Polar Bears, Psychoanalysis & Dinosaurs
Autor: David Wilson | Publicado: 2008-08-05T11:49:00-04:00

Up, Down.The state of Alaska sued U.S. Interior Secretary Dirk Kempthorne on Monday, seeking to reverse his decision to list polar bears as a threatened species under the Endangered Species Act.Governor Sarah Palin and other state officials fear a listing will cripple offshore oil and gas development in the Chukchi and Beaufort seas in Alaska's northern waters, which provide prime habitat for the only polar bears under U.S. jurisdiction.War Hero, Pretty Woman as your VP, Pro-Life, Pro-Nuclear, Pro-Oil ... all good. Weasel whizz & pundit jizz ... whatever ... and boobage forthcoming after a while, Malana.1. Alaska sues over listing polar bear as threatened, Dan Joling, August 5.2. American voters should beware the 'McNasty' in McCain, Jonathan Zimmerman, August 5.3. Pills taking over from psychotherapy, Julie Steenhuysen, August 4.4. Fewer shrinks are doing talk therapy, Carla K. Johnson, August 4.5. National Trends in Psychotherapy by Office-Based Psychiatrists, Abstract, Ramin Mojtabai & Mark Olfson, August 2008."Psychiatrists get more for three, 15-minute medication management visits than for one 45 minute psychotherapy visit."&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Dr. Ramin Mojtabai*************************************************************Alaska sues over listing polar bear as threatened, Dan Joling, August 5.ANCHORAGE — The state of Alaska sued U.S. Interior Secretary Dirk Kempthorne on Monday, seeking to reverse his decision to list polar bears as a threatened species under the Endangered Species Act.Governor Sarah Palin and other state officials fear a listing will cripple offshore oil and gas development in the Chukchi and Beaufort seas in Alaska's northern waters, which provide prime habitat for the only polar bears under U.S. jurisdiction.“We believe that the Service's decision to list the polar bear was not based on the best scientific and commercial data available,” Ms. Palin said in announcing the lawsuit.Kassie Siegel of the Center for Biological Diversity, the lead author of the petition that led to the listing, said U.S. Fish and Wildlife Service scientists addressed skeptics' objections during the listing process. She called the lawsuit “completely ridiculous and a waste of the court's time.”“This lawsuit and her head-in-the-sand approach to global warming only helps oil companies, certainly not Alaska or the polar bear,” Ms. Siegel said. “Gov. Palin should be working for sustainable, clean energy development in Alaska instead of extinction for the polar bear.”Mr. Kempthorne announced the listing May 14. The process started with the filing of the petition in 2005, a yearlong initial review, another year of public comment and additional studies, and court action to force a final decision.Mr. Kempthorne concluded that sea ice was vital to polar bear survival, that sea ice had dramatically melted in recent decades and that computer models suggest sea ice likely will further recede in the future.Summer sea ice last year shrank to a record low, about 1.65 million square miles, nearly 40 per cent less than the long-term average between 1979 and 2000.The lawsuit, filed in Washington, D.C., claims the federal analysis did not adequately consider polar bear survival through earlier warming periods centuries ago.Alaska objects to the conclusion that polar bears could be endangered within the “foreseeable future,” a timeline the Fish and Wildlife Service put at 45 years, or three generations of polar bears. The state called that number arbitrary.The state contends there are no real differences between the bears in the 19 subpopulations identified in Mr. Kempthorne's decision, and that the population as a whole is healthy. That would undermine the argument that ice loss off Alaska would affect world polar bear population.The lawsuit contends federal officials did not consider the best scientific evidence demonstrating bears' ability to survive and adapt to changing climate conditions.That view is rejected by most polar bear experts, who say the animals need ice to hunt seals and will not win a territory fight with grizzly bears that already inhabit northern Alaska.