Thursday, April 28, 2005

The search for the gay gene

British Medical Journal

BMJ 2005;330:1033 (30 April), doi:10.1136/bmj.330.7498.1033

reviews

PERSONAL VIEWS

The search for the gay gene

Another study from Dean Hamer's laboratory at the US National Institutes of Health indicates that genes may influence homosexuality in males ( Human Genetics 2005;116: 272-8[CrossRef][ISI][Medline]). The study involved a complete genome scan, the first ever conducted for the study of sexual orientation. Like the others before it, this study is far from conclusive, but it adds to the growing sense that genes play a role in male sexual orientation. The evidence for a genetic contribution to female homosexuality is less well developed, but the case is hardly closed. Social opinion in the back-ground of this research remains divided about its meaning and value.

Full

Wednesday, April 27, 2005

How Do Doctors Diagnose Depression?

From today's Washington Post:
Actors pretending to be patients with symptoms of stress and fatigue were five times as likely to walk out of doctors' offices with a prescription when they mentioned seeing an ad for the heavily promoted antidepressant Paxil, according an unusual study being published today.

The study employed an elaborate ruse—sending actors with fake symptoms into 152 doctors' offices to see whether they would get prescriptions. Most who did not report symptoms of depression were not given medications, but when they asked for Paxil, 55 percent were given prescriptions, and 50 percent received diagnoses of depression.

The study adds fuel to the growing controversy over the estimated $4 billion a year the drug industry spends on such advertising. Many public health advocates have long complained about ads showing happy people whose lives were changed by a drug, and now voices in Congress, the Food and Drug Administration and even the pharmaceutical industry are asking whether things have gone too far.

The culprit is not advertising, but it will apparently be made the scapegoat. Many types of drugs are advertised, but the study was confined to an antidepressant. The culprit is the culture of medicalization that makes anything negative a mental-health problem. It affects doctor and patient alike. It's the age we live in.

Tuesday, April 26, 2005

Keith Hoeller's letter in JAMA reply to Henderson's review of Szasz Under Fire

Letters to the Editor
Journal of the American Medical Association
JAMA. 2005;293:1978.

Szasz Under Fire

To the Editor: In reading Dr Henderson’s review of the book Szasz Under Fire: The Psychiatric Abolitionist Faces His Critics,1 it was difficult to determine why Henderson seems surprised that Dr Szasz and his critics continue to disagree. In Thomas Kuhn’s terms,2 Szasz and psychiatrists have incommensurate paradigms. The essays in this book were well-chosen and illuminated the continuing refusal of psychiatry to understand the completeness of Szasz’s rejection of what he has called "the therapeutic state."

I am most disturbed by Henderson’s suggestion that Szasz is anti-Semitic, particularly by quoting Karl Popper and not Szasz himself. And Henderson’s statement that the book lacks a human rights perspective indicates that he has apparently not read Szasz’s work where he clearly rejects, for example, a "mental patient’s bill of rights" because it claims to give the mental patient all kinds of fake freedoms but not the real freedom that matters most: freedom from being labeled and treated as a mental patient.

Keith Hoeller, PhD
Editor, Review of Existential Psychology & Psychiatry
RKHoeller@aol.com
Seattle, Wash
1. Henderson SW, reviewer JAMA. 2005;293:240-241. Review of: Szasz Under Fire: The Psychiatric Abolitionist Faces His Critics. FULL TEXT
2. Kuhn TS. The Structure of Scientific Revolutions. 2nd ed. Chicago, Ill: University of Chicago Press; 1970.

Letters Section Editor: Robert M. Golub, MD, Senior Editor.
JAMA. 2005;293:1978.

RELATED ARTICLES IN JAMA
Szasz Under Fire—ReplySchuyler W. Henderson JAMA. 2005;293:1978. EXTRACT FULL TEXT

Szasz Under Fire—Reply

In Reply: First and foremost, I have no reason to believe that Dr Szasz is anti-Semitic and every reason to believe that Karl Popper was not, and I regret any implication to the contrary. Rather, I was concerned that Popper’s letter, otherwise uncontextualized in the vituperative milieu of this book, could be read as an allusion to the anti-Semitism that has occasionally but notoriously lurked in criticisms of psychiatry, from both within and without.1

I was not surprised that there is disagreement between Szasz and his critics (a lack of which would have made for dull reading, and this book is certainly not dull). I was, however, startled by the vehemence of the invective and the degree to which many, but not all, of the parties refused this opportunity to think through and beyond various points of impasse. After all, the "continuing refusal of psychiatry to understand the completeness of Szasz’s rejection of. . . ‘the therapeutic state’" is simply matched by Szasz’s refusal to understand the rejection of his positions. Some differences cannot be reconciled, but I question whether Szasz and psychiatrists have entirely incommensurate paradigms, particularly since Szasz has practiced and taught as a psychiatrist, not without commendation.2

Because human rights are important to Szasz’s thinking and libertarian philosophies, I had noted that this book would have benefited from an expert in that field, just as the editor sought out experts in other areas pertinent to Szasz’s thinking. That Szasz might reject aspects of this perspective would be all the more reason to include such a voice.

