to wherever my computer might be. Usually, I put the kettle on. These days I gather the day's news in the time a full kettle comes to boil.

This time, rather than the usual gamut of lefty blogs, La Repubblica (which I struggle to read), and the baseball box scores, I was scrolling through a particularly rich index of New Scientist. Being sleepy, and having effectively fasted for 30 hours or so, I was inclined to seeing patterns across disparate fields.

"Secret sleep of birds revealed in brain scans" "Climate race seperates the weeds from the trees" "Even vegetarians may not be safe from 'mad cow' prions" "'Time reversal' allows wireless broadband under the sea" "How switching language can change your personality" "Smoking gene protects against cocaine addiction" "Girls are as competitive as boys- just more subtle"

Poking, prodding, observing, altering...these headlines are a geography of human activity. Some of it is everyday science (some birds seem to sleep), some seem to reflect frightening, human-driven changes (mad cow disease), some reflect very interior phenomena (language and personality), and some simply the strange but constant expansion of human horizon and integration (more broadband!). This was, after all, New Scientist. There was an experience of the headlines, however, that did not read like a catalogue of modern effort and folly. Later in the day, I likely would not have read them in quite this way:

"Martian soil could grow turnips"

"How river engineering is tied to US floods"

"Artificial brain predicts death-row executions"

Each can be seen as existing in a different moral universe. Yet each is the product of extraordinary human effort: space exploration, gigantic engineering projects, computers. Three images were evoked for me: a giant turnip pushing out of the rusty martian soil like a sunrise, a great swell of water pushing over s-shaped banks and being largely absorbed before it reaches across to the next turn of the river, and a brain-shaped phosphorescence dryly selecting the doomed from the not-doomed.

Equal parts anarchy, surrealism, karma, and dread.

Homer's Secret Odyssey?

About fifty years ago Kansas school teacher named Mrs. Doris Wood (?) took her lifelong interest in the Iliad to the skies. She began noticing very explicable patterns, for instance, that when one warrior fatally wounds another, it always reflects a clearly delineated order of power: Achilles kills Hector who killed Patroclus who killed Sarpedon. She also noted that the so-called "precession of the earth's access", which is well established as having shifted the apparent north star from Vega (in the constellation Lyra, 12000 bce) to Thuban (in Draco, 3000 bce) to Polaris in a great circle back again to Vega (about 12000 years from now).

Because of this the stars that dip below the horizon are also always subtly changing; for periods of many, many years a prominent star may vanish. Yet it would be predicted to appear again, a consequence of long observation and uninterrupted folk traditions.

According to this theory, the stars were crucial to navigation, and in a preliterate society such as Homer's, stories maintained a coherent body of vital, factual information, in this case, a map of the stars that was flexible enough to be useful over many centuries.

Achilles, the Iliad's greatest warrior, "returns to the battlefield", that is, the skies, to chase down and slay Hektor (the constellation Orion). Achilles is the bright star Sirius that is so often mistaken for an aircraft or UFO these days. Sirius had vanished from the skies sometime in the millennia prior to Homer's time.

The squads of warriors are associated with constellations, each with a superior, or brightest, star, who is part of calibrated system of stars, squadrons, and so one, each relatively more powerful or weak in regards to the next.

The book, Homer's Secret Iliad is a good read and very interesting. The schoolteacher's daughter and son-in-law put the book together from her mother's notes. Unfortunately, I had loaned the book out and cannot remember her name. The book is available at Amazon.

Now this: Is the Odyssey a star map as well? Or at the very least, is it grounded in observation and categories, and thus an early expression of those most Greek characteristics?

Vulnerable Vets

I will quote myself:

Now we have another vast, underserved, and traumatized population- returning veterans- who will be desperate for treatment, who will not receive the services, training, and economic support that greatly lessens the strain of emotional distress, and who will instead be treated as damaged brains and be subject to a largely unsupervised drug regimen.

And now a link to ABC News:

The investigation revealed that the VA waited three months to notify veterans in a VA experiment of the possible side effects from the anti-smoking drug Chantix.

All of the veterans enrolled in the Chantix study suffered from Post Traumatic Stress Disorder (PTSD) and had been recruited, with monthly $30 payments, for a behavioral study with the drug.