*************************************************************Pills taking over from psychotherapy, Julie Steenhuysen, August 4.CHICAGO — U.S. psychiatrists are trading in the analysis couch for a prescription pad, a study released on Monday says after finding that fewer psychiatrists offer psychotherapy.The shift to briefer visits for medication management, reported in the Archives of General Psychiatry, appears to be linked to better psychiatric drugs and pressure from managed care companies, which offer richer financial incentives for brief office visits."Psychiatrists get more for three, 15-minute medication management visits than for one 45 minute psychotherapy visit," said Dr. Ramin Mojtabai of Johns Hopkins University in Baltimore and formerly of Beth Israel Medical Center in New York, where he did the research.Various forms of psychotherapy, either alone or in combination with medications, are recommended to treat depression, post-traumatic stress disorder, bipolar disorder and other psychiatric illnesses.Yet Dr. Mojtabai and colleagues, who analyzed data from national surveys of office-based psychiatrist visits from 1996 through 2005, found a significant drop in the number of office-based psychiatrists providing psychotherapy.He said only 29 per cent of office-based visits to psychiatrists involved psychotherapy in 2004-5, down from 44 per cent in 1996-97.One major impact is that patients who need to receive psychotherapy must obtain it from other professionals, if they can get it at all, dr. Mojtabai said in a telephone interview.That can result in disjointed service, in which a patient sees a psychologist or social worker for therapy and a psychiatrist or a general physician for drugs."Whether it has any impact on the outcome of the disorder, we don't really know," Dr. Mojtabai said. "I don't think necessarily that it is harmful. It might not be as efficient."Brain ageDr. Eric Plakun, who leads an American Psychiatric Association committee on psychotherapy, said he noticed a shift away from psychotherapy beginning about 10 years ago, when more psychiatrists began to embrace "the age of the brain."He said medical schools began to focus more on the biology of mental illness than on traditional psychotherapy and that is now reflected in practices across the United States.Dr. Plakun said in a telephone interview that it is not clear if patients are getting therapy from other providers, or not at all."Either way, I'm worried about our patients," he said. "Patients need the best help we can give them."For Dr. Plakun, that means offering a range of services, including psychotherapy, and not just medication."If all you have is a hammer, everything looks like a nail," he said.Dr. Mojtabai thinks patients are getting therapy from others, but he said the focus probably is different from the analysis that psychiatrists have traditionally offered."Psychologists and social workers are more likely to provide short-term cognitive behavioural therapy," which focuses on changing harmful behaviours, he said.As for the type of analysis featured in movies, particularly in Woody Allen films, it is available – to a very few."If you have some hard feelings about your childhood and you live in New York and have a lot of money, you can still find psychiatrists who provide long-term psychotherapy," Dr. Mojtabai said.*************************************************************Fewer shrinks are doing talk therapy, Carla K. Johnson, August 4.CHICAGO - Cartoons about the psychiatrist's couch were recently the subject of a museum exhibition. Now, the couch itself may be headed for a museum. A new study finds a significant decline in psychotherapy practised by U.S. psychiatrists. The expanded use of pills and insurance policies that favour short office visits are among the reasons, said lead author Dr. Ramin Mojtabai of Johns Hopkins Bloomberg School of Public Health in Baltimore. "The 'couch,' or, more generally, long-term psychoanalytic psychotherapy, was for so long a hallmark of the practice of psychiatry. It no longer is," Mojtabai said. Today's psychiatrists get reimbursed by insurance companies at a lower rate for a 45-minute psychotherapy visit than for three 15-minute medication visits, he explained. His study found that the percentage of patients' visits to psychiatrists for psychotherapy, or talk therapy, fell from 44 per cent in 1996-97 to 29 per cent in 2004-05. The percentage of psychiatrists using psychotherapy with all their patients also dropped, from about 19 per cent to 11 per cent. Psychiatrists who provided talk therapy to everyone had more patients who paid out of pocket compared to those doctors who provided talk therapy less often. And they prescribed fewer pills. As talk therapy declined, TV ads contributed to an "aura of invincibility" around drugs for depression and anxiety, said Charles Barber, a lecturer in psychiatry at Yale University and author of "Comfortably Numb: How Psychiatry is Medicating a Nation." "By contrast, there's almost no marketing for psychotherapy, which has comparable if not better outcomes," said Barber, who was not involved in the study. The findings, published in Monday's Archives of General Psychiatry, are based on an annual survey of office visits to U.S. doctors. Of more than 246,000 visits sampled during the 10 years, more than 14,000 were to psychiatrists. The researchers analyzed those psychiatrist visits. The study did not survey visits to psychologists or other mental health counsellors who are not medical doctors, but who also practice talk therapy. Psychotherapy uses verbal methods to get patients to explore their