PSA. HRT. SSRIs. Houston, we have a problem.

News

Professor Stamey first suggested that a blood test for prostate-specific antigen (PSA) could indicate the presence of cancer in a paper in The New England Journal of Medicine in 1987. The discovery spawned a vast prostate screening industry - nearly a quarter of a million men will be diagnosed with prostate cancer in the US this year - and a huge growth in the number of men treated for the condition. Now, he has recanted, and suggests that the test merely indicates the size of the prostate and may do more harm than good by encouraging over-treatment. Many of the cancers detected by it are too small to be clinically meaningful and many men may have been unnecessarily treated. 'The PSA era is over,' he said in The Journal of Urology.

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Ten years ago, when I was actively practicing medicine, I was among those on the front line who were very unsure about the value of the PSA test. I give full credit to my internist colleagues for their deep and abiding suspicion of the PSA. Then Dear Abby/Ann began pushing it, then Bob Dole, then resistance became futile.

Now it looks bad for the PSA.

Hormone Replacement Therapy had a similar path. SSRIs are looking shaky -- primarily because an emergent (unconscious?) de facto collusion between manufacturers, researchers, academics and publishers produced a biased publication base. (One UK researcher clinician emerges as a hero in the SSRI debacle -- a lesson about the need to resuscitate the dying breed of clinician-researcher.)

Medicine has a problem. I think it's a research funding, tenure, promotion and publication problem, compounded by issues with professional identity and severe stress and distress among primary care physicians. The situation isn't quite hopeless; some of the steps being taken with electronic publication (advertising free!) and clinical trials registrations are very important. I think we need the AHRQ to be fully alive again -- it was badly wounded about 10 years ago by an unfortunate alliance between libertarian ideologues, anti-science politicians and fearful subspecialists. Maybe orthopods could do penance by resuscitating the AHRQ.

The younger George Bush

Salon.com News | The dunce

Recollections of a GWB business school prof:

Students who challenged and embarrassed Bush in class would then become the subject of a whispering campaign by him, Tsurumi said. "In class, he couldn't challenge them. But after class, he sometimes came up to me in the hallway and started bad-mouthing those students who had challenged him. He would complain that someone was drinking too much. It was innuendo and lies. So that's how I knew, behind his smile and his smirk, that he was a very insecure, cunning and vengeful guy." ...

"I used to chat up a number of students when we were walking back to class," Tsurumi said. "Here was Bush, wearing a Texas Guard bomber jacket, and the draft was the No. 1 topic in those days. And I said, 'George, what did you do with the draft?' He said, 'Well, I got into the Texas Air National Guard.' And I said, 'Lucky you. I understand there is a long waiting list for it. How'd you get in?' When he told me, he didn't seem ashamed or embarrassed. He thought he was entitled to all kinds of privileges and special deals. He was not the only one trying to twist all their connections to avoid Vietnam. But then, he was fanatically for the war."

Tsurumi told Bush that someone who avoided a draft while supporting a war in which others were dying was a hypocrite. "He realized he was caught, showed his famous smirk and huffed off."

Tsurumi's conclusion: Bush is not as dumb as his detractors allege. "He was just badly brought up, with no discipline, and no compassion," he said.

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Apparently Bush demonstrated even then a remarkable facility for the bald faced lie. It is his genius.

Senior US military leaders speak-up: Bush has brought us to unprecedented disaster

Guardian Unlimited | Sidney Blumenthal | Far graver than Vietnam

Or, as I've been saying lately, rather like Checknya with oil.

...But, according to the US military's leading strategists and prominent retired generals, Bush's war is already lost. Retired general William Odom, former head of the National Security Agency, told me: "Bush hasn't found the WMD. Al-Qaida, it's worse, he's lost on that front. That he's going to achieve a democracy there? That goal is lost, too. It's lost." He adds: "Right now, the course we're on, we're achieving Bin Laden's ends."

Retired general Joseph Hoare, the former marine commandant and head of US Central Command, told me: "The idea that this is going to go the way these guys planned is ludicrous. There are no good options. We're conducting a campaign as though it were being conducted in Iowa, no sense of the realities on the ground. It's so unrealistic for anyone who knows that part of the world. The priorities are just all wrong."

Jeffrey Record, professor of strategy at the Air War College, said: "I see no ray of light on the horizon at all. The worst case has become true. There's no analogy whatsoever between the situation in Iraq and the advantages we had after the second world war in Germany and Japan."