I plan to keep on top of this for several reasons: One, it illustrates the passivity of governmental regulators vis-a-vis the psychopharm industry. Two, it shows how vulnerable certain populations are to very minor incentives- in this case 30 lousy bucks a month.

And three, veterans' rights are an excellent platform for advocating against off-label uses of various psychotropic drugs as this is easy copy for journalists and the topic interests the political left, right, and center.

I can't emphasize enough the history behind this. The big drug companies have always targeted vulnerable populations. Hopefully, this group is too high profile for this to happen.

One More Day Off!

Blogging will recommence with vigor on Monday. Look for some action over the weekend.

Pigeons

At home we keep two pigeons- indian fantails named Serena and Houdini. A couple of weeks ago a weasel or something like it got into the coop and slaughtered the six we kept before. Decapitated, hearts torn out. Sunday morning, I came out, and no cooing, no thrumming. My oldest wailed in sadness when he came out to see me; I awoke my youngest with the news. So sad. Two of the pairs had chicks, one had eggs. One egg survived. It was horrible. I grieved to walk from the car and hear nothing at all, just seeing that empty coop, that avian murder scene.
But these two little sweeties hooked up nicely, and never leave each other's side. They nuzzle and do such romantic pigeon things that only a thoroughly sour heart could remain unmoved.

Now this.

Pigeons can, among other things, distinguish between Chagall and Picasso. I would call it vindicated, but I am feeling something. I am stirred.

Posting Slowdown for Monday, Tuesday, Wednesday

This is still a one-writer blog- hopefully that will change soon. But for the next few days I will be catching up on other matters, and will return to posting several times a day, five days a week on Thursday, June 19th. Please check back for daily post. Thanks for reading.

Graduation Day

What a lovely day. Our four graduates, whose self-cultivation required great bravery and persistence, have stepped past our little world into a greater one. For those who are interested, I am posting, with very little adaptation, my comments from the ceremony.

Recently a few date palm seeds were found near the Dead Sea (by the site of the Masada fortress). They were carbon dated to about 2000 years ago...one of them is now sprouting. In Buddhism teaching is said to be like planting seeds. A seed waits for the proper conditions. Sometimes it takes a long, long time.

Does anyone here use the internet? Do you ever have the sensation that you are done watching, reading, searching, whatever we do, and yet are not quite ready to let it go...

For my part I get an empty, restless feeling, a diversity of will- one part of me moving away from another part of me. Sometimes I examine this tension. I find it unpleasant. I was putting my youngest son to bed- it was hot that evening, yet he turned off the fan near his bed. He related to me with admirable clarity the reason why:

"Sometimes when it is on, my mind wants one thing and my heart wants something else and I find my fingers creeping towards the fan, so I turn it off".

This is an awareness of a divided self; the divided self being an everyday experience that is utterly universal and yet, for the most part, considered "abnormal", or undesirable, or problematic. It is as perfectly normal and adaptive as having five fingers on each hand.

Adaptive, in that it keeps many possibilities in play- choices, options. We often express these possibilities in words, as alternative plans and explanations. In some ways, this experience of a divided will is a precursor to abstract reasoning. We can imagine alternatives.

But we do not habitually use that imagination to examine ourselves. We assume- in spite of our direct experience- that our self is a more or less fixed entity. It is very difficult for me to convince myself (and here is a language problem already-convince "myself") that that very self is not a real and solid thing. This is where mindfulness comes in.

What is mindfulness? It is becoming a very popular term- and a very influential concept in psychology- because it has great utility and everyone experiences it. It is, simply put, a clear focus on the immediate present. When I am brushing my teeth, I try to keep my mind on only brushing my teeth. When I am eating, I try to keep my mind on only eating. Why?

For one thing, it immediately throws a light on how jumpy the mind is. Sometimes it seems as if we want to do everything but what we are doing in the present moment. It is a bit like looking through infrared binoculars and sitting quietly in the woods.We learn best through direct experience Knowing that this is the nature of ones minds is rather reassuring.. I am not going crazy. We are all crazy. It is perfectly normal to be crazy. But we don't have to be restless, irritated, overwhelmed, unhappy.