emotional life, thoughts or behaviour. The goal is to ease symptoms, sometimes through getting the patient to change behaviour or mental habits. Its benefits can be seen in brain imaging studies, said Dr. Eric Plakun, who leads an American Psychiatric Association committee working to restore interest in psychotherapy by psychiatrists. "The couch is far from dead," Plakun said. "The couch turns out to be an effective 21st century treatment." Talk therapy can be done by psychiatrists less expensively than split treatment, where a patient sees a doctor for pills and a counsellor for talk therapy, Plakun said, citing two prior studies. It also works better than drugs for some patients, such as those with chronic major depression and a history of childhood trauma, he said. Accreditation requirements for psychiatric residency programs are putting more emphasis on talk therapy, Plakun said. That may slow the decline of the couch. The new study doesn't answer an important question: whether other professionals are picking up the slack, said psychologist David Mohr of Northwestern University's Feinberg School of Medicine. Psychologists and social workers provide counselling but most cannot prescribe drugs, so it's possible that for patients who require both talk and pills, some co-ordination in care may be lost, Mohr said.*************************************************************National Trends in Psychotherapy by Office-Based Psychiatrists, Abstract, Ramin Mojtabai, MD, PhD, MPH; Mark Olfson, MD, MPH Arch Gen Psychiatry. 2008;65(8):962-970. Context: In addition to prescribing medications, providing psychotherapy has long been a defining characteristic of the practice of clinical psychiatry. However, there are indications that the role of psychiatrists in providing psychotherapy may have diminished in recent years. Objective: To examine recent national trends in the provision of psychotherapy by office-based psychiatrists. Design: Data from the 1996 through 2005 cross-sectional National Ambulatory Medical Care Survey were analyzed to examine trends in psychotherapy provision within nationally representative samples of visits to office-based psychiatrists. Multivariate analyses examined the time trend, adjusting for patient, visit, and setting characteristics. Practice-level analyses examined time trends in the percentage of psychiatrists who provided psychotherapy to all, some, or none of their patients during a typical week. Setting: Office-based psychiatry practices in the United States. Participants: Patients with psychiatric diagnoses visiting outpatient psychiatrists. Main Outcome Measure: Provision of psychotherapy in visits longer than 30 minutes. Results: Psychotherapy was provided in 5597 of 14 108 visits (34.0% [weighted]) sampled during a 10-year period. The percentage of visits involving psychotherapy declined from 44.4% in 1996-1997 to 28.9% in 2004-2005 (P < .001). This decline coincided with changes in reimbursement, increases in managed care, and growth in the prescription of medications. At the practice level, the decrease in providing psychotherapy corresponded with a decline in the number of psychiatrists who provided psychotherapy to all of their patients from 19.1% in 1996-1997 to 10.8% in 2004-2005 (P = .001). Psychiatrists who provided psychotherapy to all of their patients relied more extensively on self-pay patients, had fewer managed-care visits, and prescribed medications in fewer of their visits compared with psychiatrists who provided psychotherapy less often. Conclusions: There has been a recent significant decline in the provision of psychotherapy by psychiatrists in the United States. This trend is attributable to a decrease in the number of psychiatrists specializing in psychotherapy and a corresponding increase in those specializing in pharmacotherapy—changes that were likely motivated by financial incentives and growth in psychopharmacological treatments in recent years. Author Affiliations: Departments of Psychiatry, Beth Israel Medical Center (Dr Mojtabai), and College of Physicians and Surgeons, Columbia University (Dr Olfson); and the New York State Psychiatric Institute (Dr Olfson), New York. Dr Mojtabai is now with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.