W Andrew Terrill, professor at the Army War College's strategic studies institute - and the top expert on Iraq there - said: "I don't think that you can kill the insurgency". According to Terrill, the anti-US insurgency, centred in the Sunni triangle, and holding several cities and towns - including Fallujah - is expanding and becoming more capable as a consequence of US policy.

"We have a growing, maturing insurgency group," he told me. "We see larger and more coordinated military attacks. They are getting better and they can self-regenerate. The idea there are x number of insurgents, and that when they're all dead we can get out is wrong. The insurgency has shown an ability to regenerate itself because there are people willing to fill the ranks of those who are killed. The political culture is more hostile to the US presence. The longer we stay, the more they are confirmed in that view."

After the killing of four US contractors in Fallujah, the marines besieged the city for three weeks in April - the watershed event for the insurgency. "I think the president ordered the attack on Fallujah," said General Hoare. "I asked a three-star marine general who gave the order to go to Fallujah and he wouldn't tell me. I came to the conclusion that the order came directly from the White House." Then, just as suddenly, the order was rescinded, and Islamist radicals gained control, using the city as a base.

"If you are a Muslim and the community is under occupation by a non-Islamic power it becomes a religious requirement to resist that occupation," Terrill explained. "Most Iraqis consider us occupiers, not liberators." He describes the religious imagery common now in Fallujah and the Sunni triangle: "There's talk of angels and the Prophet Mohammed coming down from heaven to lead the fighting, talk of martyrs whose bodies are glowing and emanating wonderful scents."

"I see no exit," said Record. "We've been down that road before. It's called Vietnamisation. The idea that we're going to have an Iraqi force trained to defeat an enemy we can't defeat stretches the imagination. They will be tainted by their very association with the foreign occupier. In fact, we had more time and money in state building in Vietnam than in Iraq."

General Odom said: "This is far graver than Vietnam. There wasn't as much at stake strategically, though in both cases we mindlessly went ahead with the war that was not constructive for US aims. But now we're in a region far more volatile, and we're in much worse shape with our allies."

Terrill believes that any sustained US military offensive against the no-go areas "could become so controversial that members of the Iraqi government would feel compelled to resign". Thus, an attempted military solution would destroy the slightest remaining political legitimacy. "If we leave and there's no civil war, that's a victory."

General Hoare believes from the information he has received that "a decision has been made" to attack Fallujah "after the first Tuesday in November. That's the cynical part of it - after the election. The signs are all there."

He compares any such planned attack to the late Syrian dictator Hafez al-Asad's razing of the rebel city of Hama. "You could flatten it," said Hoare. "US military forces would prevail, casualties would be high, there would be inconclusive results with respect to the bad guys, their leadership would escape, and civilians would be caught in the middle. I hate that phrase collateral damage. And they talked about dancing in the street, a beacon for democracy."

General Odom remarked that the tension between the Bush administration and the senior military officers over Iraqi was worse than any he has ever seen with any previous government, including Vietnam. "I've never seen it so bad between the office of the secretary of defence and the military. There's a significant majority believing this is a disaster. The two parties whose interests have been advanced have been the Iranians and al-Qaida. Bin Laden could argue with some cogency that our going into Iraq was the equivalent of the Germans in Stalingrad. They defeated themselves by pouring more in there. Tragic.

Slate - Does God endorse George Bush?

Heaven Sent - Does God endorse George Bush? By Steven Waldman

Of course, it's always possible God did put George W. Bush in the White House. But if He did, it doesn't theologically follow that He wants him to have a second term.

Where is George Bush's genius?

Brad DeLong's Semi-Daily Journal: A Weblog: Wow! Francis Fukuyama Is Shrill!

George Bush must have a peculiar genius. He couldn't have gotten where he is without a fantastic gift.

It's not his raw IQ. Based on his SAT scores his raw IQ is probably about 120. Average to above average for college.

It's not his insight, wisdom or judgment. Those have been catastrophic.

It's not his choice of allies. Cheney? Rumsfeld?

And yet ...

He has many followers. He exerts iron control over many who are far more capable, in naive terms, than he.

My guess he has a genius for four related things:

1. Lying. I think he has a capacity for deception beyond everyday imaging. I would NEVER play poker against George Bush.

2. Raw leadership -- the peculiar gene that persuades others that he should be followed, that he is competent and wise.

3. The ability to project the appearance of wisdom, confidence, and considered judgment.

4. Rewarding his allies and punishing his enemies -- thereby imposing an iron loyalty and discipline. This requires the an incredible capacity to carry a grudge.