A rock bottom assumption of Tinicum Art and Science is that a person who is aware of the restless nature of their own mind is much more forgiving towards their own shortcomings, and that of others as well. If we can get a glimpse of how changable and restless our minds are, we can assume that if I am miserable now, I will less so in a little while. Of course, being happy now will change as well. So perhaps we should just flow along with it a little, accept it, and trust that it will change. This way we don't get stuck.

But getting stuck in a certain mode, or mood, or self conception is really easy. By sitting in silence we get a direct experience of the constantly changing nature of that "self". This is difficult for everyone. Some people are too young for it. Or too obsessive. Or too flakey. There are other types of focusing exercises to help a person move toward this awareness. But sitting in silence is very, very important.

When I was in my 20's, riding the subways in Boston, I was always, always reading. Walkmen- portable tape decks and CD players were becoming common but were not ubiquitous. I didn't like being cut off from the sounds of the city. It seemed dangerous, anyways. But my distraction was reading. And I was always perplexed at the old ladies who seemed perfectly content to sit quietly and watch the world go by. Back then, I thought they were kind of on the dull side, unintellectual. Now, with everyone fussing with ipods and cell phones every waking moment, those old ladies seem like Zen Masters to me.

I love youtube and wikipedia as much as anyone. I blog, check the baseball scores, and devour political news. But that restless, empty feeling is always there, an uneasy reminder of my divided self. Or rather, that there is no "self" really there at all.

Each of us is of multiple minds. It requires great skill to negotiate all the twists and turns and constant flow of our inner lives. Similarly, as teenagers, when our social worlds multiply and become very involved and changable, great skill is required to negotiate all of that complexity. The inner and the outer develop in parallel. And can get pretty mixed up. But neurologically speaking, the same part of the brain- a small portion of the pre-frontal cortex- is involved in the development of social awareness and inner awareness.

This is why mindfulness training makes for a happier person. We use the same neurological map to figure out both ourselves and other people. And if we practice mindfulness, an understanding of others develops. Wisdom develops. Insight develops. Fear drops away.

(to the graduates) We've planted a few seeds for you. This mindfulness and meditation training. You may not use it now, but you will realize, someday, that it works. It will help you realize that everything you need is here in the present moment. You can't breathe in the past, or the future. You can only breathe now. So go back to your breathing. And trust that if things are not so good, they will change, they will get better.

That is why we do what we do here.

The Last Day of School

That relentless rhythm of the school year has finally wound itself round to summer...tomorrow is the last day of school. The students decided to largely forgo their classes to catch up on work, to fool around, swim in the creek, and plan for the next day's party.
It has been a long year filled with marvels. A transition year, really. Over the next few weeks I will lay out some of what we accomplished and some of what we plan for next year.

One of the odder things about the education biz is the question of how you evaluate what you are doing. Can we fairly judge a school on how a bunch of 18 year olds conduct themselves? I think not. For me, the test of our school will be these kids as they approach the age of 30...are they happy, learning new things, are they pushing themselves and taking chances?

What about the handful of kids who don't graduate or moved on to other schools? Many of them keep coming back to visit. Why?

We plant seeds, and seeds take time. Maybe what a student learns at TAS just isn't relevant to the conditions of her life until much later, then suddenly, here it is.

Sometimes a seed is dormant for a long, long time. Like this one. 2000 years old, and now it is sprouting. And I thought I was a late bloomer.

Evidence Based Practice

"Evidence-Based Medicine" is a popular term these days. But it has a dark side, doesn't it? If this is a new idea, what on earth were doctors basing their decisions on before? It reminds me of a Chris Rock routine (which I have only had related to me, I have never seen it) where a father responds to criticism about his drug use and petty crimes with "Well, I take care of my children!". To which Rock says: "Aren't you supposed to take care of your children?"

Finally, it seems the evidence-based approach is wending its way through psychological circles. Not to be too snarky about it, but why now and not 10 years ago?

I hope the answer is that the high water mark of "the chemical hypothesis" has passed. The idea that behavior and emotion is determined by linear chemical processes is silly. Yet a lot of people went to the bank on that one. I think that soon it will be quite clear that a straight line from flawed gene to screwy neurochemical to maladjusted thought to an unwanted behavior does not exist. It was at best simple-minded and at worst profoundly cynical and self-serving.

But people suffer, and suffer greatly. And there is a role for medication. But psychological problems are primarily social problems and require social solutions.