*************************************************************American voters should beware the 'McNasty' in McCain, Jonathan Zimmerman, August 5.In November of 1986, the Arizona Republican Party held an election night celebration at a Phoenix hotel to toast its victorious candidates. The marquee attraction was a two-term congressman named John McCain, who won the Senate seat vacated by GOP icon Barry Goldwater.Mr. McCain delivered a rousing speech and then retired to his suite at the hotel, where he watched a replay of the address on television. But someone had failed to erect the speaking platform high enough for the 5-foot-9 senator, so only part of his face was visible on TV.That unfortunate someone was Robert Wexler, the 20-something head of Arizona's Young Republicans and the chief choreographer of the evening's events. A livid McCain went back downstairs to look for Mr. Wexler, confronting him in the hotel ballroom."I told you we needed a stage," Mr. McCain screamed at the young man, jabbing a finger in Mr. Wexler's chest. "You incompetent little [expletive]. When I tell you to do something, you do it."John McCain's biography is full of episodes like this. As far back as high school, peers nicknamed him "McNasty." He's been known to fling f-bombs at fellow lawmakers when he doesn't get his way. And in a 2006 poll, Capitol Hill staffers ranked him as the Senator with the "second hottest temper," after Alaska's Ted Stevens.Should we care? I think we should. The most important measure of a human being is the way he or she treats other people, especially those under his or her power. By many accounts, Mr. McCain degrades and demeans them. And there's no excuse for it.He's not the only one, of course. In Congress, abusive behaviour toward underlings is eminently bipartisan. Remember Cynthia McKinney, the ultra-liberal Georgia representative who allegedly struck a Capitol police officer when he tried to stop her at a security checkpoint?Ms. McKinney eventually got voted out of office, but most of Congress's bullies are still going strong. Consider four-term representative Anthony Weiner, a rising Democratic star and a leading candidate to replace Michael Bloomberg next year as mayor of New York. When staffers don't measure up to his standards, Mr. Weiner reportedly throws telephones and kicks furniture.No wonder Mr. Weiner has experienced more office turnover than any other representative in his state's delegation. Since early 2007 alone, Weiner has had three different chiefs of staff. Roughly half of his 20-odd employees have served for less than a year.We've all met people like Anthony Weiner; some of us have worked for people like them, too. You don't want a boss who degrades, harangues and humiliates you. So why would you vote for one?Here you might reply that public officials are elected to, well, serve the public. So if their arrogant and domineering style gets staffers to work harder, it's good for all of us.Let's leave aside the question of whether this style actually produces better results. Even if it did - and I have my doubts - it would still be wrong. Our lawmakers do more than simply make laws; they're supposed to represent us, in every sense of the word. By electing officials who demean employees, we also demean ourselves.How much does personal virtue matter in a public office? During the impeachment of U.S. president Bill Clinton, some of my liberal friends told me that it didn't matter at all. The president's extramarital affairs bore no relation to his public duties, so the public should just butt out.Really? Let's suppose, then, that a president struck his wife instead of simply cheating on her. Would one still deem his personal behaviour irrelevant?I don't think one would. And that's because our leaders - more than anybody else - serve as symbols of all of us; they embody our deepest beliefs, values and principles. We would never elect people who did physical harm to those under their charge. But we continue to elect verbal and emotional bullies, who can do just as much damage.And that brings us back to John McCain. During the 2000 GOP primaries, operatives for George W. Bush whispered that Mr. McCain's notorious temper made him a dangerous choice for president: After all, no one wants a madman with his finger on the nuclear button.That's absurd. There is no reason to question Mr. McCain's good judgment, which he has honed over many years of public service. But there is every reason to question his behaviour, especially toward subordinates, which speaks badly of his basic values - and of the voters'. If Americans don't want bullies in their schools and workplaces, then they shouldn't vote to put one in the White House.Most of these were lifted from Priscilla Parreira's fotoblog.Malana is a twenty year old from São Paulo entered in the 'Brazil's Next Top Model' contest - contest, reality TV, whatever, something to do with Sony. 2,500 try outs, 20 finalists, 13 semi-finalists, some lawyer won the first round. Malana is still in for the second round which starts in September. The only comments I have seen are negative - Brasilians think she looks like a man, all good, ok.In the group shots she seems to like to hide in the back. 'Like'? who knows anything about what she likes? Who even knows her real name?Very last photograph is by André Salcedo.The fastest, cheapest, easiest and cleanest step toward a sane energy environment is the powerful combination of efficiency and conservation. We know what we should be doing. What we don’t have is the leadership, the common sense or the will to get it done.(from a Spiegel article today)Down.