Schuyler W. Henderson, MD
HendersS@childpsych.columbia.edu
Columbia University New York, NY

1. Frosh S. Freud, psychoanalysis and anti-semitism. Psychoanal Rev. 2004;91:309-330. CrossRef MEDLINE

2. Dewan M Presentation at: Liberty and/or Psychiatry? 40 Years After The Myth of Mental Illness: A Symposium in Honor of Thomas Szasz on his 80th Birthday; April 15, 2000; Syracuse: State University of New York. Available at: http://www.szasz.com/Dewan.htm.
Accessed March 9, 2005.

Letters Section Editor: Robert M. Golub, MD, Senior Editor.
JAMA. 2005;293:1978.

RELATED ARTICLES IN JAMA
Szasz Under FireKeith Hoeller JAMA. 2005;293:1978. EXTRACT FULL TEXT

Sunday, April 24, 2005

Does Neuroscience Negate Personhood? (Updated)

"Should we ditch the concept of personal responsibility and construct the therapeutic state?," asked Michael Shapiro, a University of Southern California law professor.

Shapiro posed the question during a panel discussion devoted to "Responsibility and the Law," on the second day of the Our Brains and Us conference at MIT. Do any of the findings of contemporary neuroscience force us to ditch the concept of personal responsibility? Shapiro argued they don't. Why? Because we already knew that we are embedded in a network of physical causes from which our behavior arises. Neuroscience may give us a better understanding of the physical bases of causes in our brains, but it does not change the fact that our behavior has always been caused.

Those are the opening paragraphs from a new article, "Prozac Justice: Does Neuroscience Require a Therapeutic State?" by Ron Bailey, now on the Reason magazine website. It is sure to excite some comment from those of us who believe in free will and personal responsibility.

Bailey ends up expressing concern about a world where crime is regarded as a sign of illness rather than wrong-doing, and he rightly abhors the possibility of "prospective intervention" and indeterminate "therapy." But the article is plagued by a misunderstanding of free will, leading to the topsy-turvy view that while determinism would not negate moral responsibility, freedom of the will, if it existed, would. Thus:
Shapiro recognized that many people naively believe that free will, and thus personal responsibility and moral culpability, depends on the notion that people are somehow uncaused causers. But can someone really be held responsible in such a contra-causal world? Not really. As psychologist and philosopher William James put it: "If a 'free' act be a sheer novelty that comes not from me, the previous me, but ex nihilo, and simply tacks itself on to me, how can I, the previous I, be responsible?"

What's a contra-causal world? Free will does not mean actions are uncaused. It means they are caused by persons. The popular notion that persons can be reduced to mechanistic neurological processes is self-refuting—if true, its advocates are uttering not words but meaningless sounds. The "causes" of actions, Thomas Szasz reminds us, are called reasons. But those cannot be reduced to brain activity, however much they may depend on it.

Shapiro and Bailey surely can do better than James's straw-man argument—although not much better. The fact is, the free-will proposition is a self-evident axiom. One must tacitly acknowledge it even in trying to refute it.

Saturday, April 23, 2005

A Birthday Celebration for Thomas Szasz

The Reason Foundation held a small 85th birthday celebration for Thomas Szasz on April 15 at the I Ricchi restaurant in Washington D.C. It was a wonderful evening. (Unfortunately, Tom was unable to travel to Washington.) Tributes to Tom were given by Reason magazine editor Nick Gillespie, columnist and Szasz award winner Jacob Sullum, Cato Institute President Ed Crane, Norm Singleton on behalf of Representative Ron Paul, Jeff Schaler, and me. Andrea Rich, former owner of Laissez Faire Books, presented Tom a crystal flame inscribed with Thomas Jefferson's words: "I have sworn on the altar of god, eternal hostility against every form of tyranny over the mind of man." (Ironically, this is from a letter to Benjamin Rush.)

The remarks and photos are online here.

Thursday, April 21, 2005

Actresses Oppose Compulsory "Treatment" for Children

From the Associated Press:

"Actresses Kirstie Alley and Kelly Preston pleaded with [Florida] lawmakers Tuesday to prohibit schools from denying services to students who won't take mood-altering drugs to treat mental disorders.

"Alley sobbed as she told members of the House Education Council the stories of children who committed suicide or died after taking psychotropic drugs....

"Children diagnosed with attention deficit hyperactivity disorder can be eligible for special education programs for students with disabilities, including curriculum adjustments, alternative classrooms and increased parent and teacher involvement. The bill would prohibit schools receiving state money to deny those services if those students don't take prescribed drugs to treat the condition.