Here is very interesting, modest, and clear step in that direction: a manual for evidence-based practices in children's psychology.

Page nine has the criteria. Page 11 begins with "anxious and avoidant behaviors". Take a few minutes to read through it. It is a good place to start. This has some seeds of thought for adult treatment as well.

No longer any reason to wonder...

First, some data on the medicating of children:

Foster children are medicated at rates far higher than non-foster children. Much of this drug use is not justified by standard medical practice (scroll through this brief abstract, to the conclusion).

Pre-schoolers are now frequently being diagnosed with depression and bi-polar disorder.

Newer anti-depressants do not work better than the older ones (though they are far more profitable); the older ones don't work very well either. (See the second article for a good review of illegal and quasi-illegal practices Eli Lilly engaged in order to replace the profits Prozac generated for them).

Now this: Dan Carlat admits that his take on the growing scandal at Harvard Medical School was, to use a word, ingenuous. The three doctors at HMS apparently hid millions of dollars in payments from various drug companies and failed to report them as potential conflicts of interest. Carlat calls the CME (continuing medical education credits) system a huge money laundering scheme, a way of directing cash to doctors and researchers:

Rather than paying doctors directly to give accredited CME courses (which is illegal), drug companies pay third party companies to create the courses. The checks are actually written by the education company, but the ultimate source is clearly the sponsoring pharmaceutical company. The drug industry has gravitated to this form of marketing because they realize that doctors are more likely to believe information in CME courses than information from drug reps.

The Harvard scandal represents the perfect storm of this money laundering operation. It appears that the vast majority of the money eventually reported by the Harvard Trio, a combined $4.2 million over 7 years, was drug company money that was laundered and processed to seem like it wasn't drug company money. And this, I suspect, is why it was so easy for the doctors to rationalize not disclosing it.

This is a major public health issue. Does it go to far to say that, for parents at the very least, this calls into question the legitimacy of the entire system of psychopharmacological research?

In summary we have a huge boom in medicating children, a huge boom in drug company profits, a vast and invisible payment system for biasing doctors and gaming the research, and all the major medical journals absolutely dependent on advertising from drug companies. And now, the most famous medical school in the world has been found to be caught up in the whole racket.

Vic Rawlings, noise and music, and being free

What is the difference between noise and music? When I listen to a scratchy old 78 of a one of Beethoven's Rasamovsky Quartets what is it, noise or music? What if it is a really scratchy old 78? There is no clear line, of course. Instead, it is a question productive of thought, not answers.
In Zen, action is important. Action reflects a quality of mind, but not always. Intent is very important. Zen is arguably more like philosophy than religion in the sense that moral imperatives are unimportant, even discouraged. One can judge action, and judging is the closing of one's heart. One can never truly know another's intent; we can only know our own intent. Intent, then, is the quality of mind, and can only truly be known by oneself. This is a pretty fierce subjectivity, pretty cold eyed.

As a teenager, I lived and breathed the Rolling Stone Record Guide. I highlighted any five star record I dared call familiar. I avoided those one star and two star failures; I made knowing fun of Uriah Heap, as they rated as only "bullets" , a few sorry single stars, and their masterwork, whatever it was, which was granted two. Needless to say, as my opinions began to diverge, the book lost much of its authority. But it was a place to start, like Janson's History of Art, or Ezra Pound's "from Confucious to Cummings". Its breadth was its authority. And I aspired to some kind of breadth.

But what I lost, and what I struggled with throughout my years as a musician harassed by the fates and chased down by doubts, was the sense of my own style. It emerged anyways, a function of my severe limitations, but the chorus of critics, that long-ago internalized Record Guide, rarely gave approval.

But there were moments- while writing or performing- where I felt a unity of intent, ability, and action. The critics were silent, finally, if briefly.

So where is the music, the noise? Is there a meaningful difference when one is producing sound? The intent is important. A good ear- an experienced, open ear- can often tell if the intent is to communicate. But that does not matter, really. If the maker of sounds- music or noise- is experiencing a unity of intent and action, something good is happening. A fundamental experience. Coherence. And if others are playing as well, it is delicious. It may sound like an construction site- a deconstruction site- to some. Like heavy traffic, swinging cranes, and police radios. Be brave. Play on.