Combine the above with an insatiable lust for power over others, and we have a recipe for disaster -- GWB, father of the American Chechnya.

Iraq is not Vietnam....

Back to Iraq ...

I had one of those nasty revelations last night, on reading an Economist article on the state of Chechnya. It's obvious in retrospect, and I'm sure it's a common observation everywhere in the world ... except in America.

We've been blinded by our history in Vietnam. So blinded we've chosen the wrong lens for viewing our predicament.

Iraq is not Vietnam.

It is Chechnya.

Back to Iraq 3.0: It's Worse Than You Think...

Back to Iraq 3.0: It's Worse Than You Think...

Anyone who asks me to tell the “real” story of Iraq — implying all the bad things are just media hype — should refer to this post. I just told you the real story: What was once a hell wrought by Saddam is now one of America’s making.

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This guy was once a relatively optimistic observer. I think he might once have been Republican, or at least an independent.

It sounds like we've lost. Bush, Rumsfeld and their kin have cost us, and Iraq, so very, very much.

Rumsfeld and Fallujah

Key General Criticizes April Attack In Fallujah (washingtonpost.com): "The comments by Lt. Gen. James T. Conway, made shortly after he relinquished command of the 1st Marine Expeditionary Force on Sunday, amounted to a stinging broadside against top U.S. military and civilian leaders who ordered the Fallujah invasion and withdrawal."

Rumsfeld "termination justification" file is about six inches thick.

The Shrill Blog: Martin Sieff Scores the Neocons at Zero for Twenty-One

The Shrill Blog: Martin Sieff Scores the Neocons at Zero for Twenty-One

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These are 21 major neocon predictions that have been proven wrong.

Did they make ANY predictions that have been proven correct?

If these guys were ball players they'd have been retired by now. Instead they are making new plans.

Fidelity voted against expensing stock options

The New York Times > Business > Your Money > Gretchen Morgenson: A Door Opens. The View Is Ugly.

Most disturbing, some of the biggest fund companies - including Fidelity, T. Rowe Price and MFS Investment Management - cast votes with executives and against the views of most investors on the subject of expensing stock options this year.

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I want to know how Vanguard voted on this one. I'll write Fidelity and let them know I'm moving my money elsewhere.

The stories not told: Al Qaeda's chemical bombs in Jordan and Pakistan

ABCNEWS.com

In early April, authorities in Jordan disrupted what would have been an even bigger chemical attack. Officials said that terrorists linked to Abu Musab al-Zarqawi managed to smuggle three cars — packed with explosives, a chemical bomb and poisonous gas — into the capital city, Amman.

Authorities in Jordan estimate that 80,000 people would have been killed if the chemical bomb had gone off at its intended targets — the Jordanian intelligence headquarters, the U.S. Embassy in Amman, and the Jordanian prime minister's office.

'It looks quite thought-through,' said David Siegrist, director of Studies for Countering Biological Terrorism at the Potomac Institute for Policy Studies. 'They have about 800 kilos of explosive and tons of chemicals for oxidation. They also have about a ton of cyanide, which added a little extra pinch to whatever they were about to do.'

The captured leader of the plot, Jordanian Azmi al-Jayussi, told authorities that a Russian scientist had provided the chemical recipe.

And as seen on a tape obtained by ABC News, when Jordanian authorities conducted a test explosion using the same combination of chemicals, with smaller portions, it produced a toxic plume that killed rabbits placed 200 yards away.

'The kind of weapon that al Qaeda procured in Jordan anyone can buy in the United States commercially,' said Clark. 'Anyone in the United States, if they knew the right formula, could make this kind of chemical bomb that would kill thousands.'

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The story unfolds as predicted. Technologic expertise is increasingly distributed. The cost of mass murder falls faster than the cost of defense.

The 9/11 attack succeeded because the attackers got lucky -- very lucky. Yes, the US had weak defenses. Yes, we have serious problems with the quality of top and mid-level management at the FBI and CIA. Yes, we have an imcompetent government. Despite all that, the 9/11 attackers ought to have failed -- but they got lucky.

The good guys have had some luck too. These two attacks were disrupted in party by good fortune.

Luck is not a strategy. We need a better government here and better approaches abroad.

America's Problem: The Media?

CJR September/October 2004: Q & A with Howard Dean

When you’re talking about print being worse than broadcast, are you talking about the reporters for The New York Times and The Washington Post?

Absolutely.

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DeLong has been exploring this theme, but since I don't watch television I was surprised to hear Dean say that network TV was, in general higher quality than print media -- including the "elite media".