"Alley's pleas, though, came after the committee stripped language from the bill that would have required schools to tell parents that there is no medical test to diagnose a mental disorder and that they can refuse a psychological screening for their children.

"The committee also removed part of the bill that would have required schools to inform parents that physical conditions may be the cause of mental and behavioral problems, that they should consult with a medical doctor about such problems and that a diagnosed mental disorder will stay on a student's permanent record."

I guess Alley's and Preston's hearts are in the right places, but a more radical plea might have been more forceful. The bill they back would maintain all the "services" for the "diagnosed" children, and therefore the stigma of "mental disorder." The threat to children from the Therapeutic-Education State would continue.

Hat tip: David Beito.

Tuesday, April 19, 2005

Louisiana Psychologists Start Prescribing Drugs

Louisiana and New Mexico are the only states that allow psychologists who complete specialized training and pass a national exam to write prescriptions for medication. Both states began issuing the prescribing certifications and licenses to a handful of psychologists within days of each other in February.

Full Story

But a gatekeeper is still a gatekeeper. All these laws do is grant some psychiatric privileges to psychologists, privileges which should be basic rights of all citizens.

Public hearing on EU drug policy

For the interested among you, drug policy will have the European Union's ear on April 21. ENCOD advocates a regulated drug market, but not regulated by doctors. The idea of a free, unregulated market, will, of course, only frighten the EU bosses off.

Friday, April 15, 2005

Judge strikes down FDA ban on ephedra

A federal judge on Thursday struck down the FDA ban on ephedra, the once-popular weight-loss aid that was yanked from the market after it was linked to dozens of deaths.

U.S. District Judge Tena Campbell's ruling, written Wednesday and announced Thursday, overturns the ban, sends the matter back to the FDA "for further rulemaking consistent with the court's opinion" and keeps the agency from enforcement action against the companies.

Full article

Court Ruling (PDF)

Saturday, April 09, 2005

Self-Determination vs. "Assisted-Suicide"

Thomas A. Bowden of the Ayn Rand Institute writes, "“The right to life includes and implies the right to commit suicide. To hold otherwise——to declare that society or God must give you permission to kill yourself——is to contradict the right to life at its root.”"

If that is so, then why does Bowden, in the same article, endorse the assisted-suicide law in Oregon (and the proposed law in Vermont), which, in his words, “"permits physicians to prescribe a lethal dose of drugs to a mentally competent, terminally ill patient who makes written and oral requests, consults two doctors, and endures a mandatory waiting period”"?

That sounds like the "“right"” to ask permission to commit suicide, rather than the right to end one’'s own life. That "contradict[s] the right to life at its root." A consistent advocate of the right to commit suicide would oppose "“assisted-suicide”" laws and endorse full self-determination, which of course includes repeal of professional licensing, prescription laws, and the ban on forbidden drugs.

Tuesday, April 05, 2005

Alabama Libertarians back medical marijuana bill

The issue of medical marijuana raises the age-old dilemma of what to do, go for improvements for some people in the immediate future, or hold out for freedom for everybody in a more distant future? Alabama Vice Chairman of the LP, Stephen Gordon, says:
“The vast majority of people are recognizing that this is a medical issue, a compassion issue, not a marijuana legalization issue.”
Why not? I believe profoundly in the compassionate nature of man, but Gordon vice chairs the Libertarian Party, not the Compassionate Party. Why isn’t he coming down on the side of liberty for everybody?

Also interesting is the quote about a presumably ill woman.

“Using even the legal, pharmaceutical version of marijuana, Marinol, makes Campbell violently nauseous. Marijuana is the only drug that allows her to simultaneously fight nausea and pain -- so her husband buys Campbell's medicine from drug dealers on the street.”
I wonder whether state sponsored weed in Alabama will fall on its face like it did in the Netherlands, where the government tried to salvage the project by hiring professors who claim that (semi-)illegally sold marijuana is infested with germs and molds.

Friday, April 01, 2005

Government Abstinence Site Under Fire

A parenting website developed by the U.S. Dept. of Health And Human Services (HHS) is under fire because it promotes sexual abstinence, almost to the exclusion of alternatives. One of its more controversial recommendations says:

"If you believe your adolescent may be gay, or is experiencing difficulties with gender identity or sexual orientation issues, consider seeing a family therapist who shares your values to clarify and work through these issues."

Promoting abstinence is fine, said Monica Rodriguez of the Sexuality Information and Education Council of the United States, but the government should also address the needs of teenagers who are already sexually active, gay or lesbian, or who have been sexually abused.

Her 41-year-old organization as well as the ACLU, the National Education Association and more than 100 other advocacy groups are asking HHS to take down the Web site.

Full Article