When Vic Rawlings comes to Tinicum he comes to play. In the Fall, he gives two full days of lessons, in the Spring, a day of lessons and full day of electric and electronic musicnoise/noisemusic. Picture a large circle, then 10 places on the circle. One place may have an old amplifier, a short wave radio, an old electronic camera flash. Here, the flash flashes its electromagnetic pulse to our eyes when a button is pushed, but a series of slowing, dropping frequencies are registered by us as sound via the shortwave shortly thereafter.

Another station: an enclosed, circular pan with two steel balls trapped, rolling within. The wire of a contact microphone dangles from it. This connects to an antiquated speaker.

Another: a table with several things that look like inside out guitar effects pedals, the kind people stamp on to get a wail or a crunch or a phasing effect- their guts are spilling out. On the circuit board inside are wire and bits of foil. Some steel wool. These cross up the circuits, and randomly produce all manner of noise. Here one experiments. Anybody I have ever seen at that station takes on a very systematic expression- a scientist at work, or a grocer at his scales. The attempt is to reproduce that funny sound. Rarely done, and most move on, but most return.

Another: a stand holds a rectangular, black, U-shaped piece of metal about a foot long and one fifth as high. Two cello bows can be drawn across it; this sound is routed through a wah-wah pedal and off to an amplifier.

Why? Noise. Music. Put the critics to rest, give them the morning off. It is, after all, playing music, right? This is the experience of "just doing it". Zen isn't all sitting in silence.

Vic's intent is not to provide an experience of challenging Zen practice. It is, inter alia, to produce an opening, an experience of freedom and conflict. Interestingly, it was the presence of a guitar and a bass guitar that caused difficulty. Young musicians can't seem to approach these icons without the rock script, playing familiar songs and producing familiar gestures. And once you are playing from a script, you are alone, listening to the critics, doing what you are supposed to do. The conflict comes with the new, the unknown, the trying to make some sound, some communication, however untutored. There is some freedom for you. Be brave and play.

One more link on big pharma transparency

A helpful overview of the bill Sen. Chuck Grassely sponsored mandating transparency of drug company payments to physicians...

Old Links, New Links

If you are interested in the relationship between drug companies, flawed research, gigantic profits, and emotional health hit the following links:

for an up to date account of the attempts to reform the relationship between big pharma and doctors see the Carlat Psychiatry Blog. Read the article that made him famous!

Peter Breggin is likely more responsible for our awareness of how dangerous many of the these drugs are. You can link to his Center for the Study of Psychiatry and Psychology here.

You might want to read an appreciative overview of E. Foster Torrey's work. I think he is a mixed bag, but you should know about him.

If, say, Pfizer runs 20 studies on a new drug called "whoknowhowitworxiprine", one of them is bound to be positive, right? Especially if you keep tweaking the group you are using in the study by, say, not counting those people who dropped out due to "side-effects" such as chronic constipation or nervous twitches. But what happens to the other 19 studies that show the drug as being possibly dangerous or ineffective? Down the memory hole with that one! Here's another article on the same subject.

Then there is the rather disconcerting evidence that anti-depressants don't work much better than placebo. Here is one more link regarding the fact that serotonin is not the primary driver of depression.

Finally, speaking of the memory hole- which is an Orwell reference- here's a little big brother for you: that long standing attempt to find a diagnosis for every child, so they might have "access" to the mental health system. Or rather, so the big pharma companies have access to every child.

This is just a run down. Plenty more where that comes from.

Huxely, Part 3

Is it possible that a drug could wipe out guilt and shame? Is it possible that a person could take such a drug prophalactly, that is, ahead of time, so as to not remember or become preoccupied with an act of moral uncertainty? The article I linked to below brushes by that possibility.

Instead, it raised other crucial questions of the use of these drugs to patch up an terribly understaffed military mission, and of having entire units functioning less than optimally due to the drugs' many side-effects at certain dosages (I hesitate to even call them that- the deadening effect is the intent, isn't it?).

Now consider this (from Talking Points Memo):

By Andrew Tilghman - June 9, 2008, 10:09AM

The system designed to keep corporate cash from secretly slipping into the hands of doctors who do highly influential medical research isn't working very well.

Even at the nation's top institutions - such as Harvard - and affecting the most vulnerable populations - children with psychiatric problems.