I am persuaded, however, that the print media is now very poor quality, and that the NYT is no better than the rest. I don't know why, but I suspect part of the reason is that the overall print media business is less profitable than it once was.

A scarier possibility, may be that corporations, including the print media, are increasingly customer driven. They give consumers what consumers want. Unfortunately, most consumers don't want truth. They want comfort.

Acute Systems Software - TransMac

Acute Systems Software - TransMac and CrossFont

TransMac is an alternative to MacDrive -- a utility for reading HFS+ disks on a PC.

Bush - the adult crimes

Salon.com News | Stung!

In February of this year, Salon interviewed Bill Burkett, a retired lieutenant colonel in the Texas National Guard, who claims he observed aides to Bush going through his military file in 1997 to remove any embarrassing information, tossing documents in the trash, allegedly the types of documents that might help answer many of the unanswered questions surrounding Bush's Guard service. 'Activities occurred in order to, in my opinion, inappropriately build a false image of the governor's military service,' Burkett told Salon. Burkett first went public with his accusations in 1998 and has told the same story consistently for six years.

Also last February, Salon reported that Bush's mysterious decision in the spring of 1972 to stop flying and subsequently refuse to take a physical exam came at the same time the Air Force announced its Medical Service Drug Abuse Testing Program, which meant random drug testing for pilots, including Guardsmen.

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So he quit becase he'd test positive. No biggy. Yeah, he's a stinking hypocrite, but that's almost a prerequisite for political office.

On the other hand ... a conspiracy to destroy incriminating records ... occurring in the adult Bush era ... That's interesting.

GWB - a spoiled brat with substance problems -- and an adult liar

The New Republic Online: Two-Sided Story

... To me, the most overlooked and most important new detail in these memos comes next. Killian writes, "I advised him of our investment in him and his commitment." It's often forgotten that even if Bush had gone off to Alabama and served honorably by showing up for all his drills, he was still walking out on a sworn commitment he made to the Guard. The government spent a vast sum of money training Bush to become a Texas Air National Guard pilot, a highly coveted position in 1968 that saved Bush from Vietnam, and in return Bush promised he would fly for the Guard for as long as possible...

That's what Killian meant when he advised Bush of "our investment and his commitment." But Killian, the memos show, starts to realize that his moral suasion is useless. Bush has already started maneuvering around him and Killian knows he's getting rolled. "I told him I had to have written acceptance before he would be transferred," he writes, "but think he's also talking to someone upstairs."

In the next memo Bush is "suspended from flight status due to failure to perform to USAF/TexANG standards and failure to meet annual physical examination (flight) as ordered." This is the first time any official document has reported that Bush was suspended for any reason other than simply missing his physical. It's also clear in this memo that Bush has completely abandoned the idea of ever flying again. "Officer has made no attempt to meet his training certification or flight physical," the memo says. Bush even asked for a non-flying assignment. Incredibly, Killian recommends that the Texas spot abandoned by Bush--the one that with Barnes's help Bush had won by leapfrogging ahead of hundreds of other applicants--be filled by a pilot returning from combat in Vietnam. Not only did someone else get shipped off to Vietnam when Bush landed his Guard duty, but once Bush was bored with flying and abandoned his spot, a pilot returning from Vietnam was forced to replace him.

In the final Killian memo, the one with the subject line "CYA" (cover your ass), the commander makes cryptic references to a struggle with his superiors over how much slack to cut Bush, who hadn't been observed in Texas for a year. "Staudt has obviously pressured Hodges more about Bush. I'm having trouble running interference and doing my job," Killian writes. According to the Associated Press, Staudt and Hodges are Waleter B. Staudt, the commander of the Texas National Guard at the time, and Lieutenant Cololnel Bobby Hodges, one of Bush's superiors. Staudt, Killian wrote, was "pushing to sugar coat" the evaluation. Killian complains that Bush wasn't around and there's no word from Alabama about what he's been doing. He makes a small concession to the pressure he's feeling from his bosses but refuses a full cover up for Bush. "I'll backdate," he writes, "but won't rate."

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Younger Bush was a spolied rich brat with a serious alcohol problem -- and perhaps other substance problems. Young Clinton looks great next to young Bush. Young Gore looks fantastic next to young Bush. Young Kerry ... well, there's no comparison.

How does this connect to Bush today? He's flat out lied, many times, about his service. That's not something to brush off. Clinton lied like any adept politician -- he wriggled and wiggled and looked evasive. Bush lies like a true psychopath -- perfectly and without the slightest hint of guilt.