A front-page story in Sunday's New York Times reports that a Congressional probe found some top child psychiatrists earning more than $1 million in often undisclosed consulting fees from drug firms.

What's most troubling about the investigation is that the these individual doctors and their public advocacy for certain drugs for mentally ill children "has helped fuel an explosion in the use of powerful antipsychotic medicines in children."

Dr. [Joseph] Biederman is one of the most influential researchers in child psychiatry and is widely admired for focusing the field's attention on its most troubled young patients. Although many of his studies are small and often financed by drug makers, his work helped to fuel a controversial 40-fold increase from 1994 to 2003 in the diagnosis of pediatric bipolar disorder, which is characterized by severe mood swings, and a rapid rise in the use of antipsychotic medicines in children. The Grassley investigation did not address research quality.

Biederman, who works at Harvard Medical School's department of psychiatry, received $1.6 million in consulting fees from drug makers from 2000 to 2007 but for years did not report much of this income to university officials, according to information given congressional investigators.

While there are rules for disclosing such payments, there's virtually no enforcement of those guidelines.

"It's really been an honor system thing," said Dr. Robert Alpern, dean of Yale School of Medicine. "If somebody tells us that a pharmaceutical company pays them $80,000 a year, I don't even know how to check on that."

While the probe, led by Sen. Charles Grassley, (R-IA) is scrutinizing the system for disclosing such payments, there is no effort to examine whether these payments may have influenced the doctors' research.

As the Times notes: "The Grassley investigation did not address research quality."

Controlling for bias is especially important in such work, given that the scale is subjective, and raters often depend on reports from parents and children, several top psychiatrists said.

More broadly, they said, revelations of undisclosed payments from drug makers to leading researchers are especially damaging for psychiatry.

"The price we pay for these kinds of revelations is credibility, and we just can't afford to lose any more of that in this field," said Dr. E. Fuller Torrey, executive director of the Stanley Medical Research Institute, which finances psychiatric studies. "In the area of child psychiatry in particular, we know much less than we should, and we desperately need research that is not influenced by industry money.

E. Fuller Torrey is a hugely influential voice in the efforts to destigmatize mental illness (a term I am very uneasy with) and to treat it as a medical disorder. He is considered the devil himself among some groups of "psychiatric surviviors". Others consider him a man who has done great good for millions of people. To read an admission from him that psychiatry is in the midst of a "credibility" problem indicates to me that things might be changing more deeply than I though they were.

In any case, this country has a big, big drug problem. It encompasses the use of drugs for recreation, managing trauma, optimized performance, exploiting and extracting human resources, addiction, dementia, learning disabilities and much more. It also means that how research is funded and who profits from both the research and the drug products has to be utterly transparent.

We have to have a comprehensive debate on these issues. I have a feeling that in five years all these issues are going to be seen converging on our cohort of Iraq and Afganistan vets. The old distinctions between illegal, legal, recreational, medical, and enhancement are going to collapse.

Huxley, Part 2

Over time, I become very disenchanted with the overall approach we took at that hospital. In the end, I think we did more slightly more good than harm. But when the insurance arrangements collapsed in the early nineties with the emergence of HMO's and funding decreased for the treatment of the most poor and vulnerable, I was pretty happy to move on to playing music full-time for a couple of years.

But it was in this program that one can see great possibility for abuse: namely, early and thorough control of a child's behavior through drugs. And with no informed consent. After all, the parents are hardly in a position to object, and no one in the system was going to either. None of these drugs were approved for these uses (of this I am pretty sure, but not completely so), and the many side effects would certainly set the child up for future ridicule: constipation, slurring of speech, awkward movements, glazed expression, etc.

Keep in mind that this was more than fifteen years ago. You would think that long term studies on the safety of anti-psychotics (haldol, risperdol, clozaril) or anti-depressants (imipramine, prozac, and so on) would have been published. You would be wrong.

Now we have another vast, underserved, and traumatized population- returning veterans- who will be desperate for treatment, who will not receive the services, training, and economic support that greatly lessens the strain of emotional distress, and who will instead be treated as damaged brains and be subject to a largely unsupervised drug regimen.

Sure, some drugs help. But unless there is a wide and comprehensive range of services, our vets, like the poor and abused children I worked with years ago, will be presented a false choice.

It will seem as if beta-blockers and anti-depressants are the only options. And that will be because we have, once again, failed to address our societal problems with societal solutions.

Huxley here we come

(from Time magazine) While the headline-grabbing weapons in this war have been high-tech wonders, like unmanned drones that drop Hellfire missiles on the enemy below, troops like LeJeune are going into battle with a different kind of weapon, one so stealthy that few Americans even know of its deployment. For the first time in history, a sizable and growing number of U.S. combat troops are taking daily doses of antidepressants to calm nerves strained by repeated and lengthy tours in Iraq and Afghanistan.

The medicines are intended not only to help troops keep their cool but also to enable the already strapped Army to preserve its most precious resource: soldiers on the front lines. Data contained in the Army’s fifth Mental Health Advisory Team report indicate that, according to an anonymous survey of U.S. troops taken last fall, about 12% of combat troops in Iraq and 17% of those in Afghanistan are taking prescription antidepressants or sleeping pills to help them cope. Escalating violence in Afghanistan and the more isolated mission have driven troops to rely more on medication there than in Iraq, military officials say. (go to article)

This is a sticky problem, isn't it? Leaving one's opinions about the wars in Iraq or Afganistan aside...and leaving aside as well my own strong bias against the overuse of medication in psychiatry, what IS the problem here? Soldiers are a resource that need to be managed; their returning home exhausted and traumatized serves nobody's interest, right?

Here is some research on a drug, known commercially as Inderal:

[Pitman] and his colleagues tested a tongue-twister of a drug called propranolol on 41 people who had experienced automobile accidents, assaults, and other traumas serious enough for them to be treated at the emergency room of Massachusetts General Hospital in Boston. The goal was to see if this drug, given within six hours of their mishaps, would prevent terrifying, indelible memories.

Tested three months after an auto accident, one young man, who took a dummy pill as part of the experiment, was still wary about getting into a car. He had nightmares. He sweated, his heart rate jumped, and he felt nervous anytime he got behind the wheel, especially in the area where the accident occurred.

In contrast, others who survived similar accidents and took propranolol had significantly fewer problems.

The most revealing tests were done three months after the traumas, when 22 of the victims returned to Mass General Hospital for evaluation. Eight of these people took propranolol four times a day for 10 days, but had been off the drug for more than two months when tested. Fourteen of the 22 had taken dummy pills, or placebos.

All of them listened to audiotapes on which they had described the incidents that brought them to the emergency room. None of those who took propranolol showed strong responses to the tapes. But eight of the placebo patients were obviously shaken by reliving their traumas. Their heart rates increased, their palms sweated, their muscles twitched - all signs of PTSD.

From 1988 to around 1994 I worked in a somewhat innovative program in Boston that treated young children (6-12) who suffered from a wide range of abuse. Violence was the texture of much of their young lives, and of course there was a great deal of sexual abuse. It was quite common for a kid to get really wound up and seek some sort of conflict; often it ended with the child being physically restrained. When I write "innovative" I mean for its time. It was a loving, caring place, but one that put far too much emphasis on such unbounded concepts as "cerebral dysfunction". Its strength was its staff, especially the nurses. But the conceptual framework was, to be sure, weak.

The kids were viewed, conceptually, as damaged. They certainly faced a myriad of extreme disadvantages, and these were compounded, I believe, by the behavioral scheme that attempted to reinforce and reward all kinds of actions, at the expense of a more natural, genuine setting. Once they left, it was likely that they moved into a world that responded to them in a totally different manner. What they learned they left behind, unless they wound up in a good school, with a good family, and a fierce advocate to protect them throughout the brutal foster care system.

But one thing that worked was Inderal. Inderal is a beta-blocker. More specifically, a beta-adrenergic antagonist that blocks the body's use of epinephrine. It puts a ceiling on how excited or overstimulated you can get. We used it to cut the cycle of violent outbursts that made any kind of therapeutic learning impossible. It was relatively safe- so long as the patient's blood pressure was monitored.

It was developed first from an anti-fungal compound that was shown to have these properties. The scientist who discovered it won a Nobel Prize. We valued it because it allowed very traumatized children to tolerate situations they found far too frightening and disorganizing.

In more recent times it is used for stagefright, agoraphobia, and such things. The above study sees it as a treatment for PTSD per se. That is what we used it for, and lo and behold, Harvard is catching up, some twenty years later. (link)

(more soon)

Posting Slowdown?

It is the last week of the school year...which means I have no idea how busy I am. I will be posting as much as I can. Every day, one item, at least.

A stroke, inside out...

(from Sunday's Times) As a Harvard-trained neuroanatomist, Jill Bolte Taylor has always known more about brains than most people. But when a brain hemorrhage triggered her own stroke, she suddenly had a front-row seat on the deterioration of the brain.

Dr. Taylor recounts the details of her stroke and the amazing insights she gained from it in a riveting 18-minute video of her speech at the Technology, Entertainment, Design Conference in Monterey, Calif., last month. Her fascinating lecture includes a detailed explanation of the differences between the left and right sides of the brain, complete with an incredibly cool prop — a real human brain.

On a December morning in 1996, Dr. Taylor woke up with searing pain behind her left eye, the beginnings of a hemorrhagic stroke. As the left side of her brain shut down, she began to feel disconnected from her body and entered an almost-euphoric like state. It took her a while to make sense of the experience, but as her right arm became paralyzed, it dawned on her that she was having a stroke.

“How many brain scientists have the opportunity to study their own brain from the inside out?,'’ she said. “In the course of four hours, I watched my brain completely deteriorate in its ability to process all information. On the morning of the hemorrhage, I could not walk, talk, read, write or recall any of my life.'’

Her account of the experience of stroke is vivid, and at one point, she recalled, she felt like someone had taken a remote control and hit the mute button. “I was shocked to find myself inside a silent mind,'’ she said.

What is so surprising about Dr. Taylor’s story is that she experienced a sort of euphoria as she was left with only right-brain functions. She lost her sense of self, but she also shed the stress of her life and, as she puts it, “37 years of emotional baggage.'’

“Imagine what it would be like to be totally disconnected from your brain chatter,'’ she said. “I felt a sense of peacefulness.'’

Dr. Taylor’s lecture is challenging and thought-provoking, and I’d encourage you to take the time to watch it in its entirety. It took Dr. Taylor eight years to recover from the stroke, but she said she was motivated by a desire to share her experience of stroke and recovery, particularly her increased awareness of the right side of her brain. “I realized what a tremendous gift this experience could be, what a stroke of insight this could be to how we live our lives, and it motivated me to recover,'’ she said.

To learn more about Dr. Taylor, visit her Web site.

The Placebo

In a dry, but interesting reframing of the role of placebo in healing and in research from the Journal of the Royal Society of Medicine the authors assert that the placebo effect can be observed independently of a doctor's direct efforts. Placebo regimens are used in a couple of ways. In one a relatively neutral agent is used to provoke the patient into self-healing. It happens all the time. Doctors have even begun proscribing placebo for parents to use with children.
In another, placebos are used in randomized, double-blind trials (researcher and subject are unaware of which is the drug and which is the placebo). If 40% of group A improves on the drug and 30% of group B improves on the placebo, the effectiveness of the drug is considered to be 10%.
This is a big assumption, but there it is. In psychiatric drug trials, for instance, drug companies use a "placebo washout" to ensure that their drug fares better than placebo. It goes like this: a group of 100 join the trial, say they all suffer from significant anxiety problems. All are given a placebo. 40 get better. Those 40 are removed from the trial. 60 remain. The 60 are divided into two groups, A and B. One is given the drug, one is given placebo. If the drug group fares better that the placebo group the findings are reported as evidence of drug effectiveness (over placebo).
But of course, a huge chunk of people were removed to try to ensure exactly that outcome.
Nevertheless, this is standard practice.

The assumption is that the placebo is "noise" in the study. The authors suggest that not only is the placebo a potentially powerful agent for healing, but that the healing is not just a response to the clinician's care and attention.

The idea is that our bodies are deeply conditioned to healing interventions. For instance, heroin addicts have been noted to get withdrawal relief merely by injecting water into their veins. KNOWINGLY. Deception is not necessary to evoke a healing effect.

The reframing is "Contextual Healing", that the whole context of providing care provides opportunity for healing- from the mechanics of delivery, to clinician's care, to the drug agents themselves.

Some part of each of us is fundamentally healthy. We respond to healing in a multitude of ways.